Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system

International Nuclear Information System (INIS)

Zullig, Leah L; Williams, Christina D; Fortune-Britt, Alice G

2015-01-01

Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans’ health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes

Health care provider experience with canagliflozin in real-world clinical practice: favorability, treatment patterns, and patient outcomes

Directory of Open Access Journals (Sweden)

Bolge SC

2017-06-01

Full Text Available Susan C Bolge,1 Natalia M Flores,2 Shu Huang,3 Jennifer Cai1 1Janssen Scientific Affairs, LLC, Titusville, NJ, 2Kantar Health, Foster City, CA, 3Kantar Health, New York, NY, USA Purpose: This study describes how health care providers approach canagliflozin for the treatment of patients with type 2 diabetes mellitus (T2DM in the real world.Patients and methods: An Internet-based questionnaire was completed by 101 endocrinologists, 101 primary care physicians, and 100 nurse practitioners/physician assistants (NP/PAs. Health care providers were required to have experience prescribing or managing patients using canagliflozin to be included in the study. Health care providers compared canagliflozin with other T2DM medication classes on clinical characteristics, costs, and patient satisfaction. Confidence in canagliflozin was also measured. Health care providers reported their canagliflozin prescribing experience and good candidate characteristics for treatment. Finally, providers reported on patient outcomes among those receiving canagliflozin. All variables were compared across provider type.Results: Health care providers reported higher favorability for canagliflozin for blood pressure and body weight compared with dipeptidyl peptidase-4 (DPP-4 inhibitors and higher favorability for effect on blood pressure, body weight, treatment satisfaction, and glycosylated hemoglobin (HbA1c compared with sulfonylureas (SUs, with differences observed for effect on blood pressure. Health care providers reported being very/extremely confident (55%–74% with canagliflozin as a second- to fourth-line treatment. The top 3 characteristics reported by the providers, in terms of describing a good candidate for canagliflozin, include those concerned about their weight, insurance coverage/affordability, and avoiding injectable treatments. Finally, providers reported often/always observing patients’ lowering or controlling HbA1c (82%–88% and improvement in overall

Laboratory testing improves diagnosis and treatment outcomes in primary health care facilities

Directory of Open Access Journals (Sweden)

Jane Y. Carter

2012-10-01

Setting: Six rural health centres in Kenya. Design: Cross-sectional study to observe change in diagnosis and treatment made by clinical officers after laboratory testing in outpatients attending six rural health centres in Kenya. Subject: The diagnosis and treatment of 1134 patients attending outpatient services in six rural health centres were compared before and after basic laboratory testing. Essential clinical diagnostic equipment and laboratory tests were established at each health centre. Clinical officers and laboratory technicians received on-site refresher training in good diagnostic practices and laboratory procedures before the study began. Results: Laboratory tests were ordered on 704 (62.1% patients. Diagnosis and treatment were changed in 45% of tested patients who returned with laboratory results (21% of all patients attending the clinics. 166 (23.5% patients did not return to the clinician for a final diagnosis and management decision after laboratory testing. Blood slide examination for malaria parasites, wet preparations, urine microscopy and stool microscopy resulted in most changes to diagnosis. There was no significant change in drug costs after laboratory testing. The greatest changes in numbers of recorded diseases following laboratory testing was for intestinal worms (53% and malaria (21%. Conclusion: Effective use of basic laboratory tests at primary health care level significantly improves diagnosis and patient treatment. Use of laboratory testing can be readily incorporated into routine clinical practice. On-site refresher training is an effective means of improving the quality of patient care and communication between clinical and laboratory staff.

Inconsistency in health care professional work: Employment in independent sector treatment centres.

Science.gov (United States)

Bishop, Simon; Waring, Justin

2011-01-01

The purpose of this paper is to investigate the impact of recent outsourcing and public-private partnership (PPPs) arrangements on the consistency of professional employment in health care. A case study methodology is applied. The paper finds that multiple arrangements for employment within the ISTC creates numerous sources for inconsistency in employment: across the workplace, within professional groups and with national frameworks for health care employment. These are identified as having implications for organisational outcomes, threatening the stability of current partnerships, and partially stymieing intended behavioural change. The study is a single case study of an independent sector treatment centre. Future research is required to investigate wider trends of employment in heterogeneous outsourcing and PPP arrangements. The paper informs both managers and clinical professionals of the unanticipated complexities and practical challenges that can arise in partnerships and outsourcing arrangements. The paper presents a unique in-depth investigation of employment within recently established ISTCs, and highlights important employment changes for the core health care workforce and high-status professionals in the evolving health care organisational landscape.

Shared Decision-Making in Youth Mental Health Care: Using the Evidence to Plan Treatments Collaboratively.

Science.gov (United States)

Langer, David A; Jensen-Doss, Amanda

2016-12-02

The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present article first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the article then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families.

The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

Science.gov (United States)

2011-01-01

In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096

Practices of depression care in home health care: Home health clinician perspectives

Science.gov (United States)

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

2015-01-01

Objective To assess any gaps between published best practices and real-world practices of treating depression in home health care (HHC), and barriers to closing any gaps. Methods A qualitative study based on semi-structured interviews with HHC nurses and administrators from five home health agencies in five states (n=20). Audio-recorded interviews were transcribed and analyzed by a multi-disciplinary team using grounded theory method to identify themes. Results Routine home health nursing care overlapped with all functional areas of depression care. However, there were reported gaps between best practices and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care. Conclusions Strategies to close gaps between typical and best practices need to enhance HHC clinician knowledge and self-efficacy with depression treatment and improve the quality of antidepressant management and communication with primary care. PMID:26423098

Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

Science.gov (United States)

Ganz, Patricia A; Yip, Cheng Har; Gralow, Julie R; Distelhorst, Sandra R; Albain, Kathy S; Andersen, Barbara L; Bevilacqua, Jose Luiz B; de Azambuja, Evandro; El Saghir, Nagi S; Kaur, Ranjit; McTiernan, Anne; Partridge, Ann H; Rowland, Julia H; Singh-Carlson, Savitri; Vargo, Mary M; Thompson, Beti; Anderson, Benjamin O

2013-10-01

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment

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

OpenAIRE

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

2015-01-01

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

Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence.

Science.gov (United States)

Carvalho, Caroline Gomes; Medeiros-Filho, João Batista; Ferreira, Meire Coelho

2018-02-22

Oncological treatment can cause changes in the oral cavity compromising oral functions. The aim of the study was, based on a systematic review, to draft a guide directed at the team of health professionals involved in the oral care of oncological patients. A systematic search of the literature was performed for articles published between 2000 and April 2017. Searches were made of electronic databases and hand search. The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and RCTs published in English, involving pediatric and adult oncological patients and focused on the prevention and treatment of oral complications as well as studies addressing the maintenance of oral health. Among the 1237 studies identified, 129 were pre-selected and 54 were selected to form the basis for the clinical guide. The studies analyzed stress the need for oral assessments as well as preventive and curative actions prior to oncological treatment. To minimize the severity of oral problems, the studies emphasize daily oral care, the treatment of xerostomia with saliva substitute and hydration, and low-level laser therapy, nystatin, acyclovir, respectively, for the prevention and treatment of oral mucositis, oral candidiasis, and infection by herpes simplex virus. Thus, the guide produced addresses oral assessments and professional and home care before, during, and after oncological treatment. The guide drafted has the function of assisting health professionals involved in the oral care of patients with cancer, enabling the prevention or treatment of oral complications stemming from oncological treatment.

Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur

Directory of Open Access Journals (Sweden)

Yasuda Silvia

2009-07-01

Full Text Available Abstract Background There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. Methods A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Results Most patients were diagnosed with epilepsy (47% and psychosis (31% and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1–10.2 to 7.1 (95%CI 5.9–8.2 p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6–7.0 p Conclusion The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

Mental health treatment outcomes in a humanitarian emergency: a pilot model for the integration of mental health into primary care in Habilla, Darfur.

Science.gov (United States)

Souza, Renato; Yasuda, Silvia; Cristofani, Susanna

2009-07-21

There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.

Health care need

DEFF Research Database (Denmark)

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

2006-01-01

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

Treatment preferences in juvenile idiopathic arthritis – a comparative analysis in two health care systems

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Hugle Boris

2013-01-01

Full Text Available Abstract Background Variations in the treatment of juvenile idiopathic arthritis (JIA may impact on quality of care. The objective of this study was to identify and compare treatment approaches for JIA in two health care systems. Methods Paediatric rheumatologists in Canada (n=58 and Germany/Austria (n=172 were surveyed by email, using case-based vignettes for oligoarticular and seronegative polyarticular JIA. Data were analysed using descriptive statistics; responses were compared using univariate analysis. Results Total response rate was 63%. Physicians were comparable by age, level of training and duration of practice, with more Canadians based in academic centres. For initial treatment of oligoarthritis, only approximately half of physicians in both groups used intra-articular steroids. German physicians were more likely to institute DMARD treatment in oligoarthritis refractory to NSAID (p Conclusions Treatment of oligo- and polyarticular JIA with DMARD is mostly uniform, with availability and funding obviously influencing physician choice. Usage of intra-articular steroids is variable within physician groups. Physiotherapy has a fundamentally different role in the two health care systems.

Discrimination against older women in health care.

Science.gov (United States)

Belgrave, L L

1993-01-01

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

Science.gov (United States)

Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

2017-01-01

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

Science.gov (United States)

Lake, James; Turner, Mason Spain

2017-01-01

Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

Treatment patterns, health state, and health care resource utilization of patients with radioactive iodine refractory differentiated thyroid cancer

International Nuclear Information System (INIS)

Gianoukakis, Andrew G; Flores, Natalia M; Pelletier, Corey L; Forsythe, Anna; Wolfe, Gregory R; Taylor, Matthew H

2016-01-01

Patients with differentiated thyroid cancer (DTC) often respond well to treatment but some become refractory to radioactive iodine (RAI) treatment, and treatment options are limited. Despite the humanistic and economic burden RAI refractory disease imposes on patients, published research concerning treatment patterns and health care resource utilization is sparse. Data were collected from an online retrospective chart review study in the US and five European Union (EU) countries (France, Germany, Italy, Spain, and UK) with physicians recruited from an online panel. Physicians (N=211) provided demographics, disease history, treatment information, and health care resource utilization for one to four of their patients with radioactive iodine refractory differentiated thyroid cancer (RR-DTC). The majority of the patients with RR-DTC (N=623) were female (56%), and their mean age was 58.2 years. In this sample, 63.2% had papillary thyroid cancer and 57.0% were in Stage IV when deemed RAI refractory. Patients with RR-DTC experienced regional recurrence in the thyroid bed/central neck area (25.3%) and had distant metastatic disease (53.6%). At the time data were collected, 50.7% were receiving systemic treatment. Of those, 78.5% were on first-line treatment and 62.7% were receiving multikinase inhibitors. Regional differences for prescribed treatments were observed; the US was more likely to have patients receiving multikinase inhibitors (79.2%) compared with UK (41.2%) and Italy (17.1%). Additional details regarding treatment patterns and resource utilization are discussed. The current study aimed to obtain a greater understanding of RR-DTC treatment globally. These results can assist in the development and implementation of treatment guidelines and ultimately enhance the care of patients with RR-DTC

Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression

Science.gov (United States)

Campbell, Duncan G.; Bonner, Laura M.; Bolkan, Cory R.; Lanto, Andrew B.; Zivin, Kara; Waltz, Thomas J.; Klap, Ruth; Rubenstein, Lisa V.; Chaney, Edmund F.

2016-01-01

Background Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. Purpose To test whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. Methods We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Results Relative to low stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. Conclusions High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement. PMID:26935310

Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment.

Science.gov (United States)

Vernazza, Christopher R; Rousseau, Nikki; Steele, Jimmy G; Ellis, Janice S; Thomason, John Mark; Eastham, Jane; Exley, Catherine

2015-02-01

The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. It might be expected that in the context of a high-cost healthcare intervention for which

Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study.

Science.gov (United States)

Leppänen, V; Hakko, H; Sintonen, H; Lindeman, S

2016-02-01

The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.

Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.

Science.gov (United States)

Jaffee, Kim D; Shires, Deirdre A; Stroumsa, Daphna

2016-11-01

The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson's behavioral model of health services utilization. Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. Predisposing, enabling, and health system environment factors, and delayed needed health care. Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.

Private sector in public health care systems

OpenAIRE

Matějusová, Lenka

2008-01-01

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

Health Care Costs, Utilization and Patterns of Care following Lyme Disease

Science.gov (United States)

Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.

2015-01-01

Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, pLyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, pLyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization. PMID:25650808

Mental health treatment associated with community-based depression screening: considerations for planning multidisciplinary collaborative care.

Science.gov (United States)

Winchester, Bruce R; Watkins, Sarah C; Brahm, Nancy C; Harrison, Donald L; Miller, Michael J

2013-06-01

Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up. To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed. Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models. New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling). At the national level, depression screening was associated with increased new

"A constant struggle to receive mental health care": health care professionals' acquired experience of barriers to mental health care services in Rwanda.

Science.gov (United States)

Rugema, Lawrence; Krantz, Gunilla; Mogren, Ingrid; Ntaganira, Joseph; Persson, Margareta

2015-12-16

successful treatment. This study highlights the need of improving availability, accessibility, acceptability and quality of mental health care at all levels in order to improve mental health care among Rwandans affected by mental disorders.

Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden

Directory of Open Access Journals (Sweden)

Nilsson Gunnar H

2006-11-01

Full Text Available Abstract Background Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. Methods Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. Results In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. Conclusion Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.

[Affordability and availability of drugs for treatment of chronic diseases in the public health care system].

Science.gov (United States)

Helfer, Ana Paula; Camargo, Aline Lins; Tavares, Noemia Urruth Leão; Kanavos, Panos; Bertoldi, Andréa Dâmaso

2012-03-01

To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system. We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities. Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3% (São Leopoldo) to 97.6% (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs. The overall availability of the drugs surveyed was higher than the 80% recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases.

Gender disparities in health care.

Science.gov (United States)

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

2012-01-01

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

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

Science.gov (United States)

Klein, Michael C.; Ciotoli, Carlo; Chung, Henry

2011-01-01

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between…

Behavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health

Directory of Open Access Journals (Sweden)

Mack L

2011-07-01

Full Text Available Laurin J Mack, Bruce D RybarczykClinical Psychology Program, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USAAbstract: Chronic insomnia is a highly prevalent condition that has psychological and medical consequences for those who suffer from it and financial consequences for both the individual and society. In spite of the fact that nonpharmacologic treatment methods have been developed and shown to be as or more effective than medication for chronic insomnia, these methods remain greatly underutilized due to an absence of properly trained therapists and a general failure in dissemination. A stepped-care model implemented in a primary-care setting offers a public health solution to the problem of treatment accessibility and delivery of behavioral treatments for insomnia. Such a model would provide graduated levels of cognitive behavioral intervention, with corresponding increases in intensity and cost, including self-help, manualized group treatment, brief individual treatment, and finally, individualized behavioral treatment provided by a specialist. To provide such a systematic approach, future research would need to confirm several aspects of the model, and a cadre of professionals would need to be trained to administer manualized care in both group and individualized formats.Keywords: cognitive behavioral therapy, chronic insomnia, stepped care, primary care

After initial treatment for primary breast cancer: information needs, health literacy, and the role of health care workers.

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Schmidt, Anna; Ernstmann, Nicole; Wesselmann, Simone; Pfaff, Holger; Wirtz, Markus; Kowalski, Christoph

2016-02-01

After a short hospital stay of just some days follows long-term outpatient care for breast cancer patients. The aim of the study is to describe the information needs of breast cancer outpatients and to get in touch with aspects of health literacy, as well as contact various health care workers. In a multicenter study, patients were asked about their information needs 10 weeks after surgery. The analysis on hand includes data about 1248 female patients. In addition to descriptive analyses identifying the most prevalent information needs, logistic regression analyses were calculated to identify factors associated with these. The results show that information needs of breast cancer outpatients are mainly in "follow-up after acute treatment", "coping with long-term side effects", and "heredity of breast cancer". In addition to sociodemographic patient characteristics, perceived helpful contacts with various health care workers as well as a satisfactory patient's level of health literacy reduced the probability of unmet information needs. Breast cancer outpatients have numerous information needs. In addition to provide information at the right time regarding a specific disease phase, it is important that health professionals' support affected breast cancer patients in coping with the new situation.

[Aspects of economic responsibility in health care].

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Hauke, Eugen

2007-01-01

According to the final consensus of a panel of intense discussions, the health care system should/can not be excluded from the economic laws of efficiency. Appropriate adaptation of various methods and instruments of economics make these tools applicable for use in the health care system. Due to errors in the implementation of economic methods, though, the question arises who is economically responsible in the health care system. The answer is found at three different levels of the health care system. The physician plays a leading role, both personally and professionally, in being primarily responsible for the direct medical treatment of the patient. The physician's dependence, however, on the health care system reduces his independence, which markedly affects his decision-making and treatment. Management of and in health care institutions is largely independent of the profession learned. Managers and physicians acting as managers must be appropriately and duly educated in the necessary specific talents and knowledge. The organisation of a health care system should also be reserved for trained specialists where the physicians as well as other professionals are obliged to acquire the skills necessary.

Clinical trials as treatment option: bioethics and health care disparities in substance dependency.

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Timmermans, Stefan; McKay, Tara

2009-12-01

Bioethicists have warned against the dangers of mixing research with treatment. They are concerned that research priorities may take precedence over individual patient needs and that research subjects tend to misunderstand the purpose of research or overestimate the direct medical benefits of participating in studies. Yet, other work has questioned whether clinical research can always be separated from therapeutic benefit for participants. Using in-depth interviews with participants in two phase III randomized U.S. clinical trials for methamphetamine dependency, we examine the treatment options available to participants, their experiences with participating in the trials, and potential problems of trial participation. We find that while participants have experience with four alternative treatment modalities - quitting alone, support groups, in-patient treatment facilities, and consulting primary care physicians - the randomized clinical trials compare favorably to alternatives because they provide access to evidence-based behavioral treatments, specialized medical professionals, non-judgmental staff, and the possibility of receiving an experimental drug. We conclude that while randomized clinical trials are imperfect substitutes for clinical care, they constitute a fragile and sporadic therapeutic niche in a country with fundamental problems in access to health care, a mixed punitive-therapeutic drug addiction policy, and a profit-driven pharmaceutical development and approval process.

P-1139 - Increased utilization of health care services after psychotherapy

DEFF Research Database (Denmark)

Fenger, Morten Munthe; Mortensen, Erik Lykke; Poulsen, Stig Bernt

2012-01-01

Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...

Comparison of steam sterilization conditions efficiency in the treatment of Infectious Health Care Waste.

Science.gov (United States)

Maamari, Olivia; Mouaffak, Lara; Kamel, Ramza; Brandam, Cedric; Lteif, Roger; Salameh, Dominique

2016-03-01

Many studies show that the treatment of Infectious Health Care Waste (IHCW) in steam sterilization devices at usual operating standards does not allow for proper treatment of Infectious Health Care Waste (IHCW). Including a grinding component before sterilization allows better waste sterilization, but any hard metal object in the waste can damage the shredder. The first objective of the study is to verify that efficient IHCW treatment can occur at standard operating parameters defined by the contact time-temperature couple in steam treatment systems without a pre-mixing/fragmenting or pre-shredding step. The second objective is to establish scientifically whether the standard operation conditions for a steam treatment system including a step of pre-mixing/fragmenting were sufficient to destroy the bacterial spores in IHCW known to be the most difficult to treat. Results show that for efficient sterilization of dialysis cartridges in a pilot 60L steam treatment system, the process would require more than 20 min at 144°C without a pre-mixing/fragmenting step. In a 720L steam treatment system including pre-mixing/fragmenting paddles, only 10 min at 144°C are required to sterilize IHCW proved to be sterilization challenges such as dialysis cartridges and diapers in normal conditions of rolling. Copyright © 2016 Elsevier Ltd. All rights reserved.

Screening and treatment of obesity in school health care - the gap between clinical guidelines and reality.

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Häkkänen, Paula; Ketola, Eeva; Laatikainen, Tiina

2018-05-06

School health care offers a natural setting for childhood obesity interventions. Earlier studies reveal inadequate screening and treatment in primary care. However, longitudinal studies in unselected populations are lacking. We aimed to examine how school nurses and physicians identified obesity, diagnosed it and offered interventions over primary school. We compared the results with Finnish recommendations. From our cohort of 2000 primary school sixth graders (aged 12-14), 172 were obese at least once during primary school. We manually collected retrospective electronic health record (EHR) data of these 'ever-obese' children. Of the ever-obese children, 96% attended annual nurse assessments more than twice. School physicians met 53% of the ever-obese children at health checks at first grade and 93% at fifth grade. Of overweight-related extra visits to school nurses, 94% took place without parents. Parents were present in 48% of extra school physician visits. Only 29% of the 157 who became obese during the first five school grades received an obesity diagnosis. However, school physicians mentioned weight problems in EHR for 90% of the children and, similarly, school nurses for 99%. The majority received a treatment plan at least once. For 78%, at least one plan was made with the parents. Still, 28% missed nutrition plans, 31% exercise plans and 90% lacked recorded weight development targets. The gap between clinical guidelines and reality in school health care could be narrowed by improving diagnosing and parent collaboration. Obstacles in parent involvement and work methods in school health care need further study. © 2018 Nordic College of Caring Science.

Suicide Prevention: An Emerging Priority For Health Care.

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Hogan, Michael F; Grumet, Julie Goldstein

2016-06-01

Suicide is a significant public health problem. It is the tenth leading cause of death in the United States, and the rate has risen in recent years. Many suicide deaths are among people recently seen or currently under care in clinical settings, but suicide prevention has not been a core priority in health care. In recent years, new treatment and management strategies have been developed, tested, and implemented in some organizations, but they are not yet widely used. This article examines the feasibility of improving suicide prevention in health care settings. In particular, we consider Zero Suicide, a model for better identification and treatment of patients at risk for suicide. The approach incorporates new tools for screening, treatment, and support; it has been deployed with promising results in behavioral health programs and primary care settings. Broader adoption of improved suicide prevention care may be an effective strategy for reducing deaths by suicide. Project HOPE—The People-to-People Health Foundation, Inc.

Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

Directory of Open Access Journals (Sweden)

Lacreisha Ejike-King

2014-04-01

Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

Paying more for faster care? Individuals' attitude toward price-based priority access in health care.

Science.gov (United States)

Benning, Tim M; Dellaert, Benedict G C

2013-05-01

Increased competition in the health care sector has led hospitals and other health care institutions to experiment with new access allocation policies that move away from traditional expert based allocation of care to price-based priority access (i.e., the option to pay more for faster care). To date, little is known about individuals' attitude toward price-based priority access and the evaluation process underlying this attitude. This paper addresses the role of individuals' evaluations of collective health outcomes as an important driver of their attitude toward (price-based) allocation policies in health care. The authors investigate how individuals evaluate price-based priority access by means of scenario-based survey data collected in a representative sample from the Dutch population (N = 1464). They find that (a) offering individuals the opportunity to pay for faster care negatively affects their evaluations of both the total and distributional collective health outcome achieved, (b) however, when health care supply is not restricted (i.e., when treatment can be offered outside versus within the regular working hours of the hospital) offering price-based priority access affects total collective health outcome evaluations positively instead of negatively, but it does not change distributional collective health outcome evaluations. Furthermore, (c) the type of health care treatment (i.e., life saving liver transplantation treatment vs. life improving cosmetic ear correction treatment - priced at the same level to the individual) moderates the effect of collective health outcome evaluations on individuals' attitude toward allocation policies. For policy makers and hospital managers the results presented in this article are helpful because they provide a better understanding of what drives individuals' preferences for health care allocation policies. In particular, the results show that policies based on the "paying more for faster care" principle are more

[Home treatment--a treatment model of integrated care in Hamburg].

Science.gov (United States)

Schöttle, Daniel; Ruppelt, Friederike; Karow, Anne; Lambert, Martin

2015-03-01

Treatment models like "Crisis Resolution and Hometreatment (CRHT)" or "Assertive Community Treatment" (ACT), were found to be effective, enhancing the qualitative level of treatment for patients with severe mental disorders. In Germany, these are implemented only sporadically until today, often as part of a cross-sectoral Integrated Care (IC) treatment system. We will present the implementation of an "Assertive Community Treatment" embedded into an IC-treatment model in Hamburg and discuss the 3-year-outcomes. The IC-treatment model has been designed for severe mentally ill patients with psychotic disorders. Since May 2007 the model is financed by different health insurances as a managed-care "capitation-model" and its effectiveness gets continuously evaluated. The model proved to be effective in earlier studies were compared with standard care low rates of service disengagement were found as well as significantly improved psychopathology, psychosocial functioning, quality of life, satisfaction with care and adherence, while being cost effective. The rates of involuntary admissions declined to 10% in comparison to the years before. In 2011 the model was specified to the indication "first-episode adolescents and young adults in the age of 12-29" in a government-funded study "Integrated Care in Early Psychosis, ICEP Study". In this study an interdisciplinary team of child, adolescent and adult psychiatrists was implemented and since 2012 it is financed by the involved health insurances throughout an expansion of the §140 SGB V agreement. © Georg Thieme Verlag KG Stuttgart · New York.

Smoking behavior and beliefs about the impact of smoking on anti-tuberculosis treatment among health care workers.

Science.gov (United States)

Magee, M J; Darchia, L; Kipiani, M; Chakhaia, T; Kempker, R R; Tukvadze, N; Berg, C J; Blumberg, H M

2017-09-01

Tuberculosis (TB) health care facilities throughout Georgia. To describe smoking behaviors among health care workers (HCWs) at TB facilities and determine HCWs' knowledge and beliefs regarding the impact of tobacco use on anti-tuberculosis treatment. Cross-sectional survey from May to December 2014 in Georgia. Adult HCWs (age 18 years) at TB facilities were eligible. We administered a 60-question anonymous survey about tobacco use and knowledge of the effect of smoking on anti-tuberculosis treatment. Of the 431 HCWs at TB facilities who participated, 377 (87.5%) were female; the median age was 50 years (range 20-77). Overall, 59 (13.7%) HCWs were current smokers and 35 (8.1%) were past smokers. Prevalence of current smoking was more common among physicians than among nurses (18.6% vs. 7.9%, P tuberculosis treatment, and only 25.3% of physicians/nurses received formal training in smoking cessation approaches. Physicians who smoked were significantly more likely to believe that smoking does not impact anti-tuberculosis treatment than non-smoking physicians (aOR 5.11, 95%CI 1.46-17.90). Additional education about the effect of smoking on TB treatment outcomes is needed for staff of TB health care facilities in Georgia. Nurses and physicians need more training about smoking cessation approaches for patients with TB.

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

Directory of Open Access Journals (Sweden)

Tintoré M

2016-12-01

Full Text Available Mar Tintoré,1 Maggie Alexander,2 Kathleen Costello,3 Martin Duddy,4 David E Jones,5 Nancy Law,6 Gilmore O’Neill,7 Antonio Uccelli,8 Robert Weissert,9 Sibyl Wray10 1Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron, Barcelona, Spain; 2European Multiple Sclerosis Platform, Brussels, Belgium; 3National Multiple Sclerosis Society, Denver, CO, USA; 4Royal Victoria Infirmary, Newcastle-upon-Tyne, UK; 5Department of Neurology, University of Virginia, Charlottesville, VA, USA; 6Nancy Law Consulting LLC, Parker, CO, USA; 7Biogen, Cambridge, MA, USA; 8Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; 9Department of Neurology, University of Regensburg, Regensburg, Germany; 10Hope Neurology Multiple Sclerosis Center, Knoxville, TN, USA Background: Managing multiple sclerosis (MS treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods: A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results: A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT; satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment

Health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease.

Science.gov (United States)

Jimenez-Garcia, Rodrigo; de Miguel-Díez, Javier; Rejas-Gutierrez, Javier; Martín-Centeno, Antonio; Gobartt-Vázquez, Elena; Hernandez-Barrera, Valentin; Gil de Miguel, Angel; Carrasco-Garrido, Pilar

2009-08-01

To describe the health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease (COPD), and compare it with that of non-diabetic COPD patients. An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged > or =40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, health profile, quality of life (SF-12), treatment and health care resources consumption. The results corresponding to diabetic and non-diabetic patients were compared. A total of 10,711 patients (75.6% males) with COPD were evaluated. The prevalence of diabetes was 16.9%. The diabetic patients were significantly older, with a larger percentage of women, and a lesser educational level compared with the non-diabetic patients. In addition, the diabetics were more sedentary, smoked less, and presented a higher percentage of obesity (33.6% versus 19.7%) than the non-diabetic patients. The severity of airways obstruction was greater among the diabetics than in the non-diabetic patients (54.57+/-13.37% versus 57.92+/-13.39%, respectively, pconsumption of drugs for COPD. In addition, they consumed significantly more health care (and thus economical) resources than the non-diabetic patients. The results of the multivariate logistic regression analysis showed that the variables that were independently associated to COPD among diabetic patients were: higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, SF-12 mental component, SF-12 physical component and total cost of COPD. The presence of diabetes in patients with COPD shows in the bivariate analysis a more severe lung disease, greater co-morbidity, poorer quality of life, and a greater consumption of resources, as well as a less favorable course in the previous year. However, the multivariate logistic regression shows that the variables that are

What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

Science.gov (United States)

Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

2016-02-01

U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician

Disabling health care? Medicaid managed care and people with disabilities in America

DEFF Research Database (Denmark)

Hiranandani, Vanmala Sunder

2011-01-01

Medicaid, America's largest government-funded health insurance program, plays a pivotal role in providing health services to eight million adults with disabilities. Since the mid-1990s, many Medicaid programs have aggressively introduced managed care, which reconfigures service delivery using...... business principles. Most states have insufficient experience in developing managed care plans for Medicaid beneficiaries with disabilities. Middle-aged adults with physical disabilities present their own constellation of health care issues that is not readily appreciated in health and social services....... The purpose of the study was to understand their experiences in accessing physical health care services and to ascertain the effects of managed care on their health and well-being. This study found beneficiaries encounter numerous barriers in accessing preventative, treatment, and acute care services. Overall...

Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

Science.gov (United States)

Cardoso, Fatima; Bese, Nuran; Distelhorst, Sandra R; Bevilacqua, Jose Luiz B; Ginsburg, Ophira; Grunberg, Steven M; Gralla, Richard J; Steyn, Ann; Pagani, Olivia; Partridge, Ann H; Knaul, Felicia Marie; Aapro, Matti S; Andersen, Barbara L; Thompson, Beti; Gralow, Julie R; Anderson, Benjamin O

2013-10-01

Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

Science.gov (United States)

Rahmani, Zuhal; Brekke, Mette

2013-05-06

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

Treatment persistence & health care costs of adult MDD patients treated with escitalopram vs. citalopram in a medicaid population.

Science.gov (United States)

Wu, Eric Q; Ben-Hamadi, Rym; Lu, Mei; Beaulieu, Nicolas; Yu, Andrew P; Erder, M Haim

2012-01-01

Compare treatment persistence and health care costs of major depressive disorder (MDD) Medicaid patients treated with escitalopram versus citalopram. Retrospective analysis of Medicaid administrative claims data. Analyzed administrative claims data from the Florida Medicaid program (07/2002-06/2006) for patients ages 18-64 years with 21 inpatient claim or 2 independent medical claims for MDD. Outcomes included discontinuation and switching rates and prescription drug, medical, and total health care costs, all-cause and related to mental disorder. Contingency table analysis and survival analysis were used to compare outcomes between treatment groups, using both unadjusted analysis and multivariate analysis adjusting for baseline characteristics. The study included 2,650 patients initiated on escitalopram and 630 patients initiated on citalopram. Patients treated with escitalopram were less likely to discontinue the index drug (63.7% vs. 68.9%, P=0.015) or to switch to another second-generation antidepressant (14.9% vs. 18.4%, P=0.029) over the six months post-index date. Patients treated with escitalopram had $1,014 lower total health care costs (P=0.032) and $519 lower health care costs related to mental disorder (P=0.023). More than half of the total cost difference was attributable to savings in inpatient hospitalizations related to mental disorder ($571, P=0.003) and to outpatient costs ($53, PEscitalopram therapy was also associated with $736 lower medical costs related to mental disorder (P=0.009). In the Florida Medicaid program, compared to adult MDD patients initiated on citalopram, escitalopram patients have better treatment persistence and lower total health care costs due to any cause and due to mental disorder, mostly driven by lower hospitalization costs related to mental disorder.

Primary care and addiction treatment: lessons learned from building bridges across traditions.

Science.gov (United States)

Stanley, A H

1999-01-01

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

Acute mental health care according to recent mental health ...

African Journals Online (AJOL)

acute care, treatment and rehabilitation as a 72-hour assessment unit in a .... resemble prisons, such as unnecessary bars on windows and one-way glass. ..... model to consider design solutions for other acute mental health care settings.

Health and Socio-Economic Status: Factors impacting care and treatment in ovarian cancer patients

DEFF Research Database (Denmark)

Seibæk, L.; Petersen, L. K.; Blaakaer, J.

2011-01-01

To provide knowledge about health status, socio-economic status and use of public health care in women undergoing ovarian cancer surgery, in order to improve their care during the perioperative period. Method: An epidemiological methodology was applied. The material consisted of data from...... the Registry of Health and Social Conditions and the Danish Gynaecological Cancer Database on women diagnosed in 2007; this material underwent descriptive statistical analysis. Results: Data from 666 women were suitable for analysis. The majority were older, with moderate to severe systemic illness...... and a tendency to be overweight. Many had a low educational level, were retired, and lived alone with few financial resources. The quality of the surgical treatment had improved in terms of centralisation and staging procedures. Conclusions: As a group the women proved to be in a vulnerable position in terms...

Health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: an integrative review.

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Lamont, Scott; Jeon, Yun-Hee; Chiarella, Mary

2013-09-01

This integrative review aims to provide a synthesis of research findings of health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, 'snowballing' and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is tension between legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice.

Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

Directory of Open Access Journals (Sweden)

Patricia Steinert

2016-08-01

Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

Treatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs.

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Visser, Susanna N; Bitsko, Rebecca H; Danielson, Melissa L; Ghandour, Reem M; Blumberg, Stephen J; Schieve, Laura A; Holbrook, Joseph R; Wolraich, Mark L; Cuffe, Steven P

2015-06-01

To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines. Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described. Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%). These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group. Published by Elsevier Inc.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

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Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Solid health care waste management status at health care centers in the West Bank - Palestinian Territory

International Nuclear Information System (INIS)

Al-Khatib, Issam A.; Sato, Chikashi

2009-01-01

Health care waste is considered a major public health hazard. The objective of this study was to assess health care waste management (HCWM) practices currently employed at health care centers (HCCs) in the West Bank - Palestinian Territory. Survey data on solid health care waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7 m 3 (288.1 tons) of SHCW are generated monthly by the HCCs in the West Bank. This study concluded that: (i) current HCWM practices do not meet HCWM standards recommended by the World Health Organization (WHO) or adapted by developed countries, and (ii) immediate attention should be directed towards improvement of HCWM facilities and development of effective legislation. To improve the HCWM in the West Bank, a national policy should be implemented, comprising a comprehensive plan of action and providing environmentally sound and reliable technological measures.

Significance of mental health legislation for successful primary care for mental health and community mental health services: A review.

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Ayano, Getinet

2018-03-29

 Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness.  To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted.  In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed.  Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

Does Medical Malpractice Law Improve Health Care Quality?

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Frakes, Michael; Jena, Anupam B.

2016-01-01

We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

Chemotherapy versus supportive care alone in pediatric palliative care for cancer: comparing the preferences of parents and health care professionals.

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Tomlinson, Deborah; Bartels, Ute; Gammon, Janet; Hinds, Pamela S; Volpe, Jocelyne; Bouffet, Eric; Regier, Dean A; Baruchel, Sylvain; Greenberg, Mark; Barrera, Maru; Llewellyn-Thomas, Hilary; Sung, Lillian

2011-11-22

The choice between palliative chemotherapy (defined as the use of cytotoxic medications delivered intravenously for the purpose of our study) and supportive care alone is one of the most difficult decisions in pediatric oncology, yet little is known about the preferences of parents and health care professionals. We compared the strength of these preferences by considering children's quality of life and survival time as key attributes. In addition, we identified factors associated with the reported preferences. We included parents of children whose cancer had no reasonable chance of being cured and health care professionals in pediatric oncology as participants in our study. We administered separate interviews to parents and to health care professionals. Visual analogue scales were shown to respondents to illustrate the anticipated level of the child's quality of life, the expected duration of survival and the probability of cure (shown only to health care professionals). Respondents were then asked which treatment option they would favour given these baseline attributes. In addition, respondents reported what factors might affect such a decision and ranked all factors identified in order of importance. The primary measure was the desirability score for supportive care alone relative to palliative chemotherapy, as obtained using the threshold technique. A total of 77 parents and 128 health care professionals participated in our study. Important factors influencing the decision between therapeutic options were child quality-of-life and survival time among both parents and health care professionals. Hope was particularly important to parents. Parents significantly favoured chemotherapy (42/77, 54.5%) compared with health care professionals (20/128, 15.6%; p parents' desire for supportive care; for health care professionals, the opinions of parents and children were significant factors influencing this decision. Compared with health care professionals, parents more

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction

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Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O’Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Background Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. Methods A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. Results A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Conclusion Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment. PMID:28053511

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

Science.gov (United States)

Tintoré, Mar; Alexander, Maggie; Costello, Kathleen; Duddy, Martin; Jones, David E; Law, Nancy; O'Neill, Gilmore; Uccelli, Antonio; Weissert, Robert; Wray, Sibyl

2017-01-01

Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

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

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

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

Treatment acceptability and preferences for managing severe health anxiety: Perceptions of internet-delivered cognitive behaviour therapy among primary care patients.

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Soucy, Joelle N; Hadjistavropoulos, Heather D

2017-12-01

While cognitive behaviour therapy (CBT) is an established treatment for health anxiety, there are barriers to service access. Internet-delivered cognitive behaviour therapy (ICBT) has demonstrated effectiveness and has the potential to improve access to treatment. Nevertheless, it is unknown how patients perceive ICBT relative to other interventions for health anxiety and what factors predict ICBT acceptability. This study investigated these questions. Primary care patients (N = 116) who reported elevated levels of health anxiety were presented three treatment vignettes that each described a different protocol for health anxiety (i.e., medication, CBT, ICBT). Acceptability and credibility of the treatments were assessed following the presentation of each vignette. Participants then ranked the three treatments and provided a rational for their preferences. The treatments were similarly rated as moderately acceptable. Relative to medication and ICBT, CBT was perceived as the most credible treatment for health anxiety. The highest preference ranks were for CBT and medication. Regression analyses indicated that lower computer anxiety, past medication use, and lower ratings of negative cognitions about difficulty coping with an illness significantly predicted greater ICBT acceptability. Health anxiety was not assessed with a diagnostic interview. Primary care patients were recruited through a Qualtrics panel. Patients did not have direct experience with treatment but learned about treatment options through vignettes. Medication and CBT are preferred over ICBT. If ICBT is to increase treatment access, methods of improving perceptions of this treatment option are needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

[An experience of collaboration between primary health care and mental health care in La Ribera Department of Health (Valencia, Spain)].

Science.gov (United States)

Morera-Llorca, Miquel; Romeu-Climent, José Enrique; Lera-Calatayud, Guillem; Folch-Marín, Blanca; Palop-Larrea, Vicente; Vidal-Rubio, Sonia

2014-01-01

Despite the high prevalence of mental health problems among patients attending primary care, diagnosis and treatment of these disorders remain inadequate. Sound training of primary care physicians in how to manage mental health problems is needed to reduce the health, economic and social impact associated with these disorders. Among other elements, there is a need for cooperation between primary care physicians and mental health services. Distinct models are available for such collaboration. In 2006, our health department started a collaboration between these two levels of heath care, using a liaison model. Delays until the first specialist visit were reduced and satisfaction among health professionals increased, although these results should be interpreted with caution. Evidence has recently accumulated on the usefulness of the collaborative model, but evaluation of this model and extrapolation of its results are complex. We intend to evaluate our model more thoroughly, similar to other projects in our environment. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Have out-of-pocket health care payments risen under free health care policy? The case of Sri Lanka.

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Pallegedara, Asankha; Grimm, Michael

2018-04-26

Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out-of-pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income-induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink. Copyright © 2018 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study.

Directory of Open Access Journals (Sweden)

Jan A C Hontelez

Full Text Available The effect of the rapid scale-up of vertical antiretroviral treatment (ART programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up.We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009-2012 (N = 32,319. We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009-2012 in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC clinic in the last 6 months increased significantly over the period 2009-2012, for both HIV-infected people (from 59% to 67%; p<0.001, and HIV-uninfected people (from 41% to 47%; p<0.001. In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001 and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001. For HIV

The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study.

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Hontelez, Jan A C; Tanser, Frank C; Naidu, Kevindra K; Pillay, Deenan; Bärnighausen, Till

2016-01-01

The effect of the rapid scale-up of vertical antiretroviral treatment (ART) programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up. We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009-2012 (N = 32,319). We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC) clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009-2012) in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC) clinic in the last 6 months increased significantly over the period 2009-2012, for both HIV-infected people (from 59% to 67%; p<0.001), and HIV-uninfected people (from 41% to 47%; p<0.001). In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001) and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001). For HIV

Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.

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Rogers, Eleanor; Ali, Muhammad; Fazal, Shahid; Kumar, Deepak; Guerrero, Saul; Hussain, Imtiaz; Soofi, Sajid; Alvarez Morán, Jose Luis

2018-02-01

To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Cross-sectional quality-of-care study. The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. LHW implementing treatment for uncomplicated SAM in the community. Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

[Prevention and Treatment of Eating Disorders: The Health Care Network Anorexia and Bulimia nervosa].

Science.gov (United States)

Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd

2015-07-01

The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results. © Georg Thieme Verlag KG Stuttgart · New York.

Quality of health care of atopic eczema in Germany: results of the national health care study AtopicHealth.

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Langenbruch, A; Radtke, M; Franzke, N; Ring, J; Foelster-Holst, R; Augustin, M

2014-06-01

The successful treatment of atopic eczema (AE) should result in the improvement of both physical symptoms and patient's quality of life (QoL). This study was conducted using a sample of dermatologists throughout Germany. This is due to dermatologists being the main health care providers of AE. Obtaining reliable data on quality of care of AE from both the patient's and the physician's perspective. This cross-sectional study assessed: the individual clinical history; dermatology-specific QoL (DLQI); state of health (EQ-5d-VAS); treatments; burden caused by disease and treatment; patient-defined treatment benefit (PBI). Data from 1678 adult patients (60.5% female, mean age: 38.4 ± 15.9) were analysed. The most frequently used treatments during the last five years were emollients (90.4%) and topical corticosteroids (85.5%). In this study, 75.8% of the patients felt only moderately or not at all impaired by their treatment. The mean DLQI (0 = minimum-30 = maximum QoL impairment) was 8.5 ± 6.5. The EQ-5d-VAS (100 = best possible) was 63.6 ± 22.0 on average. 26.6% reported suffering 'often' or 'every night' from sleeplessness due to severe itching. Mean PBI was 2.4 ± 1.1 (4 = maximum benefit). This study provides first data on the health care of adults with AE in Germany at a national level and reveals the need for a more effective care. Whereas most patients consider their treatment-related burden as low, the daily burden of the disease seems to be high: one third reports sleeplessness due to itching which indicates insufficient therapeutic regimes in these cases. A better implementation of the German national guideline for AE and a systematic analysis of the difficulties causing its limited effects is needed. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

Oncology in primary health care

International Nuclear Information System (INIS)

Mendoza del Pino, Mario Valentín

2009-01-01

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

The impact of the survivorship care plan on health care use

DEFF Research Database (Denmark)

Jeppesen, Mette Moustgaard; Ezendam, Nicole P M; Pijnenborg, Johanna M A

2018-01-01

PURPOSE: The purpose of this paper was to assess the impact of survivorship care plan (SCP) provision and moderating factors on health care use following endometrial cancer treatment. METHODS: Women newly diagnosed with endometrial cancer were included in a pragmatic cluster randomized trial at 12...... of general practitioner, specialist, and additional health care was collected through questionnaires after diagnosis and at 6-, 12-, and 24-month follow-up and compared using linear multilevel regression analyses. RESULTS: Women who received an SCP had more cancer-related primary care visits compared...... to the usual care arm during the first year after diagnosis (β = 0.7, p women in the SCP group used more additional health care compared to women receiving usual care (24 vs. 11%, p = 0.04). Women with anxious symptoms (p = 0.03) and women who received radiotherapy (p = 0.01) had...

Mental Health Service Use for Patients with Co-occurring Mental and Physical Chronic Health Care Needs in Primary Care Settings

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Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.

2016-01-01

Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (pneeded on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863

Making health care safer: What is the contribution of health psychology?

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Vincent, Charles; Wearden, Alison; French, David P

2015-11-01

While health care brings great benefits, all treatments, and many investigations, carry some risk. As patients, we should be told of the risks of specific treatments but we are also at risk from failings in the health care system itself. We suggest that, while there are many examples of individual health psychologists who have made important contributions, this has not yet translated into a broader disciplinary engagement. Health psychologists have devoted much more attention to patients and devoted much less attention to the potentially huge impact of studying and intervening with staff, clinical practice, and organizations. We believe that there are considerable opportunities for health psychology to engage more closely with patient safety and, more importantly, that this would be of great benefit to both patients and staff. Statement of contribution What is already known on this subject? While health care brings great benefits, all treatments, and many investigations, carry some risk. Patients are also at risk from failings in the health care system itself. Studies using review of medical records in many countries have found that between 8% and 12% of patients in hospital suffer an unintended harm due to health care. What does this study add? There are many examples of individual psychologists who have made important contributions, but this has not yet translated into a broader disciplinary engagement. There are considerable opportunities for health psychology to engage more closely with patient safety. These include health behaviour change, teamwork, communication after medical error, diagnosis and decision making, organisational culture, and improving compliance with rules and standards. Psychologists providing a clinical service to specialist services in any area could expand their remit from supporting patients to a more general support and engagement with safety and quality initiatives. Health psychologists have models to understand the behaviour of people

Patients′ perception of the quality of malaria treatment in primary health care centers of Jos and Environs

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N S Jimam

2015-01-01

Full Text Available Background: Though the fight against malaria continued to be on the increased, the disease still remains a major public health problem in many developing countries, especially in the rural areas. The extent of drug use and its effect is affected among other things by the pattern in which these drugs are prescribed by the health workers. Patients′ assessment of the quality of care depends on their ability to judge whether health care providers are adhering to the defined standard of care, hence it is necessary to assess the views of patients regarding the quality of care they received from the primary health care (PHC centers. Aim: This study aimed at evaluating consumer′s perception of the quality of malaria treatment in PHC centers of Jos and environs. Materials and Methods: Nine PHC centers were selected by multi-stage random sampling, five from Jos North and four from Jos South Local Government Areas of Plateau State. Patients of both sexes within the age range of 18 years and above who visited the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. A semi-structured interviewer questionnaire which was adapted from previous health survey studies was administered to all the 249 eligible participants. The data collected were analyzed using the Statistical Package for Social Sciences (SPSS version 20.0 software programmer. Results: The result showed that there were no consistently significant differences (P > 0.05 regarding patient satisfaction between male and female patients across selected items in the various domains, that is, irrespective of respondents′ sex, their perception of the quality of health services rendered by PHCs was similar. Conclusion: It was therefore concluded that there was similar satisfaction level between the male and the female, though some key health services were not readily available in the

Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia.

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Villamil, María Del Pilar; Barrera, David; Velasco, Nubia; Bernal, Oscar; Fajardo, Esteban; Urango, Carlos; Buitrago, Sebastian

2017-09-15

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

A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care

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de Haan, A.M.; Boon, A.E.; de Jong, J.T.V.M.; Hoeve, M.; Vermeiren, R.R.J.M.

2013-01-01

A large proportion (28% up to 75%) of the treatments in youth mental health care results in premature termination (dropout). It is important to gain knowledge of the determinants of dropout because it can have very severe consequences. The aim of our meta-analytic review was to provide an overview

The Emergency Treatment And The Stj's Vision On The Waiver Of Grace For The Health Care Plans

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Eduardo Cambi

2016-12-01

Full Text Available The aim of this study is to understand the rules on waiting periods of private health care in Brazil and the need for their dismissal in case of emergency treatments. It analyzes the right to health as a fundamental social right, highlighting the treatment given to it by the Federal Constitution of 1988. Addresses the changing profile of private autonomy as a result of the constitutionalization of civil law and its submission to fundamental rights. Finally, contextualize the decisions of the High Court of Justice to demonstrate the illegality of Resolution No. 13 of the Council of Supplementary Health.

Unmanaged care: towards moral fairness in health care coverage.

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Hoffman, Sharona

2003-01-01

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

The maze and the minotaur: mental health in primary health care.

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Hirdes, Alice; Scarparo, Helena Beatriz Kochenborger

2015-02-01

The article aims to discuss the issue of integration of mental health in primary care by matrix support in mental health. We point out the main barriers in the use of this work method, as well as the facilitating factors of the matrix support of mental health in primary care. The first are within the scope of epistemological specificities, professional issues and management in the political and ideological dimensions. Among the second, we highlight: the care for people with mental disorders in the territory; the reduction of stigma and discrimination; the development of new skills for professionals in primary care; reduction of costs; simultaneous treatment of physical and mental illness, which often overlap; the possibility of incorporating mental health care in a perspective of extended clinical service using an inter/transdisciplinary approach.

Retention in mental health care of Portuguese-speaking patients

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Gonçalves, Marta; Cook, Benjamin; Mulvaney-Day, Norah; Alegría, Margarita; Kinrys, Gustavo

2013-01-01

We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005–2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients. PMID:23427258

The productivity of mental health care: an instrumental variable approach.

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Lu, Mingshan

1999-06-01

BACKGROUND: Like many other medical technologies and treatments, there is a lack of reliable evidence on treatment effectiveness of mental health care. Increasingly, data from non-experimental settings are being used to study the effect of treatment. However, as in a number of studies using non-experimental data, a simple regression of outcome on treatment shows a puzzling negative and significant impact of mental health care on the improvement of mental health status, even after including a large number of potential control variables. The central problem in interpreting evidence from real-world or non-experimental settings is, therefore, the potential "selection bias" problem in observational data set. In other words, the choice/quantity of mental health care may be correlated with other variables, particularly unobserved variables, that influence outcome and this may lead to a bias in the estimate of the effect of care in conventional models. AIMS OF THE STUDY: This paper addresses the issue of estimating treatment effects using an observational data set. The information in a mental health data set obtained from two waves of data in Puerto Rico is explored. The results using conventional models - in which the potential selection bias is not controlled - and that from instrumental variable (IV) models - which is what was proposed in this study to correct for the contaminated estimation from conventional models - are compared. METHODS: Treatment effectiveness is estimated in a production function framework. Effectiveness is measured as the improvement in mental health status. To control for the potential selection bias problem, IV approaches are employed. The essence of the IV method is to use one or more instruments, which are observable factors that influence treatment but do not directly affect patient outcomes, to isolate the effect of treatment variation that is independent of unobserved patient characteristics. The data used in this study are the first (1992

Mental health beliefs and barriers to accessing mental health services in youth aging out of foster care.

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Sakai, Christina; Mackie, Thomas I; Shetgiri, Rashmi; Franzen, Sara; Partap, Anu; Flores, Glenn; Leslie, Laurel K

2014-01-01

To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care. Focus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the "threat of mental health problems," treatment benefits versus barriers to accessing mental health services, self-efficacy, and "cues to action." Data were analyzed using a modified grounded-theory approach. Youth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports "cueing action" during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation. Youths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Can we restrict the health care menu?

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Klein, R

1994-02-01

The case of Britain's National Health Service is used to illuminate the cross-national debate about whether the availability of health care should be restricted and, if so, how this should be done. Traditionally, the NHS relied on implicit rationing by clinicians within budgetary constraints set by government. However, the logic of the 1989 reforms appeared to require explicit decisions about the packages of health care to be provided to local populations. In practice, purchasers have refused to define such packages. Explicit rationing remains very much the exception. Exploring the reasons for this suggests that defining a restricted menu of health care, by adopting a cost-utility approach and excluding specific procedures or forms of treatment on the Oregon model, is only one of many policy options. There is a large repertory of policy tools for balancing demands and resources, ranging from diluting the intensity of treatment to its earlier termination. Given that health care is characterised by uncertainty, lack of information about outcomes and patient heterogeneity, it may therefore be more 'rational' to diffuse decision-making among clinicians and managers than to try to move towards a centrally determined menu of entitlements.

Correlates of Strengthening Lessons from HIV/AIDS Treatment and Care Services in Ethiopia Perceived Access and Implications for Health System.

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Bereket Yakob

Full Text Available Access to healthcare is an important public health concept and has been traditionally measured by using population level parameters, such as availability, distribution and proximity of the health facilities in relation to the population. However, client based factors such as their expectations, experiences and perceptions which impact their evaluations of health care access were not well studied and integrated into health policy frameworks and implementation programs.This study aimed to investigate factors associated with perceived access to HIV/AIDS Treatment and care services in Wolaita Zone, Ethiopia.A cross-sectional survey was conducted on 492 people living with HIV, with 411 using ART and 81 using pre-ART services accessed at six public sector health facilities from November 2014 to March 2015. Data were analyzed using the ologit function of STATA. The variables explored consisted of socio-demographic and health characteristics, type of health facility, type of care, distance, waiting time, healthcare responsiveness, transportation convenience, satisfaction with service, quality of care, financial fairness, out of pocket expenses and HIV disclosure.Of the 492 participants, 294 (59.8% were females and 198 (40.2% were males, with a mean age of 38.8 years. 23.0% and 12.2% believed they had 'good' or 'very good' access respectively, and 64.8% indicated lower ratings. In the multivariate analysis, distance from the health facility, type of care, HIV clinical stage, out of pocket expenses, employment status, type of care, HIV disclosure and perceived transportation score were not associated with the perceived access (PA. With a unit increment in satisfaction, perceived quality of care, health system responsiveness, transportation convenience and perceived financial fairness scores, the odds of providing higher rating of PA increased by 29.0% (p<0.001, 6.0%(p<0.01, 100.0% (p<0.001, 9.0% (p<0.05 and 6.0% (p<0.05 respectively.Perceived quality of

Medical tourism and its impact on the US health care system.

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Forgione, Dana A; Smith, Pamela C

2007-01-01

The health care industry within the United States continues to face unprecedented increases in costs, along with the task of providing care to an estimated 46 million uninsured or underinsured patients. These patients, along with both insurers and employers, are seeking to reduce the costs of treatment through international outsourcing of medical and surgical care. Knows as medical tourism, this trend is on the rise, and the US health care system has not fully internalized the effects this will have on its economic structure and policies. The demand for low-cost health care services is driving patients to seek treatment on a globally competitive basis, while balancing important quality of care issues. In this article, we outline some of the issues facing legislators, health care policy makers, providers, and health service researchers regarding the impact of medical tourism on the US health care system.

Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

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Bailey Kerry A

2010-08-01

Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers.

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Konerman, Monica A; Thomson, Mary; Gray, Kristen; Moore, Meghan; Choxi, Hetal; Seif, Elizabeth; Lok, Anna S F

2017-12-01

Despite effective treatment for chronic hepatitis C, deficiencies in diagnosis and access to care preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record-based prompt on hepatitis C virus (HCV) screening rates in baby boomers in primary care and access to specialty care and treatment among those newly diagnosed. We implemented an electronic health record-based "best practice advisory" (BPA) that prompted primary care providers to perform HCV screening for patients seen in primary care clinic (1) born between 1945 and 1965, (2) who lacked a prior diagnosis of HCV infection, and (3) who lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre-BPA and post-BPA screening rates were compared, and care of newly diagnosed patients was analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics and 28% were screened. HCV screening increased from 7.6% for patients with a primary care provider visit in the 6 months prior to BPA to 72% over the 1 year post-BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment, and 9 achieved sustained virologic response thus far. Implementation of an electronic health record-based prompt increased HCV screening rates among baby boomers in primary care by 5-fold due to efficiency in determining needs for HCV screening and workflow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into electronic health record systems to increase HCV diagnosis and linkage to care. (Hepatology 2017;66:1805-1813). © 2017 by the American Association for the Study of Liver Diseases.

An Examination of the Workflow Processes of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program in Health Care Settings.

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Kaiser, David J; Karuntzos, Georgia

2016-01-01

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a public health program used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs that has been adapted for implementation in emergency departments and ambulatory clinics nationwide. This study used a combination of observational, timing, and descriptive analyses from a multisite evaluation to understand the workflow processes implemented in 21 treatment settings. Direct observations of 59 SBIRT practitioners and semi-structured interviews with 170 stakeholders, program administrators, practitioners, and program evaluators provided information about workflow in different medical care settings. The SBIRT workflow processes are presented at three levels: service delivery, information storage, and information sharing. Analyses suggest limited variation in the overall workflow processes across settings, although performance sites tailored the program to fit with existing clinical processes, health information technology, and patient characteristics. Strategies for successful integration include co-locating SBIRT providers in the medical care setting and integrating SBIRT data into electronic health records. Provisions within the Patient Protection and Affordable Care Act of 2010 call for the integration of behavioral health and medical care services. SBIRT is being adapted in different types of medical care settings, and the workflow processes are being adapted to ensure efficient delivery, illustrating the successful integration of behavioral health and medical care. Copyright © 2015 Elsevier Inc. All rights reserved.

Prison health-care wings: psychiatry's forgotten frontier?

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Forrester, Andrew; Chiu, Katrina; Dove, Samantha; Parrott, Janet

2010-02-01

There is worldwide evidence of high rates of mental disorder among prisoners, with significant co-morbidity. In England and Wales, mental health services have been introduced from the National Health Service to meet the need, but prison health-care wings have hardly been evaluated. To conduct a service evaluation of the health-care wing of a busy London remand (pre-trial) prison and examine the prevalence and range of mental health problems, including previously unrecognised psychosis. Service-use data were collected from prison medical records over a 20-week period in 2006-2007, and basic descriptive statistics were generated. Eighty-eight prisoners were admitted (4.4 per week). Most suffered from psychosis, a third of whom were not previously known to services. Eleven men were so ill that they required emergency compulsory treatment in the prison under Common Law before hospital transfer could take place. Over a quarter of the men required hospital transfer. Problem behaviours while on the prison health-care wing were common. Prison health-care wings operate front-line mental illness triaging and recognition functions and also provide care for complex individuals who display behavioural disturbance. Services are not equivalent to those in hospitals, nor the community, but instead reflect the needs of the prison in which they are situated. There is a recognised failure to divert at earlier points in the criminal justice pathway, which may be a consequence of national failure to fund services properly. Hospital treatment is often delayed.

DOH to integrate reproductive health in health care delivery.

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According to a Department of Health (DOH) official speaking at the recent Reproductive Health Advocacy Forum in Zamboanga City, the concept of reproductive health (RH) is now on the way to being fully integrated into the Philippines' primary health care system. The DOH is also developing integrated information, education, and communication material for an intensified advocacy campaign on RH among target groups in communities. The forum was held to enhance the knowledge and practice of RH among health, population and development program managers, field workers, and local government units. In this new RH framework, family planning becomes just one of many concerns of the RH package of services which includes maternal and child health, sexuality education, the prevention and treatment of abortion complications, prevention of violence against women, and the treatment of reproductive tract infections. Of concern, however, the Asian economic crisis has led the Philippine government to reduce funding, jeopardizing the public sector delivery of basic services, including reproductive health care. The crisis has also forced other governments in the region to reassess their priorities and redirect their available resources into projects which are practical and sustainable.

UNMET NEEDS FOR HEALTH CARE SERVICES IN BULGARIA

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Elka Atanasova

2016-09-01

Full Text Available Background: In all European countries, an important policy objective is the equity of access to health care. The factors that affect access to health care can differ as the demand- and supply-side factors. Moreover, there are many tools to assess the extent of inequity in access to services. One simple tool is the assessing reports of unmet needs for health care. Purpose: The study has two objectives: to examine the evidence of self-reported unmet needs and to analyze the relationship between foregone medical care and both type of residence and socioeconomic status. Materials and Methods: We use data from the European Union Statistics on Income and Living Conditions. The access to health care is measured using the concept of unmet need for medical examination or treatment during the last 12 months. The relationship between foregone medical care and both type of residence and socioeconomic status is examined through the representative survey conducted in 2014. Results: The Eurostat results show that treatment costs are the most common reason for foregone medical care in Bulgaria. We observe a gradual decrease in the share of people who reported having unmet needs due to being too expensive. According to the 2014 survey, significant differences between urban and rural areas as well as among the income groups are identified. The results show the problems in access to health care services mainly in small towns and villages. Conclusion: Although major essential changes were made in the Bulgarian health care system, the equity problems remain an important challenge to policy-makers.

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

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

2015-01-01

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

Compulsory Community Care in New Zealand Mental Health Legislation 1846-1992

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Anthony John O’Brien

2013-05-01

Full Text Available Community treatment orders are considered a new development in mental health care and are consistent with current New Zealand mental health policy of care in the community. However, since its first adoption in 1846, New Zealand mental health legislation has always made provision for compulsory mental health care out of hospital. Analysis of the text of each of the five iterations of mental health legislation shows that an initial (1846 provision for a friend or relative to take a committed patient into his or her care, as an alternative to committal to hospital, continued though various revisions until its current expression as a community treatment order. Using Rochefort’s model of change in mental health policy, we argue that a long static period until 1911 was followed by progressive change throughout the 20th century, although provision for compulsory out-of-hospital care has been continuous over the life of New Zealand’s legislation. In the late-20th century, compulsory mental health care is tied to medical treatment and mental health service surveillance of the patient’s social circumstances. We conclude with recommendations for how reformed legislation may contribute to future mental health policy by giving effect to agendas of positive rights and social inclusion.

Access, treatment and outcomes of care: a study of ethnic minorities in Europe.

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Hanssens, Lise G M; Detollenaere, Jens; Hardyns, Wim; Willems, Sara J T

2016-05-01

Recent research has shown that ethnic minorities still have less access to medical care and are less satisfied with the treatment they receive and the outcomes of the health care process. This article assesses how migrants in Europe experience access, treatment and outcomes in the European health care systems. Data were obtained from the QUALICOPC study (Quality and Costs of Primary Care in Europe). Regression analyses were used to estimate the access, treatment and outcomes of care for ethnic minorities. In several countries, migrants experience that the opening hours of their GP practice were too limited and indicate that the practice was too far away from their work or home (lower access). They are more likely to report negative patient-doctor communication and less continuity of care than native patients (worse treatment). In addition, they are less satisfied with the care they received and are more likely to postpone care (worse outcomes). In general, migrants are still disadvantaged during the health care process. However, our results also indicate that satisfaction with the health care process improves for second-generation migrants in comparison with first-generation migrants.

Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study.

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Quanbeck, Andrew R; Gustafson, David H; Marsch, Lisa A; McTavish, Fiona; Brown, Randall T; Mares, Marie-Louise; Johnson, Roberta; Glass, Joseph E; Atwood, Amy K; McDowell, Helene

2014-05-29

Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers's diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods - pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance - with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of

Personalized health care: from theory to practice.

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Snyderman, Ralph

2012-08-01

The practice of medicine stands at the threshold of a transformation from its current focus on the treatment of disease events to an emphasis on enhancing health, preventing disease and personalizing care to meet each individual's specific health needs. Personalized health care is a new and strategic approach that is driven by personalized health planning empowered by personalized medicine tools, which are facilitated by advances in science and technology. These tools improve the capability to predict health risks, to determine and quantify the dynamics of disease development, and to target therapeutic approaches to the needs of the individual. Personalized health care can be implemented today using currently available technologies and know-how and thereby provide a market for the rational introduction of new personalized medicine tools. The need for early adoption of personalized health care stems from the necessity to reduce the egregious and wasteful burden of preventable chronic diseases, which is not effectively addressed by our current approach to care. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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

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Melissa Ehman

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

Decentralizing provision of mental health care in Sri Lanka.

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Fernando, Neil; Suveendran, Thirupathy; de Silva, Chithramalee

2017-04-01

In the past, mental health services in Sri Lanka were limited to tertiary-care institutions, resulting in a large treatment gap. Starting in 2000, significant efforts have been made to reconfigure service provision and to integrate mental health services with primary health care. This approach was supported by significant political commitment to establishing island-wide decentralized mental health care in the wake of the 2004 tsunami. Various initiatives were consolidated in The mental health policy of Sri Lanka 2005-2015, which called for implementation of a comprehensive community-based, decentralized service structure. The main objectives of the policy were to provide mental health services of good quality at primary, secondary and tertiary levels; to ensure the active involvement of communities, families and service users; to make mental health services culturally appropriate and evidence based; and to protect the human rights and dignity of all people with mental health disorders. Significant improvements have been made and new cadres of mental health workers have been introduced. Trained medical officers (mental health) now provide outpatient care, domiciliary care, mental health promotion in schools, and community mental health education. Community psychiatric nurses have also been trained and deployed to supervise treatment adherence in the home and provide mental health education to patients, their family members and the wider community. A total of 4367 mental health volunteers are supporting care and raising mental health literacy in the community. Despite these important achievements, more improvements are needed to provide more timely intervention, combat myths and stigma, and further decentralize care provision. These, and other challenges, will be targeted in the new mental health policy for 2017-2026.

Public health capacity in the provision of health care services.

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Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick

2015-12-01

In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

The cost of universal health care in India: a model based estimate.

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Prinja, Shankar; Bahuguna, Pankaj; Pinto, Andrew D; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

2012-01-01

As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8%) of the GDP for universalizing health care services. The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

Health care practices in ancient Greece: The Hippocratic ideal

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Kleisiaris, Christos F.; Sfakianakis, Chrisanthos; Papathanasiou, Ioanna V.

2014-01-01

Asclepius and Hippocrates focused medical practice on the natural approach and treatment of diseases, highlighting the importance of understanding the patient’s health, independence of mind, and the need for harmony between the individual, social and natural environment, as reflected in the Hippocratic Oath. The aim of this study was to present the philosophy of care provision in ancient Greece and to highlight the influence of the Hippocratic ideal in modern health care practices. A literature review was carried out using browser methods in international databases. According to the literature, “healthy mind in a healthy body” was the main component of the Hippocratic philosophy. Three main categories were observed in the Hippocratic provision of care: health promotion, interventions on trauma care, and mental care and art therapy interventions. Health promotion included physical activity as an essential part of physical and mental health, and emphasized the importance of nutrition to improve performance in the Olympic Games. Interventions on trauma care included surgical practices developed by Hippocrates, mainly due to the frequent wars in ancient Greece. Mental care and art therapy interventions were in accordance with the first classification of mental disorders, which was proposed by Hippocrates. In this category music and drama were used as management tools in the treatment of illness and in the improvement of human behavior. The role of Asclepieion of Kos was highlighted which clearly indicates a holistic health care model in care provision. Finally, all practices regarded detailed recordings and evaluation of information within the guidelines. The Hippocratic philosophy on health care provision focused on the holistic health care model, applying standards and ethical rules that are still valid today. PMID:25512827

Committee Opinion no. 512: health care for transgender individuals.

Science.gov (United States)

2011-12-01

Transgender individuals face harassment, discrimination, and rejection within our society. Lack of awareness, knowledge, and sensitivity in health care communities eventually leads to inadequate access to, underutilization of, and disparities within the health care system for this population. Although the care for these patients is often managed by a specialty team, obstetrician–gynecologists should be prepared to assist or refer transgender individuals with routine treatment and screening as well as hormonal and surgical therapies. The American College of Obstetricians and Gynecologists opposes discrimination on the basis of gender identity and urges public and private health insurance plans to cover the treatment of gender identity disorder.

Evaluation of Student Care Process in Urban and Rural Health Care Centers and Health House in Tabriz Using Tracer Methodology

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Neda Kabiri

2015-08-01

Full Text Available Background and Objectives : Tracer methodology is a novel evaluation method which its purpose is to provide an accurate assessment of systems and processes for the delivery of care, treatment, and services at a health care organization. This study aimed to assess student care process in Tabriz using Tracer methodology. Material and Methods : This cross-sectional study was conducted in autumn 1391. Population study consisted of all the students who were covered by Tabriz health care center and study sample included an urban health care center, a rural health care center, a health house, and two schools in urban and rural areas which were selected by simple sampling method. Also, all the complicated and problematic processes were chosen to be assessed. Data were collected by interviewing, observing, and surveying documents and were compared with current standards. Results : The results of this study declared the percentage of points that each target group gained from tracer evaluation in student care process was 77% in health house, 90% in rural health care center and 83% in urban health care center. Findings indicated that documentation was the main weak point. Conclusion : According to the results of this study, student care process is sufficient; despite the fact that there are some deficiencies in caring process, as it may be improved through appropriate strategies. Furthermore, tracer methodology seems to be a proper method to evaluate various levels of health care system. ​

Health care in rural areas.

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Nath, L M

1994-02-01

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

Patient's Satisfaction with Health Care: a Questionnaire Study of Different Aspects of Care.

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Spasojevic, Nada; Hrabac, Boris; Huseinagic, Senad

2015-08-01

To determine the influence of sociodemographic factors on patients´ satisfaction with health care system. In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001). The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

Organizational Learning in Health Care Organizations

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Savithiri Ratnapalan

2014-02-01

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.

Finding the moral heart of treatment: mental health care in a French prison.

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Fernandez, Fabrice; Lézé, Samuel

2011-05-01

Morality is one of the most important elements of social actions, specifically in medical settings. Unfortunately, in social science, morality is often undertheorized and can lead to moralism. The aim of the paper is to test the "moral economy theory" which highlights the link between some local moral evaluations and a political context. We focus on "treatment" as therapeutic tool and as moral regulation of patients in a French remand centre. On the basis of an ethnography of forms of care for prisoners (2009-2010), and semi-directed interviews with working mental health professionals (n = 10), we analyse their engagement and their moral expectations of the prisoners under their care. Firstly, we show how prisoners are selected and then converted into patients deserving of attention (expectations of honesty, sincerity and compliance). Secondly, we show how these patients are divided into three main intervention categories, in which the treatment is both therapeutic and moral (expectations of responsibility, recognition of guilt, and self-esteem). Finally, we discuss these moral criteria within a new moral economy of vulnerability. Copyright © 2011 Elsevier Ltd. All rights reserved.

Oral Health Status, Treatment Needs and Knowledge, Attitude and ...

African Journals Online (AJOL)

Background: Health care workers (HCWs) from an important component of the health care system of any nation. Adequate knowledge regarding oral health is also mandatory as it is directly related to general health. Aim: The present study was undertaken to assess oral health status and treatment needs of the health ...

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

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De Jesus, Maria; Earl, Tara R

2014-01-01

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

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

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Petrochuk, M A; Javalgi, R G

1996-01-01

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

Australians with osteoarthritis: satisfaction with health care providers and the perceived helpfulness of treatments and information sources

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Basedow M

2016-08-01

Full Text Available Martin Basedow,1 Peter Hibbert,1 Tamara Hooper,1 William Runciman,1 Adrian Esterman,2 1School of Psychology, Social Work and Social Policy, 2School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia Objective: The aim of this study was to evaluate the satisfaction of Australian patients who suffer from osteoarthritis (OA with their health care providers and the perceived helpfulness of treatments and information sources. Methods: A self-administered questionnaire was conducted with a sample of 560 Australian patients who suffer from OA with questions about satisfaction with health care providers and the helpfulness of different treatment options and information sources. Logistic regression models were used to assess potential predictors of satisfaction. Thematic analysis was undertaken for attitudinal factors associated with satisfaction. Results: A total of 435 participants returned questionnaires (response rate 78%. Most respondents were highly satisfied with the care provided by their general practitioner (GP (84%, communication with their GP (88%, time spent with their GP (84%, and their ability to talk freely with their GP about their medical problem (93%, but less satisfied with their ability to talk freely about associated emotional problems (77%. Satisfaction with pharmacists (80%, rheumatologists (76%, and orthopedic surgeons (72% was high. Joint replacement surgery (91%, prescription anti-inflammatory medications (66%, aids and assistive devices (65%, intra-articular injections (63%, and prescription painkiller medications (62% were perceived as effective treatments. Less highly rated treatments were exercise (48%, physiotherapy (43%, and complementary medicines (29%. A majority of patients were satisfied with the information to manage their OA (65%. From the multivariable logistic regression analysis, four GP satisfaction factors were found to be predictors of overall satisfaction with GP care: the amount

The cost of universal health care in India: a model based estimate.

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Shankar Prinja

Full Text Available INTRODUCTION: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. METHODS: We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. RESULTS: We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73 per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8% of the GDP for universalizing health care services. CONCLUSION: The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

ICT-powered Health Care Processes

DEFF Research Database (Denmark)

Carbone, Marco; Christensen, Anders Skovbo; Nielson, Flemming

2014-01-01

The efficient use of health care ressources requires the use of Information and Communication Technology (ICT). During a treatment process, patients have often been tested and partially treated with different diagnoses in mind before the precise diagnosis is identified. To use resources well it b...... of medical specialists and the adaptation of treatments, and through the evaluation of the trustworthiness of models taking account of test results and actual treatments compared to the clinical guidelines....

Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes

DEFF Research Database (Denmark)

von Arx, Lill-Brith Wium; Gydesen, Helge; Skovlund, Søren

2016-01-01

Objective: While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome......-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors. Results: In total, 1033 respondents answered the survey. The majority of treatment beliefs...... and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy...

Boundaries and e-health implementation in health and social care

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King Gerry

2012-09-01

Full Text Available Abstract Background The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost. Methods To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA in Scotland, using three retrospective, qualitative case studies in three different health board locations. Results Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs’ understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals. Conclusions To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

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Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

The Role of Strategy in Health Care.

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

2015-11-01

Significant changes are occurring in the health care field, and spine surgeons must have an understanding of business strategy if they are going to adapt to the new health care environment. Spine surgeons will be required to demonstrate how their service provides a unique value to their patients or else the patients will obtain care from competitors. Classic methods for demonstrating value such as academic prestige and superior clinical outcomes may no longer be sufficient in the evolving health care field, and surgeons will need to demonstrate a comprehensive and cost-effective treatment algorithm for a diagnosis. This article will discuss the basics of business strategy for the spine surgeon, and ways in which the surgeon may demonstrate value to their patients.

Home health services in primary care: What can we do?

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Yasemin Çayır

2013-01-01

Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

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

Ethical thinking and discrimination in health care

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Aleksander Mlinšek

2012-02-01

Full Text Available RQ: Personal excellence of nursing focusing on self-transcendence and achievements is crucial for achieving excellence in health care. The question is whether there is unequal treatment of patients despite high ethical standards placed in health care.Purpose: Professional nurses code is a guide in assessing their ethical performance. People are different amongst each other, but have the same rights in the health system, which should be provided by health care services. The need to overcome inequalities has become a cornerstone of excellence in health care.Method: A small quantitative survey of nurses was conducted in one of the departments in a Slovenian hospital. To analyse the results, we used frequency statistics, Spearman's rank correlation test and chi-square test. Results: Providers of health care services are aware of the importance of ethics in its formation. Professional Code is relatively well known; 8.4 % of the respondents were not sure if they clearly define the principles of respect for equality. Discrimination, caused by providers of health care, is of a less extent. Ethical awareness among health care providers does not affect identification with the profession. The education level ofnursing personnel and the perception of discrimination based on religious affiliation influenced one another. Education has no influence on the perception of discrimination based on other circumstances.Organization: Health care organizations should integrate hygieneethical thinking among its strategic goals. Quality is not only quantifying the data. Personal excellence of health care providers, which is difficult to measure, is the basic building block of organizational excellence and patient satisfaction.Originality: There are not many research studies on perceptionsof discrimination in health care. The article raises the sensitive issue that we should talk more about.Limitations: The survey was conducted on a small sample size. Further research

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

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Mathibe, Maphuthego D; Hendricks, Stephen J H; Bergh, Anne-Marie

2015-10-02

Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

Multidisciplinary treatment for peripheral arterial occlusive disease and the role of eHealth and mHealth

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Fokkenrood HJP

2012-10-01

Full Text Available Hugo JP Fokkenrood,1,2 Gert-Jan Lauret,1,2 Marc RM Scheltinga,4 Cor Spreeuwenberg,3 Rob A de Bie,2 Joep AW Teijink1,21Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; 2CAPHRI Research School, Department of Epidemiology, 3Department of Integrated Care, Maastricht University, Maastricht, The Netherlands; 4Department of Vascular Surgery, Maxima Medical Centre, Veldhoven, The NetherlandsAbstract: Increasingly unaffordable health care costs are forcing care providers to develop economically viable and efficient health care plans. Currently, only a minority of all newly diagnosed peripheral arterial occlusive disease (PAOD patients receive efficient and structured conservative treatment for their disease. The aim of this article is to introduce an innovative effective treatment model termed ClaudicatioNet. This concept was launched in The Netherlands as a means to combat treatment shortcomings and stimulate cohesion and collaboration between stakeholders. The overall goal of ClaudicatioNet is to stimulate quality and transparency of PAOD treatment by optimizing multidisciplinary health care chains on a national level. Improved quality is based on stimulating both a theoretical and practical knowledge base, while eHealth and mHealth technologies are used to create clear insights of provided care to enhance quality control management, in addition these technologies can be used to increase patient empowerment, thereby increasing efficacy of PAOD treatment. This online community consists of a web portal with public and personal information supplemented with a mobile application. By connecting to these tools, a social community is created where patients can meet and keep in touch with fellow patients, while useful information for supervising health care professionals is provided. The ClaudicatioNet concept will likely create more efficient and cost-effective PAOD treatment by improving the quality of supervised training

Technical efficiency of rural primary health care system for diabetes treatment in Iran: a stochastic frontier analysis.

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Qorbani, Mostafa; Farzadfar, Farshad; Majdzadeh, Reza; Mohammad, Kazem; Motevalian, Abbas

2017-01-01

Our aim was to explore the technical efficiency (TE) of the Iranian rural primary healthcare (PHC) system for diabetes treatment coverage rate using the stochastic frontier analysis (SFA) as well as to examine the strength and significance of the effect of human resources density on diabetes treatment. In the SFA model diabetes treatment coverage rate, as a output, is a function of health system inputs (Behvarz worker density, physician density, and rural health center density) and non-health system inputs (urbanization rate, median age of population, and wealth index) as a set of covariates. Data about the rate of self-reported diabetes treatment coverage was obtained from the Non-Communicable Disease Surveillance Survey, data about health system inputs were collected from the health census database and data about non-health system inputs were collected from the census data and household survey. In 2008, rate of diabetes treatment coverage was 67% (95% CI: 63%-71%) nationally, and at the provincial level it varied from 44% to 81%. The TE score at the national level was 87.84%, with considerable variation across provinces (from 59.65% to 98.28%).Among health system and non-health system inputs, only the Behvarz density (per 1000 population)was significantly associated with diabetes treatment coverage (β (95%CI): 0.50 (0.29-0.70), p  < 0.001). Our findings show that although the rural PHC system can considered efficient in diabetes treatment at the national level, a wide variation exists in TE at the provincial level. Because the only variable that is predictor of TE is the Behvarz density, the PHC system may extend the diabetes treatment coverage by using this group of health care workers.

Shared decision-making, stigma, and child mental health functioning among families referred for primary care-located mental health services.

Science.gov (United States)

Butler, Ashley M

2014-03-01

There is growing emphasis on shared decision making (SDM) to promote family participation in care and improve the quality of child mental health care. Yet, little is known about the relationship of SDM with parental perceptions of child mental health treatment or child mental health functioning. The objectives of this preliminary study were to examine (a) the frequency of perceived SDM with providers among minority parents of children referred to colocated mental health care in a primary care clinic, (b) associations between parent-reported SDM and mental health treatment stigma and child mental health impairment, and (c) differences in SDM among parents of children with various levels of mental health problem severity. Participants were 36 Latino and African American parents of children (ages 2-7 years) who were referred to colocated mental health care for externalizing mental health problems (disruptive, hyperactive, and aggressive behaviors). Parents completed questions assessing their perceptions of SDM with providers, child mental health treatment stigma, child mental health severity, and level of child mental health impairment. Descriptive statistics demonstrated the majority of the sample reported frequent SDM with providers. Correlation coefficients indicated higher SDM was associated with lower stigma regarding mental health treatment and lower parent-perceived child mental health impairment. Analysis of variance showed no significant difference in SDM among parents of children with different parent-reported levels of child mental health severity. Future research should examine the potential of SDM for addressing child mental health treatment stigma and impairment among minority families.

[Interpretation in the Danish health-care system].

Science.gov (United States)

Lund Hansen, Marianne Taulo; Nielsen, Signe Smith

2013-03-04

Communication between health professional and patient is central for treatment and patient safety in the health-care system. This systematic review examines the last ten years of specialist literature concerning interpretation in the Danish health-care system. Structural search in two databases, screening of references and recommended literature from two scientists led to identification of seven relevant articles. The review showed that professional interpreters were not used consistently when needed. Family members were also used as interpreters. These results were supported by international investigations.

[Increased financial risks for health insurers: a challenge for providers of mental health care in the Netherlands].

Science.gov (United States)

Daansen, P J; van Schilt, J

2014-01-01

As from 2014 Dutch health insurance companies will bear the full financial risk for their clients in mental health care. Over the next years the existing risk settlement shared between insurance companies will gradually be brought to a close. Municipalities and the Ministry of Justice are already responsible for or will soon become responsible for financing health care for adolescents, patients with severe psychiatric disorders and forensic psychiatric patients. As a result, the health insurance companies are beginning to impose ever stricter conditions regarding the care 'product' they are 'buying'. To study the possible consequences, for mental health care institutions, of the increased risk to be borne by health care insurers. Use was made of relevant marketing literature and literature relating to mental health care. Studies of Dutch mental health care literature indicate that in the future the purchasing procedure will no longer consider the immediate treatment outcome as the sole performance indicator but will also take into account additional factors such as long-term improvements in patients' health, customer satisfaction and degree of patient participation, patient empowerment and autonomy. In formulating the details of their health products and business strategies, health care providers will now have to take into account not only the efficacy of the treatment they provide but also the purchasing policy and strategy of the health insurance companies.

Challenges in tuberculosis care in Western Uganda: Health care worker and patient perspectives

Directory of Open Access Journals (Sweden)

Ashley Wynne

2014-01-01

Full Text Available Uganda is one of the high burden countries that contribute 80% of the world’s tuberculosis (TB burden. Health care worker and patient perspectives provide valuable insight into gaps between policy and practice within tuberculosis control program. This study was part of a larger mixed-methods study to explore knowledge and stigma around HIV, TB and TB/HIV co-infection. We conducted a secondary analysis of the qualitative data. Findings related to challenges faced by health care workers and patients. Patient’s identified delays in diagnosis and financial burden associated with TB treatment. Health care workers called for more training on TB and TB/HIV co-infection, and identified poor referral practices between health units and lack of program funding resulting in the abandonment of DOTS programs. Training for health care workers is needed to better manage TB/HIV co-infected patients. Overall health system strengthening is needed, including referral systems tracking patients between health centers.

Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians.

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Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L

2017-07-01

Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment. © 2017 John Wiley & Sons Ltd.

Access to mental health care among women Veterans: is VA meeting women's needs?

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Kimerling, Rachel; Pavao, Joanne; Greene, Liberty; Karpenko, Julie; Rodriguez, Allison; Saweikis, Meghan; Washington, Donna L

2015-04-01

Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their mental health care met their needs completely or very well. Gender related experiences (availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort) were each associated with 2-fold increased odds of perceived access, and associations remained after adjusting for ease of getting care. Women VA users demonstrate very good objective access to mental health services. Desire for, and access to specialized mental health services for women varies across the population and are important aspects of shared decision making in referral and treatment planning for women using VA primary care.

Care for the caregiver: Stress relief and burnout among health workers in HIV care

Directory of Open Access Journals (Sweden)

Ruth Atukunda

2013-05-01

Full Text Available Introduction Health care facilities in resource-limited settings are faced with numerous challenges including high patient loads and shortage of trained health workers. However, there still remains a dearth of scientific evidence to assess and address issues associated with stress and burnout among health workers providing HIV care. Methods An annual assessment was conducted using a site capacity assessment tool to evaluate the quality of care at 18 HIV health facilities. Questions to determine stress management and HIV care among health workers were graded from 0–5 (lowest to highest score. Data on performance of health facilities were summarized on an excel sheet. Results Majority of the health facilities (67% did not have polices or practices in place to relieve stress faced by staff in providing care for persons with HIV/AIDS.Less than half of the health facilities (44.4% had policies on PEP, confidential HIV testing and counseling as well as referral for care and treatment for staff that are found to be HIV positive. Conclusion Evaluating and addressing issues associated with stress, burnout, as well as providing HIV care services among health workers in HIV settings is imperative for provision of good quality of care.

South Africa: a 21st century apartheid in health and health care?

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Mooney, Gavin H; McIntyre, Diane E

The current crisis in health and health care in South Africa results from a combination of factors: the legacy of apartheid; issues of poverty, income inequality and AIDS; and the more recent influence of neoliberal economic policies and globalisation. The legacy of apartheid has meant that both health and health care are skewed along racial lines, and 60% of health care expenditure goes largely to the 14% of the population who have private health insurance. A more equitable distribution of health care resources will result from the promised National Health Insurance, the details of which are still being debated. The AIDS epidemic in South Africa was exacerbated by the government not introducing antiretroviral treatment (ART) until the early 2000s. In 2005, it was estimated that more than 5.5 million South Africans were infected with HIV. Now all those with a CD4 count below 200 are eligible for ART. A better health service will not be enough to improve the health of South Africans. A whole-of-government approach is needed to address the persistent problems of poverty and inequality.

Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

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King, Michael W

2017-11-01

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

Increased utilization of health care services after psychotherapy: a register based study

DEFF Research Database (Denmark)

Fenger, Morten Munthe; Poulsen, Stig Bernt; Mortensen, Erik Lykke

2012-01-01

services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...... 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients increased their use of all health care services with 296% (ES=0.58) in the four year pre-post comparison, while the control...

A randomized controlled trial of support group intervention after breast cancer treatment: results on sick leave, health care utilization and health economy.

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Björneklett, Helena Granstam; Rosenblad, Andreas; Lindemalm, Christina; Ojutkangas, Marja-Leena; Letocha, Henry; Strang, Peter; Bergkvist, Leif

2013-01-01

More than 50% of breast cancer patients are diagnosed before the age of 65. Returning to work after treatment is, therefore, of interest for both the individual and society. The aim was to study the effect of support group intervention on sick leave and health care utilization in economic terms. Of 382 patients with newly diagnosed breast cancer, 191 + 191 patients were randomized to an intervention group or to a routine control group, respectively. The intervention group received support intervention on a residential basis for one week, followed by four days of follow-up two months later. The support intervention included informative-educational sections, relaxation training, mental visualization and non-verbal communication. Patients answered a questionnaire at baseline, two, six and 12 months about sick leave and health care utilization. There was a trend towards longer sick leave and more health care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p = 0.0036). Costs to society were not reduced with intervention in its present form.

Screening physical health? Yes! But...: nurses' views on physical health screening in mental health care.

Science.gov (United States)

Happell, Brenda; Scott, David; Nankivell, Janette; Platania-Phung, Chris

2013-08-01

To explore nurses' views on the role of nurses in screening and monitoring for physical care of consumers with serious mental illness, at a regional mental health care service. People with serious mental illness experience heightened incidence of preventable and treatable physical illnesses such as cardiovascular disease and diabetes. Screening and monitoring are considered universal clinical safeguards. Nurses can potentially facilitate systematic screening, but their views on physical health care practices are rarely investigated. Qualitative exploratory study. Focus group interviews with 38 nurses of a regional mental health care service district of Australia. To facilitate discussion, participants were presented with a screening system, called the Health Improvement Profile (HIP), as an exemplar of screening of physical health risks by nurses. Inductive data analysis and theme development were guided by a thematic analysis framework. Nurses argued that treatable and preventable physical health problems were common. Four main themes were identified: screening - essential for good practice; the policy-practice gap; 'screening then what?' and, is HIP the answer? Screening and monitoring were considered crucial to proper diagnosis and treatment, however, were not performed systematically or consistently. Nurse readiness for an enhanced role in screening was shaped by: role and responsibility issues, legal liability concerns, funding and staff shortages. Participants were concerned that lack of follow up would limit effectiveness of these interventions. Screening was considered an important clinical step in effective diagnosis and treatment; however, identified barriers need to be addressed to ensure screening is part of a systemic approach to improve physical health of consumers with serious mental illness. Nurses have potential to influence improvement in physical health outcomes for consumers of mental health services. Such potential can only be realised if a

Need for timely paediatric HIV treatment within primary health care in rural South Africa.

Directory of Open Access Journals (Sweden)

Graham S Cooke

2009-09-01

Full Text Available In areas where adult HIV prevalence has reached hyperendemic levels, many infants remain at risk of acquiring HIV infection. Timely access to care and treatment for HIV-infected infants and young children remains an important challenge. We explore the extent to which public sector roll-out has met the estimated need for paediatric treatment in a rural South African setting.Local facility and population-based data were used to compare the number of HIV infected children accessing HAART before 2008, with estimates of those in need of treatment from a deterministic modeling approach. The impact of programmatic improvements on estimated numbers of children in need of treatment was assessed in sensitivity analyses.In the primary health care programme of HIV treatment 346 children <16 years of age initiated HAART by 2008; 245(70.8% were aged 10 years or younger, and only 2(<1% under one year of age. Deterministic modeling predicted 2,561 HIV infected children aged 10 or younger to be alive within the area, of whom at least 521(20.3% would have required immediate treatment. Were extended PMTCT uptake to reach 100% coverage, the annual number of infected infants could be reduced by 49.2%.Despite progress in delivering decentralized HIV services to a rural sub-district in South Africa, substantial unmet need for treatment remains. In a local setting, very few children were initiated on treatment under 1 year of age and steps have now been taken to successfully improve early diagnosis and referral of infected infants.

Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh.

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Chowdhury, Fahmida; Sturm-Ramirez, Katharine; Mamun, Abdullah Al; Iuliano, A Danielle; Bhuiyan, Mejbah Uddin; Chisti, Mohammod Jobayer; Ahmed, Makhdum; Haider, Sabbir; Rahman, Mahmudur; Azziz-Baumgartner, Eduardo

2017-01-01

Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome. A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients' relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome. We interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment. People with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of laws and regulations for drug sales.

Health psychology in primary care: recent research and future directions.

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Thielke, Stephen; Thompson, Alexander; Stuart, Richard

2011-01-01

Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.

Communication Skills Training Increases Self-Efficacy of Health Care Professionals

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Norgaard, Birgitte; Ammentorp, Jette; Kyvik, Kirsten Ohm; Kofoed, Poul-Erik

2012-01-01

Introduction: Despite the knowledge of good communication as a precondition for optimal care and treatment in health care, serious communication problems are still experienced by patients as well as by health care professionals. An orthopedic surgery department initiated a 3-day communication skills training course for all staff members expecting…

Phytotherapy in primary health care

Science.gov (United States)

Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

2014-01-01

OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

Treatment adherence in South African primary health care

African Journals Online (AJOL)

system. In the context of meagre financial resources, inadequate public funds di- rected at ... issues that are highlighted as affecting adherence include health locus of control, self-efficacy, ... mined to have little or no effect, a medical .... health as controlled by internal factors .... about information technology in the treatment.

Implementing international osteoarthritis treatment guidelines in primary health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial.

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Østerås, Nina; van Bodegom-Vos, Leti; Dziedzic, Krysia; Moseng, Tuva; Aas, Eline; Andreassen, Øyvor; Mdala, Ibrahim; Natvig, Bård; Røtterud, Jan Harald; Schjervheim, Unni-Berit; Vlieland, Thea Vliet; Hagen, Kåre Birger

2015-12-02

Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8-12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model. A cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants' treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER). The results

Survey of CAM interest, self-care, and satisfaction with health care for type 2 diabetes at group health cooperative

Directory of Open Access Journals (Sweden)

Bradley Ryan

2011-12-01

Full Text Available Abstract Background Very little research has explored the factors that influence interest in complementary and alternative medicine (CAM treatments. We surveyed persons with sub-optimally controlled type 2 diabetes to evaluate potential relationships between interest in complementary and alternative medicine (CAM treatments, current self-care practices, motivation to improve self-care practices and satisfaction with current health care for diabetes. Methods 321 patients from a large integrated healthcare system with type 2 diabetes, who were not using insulin and had hemoglobin A1c values between 7.5-9.5%, were telephoned between 2009-2010 and asked about their self-care behaviors, motivation to change, satisfaction with current health care and interest in trying naturopathic (ND care for their diabetes. Responses from patients most interested in trying ND care were compared with those from patients with less interest. Results 219 (68.5% patients completed the survey. Nearly half (48% stated they would be very likely to try ND care for their diabetes if covered by their insurance. Interest in trying ND care was not related to patient demographics, health history, clinical status, or self-care behaviors. Patients with greater interest in trying ND care rated their current healthcare as less effective for controlling their blood sugar (mean response 5.9 +/- 1.9 vs. 6.6 +/- 1.5, p = 0.003, and were more determined to succeed in self-care (p = 0.007. Current CAM use for diabetes was also greater in ND interested patients. Conclusions Patients with sub-optimally controlled type 2 diabetes expressed a high level of interest in trying ND care. Those patients with the greatest interest were less satisfied with their diabetes care, more motivated to engage in self-care, and more likely to use other CAM therapies for their diabetes.

Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

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Fields, Dail; Pruett, Jana; Roman, Paul M

2015-01-01

The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

Health Care Engagement Among LGBT Older Adults: The Role of Depression Diagnosis and Symptomatology.

Science.gov (United States)

Shiu, Chengshi; Kim, Hyun-Jun; Fredriksen-Goldsen, Karen

2017-02-01

Optimal engagement in health care plays a critical role in the success of disease prevention and treatment, particularly for older adults who are often in greater need of health care services. However, to date, there is still limited knowledge about the relationship between depression and health care engagement among lesbian, gay, bisexual, and transgender (LGBT) older adults. This study utilized data from Aging with Pride: National Health, Aging, Sexuality/Gender Study, from the 2014 survey with 2,450 LGBT adults 50 years old and older. Multiple-variable regression was utilized to evaluate relationships between three indicators of health care engagement and four depression groups after controlling for background characteristics and discrimination in health care. Health care engagement indicators were "not using preventive care," "not seeking care when needed," and "difficulty in adhering to treatments." Depression groups were defined by depression diagnosis and symptomatology, including Diagnosed-Symptomatic group (Diag-Sympt), Diagnosed-Nonsymptomatic group (Diag-NoSympt), Nondiagnosed-Symptomatic group (NoDiag-Sympt), and Nondiagnosed-Nonsymptomatic group (NoDiag-NoSympt). Depression groups displayed different patterns and levels of health care engagement. The Diag-Sympt group displayed the highest "difficulty in adhering to treatments." Diag-NoSympt group displayed the lowest "not using preventive care." The NoDiag-Sympt group reported the highest "not using preventive care" and "not seeking care when needed." The NoDiag-NoSympt group had the lowest "not seeking care when needed" and "difficulty in adhering to treatments." Depression diagnosis and symptomatology are jointly associated with health care engagement among LGBT older adults. Interventions aiming to promote health care engagement among this population should simultaneously consider both depression diagnosis and symptomatology. © The Author 2017. Published by Oxford University Press on behalf of The

Implications of DSM-5 for Health Care Organizations and Mental Health Policy.

Science.gov (United States)

Castillo, Richard J; Guo, Kristina L

2016-01-01

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called "dimensional") approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM- 5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients.

Science.gov (United States)

Foley, Perry; Steinberg, Dori; Levine, Erica; Askew, Sandy; Batch, Bryan C; Puleo, Elaine M; Svetkey, Laura P; Bosworth, Hayden B; DeVries, Abigail; Miranda, Heather; Bennett, Gary G

2016-05-01

Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care

Directory of Open Access Journals (Sweden)

Lisa C. Kooistra

2016-05-01

Discussion: Although no conclusions can be drawn based on the current study, our observations suggest that a blended CBT approach might shorten treatment duration and has the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted.

Do health care providers' attitudes towards back pain predict their treatment recommendations? Differential predictive validity of implicit and explicit attitude measures

NARCIS (Netherlands)

Houben, R.M.A.; Gijsen, A.; Peterson, J.; de Jong, P.J.; Vlaeyen, J.W.S.

The current study aimed to measure the differential predictive value of implicit and explicit attitude measures on treatment behaviour of health care providers. Thirty-six physiotherapy students completed a measure of explicit treatment attitude (Pain Attitudes And Beliefs Scale For

Improving Public Health Through Access to and Utilization of Medication Assisted Treatment

Directory of Open Access Journals (Sweden)

Thomas F. Kresina

2011-10-01

Full Text Available Providing access to and utilization of medication assisted treatment (MAT for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services MAT with HIV prevention, care and treatment programs provides the best “one stop shopping” approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.

Maternal autonomy and child health care utilization in India: results from the National Family Health Survey.

Science.gov (United States)

Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Subramanian, S V

2014-07-01

The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child's primary immunization status (indicative of preventive health care use) and treatment seeking for child's acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child's acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children. © 2012 APJPH.

Mental health measurement among women veterans receiving co-located, collaborative care services.

Science.gov (United States)

Lilienthal, Kaitlin R; Buchholz, Laura J; King, Paul R; Vair, Christina L; Funderburk, Jennifer S; Beehler, Gregory P

2017-12-01

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration's electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.

Negative health care experiences of immigrant patients: a qualitative study

Directory of Open Access Journals (Sweden)

Stronks Karien

2011-01-01

Full Text Available Abstract Background Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients. Methods Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment. Results Respondents reported negative events in relation to: 1 inadequate information exchange with care providers; 2 different expectations between respondents and care providers about medical procedures; 3 experienced prejudicial behavior on the part of care providers. Conclusions We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.

Ambivalent implications of health care information systems: a study in the Brazilian public health care system

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João Porto de Albuquerque

2011-01-01

Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

Equity versus humanity in health care

African Journals Online (AJOL)

Discussions of the economic aspects of health care often blur the distinction ... occupation with the treatment of economic symptoms rather than causes. ..... New York: Basic Books,. 1974. 14. ... Harvard University Press, 1971. 21. Benatar SR.

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

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Maphuthego D. Mathibe

2015-10-01

Full Text Available Background: Primary Health Care (PHC clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. Objective: This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. Method: An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Results: Workload, staff development and support for integration affected clinicians’ performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Conclusion: Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

Frailty and Organization of Health and Social Care.

Science.gov (United States)

Clegg, Andrew; Young, John

2015-01-01

In this chapter, we consider how health and social care can best be organized for older people with frailty. We will consider the merits of routine frailty identification, including risk stratification methods, to inform the provision of evidence-based treatment and holistic, goal-oriented care. We will also consider how best to place older people with frailty at the heart of health and social care systems so that the complex challenges associated with this vulnerable group are addressed. 2015 S. Karger AG, Basel.

Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States.

Science.gov (United States)

Burger, Charles D; Ozbay, A Burak; Lazarus, Howard M; Riehle, Ellen; Montejano, Leslie B; Lenhart, Gregory; White, R James

2018-02-13

Despite multiple treatment options, the prognosis of pulmonary arterial hypertension (PAH) remains poor. PAH patients experience a high economic burden due to comorbidities, hospitalizations, and medication costs. Although combination therapy has been shown to reduce hospitalizations, the relationship between treatment, health care utilization, and costs remains unclear. To provide a characterization of health care utilization and costs in real-world settings by comparing periods before and after initiating PAH-specific treatment. This retrospective study identified PAH patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases between 2010 and 2014 who initiated treatment with endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE-5Is), or soluble guanylate cyclase (sGC) stimulators. The index date was the date of the first PAH pharmacy claim. We included patients with ≥ 2 medical claims with diagnoses for PAH (ICD-9-CM: 416.0, 416.8) or PAH-related conditions and continuous enrollment in medical and pharmacy benefits for the 6 months before and after the index date. Treatment patterns were assessed at the drug class level (ERAs, PDE-5Is, sGC stimulators, and prostacyclins) from outpatient pharmacy claims during the 6-month post-index period. All-cause and PAH-related utilization and costs were measured. McNemar's and paired t-tests were used to compare patients' health care resource utilization and costs in the 6-month pre- and posttreatment periods. A total of 3,908 patients met the selection criteria. The study sample was 63% female with a mean age of 63 ± 15 years. Only 5% of patients began initial combination therapy for PAH, defined as claims for ≥ 2 medication classes within the first 30 days of treatment. Treatment interruption (≥ 30-day gap in days supply) of any PAH-specific medication was observed in 38% of patients. Compared with the 6-month pre-index period, the proportion of patients in the 6

The occupational health status of African-American women health care workers.

Science.gov (United States)

Arnold, C W

1996-01-01

Race, ethnicity, and gender are significant indicators of occupational status, general health status, and thus, occupational health status. Although African-American women constitute only 6.8% of the total U.S. labor force, they hold 20% of the jobs in the health care industry and are disproportionately represented in those jobs that have the highest levels of workplace exposure to hazards. As a result, they are therefore more likely to be at greater exposure and risk to the spectrum of occupational health problems. In order to gain insight into the effects of race and gender on the occupational health status of African-American women health care workers, this article uses three data sources that provide different but complementary sources of information on the demographic characteristics of workers, location of categories of occupations, working conditions of jobs, and other job and worker characteristics. Given the concentration of African-American women in health care positions where there exists a greater likelihood of being exposed to occupational hazards, it is therefore both logical and appropriate for primary care physicians, especially those engaged in office-based practices, to identify this target population for special services and to be more aware of the type of health issues with which these patients are more likely to present and to experience during their working lives. Health care providers have a responsibility to assess occupational factors related to a patient's health problems and to incorporate this information into their treatment protocols and into the design and explanation of each patient's care plan.

Regional Interrelationships: A Leadership Opportunity for Health Care.

Science.gov (United States)

Rotarius, Timothy; Liberman, Aaron

Given the impact that the health care industry has on the national economy, health care executives need to move beyond simply providing health care treatments and instead focus on strategically leading their regions, including the other key industry contributors in their specific regions. Geographic and economic regions can be viewed as concentric circles of influence, with each circle recognizing the resources and contributions that are specific to a region. An acknowledgement by health care executives of the regional interrelationships that exist in a specific region is necessary for health care managers to strategically lead regional interrelationships. A template for implementation of this process is included. To understand the various factors that exist within circles of influence, several distinct yet interrelated vertical bases of knowledge will be discussed. The 5 bases of knowledge examined here include the following: Health Care, Tourism, Defense and Technology, Education, and Retail. It is important to note that the resources identified in the Tourism, Defense and Technology, Education, and Retail knowledge bases all have a direct influential relationship upon the health care resources of the region. For description purposes, the Central Florida geographic and economic region will be examined for interrelationships between the 5 knowledge bases.

Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

Directory of Open Access Journals (Sweden)

Soma Hewa

2011-12-01

Full Text Available This paper argues that the health unit program developed in Sri Lanka in the early twentieth century was an earlier model of selective primary health care promoted by the Rockefeller Foundation in the 1980s in opposition to comprehensive primary health care advocated by the Alma-Ata Declaration of the World Health Organization. A key strategy of the health unit program was to identify the most common and serious infectious diseases in each health unit area and control them through improved sanitation, health education, immunization and treatment with the help of local communities. The health unit program was later introduced to other countries in South and Southeast Asia as part of the Rockefeller Foundation's global campaign to promote public health.

Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

African Journals Online (AJOL)

Rural-Urban Disparities in Health and Health Care in Africa: Cultural Competence, Lay-beliefs in Narratives of Diabetes among the Rural Poor in the Eastern Cape ... to exist in the utilization of cardiac diagnostic and therapeutic procedures, prescription of analgesia for pains, treatment of diabetes (e.g. gym exercise).

Do health systems delay the treatment of poor children?

DEFF Research Database (Denmark)

Samuelsen, Helle; Tersbøl, Britt Pinkowski; Mbuyita, Selemani Said

2013-01-01

Child mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too...... late and that they prefer to treat their children at home, a perspective often echoed by health workers. Using the three-delay methodology, this study focus on the third phase of the model, exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health......-care facility. The overall objective is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies....

The integration of behavioral health interventions in children's health care: services, science, and suggestions.

Science.gov (United States)

Kolko, David J; Perrin, Ellen

2014-01-01

Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

People In Sub-Saharan Africa Rate Their Health And Health Care Among Lowest In World

Science.gov (United States)

Deaton, Angus S.; Tortora, Robert

2017-01-01

The health of people in sub-Saharan Africa is a major global concern. However, data are weak, and little is known about how people in the region perceive their health or their health care. We used data from the Gallup World Poll in 2012 to document sub-Saharan Africans’ perceived health status, their satisfaction with health care, their contact with medical professionals, and the priority they attach to health care. In comparison to other regions of the world, sub-Saharan Africa has the lowest ratings for well-being and the lowest satisfaction with health care. It also has the second lowest perception of personal health, after only the former Soviet Union and its satellites. HIV prevalence is positively correlated with perceived improvements in health care in countries with high prevalence. This is consistent with an improvement in at least some health care services as a result of the largely aid-funded rollout of antiretroviral treatment. Even so, sub-Saharan Africans do not prioritize health care as a matter of policy, although donors are increasingly shifting their aid efforts in sub-Saharan Africa toward health. PMID:25715657

Associations of family-centered care with health care outcomes for children with special health care needs.

Science.gov (United States)

Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick

2011-08-01

The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.

Looking beyond "affordable" health care: cultural understanding and sensitivity-necessities in addressing the health care disparities of the U.S. Hispanic population.

Science.gov (United States)

Askim-Lovseth, Mary K; Aldana, Adriana

2010-10-01

Health disparities are pervasive in the United States; but among Hispanics, access to health care is encumbered by poverty, lack of insurance, legal status, and racial or minority status. Research has identified certain aspects of Hispanic culture, values, and traditions contributing to the nature of the Hispanic patient-doctor relationship and the quality of the health care service. Current educational efforts by nonprofit organizations, government, health professionals, and pharmaceutical manufacturers fail to address the needs for accessible and appropriately culture-sensitive information when approaching the diverse Hispanic community. Understanding Hispanics' consumptive practices and expectations surrounding medications is critical to the success of many treatment regimens. Recommendations are presented to address this health care issue.

The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice

Directory of Open Access Journals (Sweden)

Meredith SE

2014-03-01

Full Text Available Steven E Meredith,1 Brantley P Jarvis,2 Bethany R Raiff,3 Alana M Rojewski,2 Allison Kurti,2 Rachel N Cassidy,2 Philip Erb,2 Jolene R Sy,4 Jesse Dallery2 1Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Department of Psychology, University of Florida, Gainesville, FL, USA; 3Department of Psychology, Rowan University, Glassboro, NJ, USA; 4Saint Louis University School of Social Work, St Louis, MO, USA Abstract: Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior. Keywords: incentives, contingency management, conditional cash transfer, pay-for-performance, wellness

The Treatment of Depressed Chinese Americans Using Qigong in a Health Care Setting: A Pilot Study

Directory of Open Access Journals (Sweden)

Albert Yeung

2013-01-01

Full Text Available Background. This pilot study examined the feasibility and efficacy of providing Qigong treatment in a health center to Chinese Americans with major depressive disorder (MDD. Methods. Fourteen Chinese Americans with MDD were enrolled, and they received a 12-week Qigong intervention. The key outcome measurement was the 17-item Hamilton Rating Scale for Depression (HAM-D17; the Clinical Global Impressions-Severity (CGI-S and -Improvement (CGI-I, the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF, and the Multidimensional Scale of Perceived Social Support (MSPSS were also administered. Positive response was defined as a decrease of 50% or more on the HAM-D17, and remission was defined as HAM-D17 ≤ 7. Patients' outcome measurements were compared before and after the Qigong intervention. Results. Participants (N=14 were 64% female, with a mean age of 53 (±14. A 71% of participants completed the intervention. The Qigong intervention resulted in a positive treatment-response rate of 60% and a remission rate of 40% and statistically significant improvement, as measured by the HAM-D17, CGI-S, CGI-I, Q-LES-Q-SF, and the family support subscale of the MSPSS. Conclusions. The Qigong intervention provided at a health care setting for the treatment of primary care patients with MDD is feasible. Further studies with larger sample sizes are warranted.

Health Care Psychology: Prospects for the Well-Being of Children.

Science.gov (United States)

Wright, Logan

1979-01-01

Health care psychology is distinguished from traditional child psychology in that it emphasizes clinical application and is concerned with primary mental health care. Diagnosis, classification, prediction, and treatment and control strategies in the field offer definite solutions to problems such as tracheotomy addiction, encopresis, psychogenic…

Role of pharmacogenetics in public health and clinical health care: a SWOT analysis.

Science.gov (United States)

Kapoor, Ritika; Tan-Koi, Wei Chuen; Teo, Yik-Ying

2016-12-01

Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.

Factors affecting the choice of treatment in occupational therapy practices in hospital-based care.

NARCIS (Netherlands)

Driessen, M.J.; Dekker, J.; Lankhorst, G.; Zee, J. van der

1996-01-01

The aim of this article was twofold: to describe the occurrence of treatment goals, health-care programmes and type of interventions chosen by occupational therapists; and to investigate relationships between treatment goals, health-care programmes and interventions. A survey on occupational therapy

[Beyond the horizon of health-care delivery - medical marketing].

Science.gov (United States)

Hoffmann, M; Großterlinden, L G; Rueger, J M; Ruecker, A H

2014-12-01

The progress in medical health care and demographic changes cause increasing financial expenses. The rising competitive environment on health-care delivery level calls for economisation and implementation of a professional marketing set-up in order to ensure long-term commercial success. The survey is based on a questionnaire-analysis of 100 patients admitted to a trauma department at a university hospital in Germany. Patients were admitted either for emergency treatment or planned surgical procedures. Competence and localisation represent basic criteria determing hospital choice with a varying focus in each collective. Both collectives realise a trend toward economisation, possibly influencing medical care decision-making. Patients admitted for planned surgical treatment are well informed about their disease, treatment options and specialised centres. The main source of information is the internet. Both collectives claim amenities during their in-hospital stay. Increasing economisation trends call for a sound and distinct marketing strategy. The marketing has to be focused on the stakeholders needs. Concomitant factors are patient satisfaction, the establishment of cooperation networks and maintenance/improvement of medical health-care quality. Georg Thieme Verlag KG Stuttgart · New York.

Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

Science.gov (United States)

Bartels, Stephen J; Coakley, Eugenie H; Zubritsky, Cynthia; Ware, James H; Miles, Keith M; Areán, Patricia A; Chen, Hongtu; Oslin, David W; Llorente, Maria D; Costantino, Giuseppe; Quijano, Louise; McIntyre, Jack S; Linkins, Karen W; Oxman, Thomas E; Maxwell, James; Levkoff, Sue E

2004-08-01

The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

Reducing the health consequences of opioid addiction in primary care.

Science.gov (United States)

Bowman, Sarah; Eiserman, Julie; Beletsky, Leo; Stancliff, Sharon; Bruce, R Douglas

2013-07-01

Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. Lack of routine addiction screening results in missed treatment opportunities in this setting. We reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction. Copyright © 2013 Elsevier Inc. All rights reserved.

Health Care Payments in Vietnam: Patients’ Quagmire of Caring for Health versus Economic Destitution

Directory of Open Access Journals (Sweden)

Andre Pekerti

2017-09-01

Full Text Available In the last three decades many developing and middle-income nations’ health care systems have been financed via out-of-pocket payments by individuals. User fees charges, however, may not be the best approach or thenmost equitable approach to finance and/or reform health services in developing nations. This study investigates the status of Vietnam’s current health system as a result of implementing user fees policies. A recent mandate by the government to increase the universal cover to 100% attempts to tackle inadequate insurance cover, one of the four major factors contributing to the high and increasing probability of destitution for Vietnamese patients (the other three being: non-residency, long stay in hospital, and high cost of treatment. Empirical results however suggest that this may be catastrophic for low-income earners: if insurance cover reimbursement decreases below 50% of actual health expenditures, the probability of Vietnamese falling into destitution will rise further. Our findings provide policy implications and directions to improve Vietnam’s health care system, in particular by ensuring the utilization of health services and financial protection for the people.

Popular Healing and Primary Health Care: A Socio-Cultural Study in ...

African Journals Online (AJOL)

kim

and/or home-based treatment did not cure a patient, other alternatives are looked for such as ... multiple health-care resources, successful rural primary health care strategy would give due attention to such local ...... Nurse practitioners and.

Health psychology in primary care: recent research and future directions

Directory of Open Access Journals (Sweden)

Thielke S

2011-06-01

Full Text Available Stephen Thielke1, Alexander Thompson2, Richard Stuart31Psychiatry and Behavioral Sciences, University of Washington, Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA; 2Group Health Cooperative, Seattle, WA, USA; 3Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USAAbstract: Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.Keywords: health psychology, primary care, integrated care, collaborative care, referral, colocation

[Gingival health and esthetics--another aspect of objectives of orthodontic treatment].

Science.gov (United States)

Ai, Dongqing; Xu, Hui; Bai, Ding

2013-04-01

Contemporary orthodontic care should be a team approach to achieve health and esthetics of soft and hard tissue. It should be given enough attention that periodontal health provides the foundation for tooth movement, and that distinct esthetic results can be achieved by subtle changes in tooth alignment and gingival contours. Orthodontic treatment planning should include evaluation of gingival health and esthetics to anticipate the need for interdisciplinary approaches. Studies on the effect of orthodontic treatment on gingiva can provides basis for maintaining gingival health and esthetic. This article will focus primarily on the gingival health and esthetic care in orthodontic treatment.

Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care.

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Jimenez, Daniel E; Bartels, Stephen J; Cardenas, Veronica; Dhaliwal, Sanam S; Alegría, Margarita

2012-06-01

Beliefs concerning the causes of mental illness may help to explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their white counterparts. This study applies the cultural influences on mental health framework to identify the relationship between race/ethnicity and differences in 1) beliefs on the cause of mental illness, 2) preferences for type of treatment, and 3) provider characteristics. Analyses were conducted using baseline data collected from participants who completed the cultural attitudes toward healthcare and mental illness questionnaire, developed for the Primary Care Research in Substance Abuse and Mental Health for the Elderly study, a multisite randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1,257 non-Latino whites, 536 African Americans, 112 Asian Americans, and 303 Latinos. African Americans, Asian Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared with non-Latino whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.

How can we increase the involvement of primary health care in the treatment of tobacco dependence? A meta-analysis.

NARCIS (Netherlands)

Anderson, P.D.; Jané Llopis, E.

2004-01-01

AIMS: A systematic review of studies testing the effectiveness of educational and practice base strategies to increase the involvement of primary health-care practitioners in the treatment of tobacco dependence. DATA SOURCES: MEDLINE, EMBASE, CINAHL and the Cochrane Library (1966-2001). Selection

Self-care practice of patients with arterial hypertension in primary health care

Directory of Open Access Journals (Sweden)

Cláudia Rayanna Silva Mendes

2016-02-01

Full Text Available Objective: to evaluate the practice of self-care performed by patients with systemic arterial hypertension in primary health care. Methods: this is a descriptive and cross-sectional study, conducted with 92 individuals with arterial hypertension in a primary care unit. The data collection occurred through script and data analyzed using descriptive statistics (frequency, mean and standard deviation and through the understanding of the adaption between capacity and self-care demand. Results: it was identified as a practice of self-care: adequate water intake, salt intake and restricted coffee, satisfactory sleep period, abstinence from smoking and alcoholism, continuing pharmacological treatment and attending medical appointments. As the demands: inadequate feeding, sedentary lifestyle, had no leisure activities, self-reported stress, and limited knowledge. Conclusion: although patients performed treatment a few years ago, still showed up self-care deficits, highlighting the need for nurses to advise and sensitize about the importance of self-care practice.

Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh

Directory of Open Access Journals (Sweden)

Chowdhury F

2017-03-01

Full Text Available Fahmida Chowdhury,1 Katharine Sturm-Ramirez,1,2 Abdullah Al Mamun,1 A Danielle Iuliano,2 Mejbah Uddin Bhuiyan,1 Mohammod Jobayer Chisti,1 Makhdum Ahmed,1 Sabbir Haider,3 Mahmudur Rahman,3 Eduardo Azziz-Baumgartner2 1Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; 2Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; 3Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh Background: Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome.Methods: A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients’ relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome.Results: We interviewed 302 customers patronizing 76 pharmacies; 186 (62% sought care for themselves and 116 (38% sought care for a sick relative. Most customers (215; 71% were males. The majority (90% of customers sought care from the study pharmacy as their first point of care, while 18 (6% had previously sought care from another pharmacy and 11 (4% from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%, lower cost (46%, availability of medicine (33%, knowing the drug seller (20%, and convenient hours of operation (19%. The most commonly recommended drugs were

Mood disorders in adolescents: diagnosis, treatment, and suicide assessment in the primary care setting.

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Neves, Marilia G; Leanza, Francesco

2014-09-01

The primary care setting is considered the entry point of adolescents with mental illness in the health care system. This article informs primary care providers about the diagnostic features and differential of mood disorders in adolescents, screening and assessment, as well as evidence-based psychosocial and psychopharmacologic therapies. The article also provides a framework for decision making regarding initiating treatment in the primary care setting and referral to mental health services. Furthermore, the article highlights the importance of the collaboration between primary care and mental health providers to facilitate engagement of adolescents with mood disorders and adherence to treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment goals in psoriasis routine care.

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Radtke, M A; Reich, K; Spehr, C; Augustin, Matthias

2015-07-01

The treatment goal algorithm for psoriasis, first originated in 2007, has ever since been adopted into treatment guidelines. It remained unclear how many patients have experienced the use of treatment goals in routine care and how these are perceived. The aim of the pilot study was to get first insight in the use and impact of therapeutic goals in a large cohort of patients with psoriasis in routine care. This study is a multicenter, non-interventional, cross-sectional health care study in n = 213 dermatology centers across Germany. A standardized physician and patient questionnaire was used, including demographics, disease and treatment characteristics. To evaluate patient treatment perception and satisfaction, a questionnaire (PsoSat) addressing 8 specific items was designed. Consistency and validity of the questionnaire were controlled by factor analyses and reliability tests. In total n = 1,883 patients were included for analysis (54.2% male). Mean age was 52 years, mean disease duration 19 years. In total 45.5% (n = 856) stated an improvement of psoriatic symptoms in the last 4 weeks. In patients including treatment goals, the course of psoriasis in the last 4 weeks was rated significantly better and predicted significantly higher patient satisfaction. Patients reporting periodic outcomes measurement of psoriasis treatment, also had significantly better course of disease, higher satisfaction and a lower psoriasis severity. A majority of patients experienced the use of treatment goals in practice. The association of using treatment goals with clinical outcomes and treatment satisfaction was markedly positive. These findings indicate that the use of treatment goals and outcome measurements in fact improve psoriasis management.

The relationship between race/ethnicity and the perceived experience of mental health care.

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Cai, Angela; Robst, John

2016-01-01

Although there is a vast amount of literature on differences in the perceived experiences of general health care among different racial/ethnic groups, few studies have examined the relationship between race/ethnicity and perceptions of mental health care. The purpose of this study was to determine whether non-Hispanic African Americans and Hispanics had more negative (or less positive) perceptions of the mental health treatment they receive compared to non-Hispanic Whites. Data were from the 1998-2006 Florida Health Services Surveys. The findings indicated that African Americans and Hispanics were less likely than Whites to have favorable perceptions of the mental health care services they received, even after adjusting for demographic and health status variables. Interventions should be designed to address disparities in mental health treatment and the perceptions of such treatment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.

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Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N

2018-02-01

Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to

A dental phobia treatment within the Swedish National Health Insurance.

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Hägglin, Catharina; Boman, Ulla Wide

2012-01-01

Severe dental fear/phobia (DF) is a problem for both dental care providers and for patients who often suffer from impaired oral health and from social and emotional distress.The aim of this paper was to present the Swedish model for DF treatment within the National Health Insurance System, and to describe the dental phobia treatment and its outcome at The Dental Fear Research and Treatment Clinic (DFRTC) in Gothenburg. A literature review was made of relevant policy documents on dental phobia treatment from the National Health Insurance System and for Västra Götaland region on published outcome studies from DFRTC. The treatment manual of DFRTC was also used. In Sweden, adult patients with severe DF are able to undergo behavioral treatment within the National Health Insurance System if the patient and caregivers fulfil defined criteria that must be approved for each individual case. At DFRTC dental phobia behavioral treatment is given by psychologists and dentists in an integrated model. The goal is to refer patients for general dental care outside the DFRTC after completing treatment. The DF treatment at DFRTC has shown positive effects on dental fear, attendance and acceptance of dental treatment for 80% of patients. Follow-up after 2 and 10 years confirmed these results and showed improved oral health. In addition, positive psychosomatic and psychosocial side-effects were reported, and benefits also for society were evident in terms of reduced sick-leave. In conlusion, in Sweden a model has been developed within the National Health Insurance System helping individuals with DF. Behavioral treatment conducted at DFRTC has proven successful in helping patients cope with dental care, leading to regular attendance and better oral health.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

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Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

Comparison of health conditions treated with traditional and biomedical health care in a Quechua community in rural Bolivia.

Science.gov (United States)

Vandebroek, Ina; Thomas, Evert; Sanca, Sabino; Van Damme, Patrick; Puyvelde, Luc Van; De Kimpe, Norbert

2008-01-14

The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively. A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients. Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options. Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient

Oral health status and need for oral care of care-dependent indwelling elderly : from admission to death

NARCIS (Netherlands)

Hoeksema, Arie R; Peters, Lilian L; Raghoebar, Gerry M; Meijer, Henny J A; Vissink, Arjan; Visser, Anita

The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in

Psychiatric History, Deployments, and Potential Impacts of Mental Health Care in a Combat Theater.

Science.gov (United States)

Varga, Colleen M; Haibach, Michael A; Rowan, Anderson B; Haibach, Jeffrey P

2018-01-01

Increasing numbers of U.S. service members access mental health care while deployed and at home station. Multiple deployments carry with them a higher risk of exposure to combat as well as the impact of cumulative stressors associated with separation from family, hostile environments, and high operations tempo. However, mental health care resources continue to be underutilized, potentially because of higher levels of stigma regarding mental health care and concerns about career impact among service members. Some studies indicate that service members who have previously sought mental health care are likely to continue to do so proactively as needed. This study examined the associations between prior deployments, prior mental health treatment, and subsequent career-impacting recommendations (e.g., duty limitations and medical evacuation) among deployed service members seeking mental health care. Materials and. This study is a retrospective review of clinical records from three U.S. military Combat and Operational Stress Control units in Afghanistan. Data were drawn from the mental health records of 1,639 Army service members presenting for outpatient mental health services while deployed in Afghanistan from years 2006 to 2008. In an unadjusted logistic regression model, service members with at least one prior deployment had a 38% greater odds (odds ratio [OR] = 1.38, 95% confidence interval [95% CI] 1.06, 1.80; p mental health treatment had a 57% lower odds (OR = 0.43, 95% CI 0.34, 0.56; p mental health treatment. After adjusting for demographics and number of prior deployments, service members with prior mental health treatment had a 58% lower odds (OR = 0.42, 95% CI 0.33, 0.56; p mental health treatment. Among service members who had a clinical mental health encounter, prior deployment was not associated with career-impacting recommendations and prior mental health treatment appeared to be protective against career-impacting recommendations. These results are in

Perception of health care providers about sexually transmitted infections

International Nuclear Information System (INIS)

Khan, A.; Izhar, V.

2015-01-01

Sexually transmitted infections represent a global health problem leading to social stigma and early morbidity and mortality. Prior to this study, different health care providers were dealing with sexually transmitted infections with various parameters and were not following the standard regime given by the WHO. The aim of this study was to investigate the perception of health care providers about sexually transmitted infections and its treatment guidelines. Methods: Cross sectional questionnaire based study was conducted from health care providers(specialists, family physicians, homeopaths and others )of Lahore from Jan 2014 to December 2014. Data was collected with consent through convenience purposive sampling of randomly selected 100 specialists, 200 family physicians, 100 homeopaths and 100 others. Trained investigators pre-tested the validity and reliability of the questionnaire before use. Data of response was coded, entered and analyzed using SPSS. Results: Out of 500 practitioners 475 (95%) completed the questionnaire. Those excluded were due to insufficient data in questionnaire. Almost all respondents were aware of STIs and the guidelines and claimed to have decent knowledge. Apart from some disagreement on the user- friendliness and communication facilitating properties, the health care provider's attitude were positive. Conclusion: Overall, all the health care providers knew about sexually transmitted infections. It was the treatment according to the guidelines, in which they differed. Specialists and Family physician in Lahore, Pakistan knew and followed the STIs guidelines while managing the patients. Homeopaths and others were receiving patients and treating most of these infections but were not aware of the standard guidelines yet somehow their patients were treated and satisfied. Enhancing the familiarity of the guidelines among users can result in a positive outcome on the treatment of STIs. (author)

Diagnosis of compliance of health care product processing in Primary Health Care

Directory of Open Access Journals (Sweden)

Camila Eugenia Roseira

Full Text Available ABSTRACT Objective: identify the compliance of health care product processing in Primary Health Care and assess possible differences in the compliance among the services characterized as Primary Health Care Service and Family Health Service. Method: quantitative, observational, descriptive and inferential study with the application of structure, process and outcome indicators of the health care product processing at ten services in an interior city of the State of São Paulo - Brazil. Results: for all indicators, the compliance indices were inferior to the ideal levels. No statistically significant difference was found in the indicators between the two types of services investigated. The health care product cleaning indicators obtained the lowest compliance index, while the indicator technical-operational resources for the preparation, conditioning, disinfection/sterilization, storage and distribution of health care products obtained the best index. Conclusion: the diagnosis of compliance of health care product processing at the services assessed indicates that the quality of the process is jeopardized, as no results close to ideal levels were obtained at any service. In addition, no statistically significant difference in these indicators was found between the two types of services studied.

Health care operations management

NARCIS (Netherlands)

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

2012-01-01

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

Primary care professional's perspectives on treatment decision making for depression with African Americans and Latinos in primary care practice.

Science.gov (United States)

Patel, Sapana R; Schnall, Rebecca; Little, Virna; Lewis-Fernández, Roberto; Pincus, Harold Alan

2014-12-01

Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to SDM included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression.

Evaluating the effectiveness of health care teams.

Science.gov (United States)

Mickan, Sharon M

2005-05-01

While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

[Bribes in health care and the patients' opinions].

Science.gov (United States)

Masopust, V

1989-07-01

In May 1988 in the North Bohemian region an anonymous enquiry was made in which 3,767 respondents participated. The enquiry was focused among others on the problem of bribes in the health services. In the paper the author analyzes views of respondents why they give "small gifts" to health workers and why they assume that the patients get better treatment when they bribe. The reason for making "small gifts" or bribes is in 31.3% to manifest appreciation of treatment, in 27.7% an attempt to obtain better treatment and in 7.1% fear of receiving no treatment. People above 45 years, pensioners, employees of the services and chronic patients are more convinced of the positive motive of making "small gifts". Almost 10% of the entire group are convinced of the effect of bribes as a stimulant for provision of better care, 49% deny it and the remainder do not know. The most critically minded patient groups are those working in industry and respondents under 30 years. From the entire group 1.57% admitted making "small gifts", i.e. 59 of 3,767 respondents, the motive of almost half of them (42.3%) was appreciation of the care provided by the attending staff. An unequivocal bribe to obtain better care or fear that care will be refused was involved in 45.8% of the "bribing group". The views of patients who admitted "small gifts" as regards the health services are worse than the views of all respondents.(ABSTRACT TRUNCATED AT 250 WORDS)

Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

DEFF Research Database (Denmark)

Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

2009-01-01

This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs be...... before pain onset. The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities.......This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...

Care and self-reported outcomes of care experienced by women with mental health problems in pregnancy: Findings from a national survey.

Science.gov (United States)

Henderson, Jane; Jomeen, Julie; Redshaw, Maggie

2018-01-01

mental health problems in pregnancy and the postnatal period are relatively common and, in pregnancy, are associated with an increase in adverse outcome. It is recommended that all women are asked about their emotional and mental health and offered treatment if appropriate. to describe the care received by women self-identifying with mental health problems in pregnancy, and to describe the effects of support, advice and treatment on outcomes in the postnatal period. this study used cross-sectional survey data collected in 2014 which described women's experience of maternity care. England PARTICIPANTS: a random sample of women who had a live birth in January 2014. the questionnaire asked about sociodemographic characteristics, whether women were asked about emotional and mental health in pregnancy, support and treatment offered, about postnatal wellbeing, and questions relating to attachment to their baby. Descriptive statistics and logistic regression were used to examine the associations between mental health and outcomes taking account of sociodemographic characteristics. the survey response rate was 47%. Women with antenatal mental health problems were significantly more worried at the prospect of labour and birth, had lower satisfaction with the experience of birth, worse postnatal mental health, and indications of poorer attachment to their baby. They received substantially more care than other women but they did not always view this positively. Support, advice and treatment for mental health problems had mixed effects. this study describes the significant additional care provided to women self-identifying with mental health problems in pregnancy, the mixed effects of support, advice and treatment, and the poor perception of staff interaction among women with mental health problems. health care professionals may need additional training to effectively support women with mental health problems during the perinatal period. Copyright © 2017 The Authors

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

Science.gov (United States)

Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

2018-02-01

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care.

Science.gov (United States)

Wentzel, Jobke; van der Vaart, Rosalie; Bohlmeijer, Ernst T; van Gemert-Pijnen, Julia E W C

2016-02-09

Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of "blend" works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The "Fit for Blended Care" instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) "blends" of online and

Oral Health Care Delivery Within the Accountable Care Organization.

Science.gov (United States)

Blue, Christine; Riggs, Sheila

2016-06-01

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

Health Care Delivery.

Science.gov (United States)

Starfield, Barbara

1987-01-01

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

Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South AfricaExperiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

Directory of Open Access Journals (Sweden)

Dudu G. Sokhela

2013-07-01

Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans.Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial.

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Salvo, Vera; Kristeller, Jean; Marin, Jesus Montero; Sanudo, Adriana; Lourenço, Bárbara Hatzlhoffer; Schveitzer, Mariana Cabral; D'Almeida, Vania; Morillo, Héctor; Gimeno, Suely Godoy Agostinho; Garcia-Campayo, Javier; Demarzo, Marcelo

2018-05-11

Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes-partly responsible for weight regain for a large number of people-and increasing awareness of emotional and other triggers for overeating. The aim of the present study protocol is to evaluate and compare the feasibility and efficacy of two mindfulness-based interventions (MBIs) addressing overweight and obesity in primary care patients: a general programme called Mindfulness-Based Health Promotion and a targeted mindful eating protocol called Mindfulness-Based Eating Awareness Training. A randomised controlled trial will be conducted to compare treatment as usual separately in primary care with both programmes (health promotion and mindful eating) added to treatment as usual. Two hundred forty adult women with overweight and obesity will be enrolled. The primary outcome will be an assessment of improvement in eating behaviour. Secondary outcomes will be (1) biochemical control; (2) anthropometric parameters, body composition, dietary intake and basal metabolism; and (3) levels of mindfulness, stress, depression, self-compassion and anxiety. At the end of each intervention, a focus group will be held to assess the programme's impact on the participants' lives, diet and health. A feasibility study on access to benefits from and importance of MBIs at primary care facilities will be conducted among primary care health care professionals and participants. Monthly maintenance sessions lasting at least 1 hour will be offered, according to each protocol, during the 3-month follow-up periods. This clinical trial will result in more effective mindfulness-based interventions as a complementary treatment in primary care for people with overweight and obesity. If the findings of

Who seeks care where? Utilization of mental health and substance use disorder treatment in two national samples of individuals with alcohol use disorders.

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Edlund, Mark J; Booth, Brenda M; Han, Xiaotong

2012-07-01

Only a fraction of individuals with alcohol use disorders (AUDs) receive any AUD treatment during a given year. If a substantial proportion of individuals with unmet need for AUD treatment are receiving mental health treatment, accessibility of AUD treatment could potentially be improved by implementing strategies to ensure that individuals receiving mental health care are referred to the AUD sector or by increasing rates of AUD treatment in individuals receiving mental health treatment. We assessed patterns and predictors of mental health treatment and AUD treatment among individuals with 12-month AUDs, using secondary data analyses from two national surveys, the National Survey on Drug Use and Health (NSDUH; n = 4,545 individuals with AUDs) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 3,327 individuals with AUDs). In both NSDUH and NESARC, 8% of individuals with AUDs reported past-year AUD treatment. Among individuals with AUDs, mental health treatment was more common than AUD treatment, with 20% of NSDUH respondents and 11% of NESARC respondents reporting receiving mental health treatment. Greater mental health morbidity increased the odds of mental health treatment, and AUD severity increased the odds of AUD treatment. Mental health morbidity also increased the odds of AUD treatment, mainly by increasing the odds of receiving the category of both AUD and mental health treatment. Because individuals with AUDs are more likely to receive mental health treatment than AUD treatment, a key opportunity to improve the overall accessibility of treatment for AUDs may be to focus on improving AUD treatment among individuals receiving mental health treatment.

Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

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Beekman Aartjan TF

2007-03-01

Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services.

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

2016-01-01

Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.

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

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

2018-01-01

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

Social support, flexible resources, and health care navigation.

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Gage-Bouchard, Elizabeth A

2017-10-01

Recent research has focused attention on the role of patients' and clinicians' cultural skills and values in generating inequalities in health care experiences. Yet, examination of how social structural factors shape people's abilities to build, refine, and leverage strategies for navigating the health care system have received less attention. In this paper I place focus on one such social structural factor, social support, and examine how social support operates as a flexible resource that helps people navigate the health care system. Using the case of families navigating pediatric cancer care this study combines in-depth interviews with parents of pediatric cancer patients (N = 80), direct observation of clinical interactions between families and physicians (N = 73), and in-depth interviews with pediatric oncologists (N = 8). Findings show that physicians assess parental visibility in the hospital, medical vigilance, and adherence to their child's treatment and use these judgments to shape clinical decision-making. Parents who had help from their personal networks had more agility in balancing competing demands, and this allowed parents to more effectively meet institutional expectations for appropriate parental involvement in the child's health care. In this way, social support served as a flexible resource for some families that allowed parents to more quickly adapt to the demands of caring for a child with cancer, foster productive interpersonal relationships with health care providers, and play a more active role in their child's health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Improving Mental Health Care in People at Risk for Getting Homeless].

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Salize, Hans Joachim; Arnold, Maja; Uber, Elisa; Hoell, Andreas

2017-01-01

Objective: Overall aim was to reduce the untreated prevalence in persons with untreated mental disorders and at risk for loosing accommodation and descending into homelessness. Primary aim was treatment initiation and treatment adherence by motivational interviewing. Secondary aims were to reduce social or financial problems. Methods: Persons at risk were identified in social welfare services or labour agencies, diagnosed and motivated to initiate treatment in a community mental health service. Results: 58 persons were included, 24 were referred to regular mental health care, 8 were stabilized enough after the initial motivational to refrain from acute treatment, 26 dropped out. During a 6-month follow-up quality of life and social support was improved (partly statistically significant) and psycho-social needs for care decreased. Conclusion: Motivational interviewing is likely to increase insight into illness and acceptance of mental health care in untreated persons with mental disorders at risk for social decline. © Georg Thieme Verlag KG Stuttgart · New York.

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

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Dwinnells, Ronald; Misik, Lauren

2017-10-01

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

Co-occurrence of substance use related and mental health problems in the Finnish social and health care system.

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Kuussaari, Kristiina; Hirschovits-Gerz, Tanja

2016-03-01

Many studies have noted that substance abuse and mental health problems often occur simultaneously. The aim of the work reported here was to study the co-occurrence of mental health problems and problems related to substance use in a sample of clients visiting the Finnish social and health care services for issues related to substance use. We collected background information on the clients and considered the parts of the treatment system in which these clients were treated. Survey data on intoxicant-related cases in the Finnish health care and social services were gathered on a single day in 2011. During the 24 hours of data collection, all intoxicant-related cases were reported and data were obtained for 11,738 intoxicant-related cases. In this analysis we took into account the clients' background variables, mental health variables, information on the treatment type and the main reasons for the client being in treatment. The χ(2) test, Fisher's exact test and binary logistic regression analysis were used. Half of the visiting clients had both substance use related and mental health problems. The strongest factors associated with the co-occurrence of substance use related and mental health problems were female sex, younger age and single marital status. Clients with co-occurring problems were more often treated in the health care services, whereas clients with only substance use related problems were primarily treated in specialized services for the treatment of substance abuse. It is important to identify clients with co-occurring substance use related and mental health problems. In this study, half of the clients presenting to the Finnish social and health care treatment system had both these problems. © 2015 the Nordic Societies of Public Health.

[Health care networks].

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Mendes, Eugênio Vilaça

2010-08-01

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

Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

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Mehta, Nishant; Rajpurohit, Ladusingh; Ankola, Anil; Hebbal, Mamata; Setia, Priyanka

2015-05-01

To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

The employee's productivity in the health care sector in Poland and their impact on the treatment process of patients undergoing elective laparoscopic cholecystectomy

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Rosiek A

2016-12-01

Full Text Available Anna Rosiek,1,2 Aleksandra Rosiek-Kryszewska,3 Łukasz Leksowski,4 Tomasz Kornatowski,2 Krzysztof Leksowski2,5 1Ross-Medica, 2Faculty of Health Sciences, Public Health Department, Nicolaus Copernicus University, 3Faculty of Pharmacy, Department of Inorganic and Analytical Chemistry, Nicolaus Copernicus University, 4Faculty of Health Sciences, Department of Rehabilitation, Nicolaus Copernicus University, 5Department of General Thoracic and Vascular Surgery, Military Clinical Hospital in Bydgoszcz, Bydgoszcz, Poland Background: Increasing the engagement of employees in the treatment process of patients may benefit a hospital and employee productivity and may result in better patient care and satisfaction with medical services. Given this, the first step in improving the quality of patient care is better availability of doctors for patients in a hospital ward.Methods: The research for this paper was conducted in six health care units in the Kuyavian-Pomeranian province in Poland. The research assessed how the elements relating to employees’ behavior and things characteristic to medical service influence patients’ willingness to recommend a hospital.Results: Patients’ perception of services is linked with the behavior of medical employees and their engagement in the treatment process.Conclusion: Our research indicates that individual employee recognition and collective recognition of hospital employees as a whole were identified as the most important factors in employee engagement in the treatment process (employee productivity and patients’ satisfaction with medical service. Keywords: employee’s productivity, workplace interventions to enhance health, hospitals, organizational health, medical staff, public health

Cost-Effectiveness Analysis of 1-Year Treatment with Golimumab/Standard Care and Standard Care Alone for Ulcerative Colitis in Poland.

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Ewa Stawowczyk

Full Text Available The objective of this study was to assess the cost-effectiveness of induction and maintenance treatment up to 1 year of ulcerative colitis with golimumab/standard care and standard care alone in Poland.A Markov model was used to estimate the expected costs and effects of golimumab/standard care and a standard care alone. For each treatment option the costs and quality adjusted life years were calculated to estimate the incremental cost-utility ratio. The analysis was performed from the perspective of the Polish public payer and society over a 30-years time horizon. The clinical parameters were derived mainly from the PURSUIT-SC and PURSUIT-M clinical trials. Different direct and indirect costs and utility values were assigned to the various model health states.The treatment of ulcerative colitis patients with golimumab/standard care instead of a standard care alone resulted in 0.122 additional years of life with full health. The treatment with golimumab/standard care was found to be more expensive than treatment with the standard care alone from the public payer perspective and from social perspective. The incremental cost-utility ratio of golimumab/standard care compared to the standard care alone is estimated to be 391,252 PLN/QALY gained (93,155 €/QALYG from public payer perspective and 374,377 PLN/QALY gained (89,137 €/QALYG from social perspective.The biologic treatment of ulcerative colitis patients with golimumab/standard care is more effective but also more costly compared with standard care alone.

Management of obesity: improvement of health-care training and systems for prevention and care.

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Dietz, William H; Baur, Louise A; Hall, Kevin; Puhl, Rebecca M; Taveras, Elsie M; Uauy, Ricardo; Kopelman, Peter

2015-06-20

Although the caloric deficits achieved by increased awareness, policy, and environmental approaches have begun to achieve reductions in the prevalence of obesity in some countries, these approaches are insufficient to achieve weight loss in patients with severe obesity. Because the prevalence of obesity poses an enormous clinical burden, innovative treatment and care-delivery strategies are needed. Nonetheless, health professionals are poorly prepared to address obesity. In addition to biases and unfounded assumptions about patients with obesity, absence of training in behaviour-change strategies and scarce experience working within interprofessional teams impairs care of patients with obesity. Modalities available for the treatment of adult obesity include clinical counselling focused on diet, physical activity, and behaviour change, pharmacotherapy, and bariatric surgery. Few options, few published reports of treatment, and no large randomised trials are available for paediatric patients. Improved care for patients with obesity will need alignment of the intensity of therapy with the severity of disease and integration of therapy with environmental changes that reinforce clinical strategies. New treatment strategies, such as the use of technology and innovative means of health-care delivery that rely on health professionals other than physicians, represent promising options, particularly for patients with overweight and patients with mild to moderate obesity. The co-occurrence of undernutrition and obesity in low-income and middle-income countries poses unique challenges that might not be amenable to the same strategies as those that can be used in high-income countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

Treatment 2.0: catalyzing the next phase of treatment, care and support.

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Duncombe, Chris; Ball, Andrew; Passarelli, Carlos; Hirnschall, Gottfried

2013-01-01

This review provides an update on the WHO/UNAIDS Treatment 2.0 strategy by reviewing the documents and technical updates issued under the initiative. Launched in 2010, this global initiative provides a framework for the continued scale-up of access to HIV care and treatment. WHO has prioritized once daily fixed-dose combination as the preferred antiretroviral (ARV) regimen to initiate HIV treatment, paving the way for programmatic simplification, with reduced toxicity and improved adherence. WHO also recommends the use of point-of-care diagnostics, with CD4 cell count technologies being implemented in the field and progress towards improving access to simplified viral load testing. The strategy also seeks mechanisms that can contribute to reducing treatment costs, such as pooled commodity procurement and public health-oriented licensing approaches. Improved service delivery, specifically through decentralization, task shifting, integration and community mobilization also has the potential to reduce costs and improve access. Support to countries has been provided through the timely release of a series of programmatic and technical updates on specific treatment-related topics. The Treatment 2.0 strategy articulates how innovation and greater efficiency can make HIV care and treatment more accessible and affordable, and guide treatment and prevention scale-up.

Cultural Beliefs and Mental Health Treatment Preferences of Ethnically Diverse Older Adult Consumers in Primary Care

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Jimenez, Daniel E.; Bartels, Stephen J.; Cardenas, Veronica; Daliwal, Sanam S.; Alegría, Margarita

2011-01-01

Background Beliefs concerning the causes of mental illness may help explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their Caucasian counterparts. This study applies the Cultural Influences on Mental Health framework to identify the relationship between race/ethnicity and differences in: (1) beliefs on the cause of mental illness; (2) preferences for type of treatment; and (3) provider characteristics. Method Analyses were conducted using baseline data collected from participants who completed the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. Results African-Americans, Asian-Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared to Non-Latino Whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. Conclusions This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services. PMID:21992942

Workers' opinions on the effect of contact with health care providers on sickness absence duration.

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Steenbeek, Romy

2014-01-01

Because of the aging working population and the increasing age of retirement the number of workers with chronic illnesses and disabilities is growing. It is important that workers with health complaints receive efficient health care in order to remain fully or at least partly productive. To explore workers' opinions about the effectiveness of contact with health care providers in shortening sickness absence duration. Data come from a four-wave study from 2005 to 2008 among Dutch workers (n=1,424). Data were obtained on visits to health care providers, sickness absence and workers' opinions on whether and how their absence could have been shortened. A third of the workers were of the opinion that the health care provider (most often the general practitioner, GP) had played a role in preventing sickness absence and 35% were of the opinion that the health care provider had limited their absence. Most often the physical therapist (71%) and mental health therapist (61%) shortened sickness absence duration, in contrast to the occupational physician (OP, 25%) and GP (32%). The effectiveness of the health care providers' treatment was associated with the cause of sickness absence. Approximately 15% of the workers reported that their sickness absence could have been shortened if health care providers had provided the proper treatment and if waiting times had been reduced. Health care providers differ in their potential to shorten sickness absence duration. Health care providers can further reduce sickness absence and health care costs by providing the proper treatment and by reducing waiting times.

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

the_monk

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

Enveloped Lives: Practicing Health and Care in Lithuania.

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Praspaliauskiene, Rima

2016-12-01

This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient-doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes. © 2016 by the American Anthropological Association.

Unmet dental needs and barriers to care for children with significant special health care needs.

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Nelson, Linda P; Getzin, Anne; Graham, Dionne; Zhou, Jing; Wagle, Elke M; McQuiston, Jessie; McLaughlin, Suzanne; Govind, Akshay; Sadof, Matthew; Huntington, Noelle L

2011-01-01

The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis. A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts. The study yielded 1,128 completed surveys. More than 90% of the children had seen a dentist within the past year; 66% saw a pediatric dentist, and 21% needed intense behavioral interventions. Although most families had high education levels, private dental insurance, and above average incomes, 20% of CSHCN had an unmet dental need. Children with craniofacial anomalies had twice as many unmet needs and children with cystic fibrosis had fewer unmet needs. Children with cerebral palsy, autism, developmental delay, and Down syndrome had more aversions to dental treatment, more treatment complications posed by their medical conditions, and more difficulty finding a dentist willing to provide care. Children with cystic fibrosis, metabolic disorders, or hemophilia encountered fewer barriers to care. The data paint a picture of high unmet dental needs with subpopulations of children with special health care needs who are more at risk for system barriers and internal family barriers to care based on their medical diagnoses.

Managed care and the quality of substance abuse treatment.

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Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

2002-12-01

In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that

Cloud based emergency health care information service in India.

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Karthikeyan, N; Sukanesh, R

2012-12-01

A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

Relational Climate and Health Care Costs: Evidence From Diabetes Care.

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Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K

2018-01-01

Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.

People in sub-Saharan Africa rate their health and health care among the lowest in the world.

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Deaton, Angus S; Tortora, Robert

2015-03-01

The health of people in sub-Saharan Africa is a major global concern. However, data are weak, and little is known about how people in the region perceive their health or their health care. We used data from the Gallup World Poll in 2012 to document sub-Saharan Africans' perceived health status, their satisfaction with health care, their contact with medical professionals, and the priority they attach to health care. In comparison to other regions of the world, sub-Saharan Africa has the lowest ratings for well-being and the lowest satisfaction with health care. It also has the second-lowest perception of personal health, after only the former Soviet Union and its Eastern European satellites. HIV prevalence is positively correlated with perceived improvements in health care in countries with high prevalence. This is consistent with an improvement in at least some health care services as a result of the largely aid-funded rollout of antiretroviral treatment. Even so, sub-Saharan Africans do not prioritize health care as a matter of policy, although donors are increasingly shifting their aid efforts in the region toward health. Project HOPE—The People-to-People Health Foundation, Inc.

Mobile Health Applications for Pediatric Care: Review and Comparison.

Science.gov (United States)

Morse, Samantha Sangie; Murugiah, Muthu Kumar; Soh, Yee Chang; Wong, Tin Wui; Ming, Long Chiau

2018-05-01

Despite the surge in mobile health (mHealth) applications (apps) about pediatric care in commercial app stores, to our knowledge, reviews of the quality of such apps are lacking. Consequently, it is a great challenge for health care professionals (HCPs) to identify appropriate and reliable mHealth apps for delivering health care services. Thus, we performed a structured review of the extant literature about mHealth apps in pediatric care and quality assessment of selected apps found in commercial app stores. A review and comparison of mHealth apps in pediatric care found in Google's Play Store (Android system) and Apple's App Store (iOS system) were performed. For the structured review of the available literature, Google Scholar, PubMed, IEEE Xplore Digital Library, and Science Direct online databases were used for the literature search. The assessment criteria used for comparison included requirement for Internet connection, size of application, information on disease, diagnostic tools, medical calculator, information on disease treatments, dosage recommendations, and drug interaction checker. Fifty mHealth apps for general pediatric care and 8 mHealth apps for specific pediatric diseases were discussed in the literature. Of the 90 mHealth apps we reviewed, 27 that fulfilled the study criteria were selected for quality assessment. Medscape, Skyscape, and iGuideline scored the highest (score=7), while PediaBP scored the lowest (score=3). Medscape, Skyscape, and iGuideline are the most comprehensive mHealth apps for HCPs as quick references for pediatric care. More studies about mHealth apps in pediatric care are warranted to ensure the quality and reliability of mHealth apps.

Health care delivery to personnel of nuclear power plants in the Czech Republic

International Nuclear Information System (INIS)

Michalek, V.; Kubat, M.

1989-01-01

An overview is presented of the system of health care delivery to the personnel of nuclear power plants in Temelin and Dukovany, Czechoslovakia. The system of curative and preventivd care is described in detail, including preventive examinations, rehabilitation and spa treatment. The organisational structure is also described of health care institutions and the tasks are outlined of the works health care centres. (L.O.)

PROVIDER CHOICE FOR OUTPATIENT HEALTH CARE SERVICES IN INDONESIA: THE ROLE OF HEALTH INSURANCE

Directory of Open Access Journals (Sweden)

Budi Hidayat

2012-11-01

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

Health Care Spending: Changes in the Perceptions of the Australian Public.

Directory of Open Access Journals (Sweden)

Jane Robertson

Full Text Available Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers.To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs.Two computer-assisted telephone interviews were conducted in 2006 (533 respondents and 2015 (1318 respondents and results compared.More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1 with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53. The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35 and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86 as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76. They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50.Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

Health Care Spending: Changes in the Perceptions of the Australian Public.

Science.gov (United States)

Robertson, Jane; Newby, David A; Walkom, Emily J

2016-01-01

Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers. To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs. Two computer-assisted telephone interviews were conducted in 2006 (533 respondents) and 2015 (1318 respondents) and results compared. More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1) with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53). The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35) and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86) as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76). They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50). Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies

Science.gov (United States)

Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Krouse, Robert S.

2014-01-01

Purpose The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies. Methods Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes. Results Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms. Conclusions Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL. Structured abstract The current literature in CRC survivor-ship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs. PMID:24442998

Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness.

Science.gov (United States)

Parsell, Cameron; Ten Have, Charlotte; Denton, Michelle; Walter, Zoe

2017-04-07

Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in

Collaboratively reframing mental health for integration of HIV care in Ethiopia.

Science.gov (United States)

Wissow, Lawrence S; Tegegn, Teketel; Asheber, Kassahun; McNabb, Marion; Weldegebreal, Teklu; Jerene, Degu; Ruff, Andrea

2015-07-01

Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method

Improving pain care through implementation of the Stepped Care Model at a multisite community health center

Directory of Open Access Journals (Sweden)

Anderson DR

2016-11-01

Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

Digital health care--the convergence of health care and the Internet.

Science.gov (United States)

Frank, S R

2000-04-01

The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.

Health care use after diagnosis of cancer in children.

NARCIS (Netherlands)

Heins, M.J.; Lorenzi, M.F.; Korevaar, J.C.; McBride, M.L.

2014-01-01

Purpose: Young patients with cancer often require extensive care during and shortly after cancer treatment for medical, psychosocial and educational problems. Approximately 85% are treated by an oncologist; however, their additional health care in this phase has barely been studied. The role of the

Consumer Directed Health Care

OpenAIRE

John Goodman

2006-01-01

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

Mental health care roles of non-medical primary health and social care services.

Science.gov (United States)

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Operations management in health care.

Science.gov (United States)

Henderson, M D

1995-01-01

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

Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

Science.gov (United States)

Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

2011-01-01

Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

Population preferences for health care in liberia: insights for rebuilding a health system.

Science.gov (United States)

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-12-01

OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. © Health Research and Educational Trust.

Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

Science.gov (United States)

Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

2012-04-01

This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

Resilient health care

DEFF Research Database (Denmark)

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

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

Patient satisfaction on tuberculosis treatment service and adherence to treatment in public health facilities of Sidama zone, South Ethiopia

Science.gov (United States)

2013-01-01

Background Patient compliance is a key factor in treatment success. Satisfied patients are more likely to utilize health services, comply with medical treatment, and continue with the health care providers. Yet, the national tuberculosis control program failed to address some of these aspects in order to achieve the national targets. Hence, this study attempted to investigate patient satisfaction and adherence to tuberculosis treatment in Sidama zone of south Ethiopia. Methods A facility based cross sectional study was conducted using quantitative method of data collection from March to April 2011. A sample of 531 respondents on anti TB treatment from 11 health centers and 1 hospital were included in the study. The sample size to each facility was allocated using probability proportional to size allocation, and study participants for the interview were selected by systematic random sampling. A Pre tested, interviewer administered questionnaire was used to collect the data. Collected data was edited, coded and entered to Epi data version 3.1 and exported to SPSS version 16. Confirmatory factor analysis was done to identify factors that explain most of the variance observed in most of the manifested variables. Bivariate and Multivariate analysis were computed to analyze the data. Result The study revealed 90% of the study participants were satisfied with TB treatment service. However, 26% of respondents had poor adherence to their TB treatment. Patient perceived on professional care, time spent with health care provider, accessibility, technical competency, convenience (cleanliness) and consultation and relational empathy were independent predictors of overall patient satisfaction (P patient satisfaction (Beta = 0.262). In multivariate analysis occupational status, area of residence, perceived time spent with health care provider, perceived accessibility, perceived waiting time, perceived professional care and over all patient satisfaction were significantly

Reducing Young Adults' Health Care Spending through the ACA Expansion of Dependent Coverage.

Science.gov (United States)

Chen, Jie; Vargas-Bustamante, Arturo; Novak, Priscilla

2017-10-01

To estimate health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage. Nationally representative Medical Expenditure Panel Survey data from 2008 to 2012. We conducted repeated cross-sectional analyses and employed a difference-in-differences quantile regression model to estimate health care expenditure trends among young adults ages 19-25 (the treatment group) and ages 27-29 (the control group). Our results show that the treatment group had 14 percent lower overall health care expenditures and 21 percent lower out-of-pocket payments compared with the control group in 2011-2012. The overall reduction in health care expenditures among young adults ages 19-25 in years 2011-2012 was more significant at the higher end of the health care expenditure distribution. Young adults ages 19-25 had significantly higher emergency department costs at the 10th percentile in 2011-2012. Differences in the trends of costs of private health insurance and doctor visits are not statistically significant. Increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults. © Health Research and Educational Trust.

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

Science.gov (United States)

Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes

Science.gov (United States)

von Arx, Lill-Brith Wium; Gydesen, Helge; Skovlund, Søren

2016-01-01

Objective While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome as measured by glycated hemoglobin (HbA1c) level, blood pressure, and lipid profile. Research design and methods This was a large-scale cross-sectional, registry-based study involving a well-defined type 2 diabetes population, in the county of Funen, Denmark. Registry data were combined with a 27-item self-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors. Results In total, 1033 respondents answered the survey. The majority of treatment beliefs and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy were factors positively associated with HbA1c levels, s-cholesterol, and low-density lipoprotein. Conversely, infrequent self-measured blood glucose was associated with a significantly higher likelihood of having a blood pressure below 130/80 mm Hg. Perceived low treatment efficacy was the only health belief associated with poorer levels of health outcome other than HbA1c. Conclusions Health behaviors were stronger predictors for health outcomes than treatment beliefs. Self-reported adherence to either the treatment regimen or general medical advice most consistently predicted both glycemic control and cardiovascular risk factors. PMID:27110367

Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

Science.gov (United States)

Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

2013-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014.

Science.gov (United States)

Wooten, Nikki R; Brittingham, Jordan A; Pitner, Ronald O; Tavakoli, Abbas S; Jeffery, Diana D; Haddock, K Sue

2018-02-06

Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78

[Impact of care pathway on the delay for initiation of antituberculosis treatment in Conakry, Guinea].

Science.gov (United States)

Camara, A; Bah-Sow, O Y; Baldé, N M; Camara, L M; Barry, I S; Bah, B; Diallo, M; Chaperon, J; Riou, F

2009-06-01

Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea. A total of 112 patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional (use of health care facilities only) and mixed (use of health care facilities, self-medication, and traditional medicine). The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.e., conventional vs. mixed, were compared with regard to delay for initiation of treatment. The care pathway was classified as mixed in two out of three patients. Multivariate analysis showed that this type of pathway was only correlated with schooling (p=0.02). The mean delay for treatment was similar, i.e., 13.4 and 12.8 weeks for conventional and mixed pathways respectively (p<0.68). The percentage of pathways including three consultations at health care facilities was significantly higher in the conventional than mixed group (72% vs. 30%, p<0.001). The main reasons given for delayed use of health care facilities were poor knowledge of tuberculosis symptoms (26%) and high cost of care (12%). The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.

Let's talk about sex: older people's views on the recognition of sexuality and sexual health in the health-care setting.

Science.gov (United States)

Bauer, Michael; Haesler, Emily; Fetherstonhaugh, Deirdre

2016-12-01

To report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals' recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care. The review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health-care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible. A total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies - seven quantitative, eight qualitative and three opinion papers - met the inclusion criteria and were appraised. The importance of sexuality to well-being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health-care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings. Sexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health-care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

[Economic aspects of anesthesia. I. Health care reform in the German Republic].

Science.gov (United States)

Bach, A; Bauer, M

1998-03-01

Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.

Perceptions and abilities related to patient engagement in diabetes care among primary health care providers in Malaysia

DEFF Research Database (Denmark)

Bjerre-Christensen, Ulla; Kragelund Nielsen, Karoline; Calopietro, Michael

Background: Malaysia seeks to transform its public health sector to manage the growing number of people with diabetes. Patient engagement is a critical clinical competency for HCPs treating people with diabetes. We investigated perceptions of and ability to practice patient engagement among doctors....... The interviews were analysed using qualitative content analysis. Summary of Results: Three main themes emerged: 1) limitations in understanding barriers to self-care and treatment especially from a psychosocial perspective, 2) substantial variation in health care providers’ skills within patient engagement...... health care providers’ ability to place the patient at the center of all therapeutic decisions. Take-home Message: Future efforts to improve self-care should seek to develop competencies within patient engagement especially strengthening understanding of psychosocial barriers to self-care. Organisation...

Health care in the Netherlands.

NARCIS (Netherlands)

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

2012-01-01

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

Can banks offer digital keys for health care?

Science.gov (United States)

Casillas, John

2013-01-01

In the quest to implement electronic health care records, health care stakeholders have uncovered an elephant in the room - how to implement patient identity and integrity solutions. Without this, linking the unique records of an individual is impossible. An inaccurate record can be dangerous for prescribing treatment. Yet many consider a unique patient identifier as an unacceptable privacy risk. Medical banking, or the convergence of banking and heath IT systems, is spawning new ideas that could impact on this difficult area. This article suggests that new forms of efficiency in payment processing may yield a common, cross-industry technology platform for managing digital identity by banks. Redefining a bank based on core competencies, the article looks at three areas: (1) the "identity theft arms race"; (2) innovations in payment processing; and (3) consumer engagement, and suggests that, as banking and health care systems converge, digital identity may become the new money. This realization may find banks fully engaged in helping health care to overcome the challenge of patient identity and integrity.

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

Science.gov (United States)

Sorrell, Jeanne M

2009-01-01

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

Innovating in Health Care – Modern Challenges

Directory of Open Access Journals (Sweden)

Sebija Izetbegović

2013-12-01

Full Text Available Introduction: The goal of this article is to present that innovating in health care begins to become an imperative in present time. Innovating will enable the achievement of the highest quality health care results and the patients' satisfaction with the least amount of financial resources.Methods: The thorough literature review of multifaceted sources was conducted including: studies, books, monographies and peer – reviewed journals with the goal of achieving the clearer picture of today's modern challenges in the complex fi eld of health care innovation.Discussion: Theoretical and empirical studies clearly indicate that the innovation is one of the key factors in the competitiveness of the organization and its survival in the market. Developed countries of the world today are making significant efforts in order for innovation to become a national priority, with special emphasis placed on measuring innovation performance. Results of theoretical and practical studies show that in the future, treatment of the most diffi cult and complex diseases of our time, through the entirely new discoveries and results, derived from the process of innovation, will project entirely new positive forms and outcomes in the health care.Conclusion: There is no doubt that the humanity and medical science will through innovation succeed to win the battles against the majority of the most complex contemporary diseases. Malignant neoplasm of tomorrow, through the application of a new, innovative approaches to research, processes and treatments will become a chronic diseases. Among many, the particular problem in the process of innovation will represent the cost of research and development (R&D, production and the safety of prescription drugs.

Parental satisfaction with quality of health care of children with sickle ...

African Journals Online (AJOL)

Assessing parental satisfaction with the health system will be a pointer to attitude towards health institutions compliance with treatment and achievement of better treatment outcome, especially in the care of children with chronic diseases such as sickle cell disease (SCD). This study determined parental satisfaction with ...

Employee assistance programs: a prevention and treatment prescription for problems in health care organizations.