WorldWideScience

Sample records for restructuring primary health

  1. Coasts under stress: restructuring and social-ecological health

    National Research Council Canada - National Science Library

    Ommer, R.E

    2007-01-01

    ... the human impact of restructuring and social-ecological health 9 The Restructuring of Health Care on Both Coasts since the 1980 s 183 The Statistical Face of Restructuring and Human Health 210 The Human Voice of Social-Ecological Restructuring: Jobs, Incomes, Livelihoods, Ways of Life, and Human Health 241vi Contents 10 11 Restructuring, Nutrition,...

  2. Health in restructuring: innovative approaches and policy recommendations

    NARCIS (Netherlands)

    Kieselbach, T.; Armgarth, E.; Bagnara, S.; Elo, A.L.; Jefferys, S.; Joling, C.; Kuhn, K.; Nielsen, K.; Popma, J.; Rogovsky, N.; Sahler, B.; Thomson, G.; Triomphe, C.E.; Widerszal-Bazyl, M.

    2009-01-01

    The health dimension of enterprise restructuring is a widely neglected area of research, intervention and public concern. Restructuring is taking place in every competing organisation and is therefore affecting all European societies. With restructuring is meant an organizational change that is much

  3. Restructuring health care through nursing and business acumen.

    Science.gov (United States)

    Goodroe, J H

    1998-03-01

    This nurse entrepreneur owns two companies that help others restructure health care processes. Utilizing knowledge from her managerial and business background, as well as clinical innovations in cardiovascular disease, set the stage for this author's successful business ventures.

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

    African Journals Online (AJOL)

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

  5. Restructuring of a Textile Manufacturing Company and Workers' Health.

    Science.gov (United States)

    Draksler, Katja; Dernovšček Hafner, Nataša; Arnerić, Niko; Dodič Fikfak, Metoda

    2018-01-01

    Organizational restructuring is associated with greater mortality and morbidity of the workers affected by it. We examined the quality of workers' health at a textile manufacturing company after restructuring, comparing three groups of workers: workers who remained (survivors), workers who lost their jobs and later found new jobs (the reemployed), and unemployed workers. A total of 1046 workers participated in a telephonic survey. The data were processed using SPSS and the R package version 1.2 of prLogistic. The differences between groups were calculated using the chi-square test and adjusted prevalence ratios. The comparison between the three groups shows significantly poorer mental health of the unemployed, who more often than survivors and the reemployed reported depression, as well as significant differences in elevated blood pressure, cholesterol level, and cardiac disorders. The reemployed, who were nonetheless in better health compared to the unemployed, reported poor mental health or depression more often in comparison to survivors. Higher morbidity of the unemployed and reemployed could be influenced by numerous factors associated with restructuring.

  6. Closing Kynect and Restructuring Medicaid Threaten Kentucky's Health and Economy.

    Science.gov (United States)

    Wright, Charles B; Vanderford, Nathan L

    2017-08-01

    Following passage of the Patient Protection and Affordable Care Act (ACA) in the United States, the Kentucky Health Benefit Exchange, Kynect, began operating in Kentucky in October 2013. Kentucky expanded Medicaid eligibility in January 2014. Together, Kynect and Medicaid expansion provided access to affordable health care coverage to hundreds of thousands of individuals in Kentucky. However, following the Kentucky gubernatorial election in 2015, the newly inaugurated governor moved to dismantle Kynect and restructure the Medicaid expansion, jeopardizing public health gains and the state economy. As the first state to announce both the closure and restructuring of a state health insurance marketplace and Medicaid expansion, Kentucky may serve as a test case for the rest of the nation for reversal of ACA-related health policies. This article describes Kynect and the Kentucky Medicaid expansion and examines the potential short-term and long-term impacts that may occur following changes in state health policy. Furthermore, this article will offer potential strategies to ameliorate the expected negative impacts of disruption of both Kynect and the Medicaid expansion, such as the creation of a new state insurance marketplace under a new governor, the implementation of a private option, and increasing the state minimum wage for workers. Copyright © 2017 by Duke University Press.

  7. [Productive restructuring and consequences for the work in health].

    Science.gov (United States)

    Pires, D

    2000-01-01

    This paper describes health care work in the context of the service sector and the current production restructuring process occurring in the world. It shows that the intensive use of high-end technological equipment and outsourcing are the main features of this process in the health area and that there are few innovations in terms of organization and work management. Concerning the impacts of the implantation of the production process in this area, it shows that, although unemployment is one of the most negative impacts, it has not yet affected the health sector. The paper also deals with the effects of production restructuring on work conditions, on the outcome of this work and on workers' health conditions. It indicates that this process does not result from economic determinism and that organized action among different social groups can influence the consequences for workers and users of the health care services. Finally, the paper concludes that there is a need for further studies on this area in order to achieve a better understanding of this process.

  8. [Subjectivity, ethics and productivity in post-productive health restructuring].

    Science.gov (United States)

    Gomes, Doris; Ramos, Flávia Regina Souza

    2015-08-01

    The scope of this paper is to analyze the ethical problems generated by the modern stressor pattern of post-transformation productivity in productive restructuring in the health area. It is a qualitative study of the descriptive and exploratory type in which 30 professionals (nurses, doctors and dental surgeons) from a metropolitan region in the South of Brazil were interviewed, all of whom had prior experience in the public and private sectors. The results were analyzed through Discursive Textual Analysis. Capitalization is revealed as a major ethical problem in the series of new issues derived from the productivity-profitability imperative in health, due to the acritical incorporation of ethics that is restricted to the company's interests or to corporate-individual interests. The ethical problem of low professional commitment to the needs of the patient and of the social collective indicates the need to build a new engaged solidarity in order to increase the quality of public healthcare. Productivity targeted at individual and social needs/interests in the area of health requires a new self-managing and collective engagement of the subjects, supported by an institutional and ethical-political effort of group action, cooperation and solidarity.

  9. Trends in nosocomial bloodstream infections following health care restructuring in Alberta between 1999 and 2005.

    Science.gov (United States)

    Lee, Mao-Cheng; Saxinger, Lynora; Forgie, Sarah E; Taylor, Geoffrey

    2010-01-01

    A previous study at the University of Alberta Hospital/Stollery Children's Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring. Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records. The University of Alberta Hospital/Stollery Children's Hospital (617 adult and 139 pediatric beds, respectively). All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs. There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged. These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

  10. Restructuring public health in Slovenia between 1985 and 2006

    NARCIS (Netherlands)

    Albreht, Tit; Klazinga, Niek S.

    2008-01-01

    OBJECTIVE: This paper explores the developments in the public health infrastructure in Slovenia in the context of the sociopolitical and legislative changes in health care over the last 20 years. It assesses the responsiveness of the public health institutes in Slovenia to the various plans on

  11. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  12. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  13. Revenue and Health Impacts of Restructuring Tobacco Excise Tax ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Other measures proposed as part of the new tax law include indexing the excise tax to inflation, adopting a unitary tax system, and earmarking taxes for the Universal Health Care program. Researchers will collect data from a survey of consumer demand for tobacco products and analyze the reasons why people consume ...

  14. (Re)form with Substance? Restructuring and governance in the Australian health system 2004/05

    OpenAIRE

    Rix, Mark; Owen, Alan; Eagar, Kathy

    2005-01-01

    The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004–2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensi...

  15. (Re)form with substance? Restructuring and governance in the Australian health system 2004/05.

    Science.gov (United States)

    Rix, Mark; Owen, Alan; Eagar, Kathy

    2005-08-24

    The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more. The year 2004-2005 was no different. This paper reviews the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the last year. At the national level some progress has been made in 2004/05 through the Australian Health Ministers' Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus in 2004-2005 at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally 'crisis managing' their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004-2005, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress.

  16. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

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

  18. A study of primary science teachers' ability to restructure knowledge in scientific texts

    Science.gov (United States)

    Loh-Yeo, Wan Inn

    The ability of elementary science teachers to restructure knowledge in an unfamiliar scientific text is investigated in this study. Science in schools is said to be characterized by an extensive reliance on textbooks with little evidence of inquiry on the part of students and teachers. The successful implementation of any inquiry science program can only be achieved if teachers can access knowledge in resources such as scientific books and journals which they are able to read critically, and translate and transform that knowledge. Participants were twelve high school graduates undertaking a teacher training course in Singapore. Recalls, problem solving, and ConSAT maps were used as a measure of readers' textbase representation, situational representation and cognitive structures respectively. The target text rewritten for a colleague and for 6sp{th} graders were used as a measure of readers' ability to restructure knowledge. Qualitative and quantitative analyses have shown a difference between able and less able readers on these measures. Able readers recalled more key concepts than less able readers and used the global text structure. Problem solutions of able readers were based on the principles of fermentation with immediate recognition of the variable and its implied consequences and likely solution. The more coherent textbase and situational representations of able readers is reflected in the ConSAT maps of such readers which approximated 44.45% of the criterion map in contrast to less than 25% for less able readers. Not surprisingly, able readers demonstrated to some degree, an ability to restructure knowledge while less able readers did not. Based on the findings of the study the investigator challenges the assumption about reading proficiency of trainee teachers and suggests attention should be paid to literacy requirements and practices. If teachers are unable to restructure knowledge in scientific texts, it is highly unlikely that they would be able to

  19. Organisational restructuring/downsizing, OHS regulation and worker health and wellbeing.

    Science.gov (United States)

    Quinlan, Michael

    2007-01-01

    A growing body of international evidence indicates that downsizing and related forms of organisational restructuring are having profound adverse effects on worker safety, health and wellbeing. In particular, evidence links downsizing to poorer mental health outcomes, including bullying and other forms of occupational violence. In Australia federal, state and territory occupational health and safety (OHS) legislation imposes obligations on employers who make changes to the workplace or work processes to identify hazards, undertake risk assessment, consult with employee representatives and take appropriate steps to manage any significant hazards that are identified, including psychosocial hazards. This study shows that while Australian regulators are aware of the problems posed by downsizing they have made only modest efforts to pursue compliance with legislative duties, producing some guidance material that refers to restructuring and workloads and launching a small number of prosecutions. At the same time, there is an increased willingness to address staffing levels and other impacts of downsizing (like working in isolation). Employer and union responses were also examined. The article concludes by identifying a number of initiatives that would enable regulators, unions and employers to address the problems posed by downsizing more effectively.

  20. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

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

  1. [Productive restructuring and its impact on labor relations in the public health services in Brazil].

    Science.gov (United States)

    Martins, Maria Inês Carsalade; Molinaro, Alex

    2013-06-01

    The restructuring of productive systems and economic globalization are directly impacting the basic social rights of workers. In the semi-peripheral countries such as Brazil, where the wage-based society and the consolidation of social rights are not completely implemented, this process of change in the world of labor contributes to aggravate the inequality in the capital-labor relationship and hampers access to employment. By means of a critical review of the scientific literature regarding changes in the world of labor and its impact on the organization and production of health services in Brazil, this article pinpoints the weakness of regulation of the labor market in Brazil, especially in the health sector. It also stresses the need to increase the debate on new forms of institutionalization of the labor relationship in order to ensure equity in the workplace and protect the rights to work and in the workplace.

  2. Health care restructuring and family physician care for those who died of cancer

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992 to 30% (1998. These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP visits to advanced cancer patients in Nova Scotia (NS during the years of health care restructuring. Methods Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics, the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000. Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212. Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department, time of day (regular hours, after hours, total length of inpatient hospital stay and number of hospital admissions during the last six months of life. Results In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED, 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP

  3. Restructuring graduate medical education to meet the health care needs of emirati citizens.

    Science.gov (United States)

    Abdel-Razig, Sawsan; Alameri, Hatem

    2013-06-01

    Many nations are struggling with the design, implementation, and ongoing improvement of health care systems to meet the needs of their citizens. In the United Arab Emirates, a small nation with vast wealth, the lives of average citizens have evolved from a harsh, nomadic existence to enjoyment of the comforts of modern life. Substantial progress has been made in the provision of education, housing, health, employment, and other forms of social advancement. Having covered these basic needs, the government of Abu Dhabi, United Arab Emirates, is responding to the challenge of developing a comprehensive health system to serve the needs of its citizens, including restructuring the nation's graduate medical education (GME) system. We describe how Abu Dhabi is establishing GME policies and infrastructure to develop and support a comprehensive health care system, while also being responsive to population health needs. We review recent progress in developing a systematic approach for developing GME infrastructure in this small emirate, and discuss how the process of designing a GME system to meet the needs of Emirati citizens has benefited from the experience of "Western" nations. We also examine the challenges we encountered in this process and the solutions adopted, adapted, or specifically developed to meet local needs. We conclude by highlighting how our experience "at the GME drawing board" reflects the challenges encountered by scholars, administrators, and policymakers in nations around the world as they seek to coordinate health care and GME resources to ensure care for populations.

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  6. Primary health care.

    Science.gov (United States)

    Romualdez, A

    1980-01-01

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

  7. Public health nurses' primary health care practice: strategies for fostering citizen participation.

    Science.gov (United States)

    Aston, Megan; Meagher-Stewart, Donna; Edwards, Nancy; Young, Linda M

    2009-01-01

    Citizen participation is heralded as a critical element of community health programs that emphasize empowerment and health promotion strategies. Although there is a growing body of research on public health nurses' primary health care practice, few studies have described how public health nurses foster citizen participation. This article presents findings from an interpretive qualitative study of public health nurses' perceptions of their role in fostering citizen participation in an eastern Canadian province at a time of significant health care restructuring. The findings from this study clearly profile public health nurses as integral to the practice of fostering citizen participation.

  8. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

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

  9. Primary health care models

    Science.gov (United States)

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

    2012-01-01

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

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  11. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    2013-09-02

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

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

    Science.gov (United States)

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

    2012-05-28

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

  13. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  14. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

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

  15. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

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

  16. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

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

  17. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    The objectives of this study are to assess contraceptive awareness, attitude and pattern of use among women aged 15-49 years in a Local Council Development ... JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTHCARE VOL 27 NO 1, MAR 2015. 104 .... 4.0. Relations. 8. 3.0. Mass media (TV, Radio, etc). 22.

  18. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    treatment for sexually transmitted diseases reported to ... Patients attending the sexually transmitted disease clinic of the Lagos State University Teaching Hospital, .... Female. 10. 20. Educational status. No education. Primary school completed. 4. 8. Secondary school completed. 20. 40. Tertiary education completed. 26. 52.

  19. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    communicable diseases such as hypertension and transitions currently experienced in Sub-Saharan. 96. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. KEYWORDS journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine ...

  20. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  1. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26 (1) 21-29. KEYWORDS. Household, expenditure,. Treatment, presumptive malaria,. Gimba ... A cross-sectional descriptive study conducted during community diagnosis posting of final year medical students of. Ahmadu Bello University ...

  2. Globalisation, rural restructuring and health service delivery in Australia: policy failure and the role of social work?

    Science.gov (United States)

    Alston, Margaret

    2007-05-01

    The impacts of globalisation and rural restructuring on health service delivery in rural Australia have been significant. In the present paper, it is argued that declining health service access represents a failure of policy. Rural communities across the world are in a state of flux, and Australia is no different: rural communities are ageing at faster rates than urban communities and young people are out-migrating in large numbers. During the past 5 years, rural Australia has also experienced a severe and widespread drought that has exacerbated rural poverty, and impacted on the health and well-being of rural Australians. Australian governments have responded to globalising forces by introducing neoliberal policy initiatives favouring market solutions and championing the need for self-reliance among citizens. The result for rural Australia has been a withdrawal of services at a time of increased need. This paper addresses the social work response to these changes.

  3. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    2012-05-01

    May 1, 2012 ... Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment was through out-of pocket spending (user-charges) with most respondents using their own money. Although this financing method shown to be associated with ...

  4. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State. 1. 2. 2. Awunor N.S , Omuemu V.O , Adam V.Y. ABSTRACT. Introduction. A nation's disease control effort is often as good as the surveillance and notification system put in place, which would help to generate the much needed ...

  5. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    living on each square inch of the phone. This study determined the prevalence of micro-organisms on the mobile phones of health workers and their role as a source of hospital acquired infection. The study utilised a cross-sectional design. A total of one hundred and eighty swabs were collected from the mobile phones of ...

  6. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

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

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    2011-10-07

    Oct 7, 2011 ... These factors include poor environmental and personal hygiene, poverty, malnutrition, unsafe water supply and ... The environment farmers live in, their standard of living and nutrition are very important to their health. ..... Globalization of food system: JOURNAL OF COMMUNITY MEDICINE AND PRIMARY ...

  8. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    instruments were pretested self-administered questionnaire and observational checklist. The data generated were analyzed using .... The observational checklist (OBL) was used to. Kwara State was carried from April to ..... supervision of health workers by middle cadre Central Zonal Office). Report on Routine immunization ...

  9. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Further studies on this subject are recommended. Employees' Assessment of Leadership in a Tertiary. Hospital in South-South Nigeria. Adeleye O. A, Aduh U. Department of Community Health, .... National Institute of Standards and Technology, (where it is trying to go in the future)”; “my senior were originally designed for ...

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

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

  11. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    activities in the health centres ( Table 2) The study showed that community health extension workers were responsible for ... development goals for mothers and children as distant as it was 40 years ago when primary health care strategy was adopted for ... Most of them were very experienced, 50% of. The study (Table II) ...

  12. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    the children didnot receive BCG vaccine while spiritual homes was the pattern in 6.9 households. 22.9% did not receive measles vaccine. A total of 63 under-five deaths were reported in 53. Table VI shows the health-seeking behaviour of. 6. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL.

  13. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, Zaria. KEYWORDS. Assessment,. Client satisfaction, ANC,. PHC centers.

  14. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. INTRODUCTION disability from complications of pregnancy and. 1 child birth. MI in birth preparedness is. Birth preparedness by a couple ensures that indispensible in rural communities where patriarchy appropriate care ...

  15. 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

  16. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    5 to improving mood and helping to manage stress . physical activity a day at least five times a week . Sedentary lifestyle is associated with obesity, Greater health benefits can be experienced with. KEYWORDS. Practice,. Exercise,. Leisure,. Work- related,. Overweight,. Obesity. Journal of Community Medicine and Primary ...

  17. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    Improving skilled attendants at birth: Experience in a primary health care facility in Rivers State, South-South Nigeria. 1. 2. Ordinioha B. , Seiyefa B. 1Community Medicine Department, University of Port Harcourt Teaching Hospital, Port Harcourt. 2Department of Family Medicine, Niger Delta University Teaching Hospital, ...

  18. Restructuring brain drain: strengthening governance and financing for health worker migration.

    Science.gov (United States)

    Mackey, Tim K; Liang, Bryan A

    2013-01-15

    Health worker migration from resource-poor countries to developed countries, also known as ''brain drain'', represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

  19. Health promotion innovation in primary health care

    Directory of Open Access Journals (Sweden)

    Alexandra McManus

    2013-01-01

    Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.

  20. Health promotion innovation in primary health care.

    Science.gov (United States)

    McManus, Alexandra

    2013-01-01

    Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.

  1. Restructuring of information technology (IT) curriculum in Nigerian ...

    African Journals Online (AJOL)

    This could be termed a basis for IT curriculum restructuring in Nigeria so as to enhance manpower development for IT industries in the country. Finally, the paper highlights the benefits that can be derived from restructuring the IT curriculum. Keywords: information technology, curriculum, restructuring, primary school, tertiary ...

  2. Promoting primary health in Belize.

    Science.gov (United States)

    Holland, J

    1983-11-01

    This article describes a 2-year project aimed at promoting primary health in a rural area of Belize with little access to health services. 27 mobile clinics were scheduled every 6 weeks. Services focused on immunization, development of a health education program, prenatal and postnatal care, and child health. A correlation was noted between the facilities available in each community (e.g. water supply) and the state of that community's health. Although family planning could not be promoted because of the government's pronatalist policy, birth spacing and breastfeeding were advocated. Project activities in the village of Santa Familia provide an example of community participation in health programs. A local lay midwife was given a traditional birth attenders course and trained to lead health education courses in the village. A community health council was established to initiate 3 projects: preschool nursery, cleaning up of the village, and latrine construction. As part of a campaign against hookworm, schoolchildren are required to wear shoes. The goal of these projects was to ensure that the villages would continue to take an interest in personal and community welfare after the departure of the health workers.

  3. The Impact of Health Care Restructuring on Nosocomial Infections and Transmission of Antimicrobial Resistant Organisms

    Directory of Open Access Journals (Sweden)

    J Conly

    2001-01-01

    Full Text Available The past decade has seen a dramatic change in Canadian health care as the treatment of many patients shifts from the hospital setting to the home or other alternative health care settings (1. Complex advances in technology and significant changes in the funding environment have also precipitated many changes in the functional capacity of our health care system. The portion of the total Canadian health care expenditures that has been allocated to hospitals and other institutions has declined steadily over the past two decades (2,3. This reduction in institutional-based funding reflects the need to develop a system that improves the use of out-of-hospital sites for delivery of health care services and decreases reliance on the specific institutional component of the health care sector. Recent data reveal that Canadian hospital discharge rates have decreased by 14% between 1994 and 1998, and there has been a reduction in the length of stay from 7.4 to 7 days (4. In conjunction with a reduction in the number of hospital beds, there has been a massive shift in the proportion of surgeries that are performed on an outpatient basis. Further developments in the delivery of care include the increased use of telehealth, which allows health care professionals to provide increasingly complex services centralized hospital sites to outlying areas.

  4. Learning Processes in the Professional Development of Mental Health Counselors: Knowledge Restructuring and Illness Script Formation

    Science.gov (United States)

    Strasser, Josef; Gruber, Hans

    2015-01-01

    An important part of learning processes in the professional development of counselors is the integration of declarative knowledge and professional experience. It was investigated in-how-far mental health counselors at different levels of expertise (experts, intermediates, novices) differ in their availability of experience-based knowledge…

  5. Health promotion and primary health care: examining the discourse.

    Science.gov (United States)

    Ashcroft, Rachelle

    2015-01-01

    The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.

  6. The controversy over the restructuring of perinatal emergency services in Portugal and the importance of citizen participation in health care decision-making processes.

    Science.gov (United States)

    Matos, Ana Raquel

    2015-01-01

    This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies.

  7. Rainbows: a primary health care initiative for primary schools.

    Science.gov (United States)

    Munns, Ailsa; Forde, Karen A; Krouzecky, Miriam; Shields, Linda

    2015-01-01

    Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care centred approach, embracing the social contexts of health and wellbeing. Recent research investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents. The results of this qualitative study indicate that all participants regard Rainbows as effective, with many perceived benefits to students and their families.

  8. Primary mental health care: Indications and obstacles

    OpenAIRE

    Y.G. Pillay; H. Subedar

    1992-01-01

    This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health) to its fruition are seldom addressed.

  9. Organization of primary health care for diabetes and hypertension in high, low and middle income countries.

    Science.gov (United States)

    Lall, Dorothy; Prabhakaran, Dorairaj

    2014-08-01

    Chronic non-communicable diseases, predominantly diabetes and cardiovascular disease are a major public health problem globally. The chronicity of these diseases necessitates a restructuring of healthcare to address the multidisciplinary, sustained care including psychosocial support and development of self-management skills. Primary healthcare with elements of the chronic-care model provides the best opportunity for engagement with the health system. In this review, the authors discuss aspects of primary healthcare for management of diabetes and hypertension and innovations such as mobile-phone messaging, web-based registries, computer-based decision support systems and multifaceted health professionals in the care team among others that are being tested to improve the quality of care for these diseases in high, middle and low-income countries. The goal of quality care for diabetes and hypertension demands innovation within the realities of health systems both in high as well as low and middle-income countries.

  10. Integrated primary health care in Australia

    Directory of Open Access Journals (Sweden)

    Gawaine Powell Davies

    2009-10-01

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

  11. Primary Health Care and Narrative Medicine.

    Science.gov (United States)

    Murphy, John W

    2015-01-01

    Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery.

  12. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity. Access to family planning also has the and mortality. It confers important health and potential to control population growth and in the development benefits to individuals, families, long run reduce green house gas emission ...

  13. Primary health care centres in Madagascar.

    Science.gov (United States)

    Andrianarisoa, A O; Rampanjato, M

    1994-01-01

    In 1976, Madagascar promised to establish 1500 primary health care centers to be run by a community health agent. The communities selected sites for the centers, nominated health agent candidates, built and maintained the centers and accommodation for the health agents, supplied the centers, and undertook their operation. The government organized the recruitment and training of the agents, paid their wages, and provided equipment and drugs. The candidates were 18-28 years old and had completed two years of secondary education. Training lasted 14 months and enabled the new agents to provide basic health care in the curative, preventive, and educational fields. The health agents can deal with normal births, family planning, vaccination, and health education. In 1991 the country had 1935 facilities that were providing primary care. Some 85% of the health agents have remained in the primary health care centers for over 10 years; 50 agents have moved out to become nurses or midwives. Financial support for the program comes from the state and external donors. Of the 1500 planned primary health care centers, 461 stopped functioning, mostly because the communities concerned have not adequately built and maintained premises for the health agents. The primary health care centers are less frequently attended than formerly because equipment is aging and drugs are in short supply. Cost recovery should be widely adopted in the national health system. More in-service training should be provided for health agents, and more tours of inspection should be carried out. Community health workers should be managed entirely by the community, and the Ministry of Health should take charge of their training. Primary health care in Madagascar has largely proved its worth; if the economic handicaps can be overcome, the program is likely to contribute to the achievement of the health-for-all goals.

  14. The primary health care service in Soweto

    OpenAIRE

    2014-01-01

    M.Cur. (Nursing Administration) With the Declaration of Alma Ata in September, 1978, a new era in health care delivery, the primary health care era with its slogan of "health for all by the year 2000' dawned. Much thought had to be put into new legislation and reorganizing of health services in South Africa. Soweto, devastated by riots in 1976, suffered badly when all health care services collapsed. Out of this crisis was born a primary health care service that provides Soweto with prevent...

  15. Orderly Sovereign Debt Restructuring

    OpenAIRE

    Canuto,Otaviano; Pinto, Brian; Prasad, Mona

    2014-01-01

    An orderly sovereign debt restructuring should place the debtor nation's public debt on a sustainable trajectory while minimizing procrastination and contagion. However, the experiences with the debt crisis of the 1980s, Russia 1998, Argentina 2001, and Greece 2010 indicate that orderly debt restructurings remain elusive, even with high-powered official intervention. When solvency problems are present, the chances of success increase if official money is lent at the risk-free rate, reflecting...

  16. Primary mental health care: Indications and obstacles

    Directory of Open Access Journals (Sweden)

    Y.G. Pillay

    1992-09-01

    Full Text Available This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health to its fruition are seldom addressed.

  17. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    economic demographic profile of respondents: status.(Table 4). One hundred and Seventy-four (44.1%) respondents had ever-utilized PHC facilities within. Reasons for non-utilization: their health district. The most frequently demanded health ...

  18. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    utilization of health services by communities;. Study Design: A cross-sectional study of all adults major factors that influence health facility use who have resided within the LGA for at least five years. include distance to facilities, cost of services, cultural beliefs of the community, educational Sample size determination and ...

  19. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    The objective of this study is to assess the awareness, attitude and willingness of artisans in Osun state to take part in. Community based ..... Educational Status. No formal education. Primary school. Secondary school. Tertiary school. 25. 95. 215. 52. 6.5. 24.5. 55.6. 13.4. Religion. Christianity. Islam. Others. 159. 225. 3. 41.1.

  20. Global health and primary care research.

    NARCIS (Netherlands)

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

    2007-01-01

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

  1. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    Awareness and Perception of Androgen Deficiency of Aging Males. (ADAM) among Men in Osogbo, Nigeria. 1. 2. 3. 1. Odu O.O , Olajide A.O , Olajide F.O , Olugbenga-Bello A.I. 1. 2. Department of Community Health/ Department of Surgery,. Ladoke Akintola University of Technology,. Ogbomoso, Nigeria. 3Department of ...

  2. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    to eat together and lying on the same bed with ocular have far reaching implications in terms of cancers patients. management, prognosis and mortality of ocular cancer. Such individuals may not access available. Further analysis indicates that respondents'. 3,9 education, gender and marital status have no health care ...

  3. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    Conclusion: Public education is needed to improve physical activity and curb the menace of health problems associated with ..... some staff with tertiary education were actually effectively address the challenges. Employers of junior staff. labour and policy makers must be made aware, through intensified advocacy, of their ...

  4. & PRIMARY HEALTH CARE COMMUNITY MEDICINE

    African Journals Online (AJOL)

    19. Prabhakara GN. Biostatistics. Jaypee Brothers 27. Brown L, Trujillo L, Macintyre K. Interventions. Medical Publishers Limited. 2006; 110-119. to reduce HIV/AIDS stigma: what have we. 20.National Population Commission Abuja, learned? AIDS Educ Prev.2003 Feb; 15(1): 49-. Nigeria. National Demographic and Health.

  5. [Renewing primary health care in the Americas].

    Science.gov (United States)

    Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa

    2007-01-01

    At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

  6. Knowledge of Health Insurance Among Primary Health-Care ...

    African Journals Online (AJOL)

    Background: The National Health Insurance Scheme (NHIS) was formally launched in Nigeria in 2005 as an option to help bridge the evident gaps in health care financing, with the expectation of it leading to significant improvement in the country's dismal health status indices. Primary Health Care (PHC) is the nation's ...

  7. Integrating mental health into primary care: a global perspective

    National Research Council Canada - National Science Library

    Funk, Michelle

    2008-01-01

    ... for mental disorders is enormous 4. Primary care for mental health enhances access 5. Primary care for mental health promotes respect of human rights 6. Primary care for mental health is affordab...

  8. RESTRUCTURING OF INDUSTRIAL ENTERPRISE

    Directory of Open Access Journals (Sweden)

    L. I. Podderegina

    2009-01-01

    Full Text Available The paper presents main principles for execution of current and strategic restructuring of national enterprises while using experience of countries with developed market economy. The principles contribute to higher efficiency in internal industrial relations at national industrial enterprises.

  9. Australian primary health care nurses most and least satisfying aspects of work.

    Science.gov (United States)

    Halcomb, Elizabeth; Ashley, Christine

    2017-02-01

    To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. A cross-sectional online survey. Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care.

  10. Corporate Restructuring and Bondholder Wealth

    NARCIS (Netherlands)

    Renneboog, L.D.R.; Szilagyi, P.G.

    2006-01-01

    This paper provides an overview of existing research on how corporate restructuring affects the wealth of creditors.Restructuring is defined as any transaction that affects the firm's underlying capital structure.Thus, it reaches well beyond asset restructuring and includes transactions such as

  11. Integrating mental health into primary health care – Uganda's ...

    African Journals Online (AJOL)

    Adele

    nutrition, attendance of antenatal care, immunisation and discouraging behaviours such as excessive alcohol consumption.5,6,7 In addition this encourages the maximum utilization of the few available health workers thereby improving accessibility. Integrating mental health into primary health care –. Uganda's experience.

  12. Moral sensitivity in Primary Health Care nurses.

    Science.gov (United States)

    Nora, Carlise Rigon Dalla; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida M

    2017-04-01

    to characterize the profile and describe the moral sensitivity of primary health care nurses. this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis. the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning. the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.

  13. Flipping primary health care: A personal story.

    Science.gov (United States)

    Mate, Kedar S; Salinas, Gilbert

    2014-12-01

    There is considerable interest in ideas borrowed from education about "flipping the classroom" and how they might be applied to "flipping" aspects of health care to reach the Triple Aim of improved health outcomes, improved experience of care, and reduced costs. There are few real-life case studies of "flipping health care" in practice at the individual patient level. This article describes the experience of one of the authors as he experienced having to "flip" his primary health care. We describe seven inverted practices in his care, report outcomes of this experiment, describe the enabling factors, and derive lessons for patient-centered primary care redesign. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. La reestructuración de los recursos sanitarios dedicados a la salud ambiental en la Comunidad de Madrid (1989-1999 The restructuring of the health resources devoted to the environmental health in the Community of Madrid

    Directory of Open Access Journals (Sweden)

    M. I. Villoria Mendieta

    2001-06-01

    restructuring necessary in order to be able to answer the whole of the problems that worry the Public Health.This work tries to describe the model of Chemist and Veterinary Services restructuring carried out within the Community of Madrid, to analyze this model, and to propose a model of restructuring of this Services that can be a paradigm for thouse Communities that have not undertaken the same process yet.The methodology we have used is the analysis of the situation before and after the Chemist and Veterinary Services restructuring carried out by means of two different Orders of the Community of Madrid.“Partido” structures have become obsolete, so the restructuring of resources is a necessity. The approach of this restructuring must be done far from any corporativist tamptation and considerating the possibility of incorporating other professionals different from the traditional ones in view of the increasing complexity of the problems of Environmental Health.

  15. Occupational therapists in primary care health management

    Directory of Open Access Journals (Sweden)

    Paula Giovana Furlan

    2017-03-01

    Full Text Available Introduction: The expansion of the working field of occupational therapists in non-hospital environments and asylums in the last few decades, which came along with the territorial health practices in the National Health System, shows the relationship between the possibilities of professional performance and the existing public policies, including management functions and services. Objectives: To characterize the role of occupational therapists in the management of primary health care in the Distrito Federal and the professional knowledge used in this practice. Method: This was a qualitative research with production and analysis of data carried out through ethnography. Data were produced with aid of observations, field diary, semi-structured interviews and literature review. The study subjects were two occupational therapists from the State Secretariat of Health of the Distrito Federal who work in the management of primary health care. Results: The expansion of the concept of health has resulted in the incorporation of different professionals to compose the management of service and programs. The role of occupational therapists depends on their knowledge about management, collective projects and integral health care. Occupational therapists of this study work on central management and welfare programs to specific populations. Conclusion: The research made it possible to analyze the expansion of the working space of occupational therapists, contributing to future discussions on professional training. It was evident that the formation of the professional core provides subsidies for a larger management practice, such as skills for group and team work, and the work with socially excluded people.

  16. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

    Directory of Open Access Journals (Sweden)

    Christos Lionis

    2009-07-01

    Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

  17. Electric industry restructuring review

    Energy Technology Data Exchange (ETDEWEB)

    Slocum Hollis, S. [Duane Morris LLP, Washington, DC (United States)

    2004-07-01

    Restructuring of the electric power industry began in the early 1990's in many jurisdictions in the United States. Restructuring was an attempt to offer large industrial customers lower rates and freedom from regulation for generators and traditional public utilities. The move has gained most attention in the past two years as some utilities report high profits while others, such as Pacific Gas and Electric Co., the largest investor-owned utility in the United States, is in bankruptcy. The August 2003 blackout in the Midwest and Northeast United States and Canada also raised questions regarding electric reliability. The question now remains whether markets should be allowed to determine the need for services and the prices to be charged, and who is in charge in the imperfect market. The Federal Energy Regulatory Commission's (FERC) Order 2000 led to the formation of a Regional Transmission Organizations which is still in the implementation stage. Its influence on precursor Order numbers 888 and 889 were discussed in this paper with reference to independent system operators; regional transmission organizations; standard market design; rates and pricing devices; congestion management; market monitoring; market investigations; reliability measures; OASIS and other information access; interconnection policy; jurisdiction; mergers and merger policy; standards of conduct; policing affiliates; municipal utilities; stranded costs; and, state restructuring scorecards. refs.

  18. If they get sick, they are in trouble: health care restructuring, user charges, and equity in Vietnam.

    Science.gov (United States)

    Sepehri, Ardeshir; Chernomas, Robert; Akram-Lodhi, A Haroon

    2003-01-01

    The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnam's health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnam's near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnam's health system. Using Vietnam's most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnam's health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.

  19. Occupational Health Services Integrated in Primary Health Care in Iran.

    Science.gov (United States)

    Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio

    2015-01-01

    A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

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

    Directory of Open Access Journals (Sweden)

    Muthyala Pavana Sandhya

    2014-01-01

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

  1. Optimizing the Primary Prevention of Type-2 Diabetes in Primary Health Care

    Science.gov (United States)

    2017-08-18

    Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style

  2. Experience of Behvarzes (Iranian primary healthcare providers) from giving primary health services in health houses.

    Science.gov (United States)

    Keshvari, Mahrokh; Mohammadi, Eesa; Farajzadegan, Ziba; Zargham-Boroujeni, Ali

    2016-01-01

    Primary healthcare (PHC) providers play a major role in provision of public health in rural areas in Iran. They are considered as the key elements of health development in rural population. There is limited research on clarification of their experiences from provision of health services in their working conditions. This study aimed to clarify the experience of PHC providers from working conditions in giving primary health services in health houses (district branches of rural health care centers). This is a content analysis qualitative study, conducted through personal and group interviews with 12 health workers working in health care centers in rural areas in Isfahan province, 2010. Sampling continued until data saturation. Data were analyzed through conventional content analysis and constant comparative method. Data analysis led to extraction of 11 categories, and finally, four themes of "ignoring the rights," "causing tension in working climate," "pressure or overload of expectations beyond the power," and "occupational worn out" were yielded from the categories. These themes reveal the concepts and nature of PHC providers' experiences from giving health care at health houses as the first level of PHC centers. The results of the present study showed that the PHC providers work in a tense condition in health houses. Although they devote themselves to the health of society members, their own health is neglected. Policy makers and authorities should amend working conditions of PHC providers through modification of resources and making supportive and collaborative strategies to improve the quality of services and promote the health level of the service receivers.

  3. [Community health in primary health care teams: a management objective].

    Science.gov (United States)

    Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

    2016-12-01

    To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  4. Primary health care supervision in developing countries.

    Science.gov (United States)

    Bosch-Capblanch, Xavier; Garner, Paul

    2008-03-01

    To (a) summarise opinion about what supervision of primary health care is by those advocating it; (b) compare these features with reports describing supervision in practice; and (c) to appraise the evidence of the effects of sector performance. Systematic review. Reports were classified into three groups and summarised using appropriate methods: policy and opinion papers (narrative summary), descriptive studies (systematically summarised) and experimental or quasi-experimental studies (design and outcomes systematically summarised). Data presented as narrative summaries and tables. 74 reports were included. In eight policy and opinion papers, supervision was conceptualised as the link between the district and the peripheral health staff; it is important in performance and staff motivation; it often includes problem solving, reviewing records, and observing clinical practice; and is usually undertaken by visiting the supervisees place of work. In 54 descriptive studies, the setting was the primary health care (PHC) or specific services and programmes. Supervisor-supervisee dyads were generally district personnel supervising health facilities or lay health workers. Supervision mostly meant visiting supervisees, but also included meetings in the centre; it appeared to focus on administration and checking, sometimes with checklists. Problem solving, feedback and clinical supervision, training and consultation with the community were less commonly described in the descriptive studies. Supervision appears expensive from studies that have reported costs. In 12 quasi-experimental trials, supervision interventions generally showed small positive effects in some of the outcomes assessed. However, trial quality was mixed, and outcomes varied greatly between studies. Supervision is widely recommended, but is a complex intervention and implemented in different ways. There is some evidence of benefit on health care performance, but the studies are generally limited in the rigor

  5. Developing primary health care and public health competencies in ...

    African Journals Online (AJOL)

    Stephen E Knight

    community-based programme within the undergraduate medical curriculum, which aims to develop primary health care (PHC) ... Methods: A cohort of 183 students concluded Selectives in 2015, and thereafter 70 (38%) completed a routine online evaluation ... educational imperatives, namely improving medical students'.

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

    African Journals Online (AJOL)

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

  7. [Clinical bioethics for primary health care].

    Science.gov (United States)

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  8. Multidisciplinary teamwork in US primary health care.

    Science.gov (United States)

    Solheim, Karen; McElmurry, Beverly J; Kim, Mi Ja

    2007-08-01

    Primary health care (PHC) is a systems perspective for examining the provision of essential health care for all. A multidisciplinary collaborative approach to health care delivery is associated with effective delivery and care providers' enrichment. Yet data regarding multidisciplinary practice within PHC are limited. The purpose of this exploratory qualitative descriptive study was to better understand team-based PHC practice in the US. Aims included (a) describing nursing faculty involvement in PHC, (b) analyzing ways that multidisciplinary work was enacted, and (c) recommending strategies for multidisciplinary PHC practice. After institutional review board (IRB) protocol approval, data collection occurred by: (a) surveying faculty/staff in a Midwestern nursing college (N=94) about their PHC practice, and (b) interviewing a purposive sample of nursing faculty/staff identified with PHC (n=10) and their health professional collaborators (n=10). Survey results (28% return rate) were summarized, interview notes were transcribed, and a systematic process of content analysis applied. Study findings show team practice is valued because health issues are complex, requiring different types of expertise; and because teams foster comprehensive care and improved resource use. Mission, membership attributes, and leadership influence teamwork. Though PHC is not a common term, nurses and their collaborators readily associated their practice with a PHC ethos. PHC practice requires understanding community complexity and engaging with community, family, and individual viewpoints. Though supports exist for PHC in the US, participants identified discord between their view of population needs and the health care system. The following interpretations arise from this study: PHC does not explicitly frame health care activity in the US, though some practitioners are committed to its ethics; and, teamwork within PHC is associated with better health care and rewarding professional

  9. Insider Privatisation and Restructuring Incentives

    DEFF Research Database (Denmark)

    Schröder, Philipp

    2003-01-01

    In the literature on privatisation and restructuring it is a generally held belief that manager owned firms will be restructured more rigorously than worker owned companies. This gives the clear recommendation that property rights and control rights should be allocated to managers in the process o...

  10. Health is primary: Family medicine for America's health.

    Science.gov (United States)

    Phillips, Robert L; Pugno, Perry A; Saultz, John W; Tuggy, Michael L; Borkan, Jeffrey M; Hoekzema, Grant S; DeVoe, Jennifer E; Weida, Jane A; Peterson, Lars E; Hughes, Lauren S; Kruse, Jerry E; Puffer, James C

    2014-10-01

    More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to "renew the specialty to meet the needs of people and society," some of which bore important fruit. Family Medicine for America's Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). Family Medicine for America's Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support

  11. Health Is Primary: Family Medicine for America’s Health

    Science.gov (United States)

    Phillips, Robert L.; Pugno, Perry A.; Saultz, John W.; Tuggy, Michael L.; Borkan, Jeffrey M.; Hoekzema, Grant S.; DeVoe, Jennifer E.; Weida, Jane A.; Peterson, Lars E.; Hughes, Lauren S.; Kruse, Jerry E.; Puffer, James C.

    2014-01-01

    PURPOSE More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to “renew the specialty to meet the needs of people and society,” some of which bore important fruit. Family Medicine for America’s Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). METHODS Family Medicine for America’s Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. RESULTS The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of

  12. Operational integration in primary health care: patient encounters and workflows.

    Science.gov (United States)

    Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Markaki, Adelais; Kritikos, Kyriakos; Petelos, Elena; Lionis, Christos

    2017-11-29

    Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web

  13. Essential drugs in primary health centres of north central Nigeria ...

    African Journals Online (AJOL)

    To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. Checklist consisting ofminimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development ...

  14. HEALTH PROMOTION IN A PRIMARY HEALTH CARE SETTING

    OpenAIRE

    French, Simon D

    1997-01-01

    Primary care practitioners are ideally situated to carry out health promotion activities. Neural tube defects are of a fairly low incidence, but the consequences are tragic. They range from life long physical and often intellectual disabilities, to death at birth. Increased folate intake, either through eating folate rich foods or through supplementation, has been shown to reduce the incidence of neural tube defects in newborns by up to 75%. Encouraging all women of child-bearing age to incre...

  15. Pharmaceutical care in Brazil's primary health care.

    Science.gov (United States)

    Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

    2017-11-13

    To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were "pharmaceutical guidance" and "pharmaceutical care." The registration of activities is mainly made in the users' medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. Activities of clinical nature performed by pharmacists in Brazil are still incipient. The difficulties found point out

  16. Specialist public health capacity in England: working in the new primary care organizations.

    Science.gov (United States)

    Chapman, J; Shaw, S; Congdon, P; Carter, Y H; Abbott, S; Petchey, R

    2005-01-01

    To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.

  17. [Primary health care product defined by health professionals and users].

    Science.gov (United States)

    Pujol Ribera, Enriqueta; Gené Badia, Joan; Sans Corrales, Mireia; Sampietro-Colom, Laura; Pasarín Rua, María Isabel; Iglesias-Pérez, Begoña; Casajuana-Brunet, Josep; Escaramis-Babiano, Georgia

    2006-01-01

    To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.

  18. Primary health care in the Southern Mediterranean region.

    NARCIS (Netherlands)

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

    1998-01-01

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

  19. Managing Primary Health Care in the South - South Geo Political ...

    African Journals Online (AJOL)

    Management of Primary Health Care (PHC) is one of the main pillars of a health system through Human Resources. Furthermore, the quality of health services depends to a large extent on the people who manage the services. The paper reviews the role of stakeholders in the management of primary health service ...

  20. Enhancing Primary Health Care Services for Adults with Intellectual Disabilities

    Science.gov (United States)

    Melville, C. A.; Finlayson, J.; Cooper, S.-A.; Allan, L.; Robinson, N.; Burns, E.; Martin, G.; Morrison, J.

    2005-01-01

    Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training…

  1. Patient Satisfaction and Factor of Importance in Primary Health Care ...

    African Journals Online (AJOL)

    Dr Olaleye

    Patient Satisfaction and Factor of Importance in Primary. Health Care Services in Botswana. Abdullahi R. Bamidele, Muhammad E. Hoque, and Hendry Van der Heever. Department of Public Health, School of Health Care Sciences. University of Limpopo (Medunsa Campus), South Africa. ABSTRACT: Primary health care ...

  2. Primary health services at district level in South Africa: a critique of the primary health care approach.

    Science.gov (United States)

    Dookie, Sunitha; Singh, Shenuka

    2012-07-02

    The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa's progress and attempts at implementing primary health care, various factors still limit its success. Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied.There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.

  3. Primary health services at district level in South Africa: a critique of the primary health care approach

    Directory of Open Access Journals (Sweden)

    Dookie Sunitha

    2012-07-01

    Full Text Available Abstract Background The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa’s progress and attempts at implementing primary health care, various factors still limit its success. Discussion Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied. There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. Summary A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.

  4. [Comprehensive primary care and segmented health systems in South America].

    Science.gov (United States)

    Giovanella, Ligia; Almeida, Patty Fidelis de

    2017-10-02

    The article analyzes recent reforms in primary health care in the South American countries, discussing the scope and challenges for establishing comprehensive primary health care in the region's health systems. The data sources were case studies conducted in 12 countries, and the analytical lines were the strategic components in the design and implementation of primary health care: national policy approaches, characteristics of financing, organization and provision, and the workforce in primary health care. The crosscutting analysis from a comparative perspective provides an overview of primary health care in the region's countries and highlights convergences and asymmetries. A common trait is the recovery of the expanded definition of primary health care with family and community components, a territorial base, multidisciplinary team, incorporation of community health workers, and social participation. Implementation revealed heterogeneities in the advances and contradictions in the models. Insufficient supply of physicians, difficulties in provision and physician retention in remote and peripheral areas, as well as in primary health care itself, precarious employment relations, and absence of career plans are common problems, and there have been recent initiatives in government intervention to direct the workforce to the public system. Segmentation of the supply of primary health care converges with the segmentation of social protection in the various countries, through maintenance of social insurance or selective and targeted insurance or coverage by private health insurance, and persistent exclusion of populations from the right to health. The article argues that implementation of comprehensive primary health care is conditioned by the prevailing modalities of social protection in health.

  5. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach.

    Science.gov (United States)

    du Toit, Rènée; Faal, Hannah B; Etya'ale, Daniel; Wiafe, Boateng; Mason, Ingrid; Graham, Ronnie; Bush, Simon; Mathenge, Wanjiku; Courtright, Paul

    2013-03-18

    The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide

  6. Restructuring Teachers' Work

    Directory of Open Access Journals (Sweden)

    Lisa Kirtman

    2002-05-01

    Full Text Available Despite repeated attempts to reform schools, teachers' work has remained surprisingly stable. The purpose of this study was to investigate implementation of a state-funded restructuring initiative that intended broad changes in teachers' professional roles. Sponsors of the founding legislation reasoned that changes in teachers' roles would contribute to higher student achievement. This study examined the question of whether and how this program of comprehensive whole-school change promoted changes in teachers' roles in school governance, collegial relations, and the classroom. Further, the study traced the relationship of these changes to one another, and weighed the likelihood that they had the capacity to affect core educational practices. Theoretically, this study is situated in the available literature on teachers' collegial relations; participation in shared decision making; and classroom roles, relationships and practice. Three elementary schools served as the sites for intensive qualitative data collection completed over a two-year period. The schools differed in geographic location (two urban, one rural, but all enrolled a racially, ethnically and linguistically diverse population of students, and more than half of the students in each school qualified for free or reduced price lunch. The study resulted in multiple types and sources of data on teachers' professional roles, including: observations in classrooms, collegial interactions, and governance situations; interviews with teachers (including teacher leaders, parents, administrators, and students; and documents pertaining to the restructuring plans and process. Findings show that changes in the three areas were achieved unevenly in the three schools. All three schools introduced changes in classroom practice and roles, ranging from the adoption of multi-age classrooms to more modest innovations in curriculum or instruction. In only one case were changes in professional roles outside

  7. Elaboration and acceptability of restructured hams added with jabuticaba skin

    Directory of Open Access Journals (Sweden)

    Ana Paula de Carvalho ALVES

    Full Text Available Abstract Jabuticaba skin flour (JSF, rich in antioxidants and fibre, was used in order to develop four restructured hams in different combinations with meat: 0% control – without the addition of JSF, with the addition of 0.5% JSF, 1.0% JSF and 1.5% JSF, meeting, therefore, the growing demand for meat products with functional appeal. Physicochemical characterizations and sensory analysis were performed, evaluating the impact of information on possible health benefits and the effect on storage. Restructured hams with JSF had higher contents of phenolic compounds; greater weight loss; a darker shade; texture profile with smaller parameters of stiffness, cohesiveness, adhesiveness, flexibility and chewiness (except the restructured ham with 0.5% JSF. Phenolic compounds, pH values, colour and TBARs did not differ with storage time, but were statistically different among JSF concentrations. Panellists preferred the restructured ham without JSF, however, the analysis of variance for overall aspect did not show a significant difference between the restructured ham “control” and those added with 0.5% and 1.0% JSF, after informing the panellists that they would possibly bring health benefits. It is concluded that it is possible to prepare and store restructured hams with JSF, at concentrations of 0.5% and 1.0% with good acceptance.

  8. Leadership for primary health care research.

    Science.gov (United States)

    Pendleton, David

    2012-10-01

    Over the last decade, I have put together a new theory of leadership. This paper describes its four propositions, which are consistent with the research literature but which lead to conclusions that are not commonly held and seldom put into practice. The first proposition is a model describing the territory of leadership that is different from either the Leadership Qualities Framework, 2006 or the Medical Leadership Competency Framework, 2010, both of which have been devised specifically for the NHS (National Health Service). The second proposition concerns the ill-advised attempt of individuals to become expert in all aspects of leadership: complete in themselves. The third suggests how personality and capability are related. The fourth embraces and recommends the notion of complementary differences among leaders. As the NHS seeks increasing leadership effectiveness, these propositions may need to be considered and their implications woven into the fabric of NHS leader selection and development. Primary Health Care research, like all fields of collective human endeavour, is eminently in need of sound leadership and the same principles that facilitate sound leadership in other fields is likely to be relevant to research teams.

  9. 78 FR 38718 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Science.gov (United States)

    2013-06-27

    ... HUMAN SERVICES Health Resources and Services Administration Lists of Designated Primary Medical Care... geographic areas, population groups, and facilities designated as primary medical care, mental health, and... (primary medical care, dental, psychiatric, vision care, podiatric, pharmacy, and veterinary care). The...

  10. The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway.

    Science.gov (United States)

    Tingvoll, Wivi-Ann; Sæterstrand, Torill; McClusky, Leon Mendel

    2016-01-01

    The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality's market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPM-inspired municipal executive leadership. This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation. Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality's hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership. The priorities of municipal senior management and the focus of the municipality's care service need clarification in the light of this reform. The voices

  11. 76 FR 68198 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Science.gov (United States)

    2011-11-03

    ... Administration Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage... designated as primary medical care, mental health, and dental health professional shortage areas (HPSAs) as... seven health professional types (primary medical care, dental, psychiatric, vision care, podiatric...

  12. Toward More Equitable Primary Health Care in Argentina and Latin ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Improving primary health care for everyone requires an effort that extends beyond the formal health sector. This project will examine the value of intersectoral collaborations at the primary healthcare level to generate practical guidance and a theoretical understanding of how these arrangements can influence health equity ...

  13. Implementation of primary health care - package or process ...

    African Journals Online (AJOL)

    After establishing the commitment of the government to comprehensive primary health care (PHC), the Department of Health and provinces are now faced with the challenge of implementation. An important response has come with the recent proposed'core package of primary health care services'.' After consultation with ...

  14. Evaluation of school health instruction in public primary schools in ...

    African Journals Online (AJOL)

    Background: Effective school health instruction in primary schools is essential in addressing the health risks and needs of school age children and adolescents. This study sought to evaluate the status of school health instruction in public primary schools in Bonny Local Government Area. Method: This is a cross sectional ...

  15. Do all types of restructuring threaten employees’ well-being? An exploratory study

    Directory of Open Access Journals (Sweden)

    Maria Widerszal-Bazyl

    2015-08-01

    Full Text Available Objectives: Most research on the negative impact of restructuring on employees’ health considers restructuring involving personnel reduction. The aim of this study was to explore the assumption that the type of restructuring, business expansion versus restructuring not involving expansion (only reductions and/or change of ownership, influences its psychological responses: appraisal of the change, psychosocial working conditions and well-being after the change. Material and Methods: The study was carried out among 857 employees that experienced restructuring in 2009 and/or 2010 and 538 employees from companies not restructured at that time. The main variables, i.e., assessment of change in terms of personal benefits and losses, psychosocial job characteristics and well-being were measured using a questionnaire developed in “The psychological health and well-being in restructuring: key effects and mechanisms” project (PSYRES. Results: It was found that the employees who experienced business expansion in comparison to those who experienced exclusively change of ownership had a higher appraisal of change, while those who experienced restructuring not involving business expansion did not differ from those who experienced change of ownership. As far as psychosocial working conditions are concerned, those employees who experienced exclusively business expansion did not differ from those in the not restructured companies (except for quantitative demands that were higher, while most psychosocial working conditions of the employees who experienced restructuring not involving expansion were poorer than in the not restructured companies. Also, well-being measures of the employees who experienced exclusively business expansion did not differ from those in the not restructured companies (except for innovative behavior that was even higher, while well-being measure of those who experienced restructuring not involving expansion was poorer than of those in

  16. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-08-01

    The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

  17. Primary health care in Canada: systems in motion.

    Science.gov (United States)

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

    2011-06-01

    During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

  18. Integrating mental health in primary healthcare in low-income countries: changing the future for people with mental disorders.

    Science.gov (United States)

    Sørensen, Carina Winkler; Bæk, Ole; Kallestrup, Per; Carlsson, Jessica

    2017-02-01

    Untreated mental disorders are a huge challenge for healthcare systems worldwide. Treatment possibilities are particularly scarce in low-income countries (LICs). WHO estimates that up to 85% of all people with a mental disorder in LICs do not have access to evidence-based treatment. This paper seeks to explore the rationale behind the WHO recommendations for improving mental health services in LICs. At the core of these recommendations is an integration of mental health services into existing primary healthcare. This article presents available research supporting this approach. Furthermore, it highlights challenges needing special attention and opportunities demanding additional research to guide a comprehensive restructuring of a healthcare system. A literature review of WHO documents and searches on PubMed for relevant supporting literature. Research from LICs that investigate mental health interventions is scarce. The evidence that does exist favours integration into primary healthcare. There is evidence that collaborative- and stepped-care interventions can provide viable treatment options for patients. Integration of mental health services into primary healthcare seems like a viable solution to ensure that treatment becomes more available, even though the evidence is limited. Locally conducted research is needed to guide the development of sustainable evidence-based mental health treatment, involving relevant healthcare providers, with optimal task-sharing and possibilities for referral of complex cases. Furthermore, to achieve this, comprehensive political will and investments are necessary pre-requisites.

  19. [The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care].

    Science.gov (United States)

    Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa

    2017-06-01

    In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.

  20. Integration of Mental Health into Primary Health Care in a rural ...

    African Journals Online (AJOL)

    Objective: Mental health has been identified as a major priority in the Ugandan Health Sector Strategic Plan. Efforts are currently underway to integrate mental health services into the Primary Health Care system. In this study, we report aspects of the integration of mental health into primary health care in one rural district in ...

  1. Health profiles of foreigners attending primary care clinics in Malaysia

    National Research Council Canada - National Science Library

    Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

    2016-01-01

    .... Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia...

  2. Factors shaping intersectoral action in primary health care services.

    Science.gov (United States)

    Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

    2014-12-01

    To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

  3. 77 FR 38838 - Lists of Designated Primary Medical Care, Mental Health, and Dental Health Professional Shortage...

    Science.gov (United States)

    2012-06-29

    ... HUMAN SERVICES Health Resources and Services Administration Lists of Designated Primary Medical Care... primary medical care, mental health, and dental health professional shortage areas (HPSAs) as of April 1.... Criteria then were defined for each of seven health professional types (primary medical care, dental...

  4. Ophthalmic Skills Assessment of Primary Health Care Workers at ...

    African Journals Online (AJOL)

    Primary eye care is at the frontline in the elimina on of the avoidable causes of blindness. Proficiency in the basic ophthalmic skills is a cri cal factor in the effec ve delivery of eye care services at the primary level of care. The aim of the study was to assess the ability of the primary health care workers to provide basic.

  5. Primary Health Care That Works: The Costa Rican Experience.

    Science.gov (United States)

    Pesec, Madeline; Ratcliffe, Hannah L; Karlage, Ami; Hirschhorn, Lisa R; Gawande, Atul; Bitton, Asaf

    2017-03-01

    Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Baseline survey of oral health of primary and secondary school ...

    African Journals Online (AJOL)

    Background: Among the issues that determine the performance of a child at school is health. In recognition of this, the Uganda government has embarked on a school health program for the success of universal primary education. Although dental health is an important component of school health there is little information on ...

  7. Primary health eye care knowledge among general practitioners ...

    African Journals Online (AJOL)

    2010-05-10

    May 10, 2010 ... Original Research: Primary health eye care knowledge among general practitioners. 52. Vol 53 No 1. S Afr Fam Pract ... Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems, presumably due to a ... hours after welding, with no visible foreign body on the cornea.

  8. Abstract: Promotion of Primary Health Care Philosophy in a ...

    African Journals Online (AJOL)

    Abstract. Background Community-based education (CBE) serves as a primordial instrument in the implementation of Primary Health Care (PHC). Learning experiences in community-based settings provide the students with opportunities to learn by means of being actively engaged in primary health care associated ...

  9. Burnout syndrome among physicians working in primary health care ...

    African Journals Online (AJOL)

    Objective: The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods: The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health ...

  10. Utilization of primary health care facilities: Lessons from a rural ...

    African Journals Online (AJOL)

    Utilization of primary health care facilities: Lessons from a rural community in southwest Nigeria. ... Nigerian Journal of Medicine ... Background: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria.

  11. Health Careers Education for Rural Primary Schoolchildren

    Science.gov (United States)

    Gorton, Susan M.

    2011-01-01

    International and national studies have reported that health professionals who grew up in a rural area are more likely to return to work in a rural area than their urban raised counterparts. The chronic severe shortage of health professionals in rural and remote Australia has meant inequitable health care for rural and remote communities and a…

  12. 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

  13. Innovation in nursing health care practice: expansion of access in primary health care.

    Science.gov (United States)

    Lowen, Ingrid Margareth Voth; Peres, Aida Maris; Ros, Carla da; Poli, Paulo; Faoro, Nilza Teresinha

    2017-01-01

    analyze the reorganization of the health care practice of nurses as an innovative strategy for expansion of access in primary care. qualitative and quantitative study, which interviewed 32 management and care nurses and collected documentary data from public reports of production of nursing consultations from 2010 to 2014, in a municipality in southern Brazil. Data processing for textual analysis was performed by IRAMUTEQ software; for simple descriptive statistical analysis, the program Excel 2013 was used. in the innovative care practice  class, associated with awareness of change, related to implementation of the FHS, its challenges and advantages, the following subclasses were identified: reorganization of schedules, nursing consultation, physical restructuring of BHUs, and shared consultation. the need to expand access to and valorization of care practice encourages the development of innovative strategies. The protagonism of care needs to be discussed in the various spaces so that each professional carry out the respective role with competence and efficacy. analisar a reorganização da prática assistencial do enfermeiro como estratégia inovadora para ampliação do acesso na atenção primária. estudo qualiquantitativo, tendo sido entrevistados 32 enfermeiros gerenciais e assistenciais e coletados dados documentais de relatórios públicos de produção de consultas dos enfermeiros de 2010 a 2014, num município sul-brasileiro. O processamento dos dados para análise textual foi realizado pelo software IRAMUTEQ; para análise estatística descritiva simples, o programa Excel 2013. na classe prática assistencial inovadora, associada à sensibilização para a mudança, relacionada à implantação da ESF, seus desafios e fortalezas, foram identificadas as subclasses: reorganização das agendas, consulta do enfermeiro, reestruturação física das UBS e consulta compartilhada. a necessidade de ampliar o acesso e valorização da prática assistencial

  14. Health Literacy in Primary Care Practice.

    Science.gov (United States)

    Hersh, Lauren; Salzman, Brooke; Snyderman, Danielle

    2015-07-15

    Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information.

  15. Restructuring of the electricity industry and environmental issues: a California research program

    National Research Council Canada - National Science Library

    Vine, E L

    2001-01-01

    As part of the restructuring of the electricity industry in many states, public benefits funding has emerged as a primary mechanism for supporting social benefits such as energy efficiency and research and development (RD...

  16. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in two districts of ...

  17. Primary health care in Somalian refugee camps.

    Science.gov (United States)

    Johnston, B

    1982-01-01

    The convergence of thousands in Somalia's refugee camps has created an emergency in health care provision. To tackle this problem, the Ministry of Health, in conjunction with UNICEF, recruited a small group of Somali professionals to draw up a plan for the training of community health workers to serve in the camps. A 2nd objective was to make an assessment of the nutritional status of the refugees, and provision of maternal and child health care. At the end of a 2 week workshop a plan was drawn up which emphasized the teaching of preventive medicine, particularly in the control of communicable diseases. It was decided that students in the postbasic training program in administration and teaching in the health service would serve as teachers. Teaching was kept basic and simple, mostly concentrating on topics related to hygiene and food preparation, for example. During program implementation inspection visits were carried out at intervals by a health educator and tutor from the nursing school. At the same time further briefing was given to as many concerned people in the camps as possible. Preliminary feedback suggested that the program was proceeding successfully. After 3 months an evaluation was carried out by teachers in the program. The evaluation showed a great deal to have been accomplished in spite of the disinterest of some parts of the population. The success was attributed to the involvement of Somalis in the camp communities. As of September 1981, the pace of the programs has increased, with the inclusion of health services from expatriate sources within Ministry of Health guidelines.

  18. Costing health care interventions at primary health facilities in ...

    African Journals Online (AJOL)

    The main objective was to estimate sector wide disease specific cost of health care intervention at health ... [Afr J. Health Sci. 2002; 9: 69-79]. Introduction interest in the costs of health care interventions derives from the desire to undertake economic evaluation that are input in health .... accounting procedure. It is based on ...

  19. Emergent themes in the sustainability of primary health care innovation.

    Science.gov (United States)

    Sibthorpe, Beverly M; Glasgow, Nicholas J; Wells, Robert W

    2005-11-21

    A synthesis of the findings of the five studies of sustainability of primary health care innovation across six domains (political, institutional, financial, economic, client and workforce) yielded three main themes. These were: the importance of social relationships, networks and champions; the effect of political, financial and societal forces; and the motivation and capacity of agents within the system. The need for routine assessment of the sustainability of primary health care innovations is discussed. Given the dearth of literature on the sustainability of primary health care innovation, there is potential to develop a program of research directed towards a future synthesis of evidence.

  20. Where does practice nursing fit in primary health care?

    Science.gov (United States)

    Annells, Merilyn

    2007-08-01

    Practice nursing is an integral and growing part of primary health care internationally and increasingly within the Australian health care system. The potential for practice nursing being considered as a specialty of community nursing, boundary issues in community nursing, and defining characteristics of practice nursing as a model of community-based nursing are discussed in this paper. As the author has worked as a practice nurse, personal reflections on the evolving practice nurse role are provided. Practice nursing is a dynamic entity and will continue to evolve in the primary health care setting. In order for practice nursing to meet the primary health care agenda, there is a need to incorporate a social model of health with the medical model of health and to promote research and scholarship to support this goal.

  1. Primary health care staff's perception of childhood tuberculosis

    DEFF Research Database (Denmark)

    Bjerrum, Stephanie; Rose, Michala Vaaben; Bygbjerg, Ib Christian

    2012-01-01

    Background: Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study...... explored primary health care staff’s perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania. Methods: We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health...... staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis. Results: Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely...

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

    Science.gov (United States)

    Petersen, Poul Erik

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  4. Restructuring nuclear regulations.

    OpenAIRE

    Mossman, Kenneth L

    2003-01-01

    Nuclear regulations are a subset of social regulations (laws to control activities that may negatively impact the environment, health, and safety) that concern control of ionizing radiation from radiation-producing equipment and from radioactive materials. The impressive safety record among nuclear technologies is due, in no small part, to the work of radiation safety professionals and to a protection system that has kept pace with the rapid technologic advancements in electric power generati...

  5. Telepaediatrics, primary health care and developing countries

    African Journals Online (AJOL)

    paediatric wards, and an existing paediatric neuro-oncology service in Jordan.8 ... of practitioners', 'which should benefit future patients'.10. Telemedicine can aid ... Telemedicine Platform, Medical Research Council, Cape Town, and School of Child and Adolescent Health, University of Cape Town. Jill Fortuin, MSc.

  6. Primary Health Care and Child Spacing

    African Journals Online (AJOL)

    Child spacing services are often introduced as a. "vertical" programme, but ideally these services should become ... It is important in planning a programme to find out first if this is a "felt need" of the community. Although it is ... vators at each of the 10 integrated family health clinic areas that have already functioning Village.

  7. PRIMARY HEALTH CARE, SELECTIVE OR COMPREHENSIVE ...

    African Journals Online (AJOL)

    hi-tech

    2003-01-01

    Jan 1, 2003 ... various developing countries such as China, Cuba,. Tanzania and Guatemala. China mobilized its people at community level against endemic diseases, and through these “barefoot ... The developing world cannot afford the luxury of vertical programs. Health personnel need to be able to appropriately ...

  8. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal provinces, South Africa.

  9. Providing Perinatal Mental Health Services in Pediatric Primary Care

    Science.gov (United States)

    Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

    2009-01-01

    After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

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

    African Journals Online (AJOL)

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

  11. Medication error in mental health: implications for primary care

    OpenAIRE

    Maidment, Ian D; Parmentier, Henk

    2009-01-01

    Medication errors are associated with significant morbidity and people with mental health problems may be particularly susceptible to medication errors due to various factors. Primary care has a key role in improving medication safety in this vulnerable population. The complexity of services, involving primary and secondary care and social services, and potential training issues may increase ...

  12. [Primary health care: challenges for implementation in Latin America].

    Science.gov (United States)

    Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo

    2013-01-01

    A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  13. Prenatal Care for Adolescents and attributes of Primary Health Care

    Directory of Open Access Journals (Sweden)

    Maria Cristina Barbaro

    2014-01-01

    Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.

  14. [Analysis of conditions for the diagnosis of rheumatic diseases in primary health care in the city of Sorocaba-SP].

    Science.gov (United States)

    Chiereghin, Adriano; Martinez, José Eduardo

    2015-01-01

    The study had as main goal to define the profile of the attending professional working at the primary healthcare sector in the city of Sorocaba, and to analyze the environment in which this professional is inserted, trying to identify if there are conditions for the care of low-complexity rheumatic diseases and possible reasons that would lead to a high degree of referral to specialists. A quantitative study was performed in which physicians of primary health care were invited to answer a questionnaire that addressed personal aspects, besides the technical aspects of four rheumatic diseases: osteoarthritis, gout, fibromyalgia and osteoporosis, which served as the basis for evaluating the care for low-complexity diseases in UBSs. It was observed that the professional is part integral of an organizational system that hinders his/her performance; moreover, certain personal difficulty techniques were realized. Together, these conditions turned out to be the factors that determine a quality of care that falls short of that expected. There must be a review of how medical education is offered, in order to seek a more qualified training, focused on the basic needs of the health system, as well as a restructuring of the entire health system in terms of its organization and management, in order to attain a suitable condition for the development of a good medical practice, and thus, for providing a good service to the community. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  15. Integrating mental health into primary health care – Uganda's ...

    African Journals Online (AJOL)

    Most developing countries and indeed many African countries have been undertaking reforms of the mental health policies and strategies to improve access and equity for the community to mental health and psychiatric services. This has been in conformity with a health policy philosophy which emphasize decentralization ...

  16. Integrating mental health into primary health care – Uganda's ...

    African Journals Online (AJOL)

    Adele

    This has been a vital activity in the implementation of the programme to equip district health workers with update knowledge and skills to handle mental health care as planned. There has been massive training and re-training of district health workers. Equally urgent, was the need to review general nurses and clinical ...

  17. Primary care in Minnesota: an academic health center's perspective.

    Science.gov (United States)

    Brooks, Kathleen D; Cieslak, Jennifer E; Radcliffe, Peter M; Sjogren, Kaia

    2008-05-01

    Although Minnesota's overall supply of primary care physicians is as good as or better than that of many other states, Minnesotans in some rural and urban communities do not have ready access to primary care. Simply training more doctors using the current model is not a viable solution to this problem. In order to increase the supply of primary care physicians, the state, its educational institutions, and its health care provider organizations will need to develop new educational opportunities, explore new models of care, and create viable systems for health care delivery for all Minnesotans. This article describes the current status of primary care in the state and ideas for addressing anticipated workforce shortages and enhancin the vitality of primary care.

  18. Information requested about organ donation in primary health care centers.

    Science.gov (United States)

    Ríos, A; Conesa, C; Ramírez, P; Sánchez, J; Sánchez, E; Ramos, F; Parrilla, P

    2006-10-01

    Information provided by primary care workers about organ donation significantly affects the attitude of the general public. The objective of this study was to evaluate information about donation requested by the general public in health centers in an autonomous community (region) of Spain and to find out how many workers provided relevant information. A random sample was taken and stratified by sex, job category, and geographical location (six health areas of our autonomous regional community, 45 municipal councils), among primary care health workers in order to obtain a total of 428 respondents in 34 primary care centers. A study was undertaken of information requested and provided about organ donation and transplantation. The chi square test was applied and differences were considered significant at levels of P organ donation and transplantation. This request for information was much greater from physicians than from the other types of workers (P = .015). Furthermore, 54% of primary care health workers (n=229) reported having provided information about donation, especially physicians (64%), with this being mainly favorable. Information had also been provided by nurses (59%) and ancillary staff (34%). Information requested from primary care health workers by the general public about organ donation and transplantation is increasing when we compare it to data from previous years. Around half of primary care workers have offered information about transplantation. Therefore, it is fundamental that these workers have adequate and correct information to provide patients and families.

  19. Journal of Community Medicine and Primary Health Care - Vol 26 ...

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... Disasters in Nigeria: A Public Health Perspective · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT ... Awareness of Breast Cancer and Practice of Breast Self-Examination among Rural Women in Ife-North Local Government Area, Osun State, South-West ...

  20. Promotion of Primary Health Care Philosophy in a Community ...

    African Journals Online (AJOL)

    2, 2015. Promotion of Primary Health Care Philosophy in a Community-Based Nursing. Education Program: Students' Perspective. Innocent Ndateba1, Mtshali Fikile2. 1Rwamagana, School of Nursing and Midwifery, Rwanda. 2University of KwaZulu-Natal, School of Nursing and Public Health, South Africa. Background.

  1. Barriers for administering primary health care services to battered ...

    African Journals Online (AJOL)

    Background: Violence against women is an important public-health problem that draws attention of a wide spectrum of clinicians. However, multiple barriers undermine the efforts of primary health care workers to properly manage and deal with battered women. Objectives: The aim of the present study was to reveal barriers ...

  2. The motivational needs of primary health care nurses to acquire ...

    African Journals Online (AJOL)

    Karien Jooste

    links with goal 3 of the sustainable development goals that focus on ensuring healthy lives and promoting well-being at ... among Primary Health Care (PHC) nurses could have a negative effect on the achievement of high standards in health ... The accessible population in this study was PHC nurses. (N ¼ 30) working at 13 ...

  3. Strategies Utilized by Professional Nurses in the Primary Health ...

    African Journals Online (AJOL)

    Information and education, health worker and adherence guidelines, use of adherence partner or treatment buddy, addressing religious beliefs, communication skills, community mobilization and continuous counselling were the strategies that were utilized by professional nurses in the primary health care facilities to ...

  4. Priorities for health services research in primary care.

    NARCIS (Netherlands)

    Schäfer, W.; Groenewegen, P.P.; Hansen, J.; Black, N.

    2011-01-01

    Background: All European health systems face several common challenges related to increases in lifestyle and chronic diseases, a decreasing future workforce, inequalities in health and the consequences of societal changes. Primary care, which has the potential to help meet these challenges, would

  5. Motivation for primary health care in Machinga district

    African Journals Online (AJOL)

    Chancellor College proved to be fruitful for all parties concerned, villagers, PHC workers and students. Health through theatre for development. This article describes work which has taken place in Liwonde recently in using theatre for. Primary Health Care education. Malawi's. P.H.C. problems are so pressing that theatre.

  6. Strengthening Primary Health Care and Social Protection: Universal ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Strengthening Primary Health Care and Social Protection: Universal Coverage in Pakistan through Heartfile Health Financing. One of the poorest countries ... Renforcement des soins de santé primaires et de la protection sociale : couverture universelle au Pakistan grâce au modèle de Heartfile. Depuis dix ans, le Pakistan, ...

  7. Attitude of Primary Health Care Nurses in Kuwait Towards Domestic ...

    African Journals Online (AJOL)

    Background: Domestic violence against women is an important public health problem. Battered women attend primary health care centers seeking for both medical treatment and support. Nurses with a positive attitude play a key role to deal with victimized women. Objectives: The current study was formulated to reveal ...

  8. Comparison of Attitude of Primary Health Care Physicians and ...

    African Journals Online (AJOL)

    Background: Domestic violence (DV) against women has increased during the past few years and became an important public health problem. Personal values and beliefs of primary health care workers can affect both diagnostic and management procedures adopted to deal with battered women. Objectives: The current ...

  9. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    DR Marwa

    Conclusion: Prescribing of higher number of drugs than the WHO recommendations and overuse of antibiotics is still a problem at health care facilities in Mwanza Tanzania. The frequency of occurrence of prescription errors found during the study was considerably high. Keywords: drug prescription, primary health care ...

  10. Toward More Equitable Primary Health Care in Argentina and Latin ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Findings will be integrated into course curricula for a master's in health systems and services management and a certificate in intersectoral primary health care ... in the developing world continue to face obstacles that limit their ability to establish careers and become leaders in the fields of science, technology, engineering, ...

  11. Legal limitations for nurse prescribers in Primary Health Care

    Directory of Open Access Journals (Sweden)

    N. Geyer

    1998-09-01

    Full Text Available The nurse plays an important role in the delivery of primary health care services in South Africa. The primary purpose is to provide the public with access to safe competent basic health care and to achieve this, the nurse should be empowered to practice within legal and ethical boundaries. This paper explores and describes the limitations imposed by legislation on the nurse’s ability to prescribe treatment in the primary health care field. The focus is mainly on the Nursing Act, the Pharmacy Act and the Medicines and Related Substances Control Act which highlights a number of limitations. It is concluded that empowerment of the nurse should not only include addressing the legal boundaries for practice, but also education and training opportunities to equip them with the expert knowledge and skills that they need to render a quality health care service.

  12. Primary prevention in public health: an analysis of basic assumptions.

    Science.gov (United States)

    Ratcliffe, J; Wallack, L

    1985-01-01

    The common definition of primary prevention is straightforward; but how it is transformed into a framework to guide action is based on personal and societal feelings and beliefs about the basis for social organization. This article focuses on the two contending primary prevention strategies of health promotion and health protection. The contention between the two strategies stems from a basic disagreement about disease causality in modern society. Health promotion is based on the "lifestyle" theory of disease causality, which sees individual health status linked ultimately to personal decisions about diet, stress, and drug habits. Primary prevention, from this perspective, entails persuading individuals to forgo their risk-taking, self-destructive behavior. Health protection, on the other hand, is based on the "social-structural" theory of disease causality. This theory sees the health status of populations linked ultimately to the unequal distribution of social resources, industrial pollution, occupational stress, and "anti-health promotion" marketing practices. Primary prevention, from this perspective, requires changing existing social and, particularly, economic policies and structures. In order to provide a basis for choosing between these contending strategies, the demonstrated (i.e., past) impact of each strategy on the health of the public is examined. Two conclusions are drawn. First, the health promotion strategy shows little potential for improving the public health, because it systematically ignores the risk-imposing, other-destructive behavior of influential actors (policy-makers and institutions) in society. And second, effective primary prevention efforts entail an "upstream" approach that results in far-reaching sociopolitical and economic change.

  13. Process engineering for primary care: Quality improvement and population health

    Directory of Open Access Journals (Sweden)

    William Riley

    2016-05-01

    Full Text Available A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery system. For example, the United States commits nearly 18% of its GDP to the health care delivery system, the largest amount of any nation, yet is 37th in achieving health or health care delivery metrics. This article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement methods. The article shows examples of how the cause-and-effect diagram, the process map, and the plan, do, study, act (PDSA cycle are important techniques to assist primary care practitioners for improving population health.

  14. Observations on primary health care in Ontario, Canada.

    OpenAIRE

    Rimmer, E M

    1990-01-01

    The Canadian health care system has developed very differently from that of its neighbour, the United States of America. It has a publicly financed and administered universal insurance plan which provides good access to high quality medicine, free at the point of delivery. Increasing costs, however, mean that painful political decisions on health will have to be made. Experiments with alternative means of financing primary health care provision and the Canadian approach to postgraduate educat...

  15. Costing health care interventions at primary health facilities in ...

    African Journals Online (AJOL)

    The main objective was to estimate sector wide disease specific cost of health care intervention at health facilities in Nouna, Burkina Faso. A step-down full costing procedure was used to estimate the costs of interventions for 33 ICD-9 diseases using the diagnosis and treatment algorithms developed by the Ministry of ...

  16. Developing primary health care and public health competencies in ...

    African Journals Online (AJOL)

    Stephen E Knight

    (Figure 1), so that millennial graduates are skilled clinicians able to provide professional and ethical health care that is needed by the whole population.3. These core competencies are consistent with three other global educational imperatives, namely improving medical students' understanding of a population health ...

  17. Humanization policy in primary health care: a systematic review

    Science.gov (United States)

    Nora, Carlise Rigon Dalla; Junges, José Roque

    2013-01-01

    OBJECTIVE To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy. METHODS A systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis. RESULTS Among the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users. CONCLUSIONS Although many practices were cited as humanizing they do not produce changes

  18. [Humanization policy in primary health care: a systematic review].

    Science.gov (United States)

    Nora, Carlise Rigon Dalla; Junges, Jose Roque

    2013-12-01

    To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy. A systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis. Among the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users. Although many practices were cited as humanizing they do not produce changes in the health services because of the

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

    NARCIS (Netherlands)

    Huijg, Johanna Maria

    2014-01-01

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

  20. [Study of primary care health needs through family health diagnosis].

    Science.gov (United States)

    Torres-Arreola, Laura Pilar; Vladislavovna Doubova, Svetlana; Reyes-Morales, Hortensia; Villa-Barragán, Juan Pablo; Constantino-Casas, Patricia; Pérez-Cuevas, Ricardo

    2006-10-31

    To assess the health needs of the eligible public population of the Mexican Institute of Social Security (IMSS). Observational, descriptive, transversal study. Family Medicine Unit number 8 of the IMSS, in the city of Tlaxcala, Mexico. A sample of 1200 families using multi-stage sampling, between October 1999 and March 2000. The designed and validated questionnaire on "Family health diagnosis" was used. A 19.2% of the families had a very low socio-economic level, and 14.9% of subjects were not entitled to Social Security. Functional illiteracy in at least one member was found in 12.6% of the families. According to the family Apgar, 93% of families were functional and two-thirds of the families were classified as nuclear. About 51.1% and 36.9% of women used programs for detection of cervical/uterine and breast cancer, respectively. Only 25% of the adult population underwent the detection tests for diabetes mellitus and hypertension and 10.9% had a chronic disease. 56.4% of families considered the quality of health care good, and only 18.13% were satisfied with the care received. Identification of health needs through diagnosis of family health is useful as a basis for establishing a hierarchy of problems as well as for developing health programs that may facilitate greater equity in attention.

  1. Primary Care-Mental Health Integration in the VA: Shifting Mental Health Services for Common Mental Illnesses to Primary Care.

    Science.gov (United States)

    Leung, Lucinda B; Yoon, Jean; Escarce, José J; Post, Edward P; Wells, Kenneth B; Sugar, Catherine A; Yano, Elizabeth M; Rubenstein, Lisa V

    2017-12-15

    Primary care-mental health integration (PC-MHI) aims to increase access to general mental health specialty (MHS) care for primary care patients thereby decreasing referrals to non-primary care-based MHS services. It remains unclear whether new patterns of usage of MHS services reflect good mental health care. This study examined the relationship between primary care clinic engagement in PC-MHI and use of different MHS services. This was a retrospective longitudinal cohort study of 66,638 primary care patients with mental illnesses in 29 Southern California Veterans Affairs clinics (2008-2013). Regression models used clinic PC-MHI engagement (proportion of all primary care clinic patients who received PC-MHI services) to predict relative rates of general MHS visits and more specialized MHS visits (for example, visits for serious mental illness services), after adjustment for year and clinic fixed effects, other clinic interventions, and patient characteristics. Patients were commonly diagnosed as having depression (35%), anxiety (36%), and posttraumatic stress disorder (22%). For every 1 percentage point increase in a clinic's PC-MHI engagement rate, patients at the clinic had 1.2% fewer general MHS visits per year (pPrimary care clinics with greater engagement in PC-MHI showed reduced general MHS use rates, particularly for patients with depression, without accompanying reductions in use of more specialized MHS services.

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

    Science.gov (United States)

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

    2013-09-30

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

  3. Developing tomorrow's integrated community health systems: a leadership challenge for public health and primary care.

    Science.gov (United States)

    Welton, W E; Kantner, T A; Katz, S M

    1997-01-01

    As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health.

  4. Economic-efficiency considerations in restructuring electric markets

    Energy Technology Data Exchange (ETDEWEB)

    Hill, L.J.

    1996-12-01

    In response to the Energy Policy Act of 1992 and the Federal Energy Regulatory Commission`s subsequent rulemaking on transmission access, many states are exploring options to restructure their electric industries. In their deliberations on restructuring, policymakers should consider (1) the reliability of the electric system; (2) income-distribution effects on ratepayers and utilities; (3) social consequences such as effects on energy conservation, renewable energy, and the environment; and (4) economic efficiency. We address economic-efficiency considerations in this study. Economic efficiency is important because it is one of the primary reasons that policymakers should consider restructuring in the first place: improving the electric-industry`s efficiency lowers costs and, hence, electric prices. In this study, we look at the sources of (in)efficiency in existing and proposed electric markets with the objective of guiding policymakers to design efficient electric markets. The advantages of a competitive market are well known: it leads to lower costs for the utility, lower prices for consumers, more product choices, better customer service, and often the need for less regulation by federal and state agencies. In the short run, firms who cannot produce at the market-clearing price are forced to leave the industry, ensuring that customers have the lowest price possible. In the long run, competition promotes innovation and lower costs. The physical and institutional characteristics of the U.S. electric industry, however, could be impediments to attaining efficiently run, competitive markets. Because of these characteristics, there are multiple sources of efficiencies and inefficiencies in existing electric markets, and there will be multiple sources in restructured ones. The objective of policymakers should not be to trade one set of inefficiencies in existing electric markets for another set in restructured markets.

  5. Health promotion in primary and secondary schools in Denmark

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Krølner, Rikke; Mortensen, Laust Hvas

    2015-01-01

    promotion at the school level regardless of socioeconomic status or other background factors. The first aim was to elucidate time trends in the number and types of school health promoting activities by describing the number and type of health promoting activities in primary and secondary schools in Denmark....... The second aim was to investigate which characteristics of schools and students that are associated with participation in many (≥3) versus few (0-2) health promoting activities during the preceding 2-3 years. METHODS: We used cross-sectional data from the 2006- and 2010-survey of the Health Behaviour...

  6. Reforming Victoria's primary health and community service sector: rural implications.

    Science.gov (United States)

    Alford, K

    2000-01-01

    In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

  7. The unique requirements of primary health care in Southern Africa

    Directory of Open Access Journals (Sweden)

    D. P. Knobel

    1986-03-01

    Full Text Available The critical need for primary health care in Southern Africa with special reference to the demands of the heterogenous population is measured against the background of the declaration of Alma Ata at the WHO/UNICEF conference in 1978. In particular the provision of primary health care to the Third World communities of the RSA as an essential part of the security power base of the State is underlined and it is analised in terms of how shortcomings in this service can be exploited in a subversive revolutionary onslaught.

  8. Brazilian community health agents and qualitative primary healthcare information.

    Science.gov (United States)

    Zanchetta, Margareth S; Pinto, Rogério Meireles; Galhego-Garcia, Wilson; da Cunha, Zeilma; Cordeiro, Hésio A; Fagundes-Filho, Francisco E; Pinho, Mônica A L; Voet, Susan M V; Talbot, Yves; Caldas, Rodrigo S; de Souza, Thiago J; Costa, Edwaldo

    2015-05-01

    The aim of this study was to explore female community health agents' views about the value of recording qualitative information on contextual health issues they observe during home visits, data that are not officially required to be documented for the Brazilian System of Primary Healthcare Information. The study was conducted in community primary healthcare centres located in the cities of Araçatuba and Coroados (state of São Paulo) and Rio de Janeiro (state of Rio de Janeiro), Brazil. The design was a qualitative, exploratory study. The purposeful sampling criteria were being female, with a minimum of three years of continuous service in the same location. Data collection with 62 participants was conducted via 11 focus groups (in 2007 and 2008). Audio files were transcribed and submitted to the method of thematic analysis. Four themes guided the analysis: working with qualitative information and undocumented observation; reflecting on qualitative information; integrating/analysing quantitative and qualitative information; and information-sharing with agents and family health teams. In 2010, 25 community health agents verified the final interpretation of the findings. Participants valued the recording of qualitative, contextual information to expand understanding of primary healthcare issues and as an indicator of clients' improved health behaviour and health literacy. While participants initiated the recording of additional health information, they generally did not inform the family health team about these findings. They perceived that team members devalued this type of information by considering it a reflection of the clientele's social conditions or problems beyond the scope of medical concerns. Documentation of qualitative evidence can account for the effectiveness of health education in two ways: by improving preventative care, and by amplifying the voices of underprivileged clients who live in poverty to ensure the most appropriate and best quality primary

  9. Primary health care in China: is China's health reform reform for the whole nation?

    Science.gov (United States)

    Cheng, Jing-Min; Yuan, Yong-Xu; Lu, Wei; Yang, Le

    2017-07-01

    Good primary health care can enhance national health status at relatively low cost. The barefoot doctor model in China was once considered to have been a successful health care policy. It was a model which was followed by other low-developed or developing countries. In recent decades, the Chinese government promulgated a number of new policies and health reforms to improve its health care system. This paper aimed to highlight the great significance of primary health care and appeal to the policymakers to change the priority to primary health care in order to be able to guarantee universal health care for the whole nation at least at primary care level. This study discussed Chinese primary health care by reviewing its history and development. Chinese government's efforts do not seem to be leading to a completely successful outcome for all the people of China as a result of the substantial imbalance of investments between tertiary level hospitals and grass-root level health care institutions. The government appears to have neglected the importance of primary health care in the implementation of health systems and resources.

  10. Integrating primary care with occupational health services: a success story.

    Science.gov (United States)

    Griffith, Karen; Strasser, Patricia B

    2010-12-01

    This article describes the process used by a large U.S. manufacturing company to successfully integrate full-service primary care centers at two locations. The company believed that by providing employees with health promotion and disease prevention services, including screening, early diagnosis, and uncomplicated illness treatment, its health care costs could be significantly reduced while saving employees money. To accurately demonstrate the cost-effectiveness of adding primary care to existing occupational health services, a thorough financial analysis projected the return on investment (ROI) of the program. Decisions were made about center size, the scope of services, and staffing. A critical part of the ROI analysis involved evaluating employee health claim data to identify the actual cost of health care services for each center and the projected costs if the services were provided on-site. The pilot initiative included constructing two on-site health center facilities staffed with primary care physicians, nurse practitioners, physical therapists, and other health care professionals. Key outcome metrics from the pilot clinics exceeded goals in three of four categories. In addition, clinic use after 12 months far exceeded benchmarks for similar clinics. Most importantly, the pilot clinics were operating with a positive cash flow within the first year and demonstrated an increasingly positive ROI. Copyright 2010, SLACK Incorporated.

  11. Using systems science for population health management in primary care.

    Science.gov (United States)

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-10-01

    Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

  12. Primary health care: a necessity in developing countries?

    Directory of Open Access Journals (Sweden)

    Evaezi Okpokoro

    2013-12-01

    Full Text Available Resource limited countries continue to be plagued with rising prevalence of malaria, tuberculosis, HIV/AIDS as well as other emerging diseases despite the huge financial support provided by bilateral and multilateral agencies to combat these diseases. While progress may have been made in reducing the global burden caused by these diseases on one hand, there has also been a weakening of the primary health care facility on the other hand which was the hallmark to the Alma Ata declaration of 1978. More attention has been placed on our global health needs while the diverse health needs of every community have been neglected. This fatal neglect at the community level highlights the need for the provision of specialize primary health care (PHC facilities which should not only be affordable, accessible and available, but be appropriate to the priority health needs of the community, especially at the rural level. Hence specialized PHC facilities will be tailored to meet the most pressing health needs of the communities it covers among other diseases. Consequently, this innovative approach will not only strengthen the primary health care system by improving wellbeing especially at the rural level but will also improve the outcome of vertical program at communities where it is most needed.

  13. Health promotion in primary and secondary schools in Denmark

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Krølner, Rikke; Mortensen, Laust Hvas

    2015-01-01

    promotion at the school level regardless of socioeconomic status or other background factors. The first aim was to elucidate time trends in the number and types of school health promoting activities by describing the number and type of health promoting activities in primary and secondary schools in Denmark......BACKGROUND: Schools are important arenas for interventions among children as health promoting initiatives in childhood is expected to have substantial influence on health and well-being in adulthood. In countries with compulsory school attention, all children could potentially benefit from health....... The second aim was to investigate which characteristics of schools and students that are associated with participation in many (≥3) versus few (0-2) health promoting activities during the preceding 2-3 years. METHODS: We used cross-sectional data from the 2006- and 2010-survey of the Health Behaviour...

  14. Revitalizing primary health care--another utopian goal?

    Science.gov (United States)

    Marahatta, Sujan B

    2010-01-01

    The quest for greater efficiency, fairness and responsiveness to the expectation of the people that system serve have brought about three generations of health system reforms in the twentieth century. The first generation saw the founding of national health care systems and extension to middle income nations of social insurance systems in the 1940s and 1950s. By the late 1960s the rising costs of hospital based care, its usage by better off, inaccessibility by the poor and rural population of even the most basic services heralded second generation reforms promoting primary health care as a means of achieving the affordable universal coverage. It included the best public health strategy that is prevention and the highest ethical principle of public health that is equity. It was expected the best system for reaching households with essential and affordable care, and the best route towards universal coverage. The primary health care approach though adopted universally did not materialize its notion of translating ethos of Health for All by 2000. Overall, primary health care movement by the end of 20th century became lifeless. Since the Declaration of Alma-Ata, fundamental changes have occurred affecting health service delivery, such as economic development and financing approaches, globalization of trade and knowledge, and the shift to privatization. This is the time to develop a new vision, taking into consideration the many changes affecting global health and the strategic developments in health of recent years. With this recognition, the third generation of reforms now underway in many countries is driven by the idea of responding more to demand, assuring access for the poor and emphasizing financing rather than just provision within the public sector. The key concern is: how to translate ethos of revitalizing in the reality. Otherwise the revitalizing concept will turn into utopian goal so like HFA by 2000 strategy.

  15. Global health strategies versus local primary health care priorities ...

    African Journals Online (AJOL)

    Eradication of both polio and measles incorporate as a fundamental strategy high routine coverage, surveillance and special national immunisation days (NIDs), which are supplementary to routine vaccination services. There has been a lively debate on whether poor countries, with many health problems that could be ...

  16. global health strategies versus local primary health care priorities

    African Journals Online (AJOL)

    Building on the successful eradication of smallpox, the World. Health Organisation, together with other agencies, is now moving quickly to the eradication of poliomyelitis, originally aimed for the year 2000. Plans for the subsequent global eradication of measles are in an advanced stage. Eradication of both polio and ...

  17. Global health strategies versus local primary health care priorities- a ...

    African Journals Online (AJOL)

    Building on the successful eraclication of smallpox, the World Health Organisation, together with other agencies, is now moving quickly to the eradication of poliomyelitis, originally aimed for the year 2000. Plans for the subsequent global eradication of measles are in an advanced stage. Eradication of both polio and ...

  18. [Health education in primary school: Alicante city (Spain) teachers' opinions].

    Science.gov (United States)

    Davó-Blanes, M Carmen; García de la Hera, Manuela; La Parra, Daniel

    2016-01-01

    This study explores the opinions of primary school teachers about health activities carried out in schools in Alicante city (Spain). An exploratory study was conducted through qualitative content analysis. Three focus groups were conducted with 25 primary school teachers (14 women and 11 men) working in 14 public and 7 private schools in the city of Alicante. Participants were asked about the health activities carried on in their schools. Teachers distinguished between health education activities promoted by the school and those included in external programmes promoted by public and private institutions. External programmes were considered as impositions, lacking continuity and chosen according to passing fads. Although teachers demonstrated a more positive attitude towards activities arising from their own initiative, they identified health education as a secondary task. Teachers considered that improving their own health education training and promoting the involvement of parents, health professionals and public institutions were the most appropriate ways to promote health education in the school. Teachers showed a more positive opinion and greater commitment towards health activities that complement and facilitate their teaching tasks. Their didactic programme and opinion should be taken into account to maximise the efficiency of the health promotion and education activities promoted by external organisations. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  19. Primary prevention of type 2 diabetes: integrative public health and primary care opportunities, challenges and strategies.

    Science.gov (United States)

    Green, Lawrence W; Brancati, Frederick L; Albright, Ann

    2012-04-01

    Type 2 diabetes imposes a large and growing burden on the public's health. This burden, combined with the growing evidence for primary prevention from randomized controlled trials of structured lifestyle programs leads to recommendations to include caloric reduction, increased physical activity and specific assistance to patients in problem solving to achieve modest weight loss as well as pharmacotherapy. These recommendations demand exploration of new ways to implement such primary prevention strategies through more integrated community organization, medical practice and policy. The US experience with control of tobacco use and high blood pressure offers valuable lessons for policy, such as taxation on products, and for practice in a variety of settings, such as coordination of referrals for lifestyle supports. We acknowledge also some notable exceptions to their generalizability. This paper presents possible actions proposed by an expert panel, summarized in Table 1 as recommendations for immediate action, strategic action and research. The collaboration of primary care and public health systems will be required to make many of these recommendations a reality. This paper also provides information on the progress made in recent years by the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC) to implement or facilitate such integration of primary care and public health for primary prevention.

  20. Essential attributes and qualifiers of primary health care

    OpenAIRE

    Andréa Silvia Walter de Aguiar; Pollyanna Martins

    2012-01-01

    Historically, the primary health care (PHC) has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country.Several theoretical and conceptual landmarks proposed approaches and indicators to assess and ch...

  1. Restructuring of Insolvent Corporations in Canada

    African Journals Online (AJOL)

    corporations and primarily large enterprises. This has given rise to the existence of dual commercial restructuring regimes, a highly distinctive feature of Canadian insolvency law. Therefore, an insolvent debtor will usually need to make an assessment of advantages and disadvantages of restructuring under each regime in.

  2. 34 CFR 200.43 - Restructuring.

    Science.gov (United States)

    2010-07-01

    ... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.43 Restructuring. (a... supplemental educational services in accordance with § 200.45. (3) Prepare a plan to carry out one of the... plan; and (B) Participate in the development of any restructuring plan. (5) Continue to comply with...

  3. Social Effects of Organisational Restructuring on Employee ...

    African Journals Online (AJOL)

    First Lady

    Abstract. This study examined the influence of the social impact of organisational restructuring on employee workplace attitudes. A sample of 725 employees drawn through stratified random sampling technique from four (4) manufacturing organisations which had been involved in an intensive restructuring process ...

  4. Social Effects of Organisational Restructuring on Employee ...

    African Journals Online (AJOL)

    This study examined the influence of the social impact of organisational restructuring on employee workplace attitudes. A sample of 725 employees drawn through stratified random sampling technique from four (4) manufacturing organisations which had been involved in an intensive restructuring process participated in the ...

  5. Governance and Enterprise Restructuring in Southeast Europe

    OpenAIRE

    Apostolov, Mico

    2010-01-01

    Purpose - The research in this paper is to be focused on examining governance and enterprise restructuring in Southeast Europe (Western Balkans) transition economies. International organizations classify the following countries in Southeast Europe (Western Balkans): Albania, Bosnia and Herzegovina, Croatia, Macedonia, Montenegro and Serbia. Design/methodology/approach - The European Bank for Reconstruction and Development (EBRD) has governance and enterprise restructuring as basic indicat...

  6. Reduction of Test Anxiety Through Cognitive Restructuring

    Science.gov (United States)

    Goldfried, Marvin R.; And Others

    1978-01-01

    On the basis of questionnaire measures of test anxiety, only those in the rational restructuring condition reported a significant decrease in subjective anxiety when placed in an analogue test-taking situation. Participants in the restructuring condition also reported greater generalized anxiety reduction in social-evaluative situations. (Author)

  7. Restructuring the Schoolbook Provision System in Indonesia

    Directory of Open Access Journals (Sweden)

    Dedi Supriadi

    1999-03-01

    Full Text Available Schoolbooks account for between 65% and 75% of all publishing activity in Indonesia. The amount of money allocated is continually increasing. Priority is given to the primary and junior secondary school levels (6+3 years, which are compulsory. Between 1969 and 1988, the Government of Indonesia (GOI has produced some 550 million primary textbooks and library books. Up to the year 2000, the GOI has decided to allocate the total of US$ 355.2 million to produce 250 million copies of primary and junior secondary school textbooks to reach the ratio of one book for each student. In addition, around Rp 20-50 billion (US$ 10-20 million annually is spent to purchase 8-17 million copies of reading books which are aimed at stimulating the reading interest of primary school children. These books are distributed free to some 168,000 primary and 26,969 junior secondary schools throughout Indonesia. Following the massive efforts to increase book availability at schools, some innovative policies are being taken. Book evaluation standards have been improved to ensure that only high quality books are used at schools. The distribution system has been restructured to guarantee that books reach targeted schools. Consequently, the book monitoring system has had to be strengthened to examine whether or not the books really reach the schools and are used properly by students and teachers in the classrooms. In the last three years, there has also been a growing concern with multicultural issues in schoolbook provision programs. In such a culturally diverse nation as Indonesia, schoolbooks should also be culturally sensitive and be recognize the varied sociocultural backgrounds which affect students' learning.

  8. [Implementing health surveillance at the primary care level].

    Science.gov (United States)

    Oliveira, Cátia Martins; Casanova, Angela Oliveira

    2009-01-01

    This paper discusses the possibilities of re-orienting work processes at the primary care level in the light of the concepts and pre-suppositions of the health surveillance system. In addition, it presents some key concepts that could help putting into operation a health surveillance system at the local level. One of these concepts is the idea of the territory as a privileged space of primary care, helping to define and identify health needs. The study further emphasizes the heuristic value of integrating knowledge and practices in the various fields of health care so as to ensure a broader vision of problems and comprehensive health care. Finally, it analyzes the contributions from epidemiological, environmental, and health surveillance for consolidating health surveillance into a system not only limited to these three areas of action. Integrated actions of epidemiological, sanitary, and environmental surveillance can favor risk management and allow for innovative and more effective answers to the demands emerging from the health area. In addition, the local teams can acquire practical experience in internal and inter-sectorial actions which, though their importance is recognized in theory, were rarely put into practice.

  9. Management of common eye conditions in a primary health care ...

    African Journals Online (AJOL)

    Prevention of blindness. South Sudan has a huge burden of blindness with an estimated prevalence in excess of 1.5% and it is a common reason for patients attending a primary care facility [1]. Seventy five percent of this blindness can be prevented or treated by properly trained middle cadre eye health worker working with ...

  10. Questionnaires for Patient Evaluation of Primary Health Care: A ...

    African Journals Online (AJOL)

    femi oloka

    ABSTRACT. Background: An increasing number of questionnaires have been developed for patient evaluation of primary health care (PHC) but these are mostly designed for developed countries' settings. Aim: To review the development, contents, measurement properties of published questionnaires for patient evaluation ...

  11. Challenges in managing dementia in a primary health care setting ...

    African Journals Online (AJOL)

    2008-09-29

    Sep 29, 2008 ... Case Study: Challenges in managing dementia in a primary health care setting. 520. Vol 51 No 6. SA Fam Pract 2009 supportive of their father's condition and they felt more worried about the neighbours' perceptions of having an unsound family member at home. A year later, the patient became withdrawn ...

  12. Quality of care offered to children attending primary health care ...

    African Journals Online (AJOL)

    antibiotic was prescribed in almost half (65/141) of the consultations, but antibiotic use was unwarranted in one-third of these cases. Health ... with clearly defined and monitored standard clinical practice routines and norms, is required to change the status quo. Primary .... Although both dosage and frequency of antibiotic ...

  13. 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.

  14. Journal of Community Medicine and Primary Health Care

    African Journals Online (AJOL)

    The Journal of Community Medicine and Primary Health Care is the official Journal of the Association of Community Physicians of Nigeria. The Journal, which is multidisciplinary and international in scope, provides a forum for the dissemination of research findings, reviews, theories and information on all aspects of public ...

  15. Primary Health Care Providers' Knowledge Gaps on Parkinson's Disease

    Science.gov (United States)

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

    2013-01-01

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

  16. RESEARCH Reasons why patients with primary health care ...

    African Journals Online (AJOL)

    102, No. 10 SAMJ. Reasons why patients with primary health care problems access a secondary hospital emergency centre. Juanita Becker, Angela Dell, Louis Jenkins, Rauf Sayed. Emergency centres (ECs) provide emergency care to people with acute trauma and illness who require the services and expertise available.

  17. Treatment adherence in South African primary health care | Kagee ...

    African Journals Online (AJOL)

    Patient non-adherence to medical treatment regimens is a pressing problem in South African primary health care. The absence of a cogent research base in the South African context has meant that solutions to the problem of non-adherence continue to elude clinicians. This paper offers an understanding of patient ...

  18. Experiences of newly qualified professional nurses in primary health ...

    African Journals Online (AJOL)

    The purpose of this study was to explore and describe the experiences of professional nurses during their first two years of professional service, inclusive of one year of community service in Primary Health Care facilities in the Eastern Cape Province. The study followed a qualitative and exploratory approach. Its design was ...

  19. Job Satisfaction: Rural Versus Urban Primary Health Care Workers ...

    African Journals Online (AJOL)

    BACKGROUND: Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one's efforts. Several factors affect job satisfaction. OBJECTIVE: To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. METHODS: A cross ...

  20. Determinants of increased primary health care use in cancer survivors.

    NARCIS (Netherlands)

    Heins, M.; Schellevis, F.; Rijken, M.; Hoek, L. van der; Korevaar, J.

    2012-01-01

    Purpose: The number of cancer survivors is increasing, and patients with cancer often experience long-lasting consequences of cancer and its treatment. Because of the variety of health problems and high prevalence of comorbidity, primary care physicians (PCPs) seem obvious candidates to take care of

  1. The motivational needs of primary health care nurses to acquire ...

    African Journals Online (AJOL)

    The results indicated that PHC nurses needed acknowledgement, organisational responsibility, strategic planning and promotion, as well as support. Significant differences between gender were not found in relation to the need to acquire power. Keywords: Motivation, Primary health care, Leader, Power, Survey ...

  2. Primary Health Care in Canada: Systems in Motion

    OpenAIRE

    Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

    2011-01-01

    Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.

  3. Health-related knowledge and behaviour of primary school children ...

    African Journals Online (AJOL)

    There is a serious need for children to be informed about the negative influence of unhealthy living which has become part and parcel of the post-industrial contemporary society. The aim of this study was to investigate the health-related knowledge and behaviour of senior primary school children in the Honeydew area, and ...

  4. Patient Satisfaction and Factor of Importance in Primary Health Care ...

    African Journals Online (AJOL)

    The objective of the study is to assess patient satisfaction and factor of importance on the service they receive at the primary health care facility in Botswana. The study was a cross sectional study in which 360 systematically selected participants completed 5 point likert scale self-administered questionnaire to rate their ...

  5. Mental health intervention programs in primary care : their scientific basis

    NARCIS (Netherlands)

    van den Brink, W.; Leenstra, A.; Ormel, J.; van de Willige, G.

    This study examines the scientific basis for mental health intervention programs in primary care. The validity of five underlying assumptions is evaluated, using the results of a naturalistic study covering a representative sample of 25 Dutch family practices and data from the literature. Our

  6. Identity of primary health care nurses: perception of "doing everything".

    Science.gov (United States)

    Fernandes, Marcelo Costa; Silva, Lucilane Maria Sales da; Silva, Maria Rocineide Ferreira da; Torres, Raimundo Augusto Martins; Dias, Maria Socorro de Araújo; Moreira, Thereza Maria Magalhães

    2018-01-01

    To analyze, in the speeches of nurses, the habitus that conforms their professional identity in the primary health care area. Qualitative study, carried out from March to October 2015, with nurses of primary healthcare units in the cities of Cajazeiras, in the state of Paraíba, and Maracanaú, in the state of Ceará. Data were collected by means of semi-structured interviews, and analyzed through discourse analysis. Nurses, in their practice and perception, perceive that professional identity is linked to the meaning that involves the word "everything". This situation constitutes a habitus that directs the range of daily actions, often distant from the profession's core of knowledge. Trying to be and do everything in primary health care involves negative repercussions in the professional identity of nurses. Strategic guidance is necessary in order to achieve and embrace elements that reflect the essence of this category.

  7. Identity of primary health care nurses: perception of "doing everything"

    Directory of Open Access Journals (Sweden)

    Marcelo Costa Fernandes

    Full Text Available ABSTRACT Objective: To analyze, in the speeches of nurses, the habitus that conforms their professional identity in the primary health care area. Method: Qualitative study, carried out from March to October 2015, with nurses of primary healthcare units in the cities of Cajazeiras, in the state of Paraíba, and Maracanaú, in the state of Ceará. Data were collected by means of semi-structured interviews, and analyzed through discourse analysis. Results: Nurses, in their practice and perception, perceive that professional identity is linked to the meaning that involves the word "everything". This situation constitutes a habitus that directs the range of daily actions, often distant from the profession's core of knowledge. Final considerations: Trying to be and do everything in primary health care involves negative repercussions in the professional identity of nurses. Strategic guidance is necessary in order to achieve and embrace elements that reflect the essence of this category.

  8. Primary health care registered nurses' types in implementation of health promotion practices.

    Science.gov (United States)

    Maijala, Virpi; Tossavainen, Kerttu; Turunen, Hannele

    2016-09-01

    Aim This study aimed to identify and reach consensus among primary health care participants [registered nurses (RNs) who receive clients, directors of nursing, senior physicians, health promotion officers, and local councillors] on the types of service provider that RNs who receive clients represent in the implementation of health promotion practices in primary health care in Eastern Finland. There is an increasing focus on public health thinking in many countries as the population ages. To meet the growing needs of the health promotion practices of populations, advance practice has been recognized as effective in the primary health care setting. The advance practice nurses share many common features, such as being RNs with additional education, possessing competencies to work independently, treating clients in both acute and primary care settings, and applying a variety of health promotion practices into nursing. The two-stage modified Delphi method was applied. In round one, semi-structured interviews were conducted among primary health care participants (n=42) in 11 health centres in Eastern Finland. In round two, a questionnaire survey was conducted in the same health centres. The questionnaire was answered by 64% of those surveyed (n=56). For data analysis, content analysis and descriptive statistics were used. Findings This study resulted in four types of service provider that RNs who receive clients represented in the implementation of health promotion practices in the primary health care setting in Eastern Finland. First, the client-oriented health promoter demonstrated four dimensions, which reached consensus levels ranging between 82.1 and 89.3%. Second, the developer of health promotion practices comprised four dimensions, which reached consensus levels between 71.4 and 85.7%. Third, the member of multi-professional teams of health promotion practices representing three dimensions, with consensus levels between 69.6 and 82.1%. Fourth, the type who showed

  9. Women's Preferred Sources for Primary and Mental Health Care: Implications for Reproductive Health Providers.

    Science.gov (United States)

    Hall, Kelli Stidham; Harris, Lisa H; Dalton, Vanessa K

    To describe women's preferences for reproductive health providers as sources of primary and mental health care. This is secondary data analysis of the Women's Health Care Experiences and Preferences Study, an Internet survey conducted in September 2013 of 1,078 women aged 18 to 55 randomly sampled from a U.S. national probability panel. We estimated women's preferred and usual sources of care (reproductive health providers, generalists, other) for various primary care and mental health care services using weighted statistics and multiple logistic regression. Among women using health care in the past 5 years (n = 981), 88% received primary and/or mental health care, including a routine medical checkup (78%), urgent/acute (48%), chronic disease (27%), depression/anxiety (21%), stress (16%), and intimate partner violence (2%) visits. Of those, reproductive health providers were the source of checkup (14%), urgent/acute (3%), chronic disease (6%), depression/anxiety (6%), stress (11%), and intimate partner violence (3%) services. Preference for specific reproductive health-provided primary/mental health care services ranged from 7% to 20%. Among women having used primary/mental health care services (N = 894), more women (1%-17%) preferred than had received primary/mental health care from reproductive health providers. Nearly one-quarter (22%) identified reproductive health providers as their single most preferred source of care. Contraceptive use was the strongest predictor of preference for reproductive health-provided primary/mental health care (odds ratios range, 2.11-3.30). Reproductive health providers are the sole source of health care for a substantial proportion of reproductive-aged women-the same groups at risk for unmet primary and mental health care needs. Findings have implications for reproductive health providers' role in comprehensive women's health care provision and potentially for informing patient-centered, integrated models of care in current

  10. Role of Primary Health Care in Ensuring Access to Medicines

    Science.gov (United States)

    Sambala, Evanson Z; Sapsed, Susan; Mkandawire, Mercy L

    2010-01-01

    To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization. PMID:20564760

  11. A renewed focus on primary health care: revitalize or reframe?

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    Rifkin Susan

    2010-07-01

    Full Text Available Abstract The year 2008 celebrated 30 years of Primary Health Care (PHC policy emerging from the Alma Ata Declaration with publication of two key reports, the World Health Report 2008 and the Report of the Commission on the Social Determinants of Health. Both reports reaffirmed the relevance of PHC in terms of its vision and values in today's world. However, important challenges in terms of defining PHC, equity and empowerment need to be addressed. This article takes the form of a commentary reviewing developments in the last 30 years and discusses the future of this policy. Three challenges are put forward for discussion (i the challenge of moving away from a narrow technical bio-medical paradigm of health to a broader social determinants approach and the need to differentiate primary care from primary health care; (ii The challenge of tackling the equity implications of the market oriented reforms and ensuring that the role of the State in the provision of welfare services is not further weakened; and (iii the challenge of finding ways to develop local community commitments especially in terms of empowerment. These challenges need to be addressed if PHC is to remain relevant in today's context. The paper concludes that it is not sufficient to revitalize PHC of the Alma Ata Declaration but it must be reframed in light of the above discussion.

  12. Service quality perceptions in primary health care centres in Greece.

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2014-04-01

    The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

  13. Creating positive practice environments in a primary health care setting.

    Science.gov (United States)

    Rabie, Tinda; Klopper, Hester C; Coetzee, Siedine K

    2017-08-01

    The aim of this study was to explore and describe the perceptions of nurse managers, nurses, and a physician in the community health centre with the most positive practice environment in a province of South Africa. Ten (N = 10) semistructured individual interviews were conducted with personnel of the community health centre with the most positive practice environment. Personnel cited the following as the most important characteristics of a positive practice environment in a primary health care setting: support, leadership and governance, collegial nurse-physician relationships, and quality of care. In a primary health care setting, it is important to train, appoint, and support managers who in turn will be able to train and support their personnel. Furthermore, reciprocal community involvement must be encouraged between personnel of the community health centre and stakeholders in the community to improve the health status of the community. Finally, group cohesions between all health care workers and managers at different organisational levels should be encouraged, as this enhances teamwork and a culture of teaching-learning and improves the competence of all staff. © 2017 John Wiley & Sons Australia, Ltd.

  14. Service quality perceptions in primary health care centres in Greece

    Science.gov (United States)

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2012-01-01

    Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

  15. Men's health in question: seeking assistance in primary health care

    Directory of Open Access Journals (Sweden)

    Max Moura de Oliveira

    2015-01-01

    Full Text Available The scope of this study was to analyze the socio-demographic profile, morbidity and frequency of seeking of adult men enrolled in a Family Doctor Program for health care in Niterói in the State of Rio de Janeiro. It is a cross-sectional study using secondary data, files and records of the first care visit in November 2003 through August 2009. The frequencies of the variables studied and the prevalence rates among those who sought and those who did not seek attention were calculated. Among the 323 men registered, 56% sought attendance. The main reason given for the first visit was a routine appointment. It was observed that 43 men were overweight, 26 were obese and 44 had abnormal blood pressure. The profile of the men who sought and those who did not seek care presented statistically significant differences (p

  16. International politics and primary health care in Costa Rica.

    Science.gov (United States)

    Morgan, L M

    1990-01-01

    Costa Rica's internationally-renowned rural health program exemplifies the principles put forth by the 1978 Alma Ata Declaration on Primary Health Care with one exception: the government has not succeeded in achieving active community participation in health. This paper uses a historical and political-economic perspective to explain why the Costa Rican government failed in its efforts to enhance community participation after Alma Ata. International agencies have been closely involved in the design and implementation of rural health services in Costa Rica since the early 1900s, yet community participation did not figure in these programs until the mid-1970s. The demise of community participation in the early 1980s is attributed to a combination of factors including partisan conflicts, social class conflicts, interest group politics and, particularly, to the shifting priorities of international health and development agencies.

  17. Do illness perceptions predict health outcomes in primary care patients?

    DEFF Research Database (Denmark)

    Frostholm, Lisbeth; Oernboel, Eva; Christensen, Kaj S

    2007-01-01

    patients, (2) patients without chronic disorders presenting physical disease, and (3) patients presenting medically unexplained symptoms (MUS). RESULTS: Negative illness perceptions were associated with poor physical and mental health at baseline. They most strongly predicted changes in health status...... at follow-up for the whole group of patients. Patients presenting with MUS had more negative illness perceptions and lower mental and physical components subscale of the SF-36 scores at all time points. CONCLUSIONS: Patients' perception of a new or recurrent health problem predicts self-reported physical......OBJECTIVE: Little is known about whether illness perceptions affect health outcomes in primary care patients. The aim of this study was to examine if patients' illness perceptions were associated with their self-rated health in a 2-year follow-up period. METHODS: One thousand seven hundred eighty...

  18. Third sector primary health care in New Zealand.

    Science.gov (United States)

    Crampton, P; Dowell, A C; Bowers, S

    2000-03-24

    To describe key organisational characteristics of selected third sector (non-profit and non-government) primary health care organisations. Data were collected, in 1997 and 1998, from 15 third sector primary care organisations that were members of a network of third sector primary care providers, Health Care Aotearoa (HCA). Data were collected by face-to-face interviews of managers and key informants using a semi-structured interview schedule, and from practice computer information systems. Overall the populations served were young: only 4% of patients were aged 65 years or older, and the ethnicity profile was highly atypical, with 21.8% European, 36% Maori, 22.7% Pacific Island, 12% other, and 7.5% not stated. Community services card holding rates were higher than recorded in other studies, and registered patients tended to live in highly deprived areas. HCA organisations had high patient to doctor ratios, in general over 2000:1, and there were significant differences in management structures between HCA practices and more traditional general practice. Third sector organisations provide services for populations that are disadvantaged in many respects. It is likely that New Zealand will continue to develop a diverse range of primary care organisational arrangements. Effort is now required to measure quality and effectiveness of services provided by different primary care organisations serving comparable populations.

  19. Preparing nursing students for contemporary practice: restructuring the psychomotor skills laboratory.

    Science.gov (United States)

    Snyder, M D; Fitzloff, B M; Fiedler, R; Lambke, M R

    2000-05-01

    The restructured laboratory experience offered a safe environment that supported student experimentation with psychomotor skills and self-initiated approaches to problem solving. Restructuring psychomotor laboratory experiences with emphasis on communication and conceptualization of principles supported students to begin addressing clinical problems with flexibility, creativity, and the premise for lifelong skill acquisition. Students who have skills that extend beyond technique will inevitably be better prepared to meet the demands of health care systems and patients now and in the future.

  20. [Patient satisfaction measure of the quality of primary health care].

    Science.gov (United States)

    Plentara, Radosław; Knyszyńska, Anna; Bazydło, Marta; Zabielska, Paulina; Kim, Andrzej; Kotwas, Artur; Rotter, Iwona; Kamola, Jolanta; Karakiewicz, Beata

    2015-01-01

    Primary health care centers are subject to supply and demand, while being the foundation of the health care system in the country. The aim of the study determination of satisfaction level of the patients with basic health care services. 124 persons we studied using a standardized questionnaire EUROPEP, developed by The European Working Party on Quality in Family Practice. Experiences 68% of respondents indicate the kindness and helpfulness of nurses POS, and more than half of the respondents (52%) said the same in the case of receptionists. Most of the respondents had a positive opinion about the behavior of GPs emphasizing their delicacy during the medical examinations (83%), respect for intimacy (82%), as well as a benevolent attitude towards patients (77%). However, despite the positive assessment of behavior, doctors in the opinion of 52% of the respondents did not offer them any preventive examinations, and in many cases (43%) did not pass the information regarding the healthy lifestyle. Every third patient (32%) did not receive information from doctor about the side effects of drugs. The results showed that significantly fewer than half of the GPs was interested in the sphere of psychosocial of their patients. Only 27% of respondents received from the doctor's help in dealing with fears about health. An even smaller percentage of respondents experienced interest in respect of their personal (23%) or material (23%) situation, while questions about family members from doctors heard 35% of patients. 1. The overall level of patient satisfaction with primary care services is high. Positively evaluated is the availability of a doctor, kindness, interest in health issues. 2. Patients experience a deficit of prevention and health promotion and they consider inadequate medical attention psychosocial problems. 3. It is necessary increased involvement of staff in health promotion and health prevention education through training in interpersonal communication. 4

  1. [Primary health care and the millennium development goals].

    Science.gov (United States)

    Faye, A; Bob, M; Fall, A; Fall, C

    2012-01-01

    Member countries of the World Health Organization (WHO) met in Alma Ata (8-12 September 1978) to define and advocate the implementation of primary health care (PHC) worldwide, above all, in developing countries, which had a real need to review their strategies for meeting the health needs of their populations. They did not suspect that 20 years later the vision they displayed would remain undeniably relevant. Here we examine the similarities and points of convergence of their declaration about PHC with the Millennium Development Goals that seek today to reduce poverty across the world. An exhaustive and analytic literature review was conducted to collect those similarities. Further analysis of the definitions, objectives, principles and recommendations of the Alma Ata Declaration and the Millennium Declaration reveals multiple dependencies and fundamental points of similarity between these two representations. Almost all states have pledged to achieve the eight MDG by 2015: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. The Alma Ata conference defined primary health care as essential health care, based on practical methods and techniques that are both scientifically sound and socially acceptable, universally accessible to all individuals and all families of the community, through their full participation and at a cost that the community and countries can afford at all stages of their development in the spirit of self-reliance and self-determination. It is an integral part of economic and social development. The following principles are involved in the achievement of both primary health care and the MDG: social equity, community participation, and intersectorality. Public health is an essential condition of poverty

  2. HEALTH BEHAVIOURS OF THE PERSONNEL OF PRIMARY SCHOOLS IN ANKARA

    Directory of Open Access Journals (Sweden)

    Serife AK

    2006-04-01

    Full Text Available The main purpose of study is to define the health behaviour profile of the personnel of primary schools as well as to define the topics to be given priority in health education activities. The research population consisted of all personnel of 564 primary schools in Ankara province. The study group (30 schools was estimated by cluster sampling method. The Health Behaviours Questionnaire, which consists of 47 items on health behaviours and demographic characteristics, was used for data collection. In the study, 849 school workers (67,5% female were interviewed. Teachers constituted the largest group (82,3% while the cleaning staff (7.0%, school administrators (6.3%, and other personnel (4.4% were sharing the rest in small proportions. Of the study group 41,7 % are cigarette smokers and of them 67.3% smoke every time and 11,9% sometime in school. Very few school personnel (14,8% do physical exercise regularly. Majority of school personnel (71,3% stated that they brush their teeth at least twice a day regularly. However, only 23,7% of school personnel go to have regular dental control. All results were discussed in details considering the effects of health behaviours of school personnel on students, and some recommendations were developed for health education activities in schools. [TAF Prev Med Bull 2006; 5(2.000: 83-93

  3. Optimisation Modelling of Efficiency of Enterprise Restructuring

    Directory of Open Access Journals (Sweden)

    Yefimova Hanna V.

    2014-03-01

    Full Text Available The article considers issues of optimisation of the use of resources directed at restructuring of a shipbuilding enterprise, which is the main prerequisite of its efficiency. Restructuring is considered as a process of complex and interconnected change in the structure of assets, liabilities, enterprise functions, initiated by dynamic environment, which is based on the strategic concept of its development and directed at increase of efficiency of its activity, which is expressed in the growth of cost. The task of making a decision to restructure a shipbuilding enterprise and selection of a specific restructuring project refers to optimisation tasks of prospective planning. Enterprise resources that are allocated for restructuring serve as constraints of the mathematical model. Main criteria of optimisation are maximisation of pure discounted income or minimisation of expenditures on restructuring measures. The formed optimisation model is designed for assessment of volumes of attraction of own and borrowed funds for restructuring. Imitation model ensures development of cash flows. The task solution is achieved on the basis of the complex of interrelated optimisation and imitation models and procedures on formation, selection and co-ordination of managerial decisions.

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

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    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.

  5. Primary oral health care: a missing link in public health in Pakistan.

    Science.gov (United States)

    Basharat, S; Shaikh, B T

    2016-12-12

    In Pakistan, the limited availability of oral health care and the high level of unmet oral health care needs are well documented. The recorded prevalence of dental caries is 50-70% and that of oral cancer is among the highest in the world. Although oral health care has been declared to be part of the primary health care system, oral health disparities between rich and poor, and emerging problems of access to and use of appropriate care have never been addressed, reflecting a lack of awareness among both patients and health system decisionmakers. Oral cancer screening and atraumatic restorative treatment for tooth decay could be included in a basic package of oral care that does not require qualified dental surgeons. This article develops an argument, based on literature review and an analysis of the health system in Pakistan, for how a basic oral health programme could be an accessible, affordable and acceptable component of the primary health care system.

  6. Occupational Therapy in Primary Health Care: responsibilities, actions, and technologies

    Directory of Open Access Journals (Sweden)

    Renata dos Humildes Oliveira

    2012-12-01

    Full Text Available This article aims to provide means to mobilize occupational therapists towards reflections and studiesthat support and tool up Occupational Therapy (OT for its attributions, actions and technologies related toPrimary Health Care (PHC. It is the result of discussions held at the First National Seminar on OccupationalTherapy in PHC, which occurred in the Brazilian Congress of OT in Sao Paulo/2011. Its goal is to look at PHCin the sanitary international movement, its expression in Brazil and some historical reflections on the insertionof OT at such level of care. It points out that the formation of such profession, in spite of being historicallygrounded on the biomedical view of health, has contributed to a more effectual and comprehensive approachto the concept of health, for in its object of study and intervention, which includes the understanding of therelationship that individuals establish with their everyday activities, there is an expansion of awareness of the processes of illness and disabilities and also the biopsychosocial understanding of the individuals cared at thislevel. It also carries out an exercise of confrontation between the principles and propositions advocated byPrimary Care and the normative, epistemic and pragmatic precepts of this profession, suggesting possible OTattributions, actions and technologies related to Primary Health Care. It ends with the warning that, in spite ofOT progress so far, this profession is still quantitatively and qualitatively limited as to its actions, attributionsand technologies, and suggests further studies and debates on the matter to strengthen and tool up OccupationalTherapy for Primary Health Care.

  7. Smartphone threshold audiometry in underserved primary health-care contexts.

    Science.gov (United States)

    Sandström, Josefin; Swanepoel, De Wet; Carel Myburgh, Hermanus; Laurent, Claude

    2016-01-01

    To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18-88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of -1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of -1.0 dB ± 7.1 SD. Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

  8. Primary care priorities in addressing health equity: summary of the WONCA 2013 health equity workshop.

    Science.gov (United States)

    Shadmi, Efrat; Wong, William C W; Kinder, Karen; Heath, Iona; Kidd, Michael

    2014-11-07

    Research consistently shows that gaps in health and health care persist, and are even widening. While the strength of a country's primary health care system and its primary care attributes significantly improves populations' health and reduces inequity (differences in health and health care that are unfair and unjust), many areas, such as inequity reduction through the provision of health promotion and preventive services, are not explicitly addressed by general practice. Substantiating the role of primary care in reducing inequity as well as establishing educational training programs geared towards health inequity reduction and improvement of the health and health care of underserved populations are needed. This paper summarizes the work performed at the World WONCA (World Organization of National Colleges and Academies of Family Medicine) 2013 Meetings' Health Equity Workshop which aimed to explore how a better understanding of health inequities could enable primary care providers (PCPs)/general practitioners (GPs) to adopt strategies that could improve health outcomes through the delivery of primary health care. It explored the development of a health equity curriculum and opened a discussion on the future and potential impact of health equity training among GPs. A survey completed by workshop participants on the current and expected levels of primary care participation in various inequity reduction activities showed that promoting access (availability and coverage) to primary care services was the most important priority. Assessment of the gaps between current and preferred priorities showed that to bridge expectations and actual performance, the following should be the focus of governments and health care systems: forming cross-national collaborations; incorporating health equity and cultural competency training in medical education; and, engaging in initiation of advocacy programs that involve major stakeholders in equity promotion policy making as well as

  9. Hospital restructuring and nursing leadership: a journey from research question to research program.

    Science.gov (United States)

    Cummings, Greta G

    2006-01-01

    The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.

  10. Variation in local health department primary care services as a function of health center availability.

    Science.gov (United States)

    Wright, Brad; Nice, Andrew J

    2015-01-01

    We aim to gain a clearer understanding of the effect of colocated federally qualified health centers (FQHCs) on the delivery of primary care and preventive services by local health departments (LHDs). We collected data from the 2010 National Association of County & City Health Officials Profile of Local Health Departments, the 2010 Uniform Data System, and the 2011 Area Resource File. Forty-eight states, excluding Rhode Island and Hawaii. The analytic sample contained data on 2107 LHDs across the country. We modeled 4 measures of primary care activity for each LHD: provision of screening for (1) heart disease, (2) diabetes, and (3) hypertension, and (4) provision of comprehensive primary care. Local health departments in counties with an FQHC grantee have, on average, 32% lower odds of providing hypertension screening, but having an FQHC grantee in the county does not influence LHDs' primary care provision or screening for heart disease or diabetes. However, in an alternate model examining FQHC delivery sites per capita, each site is associated with a decrease in the odds of LHDs providing primary care (4% lower odds) or screening for heart disease (2% lower odds), diabetes, or hypertension (both 1% lower odds). Local health departments are more involved in disease screening than the provision of primary care. However, larger LHDs are more likely to provide both screening and primary care. Our current study provides evidence that the availability of an FQHC in the same county as an LHD partially explains the variation in LHDs' provision of primary care services. Local health departments with colocated FQHCs can focus on more traditional public health activities, while LHDs in areas without an FQHC may find that ensuring access to care is more challenging, possibly leading LHDs to directly provide primary care services.

  11. Reestruturação produtiva e saúde no setor metalúrgico: a percepção das trabalhadoras Economic restructuring and health in the metal sector: the female workers' perceptions

    Directory of Open Access Journals (Sweden)

    Angela Maria Carneiro Araújo

    2006-04-01

    Full Text Available Este artigo discute a nova divisão sexual do trabalho que resulta do processo de reestruturação produtiva na indústria metal-mecânica, enfatizando seus impactos sobre as condições de trabalho e de saúde das mulheres trabalhadoras. A pesquisa de natureza qualitativa, que foi realizada em plantas de diferentes tamanhos nos setores de autopeças e eletroeletrônico, no ABC paulista e em Campinas, examinou as novas formas do trabalho feminino como resultado da introdução de novas práticas gerenciais e de inovações tecnológicas. Foram também investigadas as percepções das trabalhadoras sobre as mudanças no seu trabalho e nas suas condições de saúde, com o propósito de compreender a relação entre novas formas de organização do processo de trabalho e o aprofundamento do sofrimento psicofísico no trabalho. Concluiu-se que o processo de reestruturação das empresas estudadas tem um claro bias de gênero na medida em que os lugares ocupados pelas mulheres na nova divisão do trabalho contribuem para aumentar a deterioração das suas condições de trabalho. Nas fábricas pesquisadas as trabalhadoras estão mais concentradas nos postos com salários menores, sob condições de trabalho ruins e sem proteção contra os riscos derivados das atividades desempenhadas. O artigo mostra que há uma nítida relação entre as mudanças nas condições de trabalho das mulheres e o crescimento de problemas de saúde e de doenças ocupacionais (como as LER e o estresse, entre outras.This paper discusses the new gender division of labour which results from the restructuring process in the metal industry emphasizing its impacts on the work and health conditions of women workers. The qualitative research conducted in plants of different sizes in the ABC and Campinas (both in the State of São Paulo focused on the new forms of female work as a result of the introduction of new management practices and new technologies. It also examines the

  12. A A common symptom in primary health care: The cough

    Directory of Open Access Journals (Sweden)

    Halil Akbulut

    2015-08-01

    Full Text Available Cough is the common symptom consulted by primary health care providers. Although treatment of cough is usually simple, healing period could be longer if it diagnosed wrong. Basicly cough divide into two groups; acute and chronic. While the most common cause of acute cough is upper respiratory tract infections, causes of chronic cough are allergic rihinitis, chronic sinusitis, asthma and gastroeosefageal reflux diseases. Nonetheless cough could be the clinical evidence of highly mortal diseases like pulmonary embolism, tuberculosis and lung cancer. Consequently patients with cough symptom must be evaluated delicately and essential follow up protocol must be planned by primary health care providers. [TAF Prev Med Bull 2015; 14(4.000: 333-337

  13. Cervical cancer screening in primary health care setting in Sudan

    DEFF Research Database (Denmark)

    Ibrahim, Ahmed; Aro, Arja R.; Rasch, Vibeke

    2012-01-01

    OBJECTIVE: To determine the feasibility of visual inspection with the use of acetic acid (VIA) as a screening method for cervical cancer, an alternative to the Pap smear used in primary health care setting in Sudan, and to compare sensitivity, specificity, positive and negative predictive values......, and histological diagnosis of positive cases of both tests. METHODS: A cross-sectional study of 934 asymptomatic women living in Khartoum, Sudan, was conducted during 2009-2010. A semi-structured questionnaire containing socio-economic and reproductive variables was used to collect data from each participant...... of this study showed that VIA has higher sensitivity and lower specificity compared to Pap smear, but a combination of both tests has greater sensitivity and specificity than each test independently. It indicates that VIA is useful for screening of cervical cancer in the primary health care setting in Sudan...

  14. Performance of cell counters in primary health care.

    Science.gov (United States)

    Sandberg, S; Thue, G; Christensen, N G; Lund, P K; Rynning, M

    1991-06-01

    The results are presented from two external quality control surveys of cell counters in primary health care. The precision of haemoglobin measurements in the normal range was better than that obtained by conventional haemometers. The analytical quality of leucocyte analyses was about the same as that performed by hospital instruments. The precision of cell counters with respect to thrombocytes was poorer than that obtained on hospital instruments, especially in the lower level. Celldyn and Sysmex instruments performed best among the instruments examined. Reliable cell counter results were associated with medical laboratory technicians as operators of the instruments. To improve the analytical quality of the laboratory in primary health care, it appears necessary to establish an external quality assurance programme, including a laboratory consultancy service.

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

    Science.gov (United States)

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

    2017-12-01

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

  16. Bullying involvement in primary school and common health problems

    OpenAIRE

    Wolke, D; Woods, S; Bloomfield, L; Karstadt, L

    2001-01-01

    AIMS—To examine the association of direct (e.g. hitting) and relational (e.g. hurtful manipulation of peer relationships) bullying experience with common health problems.
METHODS—A total of 1639 children (aged 6-9 years) in 31 primary schools were studied in a cross sectional study that assessed bullying with a structured child interview and common health problems using parent reports. Main outcome measures were common physical (e.g. colds/coughs) and psychosomatic (e.g. ...

  17. Connecting Health and Labour: Bringing together occupational health and primary care to improve the health of working people. Executive summary

    NARCIS (Netherlands)

    Anonymous

    2012-01-01

    The global conference "Connecting Health and Labour: What Role for Occupational health in Primary Health Care?" took place in The Hague from 29 November to 1 December 2011. The conference was organized by WHO in collaboration with TNO Work and Health and the Dutch government and with support from

  18. Connecting Health and Labour: Bringing together occupational health and primary care to improve the health of working people

    NARCIS (Netherlands)

    Ivanov, I.D.; Buijs, P.

    2012-01-01

    The global conference "Connecting Health and Labour: What Role for Occupational health in Primary Health Care?" took place in The Hague from 29 November to 1 December 2011. The conference was organized by WHO in collaboration with TNO Work and Health and the Dutch government and with support from

  19. Sexual health inquiry and support is a primary care priority.

    Science.gov (United States)

    Sadovsky, Richard; Nusbaum, Margaret

    2006-01-01

    The World Health Organization defines sexual health as "a state of physical, emotional, mental and sexual well-being related to sexuality." This broad definition goes beyond simply inquiring about sexual dysfunction and ideally fits the model of patient-centered primary care. As we observe that sexual health and physical health are often closely related, discussions about sexual activity can be very revealing. Sexual intimacy appears positively related to loving relationship satisfaction and stability. Sexual problems have a clear negative impact on both the quality of life and emotional state regardless of age. Learning about specific sexual dysfunctions among men can reveal a variety of as-yet-undiagnosed comorbid pathologic conditions such as: (i) depression and other emotional illnesses; (ii) psychosocial stress; (iii) actual cardiovascular disease as well as related risk factors such as hypertension, diabetes, and/or hyperlipidemia; (iv) hyperprolactinemia; and (v) low serum testosterone. Specific sexual dysfunctions among women can reveal pathologic conditions such as: (i) depression and other adverse imitational and psychosocial conditions; (ii) low serum estrogen or testosterone; and/or (iii) vaginal or pelvic disorders. A discussion about sexual health can be accomplished efficiently in a primary care office with the inquiring clinician having the option to deal with any sexual problems and dysfunctions directly, or to refer the patient to an appropriate specialized care source.

  20. Mental health care: how can Family Health teams integrate it into Primary Healthcare?

    Science.gov (United States)

    Gryschek, Guilherme; Pinto, Adriana Avanzi Marques

    2015-10-01

    Mental health is one of the responsibilities of Brazil's Family Health system. This review of literature sought to understand what position Mental Health occupies in the practice of the Family Health Strategy. A search was made of the scientific literature in the database of the Virtual Health Library (Biblioteca Virtual de Saúde), for the keywords: 'Mental Health'; 'Family Health'; 'Primary Healthcare'. The criteria for inclusion were: Brazilian studies from 2009 through 2012 that contributed to understanding of the following question: "How to insert Mental health care into the routine of the Family Health Strategy?" A total of 11 articles were found, which identified difficulties and strategies of the professionals in Primary Healthcare in relation to mental health. Referral, and medicalization, were common practices. Matrix Support is the strategy of training and skill acquisition for teams that enables new approaches in mental health in the context of Primary healthcare. It is necessary for Management of the Health System to take an active role in the construction of healthcare networks in mental health.

  1. Oncologic prevention and suggested working standards in primary health care

    Directory of Open Access Journals (Sweden)

    Konstantinović Dejan

    2016-01-01

    Full Text Available On the ground of the available data, this paper presents the problem of malignant diseases in Central Serbia, and most common carcinogens. Division of carcinogens, cancerogenesis and natural history of disease, early detection of cancer and palliative management are explained. The role and capacities of primary health care doctors in treatment of patients with suspect malignant disease are presented. Authors are suggesting standards for medical tasks and contemporary principles in approach to patients with malignant diseases in everyday practice.

  2. The ethics of complex relationships in primary care behavioral health.

    Science.gov (United States)

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  3. Mechanisms for communicating within primary health care teams

    Science.gov (United States)

    Brown, Judith Belle; Lewis, Laura; Ellis, Kathy; Stewart, Moira; Freeman, Thomas R.; Kasperski, M. Janet

    2009-01-01

    ABSTRACT OBJECTIVE To explore the types of communication used within primary health care teams (PHCTs), with a particular focus on the mechanisms teams use to promote optimal clinical and administrative information sharing. DESIGN A descriptive qualitative study. SETTING Primary health care teams in Ontario between August 2004 and October 2005. PARTICIPANTS Purposive sampling was used to recruit 121 members from 16 PHCTs reflecting a range of health care professionals, including family physicians, nurse practitioners, nurses, pharmacists, dietitians, social workers, office managers, health promoters, and receptionists. METHODS Individual in-depth interviews were conducted. An iterative analysis process was used to examine the verbatim transcripts created from the interviews. Techniques of immersion and crystallization were used in the analysis. MAIN FINDINGS Analysis of the data revealed that communication occurs through formal and informal means. Formal communication included regular team meetings with agendas and meeting minutes, memorandums, computer-assisted communication, and communication logs. Informal communication methods were open and opportunistic, reflecting the traditional hallway consultation. For patient care issues, face-to-face communication was preferred. Team member attributes facilitating communication included approachability, availability, and proximity. Finally, funding issues could be an impediment to optimal communication. CONCLUSION Primary health care is experiencing demands for enhanced and efficient communication that optimizes team functioning and patient care. This study describes formal and informal mechanisms of communication currently used by PHCTs. Attributes that facilitate team communication, such as approachability, availability, and proximity of team members, were highlighted. New funding arrangements might alleviate concerns about remuneration for attendance at meetings. PMID:20008604

  4. Improving health promotion using quality improvement techniques in Australian Indigenous primary health care

    Directory of Open Access Journals (Sweden)

    Nikki ePercival

    2016-03-01

    Full Text Available While some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centres. Our study objectives were to: (a describe the scope and quality of health promotion activities; (b describe the status of health centre system support for health promotion activities; and (c introduce a CQI intervention and examine the impact on health promotion activities and health centres systems over two years. Baseline assessments showed sub-optimal health centre systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health centre systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence based health promotion by engaging front line health practitioners in decision making processes about the design/redesign of health centre systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff and members of the local community to address organisational and policy level barriers.

  5. Cost of delivering health care services at primary health facilities in Ghana.

    Science.gov (United States)

    Dalaba, Maxwell Ayindenaba; Welaga, Paul; Matsubara, Chieko

    2017-11-17

    There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs) and Community-based Health Planning and Services (CHPS) in Ghana. The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs) from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD) attendance were estimated. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC). The cost per OPD attendance was higher at CHPS (US$8.79) than at HCs (US$5.16). The average Internally Generated Funds (IGF) recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS) reimbursement was the main source of revenue accounting for over 90% total IGF. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar studies involving large numbers of primary health facilities in

  6. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  7. Management of pharmaceutical services in the Brazilian primary health care.

    Science.gov (United States)

    Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

    2017-11-13

    To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

  8. Improving access to primary mental health care for Australian children.

    Science.gov (United States)

    Bassilios, Bridget; Nicholas, Angela; Reifels, Lennart; King, Kylie; Spittal, Matthew J; Fletcher, Justine; Pirkis, Jane

    2016-11-01

    This study examines the uptake by children aged predominantly 0-11 years of an Australian primary mental health service - the Access to Allied Psychological Services programme - which began in 2001. In particular, it considers access to, and use of, the child component of Access to Allied Psychological Services, the Child Mental Health Service, introduced in 2010. Using routinely collected programme data from a national minimum dataset and regional population data, we conducted descriptive and regression analysis to examine programme uptake, predictors of service reach and consumer- and treatment-based characteristics of service. Between 2003 and 2013, 18,631 referrals for children were made and 75,178 sessions were scheduled via Access to Allied Psychological Services, over 50% of which were via the Child Mental Health Service in its first 3 years of operation. The rate of referrals for children to the Child Mental Health Service was associated with the rate of Access to Allied Psychological Services referrals for consumers aged 12+ years. The Child Mental Health Service has increased services provided within the Access to Allied Psychological Services programme for children with emotional and behavioural issues and their families, and is potentially filling a service gap in the area of prevention and early intervention for children who have significant levels of need but are unable to access other mental health services. Our findings are policy-relevant for other developed countries with a similar primary mental health care system that are considering means of improving service access by children. © The Royal Australian and New Zealand College of Psychiatrists 2016.

  9. Restructuring School Counseling in a Megalopolis

    Science.gov (United States)

    Jones, Wendell H.

    1970-01-01

    School counselors seeking to restructure the services of the institution for which they work may consider adapting one or more of the proposals presented in this paper as a way to improve existing conditions of employment. (Author)

  10. Quality Indicators for Primary Health Care: A Systematic Literature Review.

    Science.gov (United States)

    Simou, Effie; Pliatsika, Paraskevi; Koutsogeorgou, Eleni; Roumeliotou, Anastasia

    2015-01-01

    Data have indicated that countries with a strong system of Primary Health Care (PHC) are more likely to have efficient health systems and better health outcomes than countries that focus strongly on hospital services. The aim of the article was to systematically review implemented quality projects used for evaluation of quality in PHC services. A systematic literature review was conducted via MEDLINE to identify papers referring to international or national PHC quality assessment projects, published in English from 1990 to 2010. Projects were included if they had been implemented, had a holistic approach, and reported specifications of the quality indicators used. Sixteen publications were considered eligible for further analyses, referring to 10 relevant projects and a total of 556 indicators. Number and content of indicators and their domains varied across projects. Regarding raw data, lack of standardization of collection tools between projects could lead to invalid comparisons. In areas that international projects operate in parallel to national initiatives, there may be problems regarding expenses and burden of data collection, which might create competing interests and low quality of information. Further actions for alignment of quality projects on primary health care are required, for future results to become comparable.

  11. Indoor environment and pupils' health in primary schools

    DEFF Research Database (Denmark)

    van Dijken, F.; van Bronswijk, J.E.M.H.; Sundell, Jan

    2006-01-01

    Dutch children are legally bound to spend 15% of their time in a school setting. The indoor environment in Dutch primary schools is known to be substandard. However, it is unclear to what extent the health of pupils is affected by the indoor school environment. The paper aims to assess the associ......Dutch children are legally bound to spend 15% of their time in a school setting. The indoor environment in Dutch primary schools is known to be substandard. However, it is unclear to what extent the health of pupils is affected by the indoor school environment. The paper aims to assess...... the associations between indoor environmental quality in Dutch schools and pupils' health, also taking into account the children's home environment and personal factors. A cross-sectional study was performed in 11 classrooms in 11 different schools in the Netherlands. The study included exposure measurements......, building inspections, and a questionnaire survey on pupils' health and domestic exposure. Principal Component Analysis (PCA) and non-parametric tests were performed to assess relationships. None of the schools complied with all indoor environmental quality standards. The importance of both the school...

  12. Oral health technicians in Brazilian primary health care: potentials and constraints.

    Science.gov (United States)

    Aguiar, Dulce Maria Lucena de; Tomita, Nilce Emy; Machado, Maria de Fátima Antero Sousa; Martins, Cleide Lavieri; Frazão, Paulo

    2014-07-01

    Different perspectives on the role of mid-level workers in health care might represent a constraint to health policies. This study aimed to investigate how different agents view the participation of oral health technicians in direct activities of oral healthcare with the goal of understanding the related symbolic dispositions. Theoretical assumptions related to inter-professional collaboration and conflicts in the field of healthcare were used for this analysis. A researcher conducted 24 in-depth interviews with general dental practitioners, oral health technicians and local managers. The concepts of Pierre Bourdieu supported the data interpretation. The results indicated inter-professional relations marked by collaboration and conflict that reflect an action space related to different perspectives of primary care delivery. They also unveiled the symbolic devices related to the participation of oral health technicians that represent a constraint to the implementation of oral health policy, thus reducing the potential of primary health care in Brazil.

  13. Consanguineous marriages : Preconception consultation in primary health care settings.

    Science.gov (United States)

    Hamamy, Hanan

    2012-07-01

    Consanguinity is a deeply rooted social trend among one-fifth of the world population mostly residing in the Middle East, West Asia and North Africa, as well as among emigrants from these communities now residing in North America, Europe and Australia. The mounting public awareness on prevention of congenital and genetic disorders in offspring is driving an increasing number of couples contemplating marriage and reproduction in highly consanguineous communities to seek counseling on consanguinity. Primary health care providers are faced with consanguineous couples demanding answers to their questions on the anticipated health risks to their offspring. Preconception and premarital counseling on consanguinity should be part of the training of health care providers particularly in highly consanguineous populations.

  14. Sexual health in primary health care - a qualitative study of nurses' experiences.

    Science.gov (United States)

    Klaeson, Kicki; Hovlin, Lina; Guvå, Hanna; Kjellsdotter, Anna

    2017-06-01

    To illuminate nurses' experiences and opportunities to discuss sexual health with patients in primary health care. Sexual health is a concept associated with many taboos, and research shows that nurses feel uncomfortable talking to patients about sexual health and therefore avoid it. This avoidance forms a barrier between patient and nurse which prevents nurses from giving satisfactory health care to patients. A qualitative descriptive design. Semi-structured interviews were conducted with nine nurses in primary health care in Sweden. Data were analysed using qualitative content analysis. During the analysis phase, five subcategories and two main categories were identified. The two main categories were as follows: 'factors that influence nurses' opportunities of talking to patients about sexual health' and 'nurses' experiences of talking to patients about sexual health'. Social norms in society were an obstacle for health professionals' opportunities to feel comfortable and act professionally. The nurses' personal attitude and knowledge were of great significance in determining whether they brought up the topic of sexual health or not. The nurses found it easier to bring up the topic of sexual health with middle-aged men with, for example, diabetes. One reason for this is that they found it easier to talk to male patients. A further reason is the fact that they had received training in discussing matters of sexual health in relation to diabetes and other conditions affecting sexual health. Nurses in primary care express the necessity of additional education and knowledge on the subject of sexual health. The healthcare organisation must be reformed to put focus on sexual health. Guidelines for addressing the topic of sexual health must be implemented to establish conditions that will increase nurse's knowledge and provide them with the necessary tools for discussing sexual health with patients. © 2016 John Wiley & Sons Ltd.

  15. Eye health promotion in the South African primary health care system*

    Directory of Open Access Journals (Sweden)

    H. L. Sithole

    2010-12-01

    Full Text Available Objective: There is currently very little or no research being done in South Africa on eye health promotion. Also, there is no evidence of any existing eye health promotion policy in the South African primary health care system. The purpose of this paper therefore is to highlight the lack of an integrated eye health promotion policy in the South African primary health care system.Approach: A literature review of research databases was conducted to identify research done in the previous years pertinent to eye health promotion in South Africa. Also, documents were requested from the South African National Department of Health to ascertain claims of any existing guidelines on eye care. It was found that these documents included the national guidelines on prevention of blindness, refractive error screening for persons 60 years and older, cataract surgery in South Africa, management and control of eye conditions at primary level.Although there is currently no integrated eye health promotion policy in South Africa, the fragmented national guidelines represent the existing policies on eye health promotion.  The custodians of these policies are the eye care coordinators located in each of the nine provinces.Conclusion: Although there are eye care coordinators in each province, there is no evidence of any eye health promotion activities being done in those provinces. Also, only one province out of nine has dedicated health promotion personnel that are not only focusing on eye health matters. This greatly compromises the initiatives of eliminating avoidable blindness. It is therefore recommended that an integrated eye health promotion model be developed so that it may form part of the South African primary health care system. (S Afr Optom 201069(4 200-206

  16. Annual report on contractor work force restructuring, fiscal year 1997

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    This report summarizes work force restructuring and community transition activities at all sites. It outlines work force restructuring activity for FY 1997, changing separation patterns, cost savings and separation costs, program assessment, activities to mitigate restructuring impacts, community transition activities, status of displaced workers, lessons learned, and emerging issues in worker and community transition. Work force restructuring and community transition activities for defense nuclear sites are summarized, as are work force restructuring activities at non-defense sites.

  17. Health service utilization patterns of primary care patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Laux Gunter

    2007-10-01

    Full Text Available Abstract Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners by primary care patients with osteoarthritis (OA. Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9 to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6% questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done

  18. [Traffic accidents: a health problem in primary care].

    Science.gov (United States)

    Blanquer, J J; Rapa, M; Melchor, A; Jiménez, T; Adam, A; Mulet, M J

    1993-09-15

    To discover the prevalence and most relevant epidemiological characteristics of the victims of traffic accidents which occur in our health area. Hospital Casualty department (HC), Health area 19, Alcoy. This was an observational, crossover study, based on the collection of data from all those patients who had been brought into the HC for attention because of a traffic accident and who were attended between October 1, 1990 and September 31, 1991. During the study period a total of 1,111 traffic accident victims were attended. Their average age was 26.62 (SD +/- 15.95), with 69.6% being men and 30.2% women. 60.7% of the victims were attended on non-working days or the eve of a non-working day. 44.5% of those involved in accidents were in four-wheeled vehicles; 40% on two-wheeled vehicles and 11.1% of the victims were pedestrians. Injuries were light in 73.3% of cases; moderate in 15.9% and in the other 8.8% serious, grave or critical. 43.7% of the total had the accident in an urban area and 40.9% on the open road. The high prevalence of victims of accidents (8.3 per 1000 inhabitants) observed in our health area can be explained by the type of study. It is vital to obtain valid information of the real importance of this health problem. The primary care doctor must take preventive action concerning traffic accidents: a) through full studies of traffic accident levels among primary care centre users; b) primary preventive action, through the spreading of information on norms of safety; and c) secondary and tertiary prevention, by means of effective and efficacious outpatient emergency measures, as well as a thorough rehabilitation of accident victims.

  19. [Frequent attendance in a Primary Health Care District].

    Science.gov (United States)

    Menéndez Granados, Nicolás; Vaquero Abellán, Manuel; Toledano Estepa, Manuel; Pérez Díaz, Manuel Modesto; Redondo Pedraza, Rosa

    2017-10-09

    To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain). An ecological study was performed, including data from 2011 to 2015. Defining FA as those subjects who made12 or more appointments per year; independently analysed for nursing, general practice and paediatrics. Prevalence of frequent attendance and FA/professional ratio were used as dependent variables. Demographic characteristics from district population, number of health professionals and use of general facilities were also examinated. Aiming to understand FA distribution, primary health settings were classified according to facility size and environmental location (urban, suburban and rural). The mean prevalence for FA was 10.86% (0.5 SE) for nursing; general practice 21.70% (0.7 SE) and for paediatrics 16.96% (0.7 SE). FA/professional ratios for the different professional categories were: 101.07 (5.0 SE) for nursing, 239.74 (9.0 SE) for general practice and 159.54 (9.8 SE) for paediatrics. A major part of primary health care users make a high number of consultations. From this group, women overuse nursing and general practitioner services more compared to men. A higher prevalence of FAs was observed in smaller settings, in rural areas. Although taking the FAs:professional ratio as the bar, medium-size practices are more highly overused. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Primary health care research in Bolivia: systematic review and analysis.

    Science.gov (United States)

    Alvarez, Francisco N; Leys, Mart; Mérida, Hugo E Rivera; Guzmán, Giovanni Escalante

    2016-02-01

    Bolivia is currently undergoing a series of healthcare reforms centred around the Unified Family, Community and Intercultural Health System (SAFCI), established in 2008 and Law 475 for Provision of Comprehensive Health Services enacted in 2014 as a first step towards universal health coverage. The SAFCI model aims to establish an intercultural, intersectoral and integrated primary health care (PHC) system, but there has not been a comprehensive analysis of effective strategies towards such an end. In this systematic review, we analyse research into developing PHC in Bolivia utilizing MEDLINE, the Virtual Health Library and grey literature from Pan American Health Organization/World Health Organization's internal database. We find that although progress has been made towards implementation of a healthcare system incorporating principles of PHC, further refining the system and targeting improvements effectively will require increased research and evaluation. Particularly in the 7 years since establishment of SAFCI, there has been a dearth of PHC research that makes evaluation of such key national policies impossible. The quantity and quality of PHC research must be improved, especially quasi-experimental studies with adequate control groups. The infrastructure for such studies must be strengthened through improved financing mechanisms, expanded institutional capacity and setting national research priorities. Important for future progress are improved tracking of health indicators, which in Bolivia are often out-of-date or incomplete, and prioritization of focused national research priorities on relevant policy issues. This study aims to serve as an aid towards PHC development efforts at the national level, as well as provide lessons for countries globally attempting to build effective health systems accommodating of a multi-national population in the midst of development. © The Author 2015. Published by Oxford University Press in association with The London School

  1. Primary Health Care Reform in Portugal: Portuguese, modern and innovative.

    Science.gov (United States)

    Biscaia, André Rosa; Heleno, Liliana Correia Valente

    2017-03-01

    The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.

  2. On the functional vs. lexical nature of restructuring heads: evidence for a fine-grained classification of restructuring modals

    Directory of Open Access Journals (Sweden)

    Irene Balza

    2012-01-01

    Full Text Available This paper examines in detail the thematic and syntactic properties of a set of (non-restructuringstructures in Germanic, Romance and Basque. Based on the comparison of these structures, I propose a finegrainedclassification of (non-restructuring constructions that include Functional Restructuring, Semi-Lexical Restructuring, Lexical Restructuring and Non-Restructuring constructions. The four types involvecomplements of different underlying structures (VPs, vPs or even as large as NegP/TPs. The results of theanalysis argue against Cinque’s (2005 hypothesis that all restructuring verbs are exclusively functional, andcontradicts Wurmbrand’s (1999 claim that, within the mixed class of restructuring verbs, modals must beraising verbs.

  3. Reestruturação produtiva e saúde do trabalhador: um estudo de caso Restructuring of production and workers' health: a case study

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    Maria Silvia Monteiro

    1998-04-01

    Full Text Available Foi realizado um estudo de caso em uma empresa tendo como objetos da pesquisa a forma de administração praticada e os trabalhadores da área de produção, e como objetivo identificar os possíveis efeitos das estratégias participativas no trabalho sobre a saúde dos trabalhadores. Analisaram-se dados relativos à empresa: histórico, características da administração praticada, organização da produção e do processo de trabalho; e também dados relacionados aos trabalhadores da área de produção: idade, grau de escolaridade, percepção sobre o trabalho, vida familiar, vida social, lazer e morbidade referida. Concluiu-se que as características da administração praticada tiveram origem nas idéias vindas do Japão, incluindo a flexibilização da produção, a terceirização, a polivalência e a participação no trabalho. Para os trabalhadores, a participação no trabalho foi sempre referida de forma ambígua, alguns relatando efeitos positivos, como maior liberdade e respeito, com boas repercussões na vida dentro e fora do trabalho. Para uma parte da população estudada, as características da organização do trabalho praticada na empresa têm efeitos deletérios sobre sua saúde, gerando queixas de dificuldade para dormir, nervosismo, sonhos com o trabalho, dores de cabeça etc.We performed a case study on a company focusing on the form of management and the shop floor workers, in order to identify the possible effects of participant work strategies on workers' health. Data on the company included its history, type of management, and organization of both production and the work process. Data on shop floor workers included age, schooling, perceptions of work, family life, recreation, and self-reported disease history. We concluded that the characteristics of the management model adopted by the company originated from ideas imported from Japan, including flexibilization of production, outsourcing, performance of multiple tasks

  4. Primary Health Care: care coordinator in regionalized networks?

    Science.gov (United States)

    Almeida, Patty Fidelis de; Santos, Adriano Maia Dos

    2016-12-22

    To analyze the breadth of care coordination by Primary Health Care in three health regions. This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. Analisar o alcance da coordenação do cuidado pela Atenção Primária à Saúde em três regiões de saúde. Trata-se de estudo de caso, com abordagem quantitativa e qualitativa. Foram realizadas 31 entrevistas semiestruturadas com gestores municipais, regionais e estaduais e estudo transversal com aplicação de questionários para médicos (74), enfermeiros (127) e amostra representativa de usuários (1.590) da Estratégia Saúde da Família em três municípios-sede de regiões de saúde do estado da Bahia. A função de porta de entrada preferencial pela Atenção Primária à Saúde deparava-se com forte concorrência de servi

  5. Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis: a Review Featuring a Women's Health Perspective

    Science.gov (United States)

    Marchioni Beery, Renée M.; Vaziri, Haleh; Forouhar, Faripour

    2014-01-01

    Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are two major types of chronic cholestatic liver disease. Each disorder has distinguishing features and variable progression, but both may ultimately result in cirrhosis and hepatic failure. The following offers a review of PBC and PSC, beginning with a general overview of disease etiology, pathogenesis, diagnosis, clinical features, natural course, and treatment. In addition to commonly associated manifestations of fatigue, pruritus, and fat-soluble vitamin deficiency, select disease-related topics pertaining to women's health are discussed including metabolic bone disease, hyperlipidemia and cardiovascular risk, and pregnancy-related issues influencing maternal disease course and birth outcomes. This comprehensive review of PBC and PSC highlights some unique clinical considerations in the care of female patients with cholestatic liver disease. PMID:26357630

  6. Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis: a Review Featuring a Women's Health Perspective.

    Science.gov (United States)

    Marchioni Beery, Renée M; Vaziri, Haleh; Forouhar, Faripour

    2014-12-01

    Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are two major types of chronic cholestatic liver disease. Each disorder has distinguishing features and variable progression, but both may ultimately result in cirrhosis and hepatic failure. The following offers a review of PBC and PSC, beginning with a general overview of disease etiology, pathogenesis, diagnosis, clinical features, natural course, and treatment. In addition to commonly associated manifestations of fatigue, pruritus, and fat-soluble vitamin deficiency, select disease-related topics pertaining to women's health are discussed including metabolic bone disease, hyperlipidemia and cardiovascular risk, and pregnancy-related issues influencing maternal disease course and birth outcomes. This comprehensive review of PBC and PSC highlights some unique clinical considerations in the care of female patients with cholestatic liver disease.

  7. Towards a more demand oriented health care: analyzing demand for local primary health care .

    NARCIS (Netherlands)

    Bakker, D.H. de; Zwaanswijk, M.; Zantinge, E.M.; Verhaak, P.F.M.

    2007-01-01

    One of the goals of the current health care reform in the Netherlands is to strengthen demand orientation. Community based primary health care provision should be tuned to local demand. Information on local demand is missing, however. Research goal is to provide local decision makers (patient

  8. Multidisciplinary Practice Experience of Nursing Faculty and Their Collaborators for Primary Health Care in Korea

    Directory of Open Access Journals (Sweden)

    Mi Ja Kim, PhD, RN, FAAN

    2008-03-01

    Conclusion: Teamwork should be included in all health professions' curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide.

  9. Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis

    OpenAIRE

    Mugisha, James; Abdulmalik, Jibril; Hanlon, Charlotte; Petersen, Inge; Lund, Crick; Upadhaya, Nawaraj; Ahuja, Shalini; Shidhaye, Rahul; Mntambo, Ntokozo; Alem, Atalay; Gureje, Oye; Kigozi, Fred

    2017-01-01

    Background Mental, neurological and substance use disorders contribute to a significant proportion of the world?s disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. Methods A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was d...

  10. Quality of Health Assistants in primary Health centres in Rural Maharashtra, India

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    Enakshi Ganguly

    2013-01-01

    Full Text Available Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.

  11. Retail health clinics drive innovation into primary care practices.

    Science.gov (United States)

    Kissinger, Mark

    2008-01-01

    A myriad of patient dissatisfaction issues stemming from antiquated approaches to primary care access are resulting in the establishment of retail health clinics (RHCs) throughout the country. RHCs are usually located within retail stores or stand-alone pharmacies and are staffed by nurse practitioners (NPs). They offer treatment for colds, coughs, skin rashes, and ear infections along with offering preventive care and physicals. As disruptive innovations, or innovations that offer services to ignored markets, these clinics are siphoning patient care visits away from primary care physicians because of their attention to quick access, affordable prices, and consumer-friendly approaches. In response, family and internal medicine physicians must follow three strategies to secure their patient population as well as attract new patients: build relationships with RHCs through referral networks and NP supervisory agreements, transform the provision of patient access through the development of physician-owned RHCs, and support the concept of the advanced medical home.

  12. The Burnout Condition of Primary Health Care Personnel

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    Mehmet Kaya

    2007-10-01

    Full Text Available The concept of burnout was first introduced by Fredeunberger in 1974. Fredeunberger had stated that burnout occurred more commonly in occupations whose members directly work with people. The aim of the study is to examine the burnout status of primary health care staff. The universe of this descriptive study is 466 health staff who work in primary health care units in Kecioren. The participation of the study was 54%. A Questionnaire including Maslach Burnout Inventory (MBI and some characteristics of the participants were used for data collection. Mann-whitney U and Kruskal Wallis tests have been used for analizing the survey data. Seventyseven percent of the participants were female and the emotional exhaustion score of female was higher than male (p<0.01. The age of the participants effect the individual achievement scores (p<0.01. The profession or marital status of the participants didn’t affect the MBI scores. Some socio-demografic characteristics of the participants such as gender and age, affect the scores of MBI. Comprehensive studies which display the causes of problems, needed in this issue. [TAF Prev Med Bull. 2007; 6(5: 357-363

  13. Telemedicine in Primary Health: The Virtual Doctor Project Zambia

    Directory of Open Access Journals (Sweden)

    Mustarde Paul

    2011-05-01

    Full Text Available Abstract This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront.

  14. Motives for requesting an electrocardiogram in primary health care.

    Science.gov (United States)

    Santos, Paulo; Martins, Carlos; Sá, Luísa; Hespanhol, Alberto; Couto, Luciana

    2015-05-01

    The management of requests for diagnostic exams presents its own inherent characteristics in primary health care and reflects the specific nature of the physician-patient relationship. The scope of the study was to identify the reasons for requesting an electrocardiogram (ECG) in primary health care. A cross-sectional study was conducted in an urban region in Portugal, establishing the motives to ask for an ECG consecutively over two years, starting on 01/03/2007 using data retrieved from structured forms filled out by the physician at the moment of requesting the exam. A total of 870 ECGs of 817 patients were included. Symptoms manifested during the patient visit justified 48.5% of the ECGs, and follow-up of cardiovascular risk factors motivated 25.2%. A global health examination accounted for 22.8% of the requests. Multivariate analysis showed that the presence of symptoms (p < 0.001), presence of any cardiovascular risk factor (p = 0.002), hypertension (p < 0.001), diabetes (p = 0.002), and urgency (p < 0.001) were the main factors associated with the requests. The requests for electrocardiograms are predominantly for clinical reasons as a result of patients symptoms. The integration of expectations and beliefs of the patients is present in the decision-making process.

  15. Improving motivation among primary health care workers in Tanzania: a health worker perspective

    DEFF Research Database (Denmark)

    Manongi, Rachel N; Marchant, Tanya C; Bygbjerg, Ib Christian

    2006-01-01

    In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality.The aim of this study was to explore the experiences of health workers working in the prim...... identified in the results and suggests that some of the preferences presented by the health workers be discussed at policy level with a view to adding value to most services with minimum additional resources....

  16. [Description of the pharmaceutical services offered by the universal health care system at the primary care level in Londrina, Paraná, Brazil].

    Science.gov (United States)

    Menolli, Poliana Vieira da Silva; Ivama, Adriana Mitsue; Cordoni Júnior, Luis

    2009-03-01

    To describe the pharmaceutical services offered at the primary care level by Brazil's Sistema Unico de Salud (Universal Health Care System). The study took place in Londrina, Paraná, in January-March 2003. The World Health Organization's recommended drug use indicators were employed. Included in the study were 13 primary health care facilities in which 390 patients were interviewed. None of the facilities had a pharmacist. The average office visit lasted 8.6 minutes; the mean number of drugs prescribed was 2.2; and injections were given in 10.9%. Generic drugs were prescribed 66.5% of the time and 73% of the prescribed drugs were included in the Lista Municipal de Medicamentos Esenciales (Municipal List of Essential Drugs). Only 46.6% of the patients interviewed reported having the basic instructions required for appropriate use of the drug prescribed. These results can aid in restructuring the municipality's pharmaceutical services because they underscore the need to improve and to increase rational drug use as a therapeutic resource imperative to supporting health efforts.

  17. Evaluation of Enviromental Health in Primary Schools, Kemalpasa-Izmir

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    Ahmet Soysal

    2008-10-01

    Full Text Available AIM: The aim of this study was to evaluate the situation of environmental health and the differences in environmental health among primary schools of county seat and rural area in Kemalpasa county, Izmir. METHODS: Fourty six primary schools in Kemalpasa county constituted the research universe this cross-sectionel study. We intended to reach all of these schools. Surrounding conditions, toilet hygene, waste materials, food and water safety of the schools were evaluated. Data were collected from school administrators by questionnaire and by measuring and observing some of the variables. RESULTS: Of the 46 primary schools found in Kemalpasa county 9 are located in the county seat and 37 are located rural area. The mean number of classrooms was 10.8±1.4 (1-38 and students was 320.1±55.9 (7-1323 in these schools. Twenty (43.5% of these schools were located on the main roads with heavy traffic, 8 (17.4% had playground features appropriate for accidents, 31 (67.4% had enviromentproffesionals, 33 (71.7% had preventive walls around them, 28 (60.9% had connection to the canalization system, 31 (67.4% had the necessary measures taken for fire. Of the 16 (34.8% schools those had canteens, 12 (75.0% of them were not licenced for sanitation, 11 (68,8% of them could not get systematic porter inspection. Among these primary schools 37 (80.4% had sufficient amount of soap and 5 (10.9% had paper towels. Fourty four (95.7% of the schools had their water analyzed at various intervals, 17 (37.0% had water tanks in case of inadequate water supply. There was a significant difference among schools in the county seat of Kemalpasa compared to schools in the countryside on being connected to canalization network (p=0.007, on having necessary fire precautions (p=0.021, on providing waste baskets in the school coridors (p=0.001 and on making porter examinations in the canteen personels (p=0.035. CONCLUSION: This study shows that the primary schools in the county of

  18. Health profiles of foreigners attending primary care clinics in Malaysia.

    Science.gov (United States)

    Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

    2016-06-14

    The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care. Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters. More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public

  19. Health information technology workforce needs of rural primary care practices.

    Science.gov (United States)

    Skillman, Susan M; Andrilla, C Holly A; Patterson, Davis G; Fenton, Susan H; Ostergard, Stefanie J

    2015-01-01

    This study assessed electronic health record (EHR) and health information technology (HIT) workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT. Rural primary care practices (1,772) in 13 states (34.2% response) were surveyed in 2012 using mailed and Web-based questionnaires. EHRs or HIT were used by 70% of respondents. Among practices using or intending to use the technology, most did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill gaps. Many practices had staff with some basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds (61.4%) needed more staff training. Affordable access to vendors/consultants who understand their needs and availability of community college and baccalaureate-level training were the workforce-related barriers cited by the highest percentages of respondents. Accessing the Web/Internet challenged nearly a quarter of practices in isolated rural areas, and nearly a fifth in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers in small and isolated rural areas than in large rural areas. Rural primary care practices mainly will rely on existing staff for continued implementation and use of EHR/HIT systems. Infrastructure and workforce-related barriers remain and must be overcome before practices can fully manage patient populations and exchange patient information among care system partners. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations. © 2014 National Rural Health Association.

  20. Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

    Science.gov (United States)

    Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

    2015-01-01

    (1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

  1. Electronic health records and support for primary care teamwork

    Science.gov (United States)

    Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

    2015-01-01

    Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

  2. Electronic health records and support for primary care teamwork.

    Science.gov (United States)

    O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

    2015-03-01

    Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  3. Intertester reliability of shoulder complaints diagnoses in primary health care.

    Science.gov (United States)

    Storheil, Benny; Klouman, Elise; Holmvik, Stian; Emaus, Nina; Fleten, Nils

    2016-09-01

    Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting. Cross-sectional study. Four primary health care clinicians used patients' history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints. 62 patients, aged 18-75 years. Reliability of diagnoses was assessed by observed intertester agreement and Cohen's kappa. A total of 372 diagnostic pairs were available for intertester comparisons. Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73). Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints. Key points   Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary

  4. Essential interventions on workers' health by primary health care : a scoping review of the literature: a technical report

    NARCIS (Netherlands)

    Buijs, P.; Dijk, F. van

    2014-01-01

    The TNO review Essential interventions on Workers’ Health by Primary Health Care shows those interventions in primary, secondary and tertiary prevention are necessary and feasible but not yet satisfactorily evidence-based. Necessary, because primary or community health care covers about 80% of the

  5. [INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE WITH PRIMARY HEALTH CARE IN CROATIA – OPINIONS OF PRIMARY HEALTH CARE PHYSICIANS].

    Science.gov (United States)

    Radovčić, Z; Nola, I A

    2015-01-01

    Since the turn of the century, Complementary and Alternative Medicine (CAM) has been on the fast track in Croatia, particularly in big cities. Following the examples of developed health systems in the world, it was to be expected that sooner or later CAM would be integrated within primary health care system in Croatia as well. The main aim of this survey was to reveal the actual attitude and opinion of the Croatian primary health care physicians toward CAM. Specific aims were to reveal the physicians’ need for additional education and to reveal the need for keeping CAM therapy records in patient history of illness. On-line questionnaire consisted of 10 questions with two possible answers, Yes or No. The questionnaire was sent to 388 e-addresses and 84 (21.6%) of them responded. This response rate we considered sufficient for further statistical analyses. Although most of the respondents could differentiate alternative and complementary medicine, 21.4% of them still did not know the difference between these two types of medical approach. Furthermore, 79.8% of the respondents confirmed patient interest in CAM. Almost 72% of the respondents considered they did not have sufficient knowledge for informative conversation about CAM with their patients. Only 27.4% of the respondents had enrolled some kind of formal education related to CAM, and almost 73% confirmed their need for formal education on the topic; 88.1% of the respondents considered that CAM methods should be combined with conventional medicine and 97.6% believed that primary health care physicians should keep records on patient use of CAM methods. Interestingly, 76.2% of the same randomly chosen primary health care physicians considered that there is strong resistance among medical doctors towards CAM methods, but our results did not show it. According to the results of our survey, although the majority of respondents (primary care physicians) distinguished alternative and complementary medicine, 21.4% of

  6. [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.

  7. Counselling for mental health and psychosocial problems in primary care.

    Science.gov (United States)

    Bower, Peter; Knowles, Sarah; Coventry, Peter A; Rowland, Nancy

    2011-09-07

    The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care. To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care. To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011). Randomised controlled trials of counselling for mental health and psychosocial problems in primary care. Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events. Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the

  8. Defining a Role for the Health Educator in the Primary Care Setting

    Science.gov (United States)

    Carlton, Bill; Carlton, Mary A.

    1978-01-01

    The need for a role definition for health educators in primary health care programs is discussed. A program in diabetic education is offered as an illustration of health educator involvement in health care delivery. (MJB)

  9. Prevention of mental handicaps in children in primary health care.

    Science.gov (United States)

    Shah, P M

    1991-01-01

    Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap.

  10. Conceptions on pharmaceutical services in Brazilian primary health care.

    Science.gov (United States)

    Costa, Ediná Alves; Araújo, Patrícia Sodré; Penaforte, Thais Rodrigues; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

    2017-11-13

    To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects. This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions. Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services. The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual

  11. Conceptions on pharmaceutical services in Brazilian primary health care

    Directory of Open Access Journals (Sweden)

    Ediná Alves Costa

    2017-11-01

    Full Text Available ABSTRACT OBJECTIVE To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015, which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions. RESULTS Among the wide diversity of conceptions on pharmaceutical services (PS, we highlight the ones focused on 1 logistic control of medicines with activities concerning guidance or information on their use and 2 guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services. CONCLUSIONS The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified

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

    African Journals Online (AJOL)

    ... weight management, sufficient exercise, discontinuing smoking habits, stress management, and secondary prevention which involves annual medicals, and a focussed approach of specific screening protocols. Keywords: Primary health care; primary care; managed health care; medical scheme; cardiovascular disease,

  13. Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

    Science.gov (United States)

    Pons-Vigués, Mariona; Berenguera, Anna; Coma-Auli, Núria; Pombo-Ramos, Haizea; March, Sebastià; Asensio-Martínez, Angela; Moreno-Peral, Patricia; Mora-Simón, Sara; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta

    2017-06-13

    Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having

  14. Organizational scope of practice: assessing the primary care and public health activities of health centers and health departments in Iowa.

    Science.gov (United States)

    Wright, Brad; Ugwi, Patience; Nice, Andrew J

    2015-04-01

    The objective was to understand how Federally Qualified Health Centers (FQHCs) and local health departments (LHDs) address their shared mission of improving population health by determining the scope of primary care and public health activities each provides in their community. A brief mail survey was designed and fielded among executive directors at all 14 FQHCs in Iowa, and 13 LHDs in Iowa representing counties with and without an FQHC. This survey contained a mixture of questions adapted from previously validated primary care and public health survey instruments. Using survey responses, each FQHC and LHD was given 2 scores (each ranging from 0-100) measuring the extent of their primary care and public health activities, respectively. The overall response rate was 85.2%; the response rate was 78.6% within FQHCs and 91.7% within LHDs. Overall, FQHCs had higher scores (73.8%) compared to LHDs (27.3%) on total primary care services, while both LHDs (79.3%) and FQHCs (70.9%) performed particularly well on public health services. FQHCs and LHDs in Iowa address a variety of public health and primary care issues, including but not limited to screening for chronic diseases, nutrition counseling, immunizations, and behavioral health. However, FQHCs provide a higher amount of primary care services and nearly as many public health services when compared to LHDs. In a value-based health care delivery system, integrating to improve population health is a wise strategy to maximize efficiency, but this will require maximizing coordination and minimizing duplication of services across different types of safety net providers.

  15. Availability and type of human resource for health in public primary ...

    African Journals Online (AJOL)

    Background: Health human resource capacity is one of the major determinants of an effective health care delivery system. It is more importantly so in the Primary Health Care system, which is the key component of every health system. This study assessed the available and type of human resource for health in public primary ...

  16. Family functioning style and health: opportunities for health prevention in primary care

    Science.gov (United States)

    García-Huidobro, Diego; Puschel, Klaus; Soto, Gabriela

    2012-01-01

    Background The relationship between family and health has not been studied in detail in primary care. Aim To evaluate the association between family functioning style and health problems among families receiving primary care. Design and setting Cross-sectional study in an underserved primary care clinic in Santiago, Chile. Method Families registered at the Juan Pablo II Primary Care Clinic in Santiago, Chile from 2006 to 2010 formed the study sample. Each family selected an adult family member to answer a questionnaire to provide data on: family sociodemographics; health problems among family members; and the family functioning style, as assessed with the Family Functioning Style Scale (FFSS). The t-test was used to assess differences in family functioning styles between families with and without health problems, and analysis of variance was used to study the relationship between the family functioning style and the number of health problems present. Results A total of 6202 families, comprising 25 037 people, were assessed. The following diseases and conditions were examined: in children — asthma or recurrent bronchitis, delayed development, enuresis or encopresis, behavioural problems, overweight; in adolescents and adults — teenage pregnancy, asthma or chronic obstructive pulmonary disease, smoking, hypertension, type 2 diabetes, major depression, alcohol or drug abuse, and frailty. Families with health problems had a significantly lower FFSS score than families without health conditions. Mental health diseases had the strongest association with family functioning style. An inverse relationship between the number of health problems and the FFSS score was also observed. Conclusion A better family functioning style was associated with a lower prevalence of health problems in families. Bases for further research considering the family as a target for clinical interventions are provided. PMID:22429437

  17. Investigating referral pathways from primary care to consumer health organisations.

    Science.gov (United States)

    Young, Charlotte E; Mutch, Allyson J; Boyle, Frances M; Dean, Julie H

    2010-01-01

    While chronic disease places an increasing burden on Australia's primary care system it is unrealistic to expect GPs to meet the range of support needs experienced by patients managing chronic conditions. Consumer health organisations (CHO) have the potential to augment clinical care by providing a variety of supportive services; however, they are underutilised by patients and GPs. This qualitative study investigates GPs' knowledge and perceptions of CHO and their contributions to chronic disease care. The study involved semi-structured interviews with 10 GPs. Overall, participants demonstrated clear understanding of the role of CHO in chronic disease management, but a critical finding was the way GPs' view of their own chronic care role appears to influence referral practices. GPs operating in a traditional role were less likely to refer to CHO than those who had adopted a chronic care approach. A second key finding related to GPs' views of Diabetes Australia. All GPs identified this organisation as an important referral point, providing some reassurance that CHO can be integrated into the primary care sector. Further research is needed to determine how the 'definite advantages' associated with Diabetes Australia can be used to extend GP referral and enhance the health system's integration of other CHO.

  18. [New guidelines for antibiotic use in primary health care].

    Science.gov (United States)

    Eliassen, Knut Eirik; Fetveit, Arne; Hjortdahl, Per; Berild, Dag; Lindbaek, Morten

    2008-10-23

    In 2000, the first national guideline is on antibiotic use in general practice wee distributed to all general practitioners and medical students in Norway. Here we describe the development of new guidelines. A working group of 30 people searched relevant databases for literature. We have especially used research from Norway and from general practice and nursing homes. The main recommendations of the 2000 guidelines are upheld. For upper respiratory tract infections there is now an even better evidence base to support strict indications for antibiotic treatment. A good evidence base supports continuation of the Norwegian tradition of prudent antibiotic use in primary health care. In some areas there is insufficient research. After an initiative from the Directorate of Health, the Antibiotic Centre for Primary Medicine have developed the new guidelines as a part of the governmental strategy to combat antimicrobial resistance. Prudent antibiotic use is seen as an important measure. For this reason, the guidelines will also be printed in a booklet that will be sent to general practitioners, medical students and nursing homes.

  19. Integration of mental health into primary care in Sri Lanka

    Science.gov (United States)

    2012-01-01

    Introduction Sri Lanka has one of the highest suicide rates in the world, with recent protracted conflict and the tsunami aggravating mental health needs. This paper describes a project to establish a systematic “train the trainers” programme to integrate mental health into primary care in Sri Lanka's public health system and private sector. Methods A 40 hour training programme was delivered to curriculum and teaching materials were adapted for Sri Lanka, and delivered to 45 psychiatrists, 110 medical officers of mental health and 95 registered medical practitioners, through five courses, each in a different region (Colombo, Kandy, Jaffna, Galle and Batticola). Participants were selected by the senior psychiatrist of each region, on the basis of ability to conduct subsequent roll out of the training. The course was very interactive, with discussions, role plays and small group work, as well as brief theory sessions. Results Qualitative participant feedback was encouraging about the value of the course in improving patient assessments and treatments, and in providing a valuable package for roll out to others. Systematic improvement was achieved between pre- and post-test scores of participants at all training sites. The participants had not had prior experience in such interactive teaching methods, but were able to learn these new techniques relatively quickly. Conclusions The programme has been conducted in collaboration with the Sri Lankan National Institute of Mental Health and the Ministry of Health, and this partnership has helped to ensure that the training is tailored to Sri Lanka and has the chance of long term sustainability. PMID:23277794

  20. Perceived risk of mental health problems in primary care.

    LENUS (Irish Health Repository)

    2015-01-01

    In the face of limited resources and an aging population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalization, hospitalization and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care (PC). We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community to rank perceived risk of mental health concerns (including neurocognitive and mood disorders) from 1 (mild) to 3 (severe). The mean age of the 4499 people assessed was 76.3 years (SD = 7.3) and 2645 (58.8%) were female. According to the PC team 1616 (35.9%) were perceived to have mental health concerns of whom 847 (52.4%) were mild, 559 (34.6%) were moderate and 210 (13%) were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR = 2.22, 95% CI 1.83-2.69 for institutionalization; OR = 1.66, 95% CI 1.41-1.94 for hospitalization; OR = 1.69, 95% CI 1.42-2.01 for death). These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

  1. Functional health literacy among primary health care users in transitional Kosovo.

    Science.gov (United States)

    Kamberi, Haxhi; Hysa, Bajram; Toçi, Ervin; Jerliu, Naim; Qirjako, Gentiana; Burazeri, Genc

    2013-01-01

    Adequate functional health literacy is considered as a basic prerequisite for a proper health-seeking behavior of adult individuals. Our aim was to assess the levels and socioeconomic correlates of functional health literacy among adult primary care users in transitional Kosovo. A cross-sectional study was conducted in Kosovo in November 2012-February 2013 including a representative sample of 1035 primary health care users aged > or = 18 years (60% females; overall mean age: 44.3 +/- 16.9 years; overall response rate: 86%). The cross-culturally adapted long version of TOFHLA test (an instrument assessing reading comprehension and numerical abilities) was used to assess functional health literacy among study participants. TOFHLA scores range between 0-100 with higher scores implying better functional health literacy. The analysis of variance (ANOVA) was used to assess the association of functional health literacy with demographic and socioeconomic characteristics. Mean score of the functional health literacy was significantly higher among younger participants, in men, in highly educated individuals and participants with better self-reported income level. Our findings indicate that vulnerable socioeconomic individuals exhibit lower functional health literacy levels in post-war Kosovo. Health care professionals and particularly policy makers in Kosovo must be aware of the excess risk among the low socioeconomic groups and should tailor intervention programs accordingly.

  2. [Workers in primary health care and partner violence against women].

    Science.gov (United States)

    Arredondo-Provecho, Ana Belén; Broco-Barredo, Manuel; Alcalá-Ponce de León, Teresa; Rivera-Álvarez, Araceli; Jiménez Trujillo, Isabel; Gallardo-Pino, Carmen

    2012-01-01

    Morbidity associated to partner violence against women (PVAW) justify these patients repeated visits to Health Services. Primary Care is the ideal place for detectión and first aid, due to its easy accesibility and continuated assistance. Nevertheless, numbers show important difficulties to achieve this goal. Our aim is to find out the level of knowledge, opinions, awareness about organizacional barriers and improvement proposals suggested by the workers of primary care. Cross-sectional descriptive study using an anonymous and voluntary survey during the months of August and September 2010, targeted to all professionals who perform their work in a Primary Care Area of Madrid. We made a descriptive analysis of variables and used chi(2) to compare the answers. Answer rate is 170 (21.4%). There are stereotypes regarding battered woman and perpetrador. 118 (70.7%) professionals believe that this is a major problem and 154 (91.7%) that usually goes unnoticed. 91 (55.2%) know their legal commitments. 73 (51.8%) think that there are organizational barriers, among them: the burden of care 50(29%), lack of specific training 40(23.5), lack of knowledge about the procedure to be followed 20(11.8%) and about the professional responsabilities 12 (7%). All profesional categoríes showed an average level of knowledge, except for social workers that was high. Primary Care workers think that PVAW is an important issue that usually goes unnoticed. Half of them know the legal commitments o detección. There are organizacional barriers and stereotypes.

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

    Science.gov (United States)

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

    2018-01-01

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

  4. Diabetes Connect: Developing a Mobile Health Intervention to Link Diabetes Community Health Workers with Primary Care

    Science.gov (United States)

    Cherrington, Andrea L.; Agne, April A.; Lampkin, Yolanda; Birl, Annie; Shelton, Tanya C.; Guzman, Alfredo; Willig, James H.

    2016-01-01

    Community Health Worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the healthcare team and enhance care. We tested a model for the integration of a CHW delivered mHealth intervention to improve diabetes self-management. Seventy-two African American patients with diabetes were followed using the mHealth tool. This project partnered an academic institution, a safety-net clinic, and African American churches. The integration of mHealth technology into CHW programs was successfully achieved and readily accepted. PMID:26353025

  5. The process of formation of mental health for nurses in primary health care

    Directory of Open Access Journals (Sweden)

    Hilton Giovani Neves

    2012-04-01

    Full Text Available This study was based on descriptive, exploratory and qualitative approach and aimed at analyzing scientific knowledge that was developed in the formation of Family Health (FH nurses to address Mental Health in Primary Care regarding psychosocial aspects. Research conducted in 2008 with three teams of FH nurses a municipality in the countryside of Mato Grosso, whose data were submitted to content analysis. The results were organized according to two themes "The limitations of official spaces for the training of nurses" and "The Family Health as well as the transformation praxis in Mental Health ". It was concluded that the official spaces mentioned above do not give too much importance to education on mental health, the same occurs in the context of lifelong learning. Despite the limited provision of skills for Mental Health care, we have found significant changes such as the sensitization to emotional and psychological manifestations of the population with higher awareness of health.

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

    Science.gov (United States)

    Vaughan, J P; Walt, G

    1984-07-01

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

  7. Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.

    Science.gov (United States)

    Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David

    2017-03-22

    Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Pharmaceutical care in Brazil’s primary health care

    Science.gov (United States)

    Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

    2017-01-01

    ABSTRACT OBJECTIVE To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. RESULTS From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were “pharmaceutical guidance” and “pharmaceutical care.” The registration of activities is mainly made in the users’ medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. CONCLUSIONS Activities of clinical nature performed by pharmacists

  9. 78 FR 41866 - Restructuring of Regulations on the Importation of Plants for Planting

    Science.gov (United States)

    2013-07-12

    ... Animal and Plant Health Inspection Service 7 CFR Parts 319 and 340 RIN 0579-AD75 Restructuring of Regulations on the Importation of Plants for Planting AGENCY: Animal and Plant Health Inspection Service, USDA... importation of plants for planting. This action will allow interested persons additional time to prepare and...

  10. Evaluation of Mental Health Integration in Primary Health Care in View of Participants and Rural Health Workers of Dezful, Khuzestan

    Directory of Open Access Journals (Sweden)

    Khosrotaj

    2015-04-01

    Full Text Available Background Evaluation and determination of different achievements of interventions in health care is one of the important responsibilities of the health system. Objectives The aim of present study was to evaluate the integration of mental health program in the primary health care (PHC system in rural areas of Dezful district in view of participants and health workers. Patients and Methods In this descriptive-cross sectional research, which was done in rural areas of Dezful during year 2014, the main indexes of mentioned integration such as knowledge, attitude and performance of physicians, health workers and participants were measured. The data collection instrument was valid and reliable questionnaires, which are often used by the mental health department of the health ministry. Validity and reliability of questionnaires have frequently been confirmed by researchers in different studies. The study population included all 19 rural physicians, 89 health workers and a random sample of 15 - 60 year-old participants in the health network of Dezful. Frequency of distribution and computation of central and distribution indexes were used for data analysis. Results The amount of physicians’ knowledge was about 50%, while the rate of health workers’ knowledge was 62%. The rate of health workers’ attitude was 92%, while the rate of participants’ knowledge was 50% and the rate of participants’ attitude was 19%. Consequently, the integration of mental health in primary health care system of rural areas of Dezful district has been relatively successful. Conclusions The integration of mental health into primary health care is an important priority in the Iranian health system. Monitoring and evaluation of this strategic project to remove its weaknesses is essential.

  11. Primary health care to elderly people: Occupational Therapy actions perspectives

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    Cassio Batista Alves

    2015-09-01

    Full Text Available In Brazil, Occupational Therapy (OT was legislated in 1969, and was introduced into the Primary Health Care (PHC in the 90s. At this level of care, the OT serves various stages of human development, including aging, in a perspective of care and active aging line, seeks to optimize opportunities for health, participation and safety, using clinical reasoning in order to plan, guide, conduct and reflect their actions in producing the line of care. This career considers human activities as part of the construction of the man himself as an expertise area and seeks to understand the relationships that the active human establishes in its life and health. This study aimed to verify the actions and identify the occupational therapy line of care with the elderly in APS. This is a qualitative study that used a semi-structured interview applied during April to May 2013 with six occupational therapists that cared for older people in the APS at Uberaba-MG. The data was analyzed using the Collective Subject Discourse (CSD technique. We observed that the OT actions to produce line of care for the elderly happen according to the general public care, whether individual or group, with the team during case discussions, referrals or work management and the territory during the territorial diagnosis and networks formation, all permeated by the principles of fairness, integrity, intersectoriality and clinical reasoning in OT.

  12. Patient satisfaction with pharmaceutical services in Brazilian primary health care.

    Science.gov (United States)

    Soeiro, Orlando Mario; Tavares, Noêmia Urruth Leão; Nascimento, José Miguel do; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Karnikowski, Margô Gomes de Oliveira; Leite, Silvana Nair; Costa, Karen Sarmento

    2017-11-13

    To evaluate patient satisfaction with pharmaceutical services in Brazilian primary health care. This is a cross-sectional, exploratory, and evaluative study on a representative sample from the five Brazilian geopolitical regions resulting from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The outcome was the patient's satisfaction, obtained using the item response theory. Associations were tested using Pearson's Chi-square test with sociodemographic and health variables, and multiple logistic regression analyses were carried out. The Hosmer-Lemeshow test was used to verify the adequacy of the final model. Logistic regression results were presented as odds ratio. The overall percentage of patients satisfied with these services was 58.4% (95%CI 54.4-62.3). The "opportunity/convenience" aspect had the lowest satisfaction percentage (49.5%; 95%CI 46.4-52.6) and "interpersonal aspects," the highest percentage (90.5%; 95%CI 88.9-91.8), significantly higher than other aspects. Sex, age group, limitations due to disease, and self-perception of health remained associated in the final multiple logistic model regarding general satisfaction. Most of the interviewed users were satisfied with pharmaceutical services in Brazilian cities, and the satisfaction with the customer's service was determinant in the patient's overall satisfaction.

  13. School Mapping Restructure in China: What Role for the Small Rural School?

    Science.gov (United States)

    Zhao, Dan; Parolin, Bruno

    2011-01-01

    Despite significant progress over the past fifteen years associated with School Mapping Restructure (SMR) in Chinese rural schools, many small schools have been closed or have merged with larger primary schools. This has resulted, among other things, in difficulties for many students in rural areas who now have to travel longer distances to a…

  14. Essential attributes and qualifiers of primary health care

    Directory of Open Access Journals (Sweden)

    Andréa Silvia Walter de Aguiar

    2012-06-01

    Full Text Available Historically, the primary health care (PHC has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country.Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1.A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicine in Europe, which describes 12 characteristics: general, accessible, integrated, continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2.Donabedian(3 systematized a group of important

  15. Towards a more demand oriented health care: analyzing demand for local primary health care .

    OpenAIRE

    Bakker, D.H. de; Zwaanswijk, M.; Zantinge, E.M.; Verhaak, P.F.M.

    2007-01-01

    One of the goals of the current health care reform in the Netherlands is to strengthen demand orientation. Community based primary health care provision should be tuned to local demand. Information on local demand is missing, however. Research goal is to provide local decision makers (patient organizations, insurers, providers) with a tool to analyse local demand, thus creating a basis for an informed discussion. Methods: Known sociodemographic characteristics of local areas on age, gender, h...

  16. Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health

    Directory of Open Access Journals (Sweden)

    Buykx Penny

    2011-03-01

    Full Text Available Abstract Background Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. Methods/Design The evaluation framework aims to examine the health service over a six-year period in terms of: (a Structural domains (health service performance; sustainability; and quality of care; (b Process domains (health service utilisation and satisfaction; and (c Outcome domains (health behaviours, health outcomes and community viability. Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. Discussion This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how

  17. Primary Health Care and partnerships: collaboration of a community agency, health department, and university nursing program.

    Science.gov (United States)

    Leonard, L G

    1998-03-01

    Health care reform proposals emphasize health care that is essential, practical, scientifically sound, coordinated, accessible, appropriately delivered, and affordable. One route to achievement of improved health outcomes within these parameters is the formation of partnerships. Partnerships adopting the philosophy and five principles of Primary Health Care (PHC) focus on health promotion and prevention of illness and disability, maximum community participation, accessibility to health and health services, interdisciplinary and intersectoral collaboration, and use of appropriate technologies such as resources and strategies. A community service agency serving a multicultural population initiated a partnership with a health department and a university undergraduate nursing program. The result was a preschool health fair and there were benefits for each partner-benefits which could not have been realized without the collaboration. The health fair partnership planning, implementation, and evaluation process was guided by a framework shaped by the philosophy and five principles of PHC. The educational process described can be applied to other learning experiences where the goal is to help students understand and apply the concepts of PHC, develop myriad nursing competencies, and form collaborative relationships with the community and health agencies. Community health care dilemmas and nursing education challenges can be successfully addressed when various disciplines and sectors form effective partnerships.

  18. Merging, partnering, and restructuring: coping with the culture clashes.

    Science.gov (United States)

    Neuhauser, P C; Bender, R

    1998-01-01

    Turmoil in the health-care industry caused by restructuring, mergers, and acquisitions shows no sign of letting up. This condition will continue as the industry adjusts to government and marketplace pressures. To ensure that you can carry out a merger successfully, you should look to creating a new, blended organizational culture. By viewing a model of culture as having three layers, you can develop an action plan to increase trust and open communications between the groups. An examination of organizations involved in complex changes such as a merger or acquisition shows that those who succeed focus on the human part of the equation.

  19. Work context, job satisfaction and suffering in primary health care

    Directory of Open Access Journals (Sweden)

    Greisse da Silveira Maissiat

    Full Text Available OBJECTIVE: To evaluate the work context, job satisfaction and suffering from the perspective of workers in primary health care. METHOD: This cross-sectional study was conducted with 242 employees of a municipality of Rio Grande do Sul, Brazil, from May to July 2012. The adopted instruments were the Work Context Assessment Scale (EACT and the Job Satisfaction and Suffering Indicators Scale (EIPST. Research also included descriptive and inferential statistical analysis. RESULTS: Organization (91.3% and work conditions (64% received the worst scores in terms of context. The indicators of job satisfaction were related to professional achievement (55.8%, freedom of expression (62.4% and recognition (59.9%. However, 64.5% presented professional exhaustion, which had an inverse association with age and years in the institution (p<0.05. CONCLUSION: The workers evaluated their work context as inappropriate and complained of exhaustion, although they claimed their work affords some satisfaction.

  20. [Work context, job satisfaction and suffering in primary health care].

    Science.gov (United States)

    Maissiat, Greisse da Silveira; Lautert, Liana; Pai, Daiane Dal; Tavares, Juliana Petri

    2015-06-01

    To evaluate the work context, job satisfaction and suffering from the perspective of workers in primary health care. This cross-sectional study was conducted with 242 employees of a municipality of Rio Grande do Sul, Brazil, from May to July 2012. The adopted instruments were the Work Context Assessment Scale (EACT) and the Job Satisfaction and Suffering Indicators Scale (EIPST). Research also included descriptive and inferential statistical analysis. Organization (91.3%) and work conditions (64%) received the worst scores in terms of context. The indicators of job satisfaction were related to professional achievement (55.8%), freedom of expression (62.4%) and recognition (59.9%). However, 64.5% presented professional exhaustion, which had an inverse association with age and years in the institution (psatisfaction.

  1. Characterizing Primary Care Visit Activities at Veterans Health Administration Clinics.

    Science.gov (United States)

    Gutierrez, Jennifer C; Terwiesch, Christian; Pelak, Mary; Pettit, Amy R; Marcus, Steven C

    2015-01-01

    Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better under stand how primary care providers (PCPs) currently spend visit time and to provide insight into potential opportunities for revision or redistribution of healthcare tasks. We videotaped 27 PCPs during office visits with 121 patients at four Veterans Health Administration medical centers. Based on patterns emerging from the data, we identified a taxonomy of 12 provider activity categories that enabled us to quantify the frequency and duration of activities occurring during routine primary care visits. We conducted descriptive and multivariate analyses to examine associations between visit characteristics and provider and clinic characteristics. We found that PCPs spent the greatest percentage of their visit time discussing existing conditions (20%), discussing new conditions (18%), record keeping (13%), and examining patients (13%). Providers spent the smallest percentage of time on preventive care and coordination of care. Mean visit length was 22.9 minutes (range 7.9-58.0 minutes). Site-level ratings of medical home implementation were not associated with differences in how visit time was spent. These data provide a window into how PCPs are spending face-to-face time with patients. The methodology and taxonomy presented here may prove useful for future quality improvement and research endeavors, particularly those focused on opportunities to increase nonappointment care and to ensure that team members work at the top of their skill level.

  2. 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.

  3. A focus group study on primary health care in Johannesburg Health ...

    African Journals Online (AJOL)

    nurse conflict and poor teamwork. This may threaten attempts to re-engineer primary health care in order to increase the presence of doctors at clinic level. The discipline of family medicine can make a difference, but reorganisation of the system ...

  4. Medicine dispensing service in primary health care of SUS.

    Science.gov (United States)

    Leite, Silvana Nair; Bernardo, Noemia Liege Maria da Cunha; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Soares, Luciano

    2017-11-13

    To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines. This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services. More than half (53%) of the units presented a space smaller than 10 m2 for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities. There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.

  5. Medicine dispensing service in primary health care of SUS

    Directory of Open Access Journals (Sweden)

    Silvana Nair Leite

    2017-11-01

    Full Text Available ABSTRACT OBJECTIVE To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines. METHODS This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines, 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services. RESULTS More than half (53% of the units presented a space smaller than 10 m2 for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities. CONCLUSIONS There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.

  6. [Management of adult secondary insomnia in primary health care].

    Science.gov (United States)

    Cavadas, Luís Filipe; Ribeiro, Lúcia

    2011-01-01

    Insomnia is the most common sleep disorder in adults, with secondary insomnia being the most prevalent. This sleep disorder is associated with important medical and social consequences. The General Practitioner (GP) plays a key role in the diagnosis of insomnia, which may affect about 69% of their patients in the PHC (Primary Health Care). Recognize the differential diagnosis of secondary insomnia in adults, evaluate and manage these patients in the PHC, appropriately use the treatments available and meet the criteria for referral. Bibliographic search in MEDLINE databases, and evidence based review databases, using the MeSH terms: Primary Health Care, Sleep Disorders, Insomnia, for articles published since January 2000 until July 2009, in English, Portuguese, French and Spanish. Index de Revistas Médicas Portuguesas and scientific societies dedicated to sleep disorders were searched. Mood and anxiety disorders are the main co-morbidities associated with secondary insomnia, being present in 30% to 50% of patients with insomnia. The medical pathology and substance abuse are present respectively in 10% of patients. It is essential a proper clinical history, with a history of sleep, sleep diary and the partner information. There is evidence that the combination of specific pharmacological treatments (benzodiazepines and the benzodiazepine receptor agonists) with the nonpharmacological (cognitive-behavioral therapy) may be useful in secondary insomnia, as co-adjuvant treatment of the underlying disease. There are several treatment options with their indications and adverse effects. The criteria for referral should be defined according to the availability of human resources. Due to the high prevalence and the serious consequences of secondary insomnia in adults, it must be systematically managed by the GP. It is important to know and to use non-pharmacological therapy in GP consultation, because this therapy was shown to be important in treating this type of insomnia

  7. Using the Primary Literature in an Allied Health Microbiology Course

    Directory of Open Access Journals (Sweden)

    Donald P. Breakwell

    2009-12-01

    Full Text Available A strategy was adapted for using the primary literature to foster active learning in an allied health microbiology course. Recent journal articles were selected that underscored the fundamental microbiological principles to be learned in each course unit. At the beginning of the semester, students were taught the relationship between the layout of scientific articles and the scientific method. During the rest of the semester, students were oriented to the topic of each paper by viewing videos from Unseen Life on Earth: an Introduction to Microbiology, reading assigned pages from the text, and participating in mini-lectures and discussions. After all preparatory material was completed, a paper was read and discussed in small groups and as a class. Students were assessed using daily reading quizzes and end-of-unit concept quizzes. While reading quizzes averaged approximately 93%, concept quiz grades averaged approximately 82%. Student recognition of the terms used in each unit’s scientific article was assessed with pre-read and post-read wordlists. For the self-assessment, the percent change between pre-read and post-read word cognition was, as expected, highly significant. Approximately 80% of students agreed that reading the scientific articles was a valuable part of the class and that it provided meaning to their study of microbiology. Using the primary scientific literature facilitated active learning in and out of the classroom. This study showed that introducing the scientific literature in an allied health microbiology class can be an effective way of teaching microbiology by providing meaning through the current literature and understanding of the scientific method.

  8. Europe's strong primary care systems are linked to better population health but also to higher health spending.

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.; Zee, J. van der; Groenewegen, P.

    2013-01-01

    Strong primary care systems are often viewed as the bedrock of health care systems that provide high-quality care, but the evidence supporting this view is somewhat limited. We analyzed comparative primary care data collected in 2009-10 as part of a European Union-funded project, the Primary Health

  9. Europe's strong primary care systems are linked to better population health but also to higher health spending

    NARCIS (Netherlands)

    Kringos, Dionne S.; Boerma, Wienke; van der Zee, Jouke; Groenewegen, Peter

    2013-01-01

    Strong primary care systems are often viewed as the bedrock of health care systems that provide high-quality care, but the evidence supporting this view is somewhat limited. We analyzed comparative primary care data collected in 2009-10 as part of a European Union-funded project, the Primary Health

  10. Client waiting time in an urban primary health care centre in Lagos ...

    African Journals Online (AJOL)

    Background: Primary Health Care is the usual entry point into the health system and has the potential to touch the lives of most people. However one of the reasons for poor uptake of health services at primary health care facilities in Nigeria is long waiting time. This study was carried out to assess client waiting time and ...

  11. Preliminary Exploration of the Mental Health Education Competency Survey of Primary and Middle School Head Teachers

    Science.gov (United States)

    Liu, Chunyu; Liu, Yanling; Guo, Cheng; Lan, Haiying

    2014-01-01

    Despite a recent focus on the mental health of students, primary and middle school mental health education in China has been hampered by a lack of resources and inadequate professional training. This study assessed the mental health education competency of primary and middle school head teachers using the Mental Health Education Competency…

  12. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    Science.gov (United States)

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  13. Restructuring the State Electricity Boards (SEB'S) in India: the case of HSEB

    Energy Technology Data Exchange (ETDEWEB)

    Kanika, T.Bhal [Haryana State Electricity Board, HSEB, Dept. of Management (India); Abhishek, Kalra; Madhuri, Agarwal [Haryana State Electricity Board, HSEB, B. Tech, Mechanical Engineering (India)

    2001-11-01

    In India, power generation and distribution is the responsibility of the different States that have their own electricity boards through which this is done. Of late, in the wake of liberalization, many attempts have been made to reform the power sector, in the light of the poor performance of these boards. The Haryana State Electricity Board (HSEB) is the primary supplier of power in one of the States called Haryana. For quite some years, it was facing problems with revenues, low PLF etc. A review was done and counselling help sought from prominent Consultancy firms. As a result a large scale restructuring was planned. The present paper looks at the attempts of HSEB at restructuring and the consequences of the restructuring efforts. (authors)

  14. Health communication in primary health care -a case study of ICT development for health promotion.

    Science.gov (United States)

    Mahmud, Amina Jama; Olander, Ewy; Eriksén, Sara; Haglund, Bo Ja

    2013-01-30

    Developing Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel. A qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis. Health communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel. Health communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate

  15. Population health in New Zealand 2000-2013: From determinants of health to targets.

    Science.gov (United States)

    Sheridan, Nicolette F; Kenealy, Timothy W; Schmidt-Busby, Jacqueline Ig; Rea, Harold H

    2015-01-01

    To determine how 'population health' has been understood in practice and policy and has influenced health system restructuring in New Zealand since 2000. Interviews in 2007-2008 with managers, clinicians, government policy advisors and academics were undertaken to explore the relationships between population health, determinants of health, and health system restructuring. This was augmented by a review of major government health policies from 2009 to 2013 to establish which notions of population health were reflected. Population health shifted from a broad notion of health determinants to focus on a small number of quantifiable health targets driven by financial incentives. Meantime, an emphasis on 'quality and safety' impeded population health activities. District Health Board programmes to identify high risk individuals, by disease or hospital service utilisation, diverted attention from broader population health outcomes. District Health Boards were not held accountable for integrating a population health approach in service planning and did not initiate or lead intersectoral work. Community consultation was limited. Primary Health Organisations, although mandated to address population health, typically aligned with the small-business model of general practice making service integration difficult to achieve. In policy, 'population health' dropped from favour in the mid-2000s, although many documents, outside the health sector, carried forward these values. A progressively narrower focus on a small number of health targets and on organisational processes undermined earlier policy intentions and health system restructuring that sought to improve broader population health outcomes.

  16. Stigma-related mental health knowledge and attitudes among primary health workers and community health volunteers in rural Kenya.

    Science.gov (United States)

    Mutiso, Victoria N; Musyimi, Christine W; Nayak, Sameera S; Musau, Abednego M; Rebello, Tahilia; Nandoya, Erick; Tele, Albert K; Pike, Kathleen; Ndetei, David M

    2017-09-01

    The study was conducted in rural Kenya and assessed stigma in health workers from primary health facilities. This study compared variations in stigma-related mental health knowledge and attitudes between primary health workers (HWs) and community health volunteers (CHVs). Participants ( n = 44 HWs and n = 60 CHVs) completed the self-report Mental Health Knowledge Schedule and the Reported and Intended Behavior Scale, along with sociodemographic questions. Multiple regression models were used to assess predictors of mental health knowledge and stigmatizing behaviors. HWs had significantly higher mean mental health knowledge scores than CHVs, p mental health knowledge, and self-rating of sense of belonging to the community and mental health knowledge remained the main predictors of positive attitudes. Results suggest that stigma-related mental health knowledge and attitudes are associated, and interventions should target these areas with health workers. There is scope for intervention to increase knowledge and positive attitudes for individuals who feel a strong sense of community belonging. Future studies should test feasible ways to reduce stigma in this population.

  17. Making primary health care work: the case of Fundacao Esperanca.

    Science.gov (United States)

    Offenheiser, R C

    1986-01-01

    For the past 15 years, the Fundac Esperanca, a private organization founded in Santarem by a North American Franciscan priest, has been working to provide the widely scattered rural residents in the mid-Amazon region of Brazil with effective health care. Early efforts focused on Esperanca's hospital boat, which traveled up and down the river to reach the remote settlements. During the 1st decade of operation, Esperanca vaccinated some 150,000 people and provided general medical and surgical services to countless others. Yet, by the late 1970s, the program's staff were beginning to question the longterm effectiveness of their efforts. In 1979, Esperanca decided it could have a longer lasting impact on health in the mid-Amazon region if it could mobilize rural communities to improve family diets and sanitary practices and carry out comprehensive vaccination campaigns. Supported by a grant from Private Agencies Collaborating Together (PACT), it launched its own primary health care program. This initiative began with a health survey of the region. The studies revealed that 1/3 of the children under age 6 were malnourished, 90% had untreated cavities, and 2/3 of the 10,000 people tested showed evidence of parasitosis. There were higher than normal incidences of malaria, anemia, tuberculosis, diphtheria, uterine cancer in women, smallpox, and visual problems. The social, cultural, and demographic characteristics of the region also were discouraging. Most people lived in widely scattered river villages and were illiterate, with little understanding of hygiene, nutrition, or public health. None of the settlements had formal health care systems. Esperanca chose to make the community paramedic the keystone of its program, stating clearly that the outreach worker is the conduit to clinical services in Santarem. In time, it was decided to phase out the hospital boat's activities. It had come to signal the wrong message, i.e., the doctors were coming and good health was on the

  18. [Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

    Science.gov (United States)

    Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

    2017-10-01

    The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

  19. Health care, quality certification and institutional support: a focus on primary health care in Brazil

    Directory of Open Access Journals (Sweden)

    Antônio Thomaz Gonzaga da Matta-Machado

    2016-05-01

    Full Text Available Objective. To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ. Materials and methods. A cross-sectional study was conducted through interviews with 16 960 profes- sionals in Brazil in 2012. To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. Results. A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health. The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. Conclusion. Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

  20. Providing primary health care through integrated microfinance and health services in Latin America.

    Science.gov (United States)

    Geissler, Kimberley H; Leatherman, Sheila

    2015-05-01

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

  1. Hospitalization in older adults: association with multimorbidity, primary health care and private health plan

    Directory of Open Access Journals (Sweden)

    Bruno Pereira Nunes

    Full Text Available ABSTRACT OBJECTIVE Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization. METHODS A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older living in the urban area of the city of Bagé, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (≥ 2 and ≥ 3. The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables. RESULTS The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8–19.6 and 10.6% (95%CI 9.1–12.1, respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition’ form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09–2.69 times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan. CONCLUSIONS The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases.

  2. New demands for primary health care in Brazil: palliative care

    Directory of Open Access Journals (Sweden)

    Cássia Regina de Paula Paz

    Full Text Available Objective.Assess the need for incorporation of palliative care in primary health care (PHC through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Methods. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS to identify the indication of palliative care. Results. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141 had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%, followed by disorders related to quality of care during pregnancy and childbirth (24.38%. Conclusion. It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.

  3. New demands for primary health care in Brazil: palliative care.

    Science.gov (United States)

    de Paula Paz, Cássia Regina; Reis Pessalacia, Juliana Dias; Campos Pavone Zoboli, Elma Lourdes; Ludugério de Souza, Hieda; Ferreira Granja, Gabriela; Cabral Schveitzer, Mariana

    2016-04-01

    Assess the need for incorporation of palliative care in primary health care (PHC) through the characterization of users eligible for this type of care, enrolled in a program for devices dispensing. Descriptive study of case series conducted in 14 health units in São Paulo (Brazil) in 2012. It was included medical records of those enrolled in a program for users with urinary and fecal incontinence, and it was applied Karnofsky Performance Scale Index (KPS) to identify the indication of palliative care. 141 of the 160 selected medical records had KPS information. Most cases (98.3%, 138/141) had performance below 70% and, therefore, patients were eligible for palliative care. The most frequent pathologies was related to chronic degenerative diseases (46.3%), followed by disorders related to quality of care during pregnancy and childbirth (24.38%). It is necessary to include palliative care in PHC in order to provide comprehensive, shared and humanized care to patients who need this.

  4. Understanding physiotherapists' roles in ontario primary health care teams.

    Science.gov (United States)

    Dufour, Sinéad Patricia; Lucy, S Deborah; Brown, Judith Belle

    2014-01-01

    To understand physiotherapists' roles and how they are enacted within Ontario primary health care (PHC) teams. Following a pragmatic grounded theory approach, 12 physiotherapists practising within Ontario PHC teams participated in 18 semi-structured in-depth in-person interviews. All interviews were audiotaped and transcribed verbatim, then entered into NVIVO-8. Coding followed three progressive analytic stages and was iterative in nature, guided by grounded theory. An explanatory scheme was developed. Physiotherapists negotiate their place within the PHC teams through five interrelated roles: (1) manager; (2) evaluator; (3) collaborator; (4) educator; and (5) advocate. These five roles are influenced by three contextual layers: (1) inter-professional team; (2) community and population served; and (3) organizational structure and funding. Canada's PHC mandate (access, teams, information, and healthy living) frame the contexts that influence role enactment. To fulfill the PHC mandate, physiotherapists carry out multiple roles that are based on a broad holistic perspective of health, within the context of a collaborative inter-professional team and the community, through an evidenced-informed approach to care. There appear to be multiple ways of successfully integrating physiotherapists within PHC teams, provided that role enactment is context sensitive and congruent with the mandate of PHC.

  5. Primary health care models: medical students’ knowledge and perceptions.

    Science.gov (United States)

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

    2012-03-01

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

  6. An analysis of the meaning of integrated Primary Health Care from the KwaZulu- Natal Primary Health Care context

    Directory of Open Access Journals (Sweden)

    M.N. Sibiya

    2009-09-01

    Full Text Available In South Africa, integration o f services policy was enacted in 1996 with the aim of increasing health service utilization by increasing accessibility and availability of all health care services at Primary Health Care (PHC level. Integration of PHC services continues to be seen as a pivotal strategy towards the achievement of the national goals of transformation of health services, and the attainment of a comprehensive and seamless public health system. Although the drive behind the integration of PHC services was to improve accessibility of services to the community, the problem however, arises in the implementation of integrated PHC (IPHC as there is no agreed upon understanding of what this phenomenon means in the South African context. To date no research studies have been reported on the meaning of the integration of PHC services. Hence, there is a need for shared views on this phenomenon in order to facilitate an effective implementation of this approach. A cross-sectional study, using a qualitative approach was employed in this study in order to analyze the phenomenon, IPHC in KwaZulu-Natal and the meaning attached to it in different levels of the health system. A grounded theory was selected as it is a method known for its ability to make greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations, interviews and document analysis. The sample size for interviews was comprised of 38 participants. Strauss and Corbin’s process of data analysis was used. It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a comprehensive

  7. Northern nursing practice in a primary health care setting.

    Science.gov (United States)

    Vukic, Adele; Keddy, Barbara

    2002-12-01

    This paper explicates the nature of outpost nursing work, and/or the day-to-day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices. It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities. The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on-site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process. The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as 'other' and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community. The nurses in this study

  8. Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

    Science.gov (United States)

    Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

    2015-01-01

    This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with

  9. Socio-economic correlates of functional health literacy among patients of primary health care in Kosovo.

    Science.gov (United States)

    Toçi, E; Burazeri, G; Kamberi, H; Jerliu, N; Sørensen, K; Brand, H

    2014-09-01

    Functional health literacy (FHL) has been related to individual characteristics, ill-health and disease knowledge. However, the information about FHL in Kosovo is very limited and thus the aim of this study was to assess the demographic and socio-economic correlates of FHL among users of primary health care in Kosovo, a postconflict country in the Western Balkans. Cross-sectional study. A cross-sectional study was conducted in Kosovo between November 2012-February 2013, including a representative sample of 1035 consecutive primary care users aged ≥18 years (60% females; overall mean age: 44.3 ± 16.9 years; overall response rate: 86%). Test of Functional Health Literacy in Adults (TOFHLA) was used to assess FHL. General linear model and logistic regression were used to assess the association of TOFHLA score with demographic and socio-economic characteristics. Overall, four out of five participants exhibited inadequate or marginal FHL in this Kosovo sample. FHL score was independently and inversely related to age, but positively associated with educational attainment and being in a situation other than unemployed. Limited or marginal FHL was very common among primary care users in Kosovo and considerably higher than in the neighbouring Serbia. The low health literacy levels in Kosovo may provide an additional barrier towards achievement of health care goals. There is a need to design and implement suitable and effective educational and health system interventions in the Kosovo context. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  10. Restructuring the System Is the Solution.

    Science.gov (United States)

    Perelman, Lewis J.

    1988-01-01

    For the U.S. to survive despite intensifying international competition, accelerating technological change, oppressive public and private debt, and demographic and work force changes, the learning enterprise must become far more productive. Two 1998 scenarios are presented: business-as-usual (favoring the rich) and a restructured system based on…

  11. Restructuring Student Services: A Philosophical Framework.

    Science.gov (United States)

    Kotter, Marie L.

    1995-01-01

    Provides a framework for student services professionals that can be used as a philosophical rationale for making decisions and implementing practical budget strategies. Outlines models for student-centered universities and colleges and for restructuring student services. Examines holistic student assessment and how to redesign learning-oriented…

  12. Urban restructuring and deregulations in Latin America

    NARCIS (Netherlands)

    Carmona, M.

    1992-01-01

    With this work we continue the debate on the trends of urban restructuring in Latin America. In fact due to the large economic crisis of the 80-ies, the continent has decreased is living standards to that of 12 years ago. The productive potential has increased in 1,3% in circumstances that in the

  13. Restructure Staff Development for Systemic Change

    Science.gov (United States)

    Kelly, Thomas F.

    2012-01-01

    This paper presents a systems approach based on the work of W. Edwards Deming to system wide, high impact staff development. Deming has pointed out the significance of structure in systems. By restructuring the process of staff development we can bring about cost effective improvement of the whole system. We can improve student achievement while…

  14. Restructuring the energy industry: A financial perspective

    Energy Technology Data Exchange (ETDEWEB)

    Abrams, W.A.

    1995-12-31

    This paper present eight tables summarizing financial aspects of energy industry restructuring. Historical, current, and future business characteristics of energy industries are outlined. Projections of industry characteristics are listed for the next five years and for the 21st century. Future independent power procedures related to financial aspects are also outlined. 8 tabs.

  15. Education and Political Restructure in Nigeria

    Science.gov (United States)

    Ayeni, Matthew Adedeji; Adeleye, Joseph Olusola

    2013-01-01

    To say that education is a potent factor in any political restructuring is an indisputable fact. For a meaningful political development to take place in any nation, especially like Nigeria. The place of education is never in doubt to influence positively those in the position of authority to ascertain what are needed to put in place for effective…

  16. Dynamic Restructuring Of Problems In Artificial Intelligence

    Science.gov (United States)

    Schwuttke, Ursula M.

    1992-01-01

    "Dynamic tradeoff evaluation" (DTE) denotes proposed method and procedure for restructuring problem-solving strategies in artificial intelligence to satisfy need for timely responses to changing conditions. Detects situations in which optimal problem-solving strategies cannot be pursued because of real-time constraints, and effects tradeoffs among nonoptimal strategies in such way to minimize adverse effects upon performance of system.

  17. Application of Rational Restructuring to Anxiety Disorders.

    Science.gov (United States)

    Goldfried, Marvin R.

    1988-01-01

    Outlines theoretical assumptions and research base for rational restructuring, cognitive-behavioral intervention procedure for reducing certain anxiety-related disorders, such as various forms of social-evaluative anxiety (social anxiety, unassertiveness, public speaking, test anxiety). Describes intervention procedures within consultation session…

  18. Understanding persons with psychological distress in primary health care.

    Science.gov (United States)

    Arvidsdotter, Tina; Marklund, Bertil; Kylén, Sven; Taft, Charles; Ekman, Inger

    2016-12-01

    The purpose of this study was to gain more knowledge and a deeper understanding of experiences of persons living with psychological distress who seek help in primary care. Psychological distress is a state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life. The lack of effective care for and difficulty in identifying psychological distress is frustrating for patients and health professionals alike. The aim was therefore to gain more knowledge about the experience of living with psychological distress. Twelve persons (nine women and three men) aged 23-51 years were interviewed. Analyses were based on a phenomenological hermeneutic method and indicated that psychological distress may be seen as an imbalance (incongruence) between the self and the ideal self, which slowly breaks down a person's self-esteem. This imbalance was described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one's grip on life. It seems to be associated with a gradual depletion of existential capacities and lead to dissatisfaction, suffering, poor self-esteem and lack of control. As psychological distress may be a forerunner to mental, physical and emotional exhaustion, there is a need to initiate preventive or early interventions to avoid mental, physical and emotional chaos in such patients. Patients' with psychological distress need to be involved in a person-centred salutogenic dialogue with health professionals to become aware of and strengthen their own capacities to regain health and well-being. © 2015 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

  19. A survey of primary and specialised health care provision to prisons in England and Wales.

    OpenAIRE

    Cornford, C S; Mason, J.; Buchanan, K.; Reeves, D.; Kontopantelis, E; Sibbald, B; Thornton-Jones, H.; Williamson, M.; Baer, L

    2008-01-01

    Background Prison health care in England, including primary care, is now incorporated into the National Health Service; the impetus for the change is in part due to concern about standards of health care within prisons. The demographic characteristics and health status of patients within prisons are relatively well understood, as are the problems faced by health care professionals. Less is known about current health care provision. Aims To describe the organisation of primary heal...

  20. 24 CFR 401.404 - Proposed Restructuring Commitment.

    Science.gov (United States)

    2010-04-01

    ... Development (Continued) OFFICE OF HOUSING AND OFFICE OF MULTIFAMILY HOUSING ASSISTANCE RESTRUCTURING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MULTIFAMILY HOUSING MORTGAGE AND HOUSING ASSISTANCE RESTRUCTURING... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Proposed Restructuring Commitment...

  1. 24 CFR 401.401 - Consolidated Restructuring Plans.

    Science.gov (United States)

    2010-04-01

    ... Development (Continued) OFFICE OF HOUSING AND OFFICE OF MULTIFAMILY HOUSING ASSISTANCE RESTRUCTURING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MULTIFAMILY HOUSING MORTGAGE AND HOUSING ASSISTANCE RESTRUCTURING... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Consolidated Restructuring Plans...

  2. 24 CFR 401.406 - Execution of Restructuring Commitment.

    Science.gov (United States)

    2010-04-01

    ... Development (Continued) OFFICE OF HOUSING AND OFFICE OF MULTIFAMILY HOUSING ASSISTANCE RESTRUCTURING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT MULTIFAMILY HOUSING MORTGAGE AND HOUSING ASSISTANCE RESTRUCTURING... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Execution of Restructuring...

  3. Assessing The Impact Of Railway Restructuring In Nigeria | Ibe ...

    African Journals Online (AJOL)

    The study presents railway restructuring as a solution option to railway problems in Nigeria. It aims at ascertaining the efficiency of the critical input factors of Nigerian Railway corporation (NRC) while comparing it with that of the restructured developed and best practices railways to establish the basis for restructuring.

  4. Actions on social determinants and interventions in primary health to improve mother and child health and health equity in Morocco.

    Science.gov (United States)

    Boutayeb, Wiam; Lamlili, Mohamed; Maamri, Abdellatif; Ben El Mostafa, Souad; Boutayeb, Abdesslam

    2016-02-02

    Over the last two decades, Moroccan authorities launched a number of actions and strategies to enhance access to health services and improve health outcomes for the whole population in general and for mother and child in particular. The Ministry of Health launched the action plans 2008-2012 and 2012-2016 and created the maternal mortality surveillance system. The Moroccan government opted for national health coverage through a mandatory health insurance and a scheme of health assistance to the poorest households. Other initiatives were devoted indirectly to health by acting on social determinants of health and poverty reduction. In this paper, we present results of an evaluation of interventions and programmes and their impact on health inequity in Morocco. We used data provided by national surveys over the last decades, information released on the website of the Ministry of Health, documentation published by the Moroccan government and international reports and studies related to Morocco and published by international bodies like the World Health Organisation, United Nations Development Programme, United Nations Population Fund, UNICEF, UNESCO and the World Bank. A short review of scientific publications was also carried out in order to select papers published on health equity, social determinants, health system and interventions in primary health in Morocco. Inferential and descriptive statistics (including principal component analysis) were carried out using software SPSS version 18. The findings indicate that substantial achievements were obtained in terms of access to health care and health outcomes for the whole Moroccan population in general and for mothers and children in particular. However, achievements are unfairly distributed between advantaged and less advantaged regions, literate and illiterate women, rural and urban areas, and rich and poor segments of the Moroccan population. Studies have shown that it is difficult to trace the effect of a primary

  5. On the functional vs. lexical nature of restructuring heads: evidence for a fine-grained classification of restructuring modals

    Directory of Open Access Journals (Sweden)

    Irene Balza

    2012-05-01

    Full Text Available This paper examines in detail the thematic and syntactic properties of a set of (non-restructuring structures in Germanic, Romance and Basque. Based on the comparison of these structures, I propose a fine-grained classification of (non-restructuring constructions that include Functional Restructuring, Semi-Lexical Restructuring, Lexical Restructuring and Non-Restructuring constructions. The four types involve complements of different underlying structures (VPs, vPs or even as large as NegP/TPs. The results of the analysis argue against Cinque’s (2005 hypothesis that all restructuring verbs are exclusively functional, and contradicts Wurmbrand’s (1999 claim that, within the mixed class of restructuring verbs, modals must be raising verbs.

  6. Disability inclusion in primary health care in Nepal: an explorative study of perceived barriers to access governmental health services.

    NARCIS (Netherlands)

    Hees, S. van; Cornielje, H.; Wagle, P.; Veldman, E.

    2014-01-01

    Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary

  7. Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

    Science.gov (United States)

    2012-01-01

    Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health

  8. Evaluation of computerized health management information system for primary health care in rural India.

    Science.gov (United States)

    Krishnan, Anand; Nongkynrih, Baridalyne; Yadav, Kapil; Singh, Satyavir; Gupta, Vivek

    2010-11-16

    The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924). The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision.

  9. Evaluation of computerized health management information system for primary health care in rural India

    Directory of Open Access Journals (Sweden)

    Singh Satyavir

    2010-11-01

    Full Text Available Abstract Background The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS, New Delhi has a computerized Health Management Information System (HMIS since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. Methods The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. Results There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR 1674,217 (USD 35,622. Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213. The annual savings is around INR 894,283 (USD 11,924. Conclusion The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision.

  10. The missing link--the role of primary care in global health.

    Science.gov (United States)

    Rao, Mala; Pilot, Eva

    2014-01-01

    This chapter provides an overview of the role of primary care in the context of global health. Universal health coverage is a key priority for WHO and its member states, and provision of accessible and safe primary care is recognised as essential to meet this important international policy goal. Nevertheless, more than three decades after Alma Ata, the provision of primary health care remains inadequate, indicating that primary care has not received the priority it deserves, in many parts of the world. This is despite the proven health benefits that result from access to comprehensive primary health care. We highlight some examples of good practice and discuss the relevance of primary care in the context of health equity and cost-effectiveness. Challenges that influence the success of primary care include the availability of a qualified workforce, financing and system design and quality assurance and patient safety.

  11. The missing link – the role of primary care in global health

    Science.gov (United States)

    Rao, Mala; Pilot, Eva

    2014-01-01

    This chapter provides an overview of the role of primary care in the context of global health. Universal health coverage is a key priority for WHO and its member states, and provision of accessible and safe primary care is recognised as essential to meet this important international policy goal. Nevertheless, more than three decades after Alma Ata, the provision of primary health care remains inadequate, indicating that primary care has not received the priority it deserves, in many parts of the world. This is despite the proven health benefits that result from access to comprehensive primary health care. We highlight some examples of good practice and discuss the relevance of primary care in the context of health equity and cost-effectiveness. Challenges that influence the success of primary care include the availability of a qualified workforce, financing and system design and quality assurance and patient safety. PMID:24560266

  12. The missing link - the role of primary care in global health.

    Science.gov (United States)

    Rao, Mala; Pilot, Eva

    2014-12-01

    This chapter provides an overview of the role of primary care in the context of global health. Universal health coverage is a key priority for WHO and its member states, and provision of accessible and safe primary care is recognised as essential to meet this important international policy goal. Nevertheless, more than three decades after Alma Ata, the provision of primary health care remains inadequate, indicating that primary care has not received the priority it deserves, in many parts of the world. This is despite the proven health benefits that result from access to comprehensive primary health care. We highlight some examples of good practice and discuss the relevance of primary care in the context of health equity and cost-effectiveness. Challenges that influence the success of primary care include the availability of a qualified workforce, financing and system design and quality assurance and patient safety.

  13. Primary health care as assessed by health professionals: comparison of the traditional model versus the Family Health Strategy.

    Science.gov (United States)

    Flôr, Cristina Rabelo; Oliveira, Cláudia Di Lorenzo; Cardoso, Clareci Silva; Rabelo, Cleonice Ferreira; Gontijo, Bernardo Luis; Carvalho, Suzana Freitas de; Bretas, Pedro Messenger Caldeira; Silva, Hygor Cabral; Pereira, Mariana Linhares; Pádua, Cristiane Menezes de

    2017-01-01

    The Family Health Strategy (FHS) should be first-contact care in the Brazilian Health System. However, Primary Health Care (PHC) still encompasses two models: the FHS and the traditional health care facilities. The expansion of the FHS has been slow and heterogeneous in many cities, rendering a comparative evaluation of key quality-related elements of PHC models crucial. To compare the performance of PHC models as perceived by health professionals. A cross-sectional study involving managers and health professionals from PHC of a medium-size city in South-eastern Brazil. Data were collected by applying the Primary Care Assessment Tool. The performance was estimated through primary health care indexes (general and partial PHCI by attributes). Univariate polytomous logistic regression was performed to compare care model performances according to their attributes. Strength of association was estimated by odds ratio with 95% confidence interval. Three managers and 81 health professionals participated in the study. The FHS had a better index rating than the traditional care model for general PHCI and for the attributes longitudinality, comprehensiveness, family focus and professional level. Although the FHS attained higher scores compared to the traditional model, it has not yet achieved the performance expected. This scenario points to the need for increased FHS cover and quality improvements at the existing units.

  14. Restructuring local distribution services: Possibilities and limitations

    Energy Technology Data Exchange (ETDEWEB)

    Duann, D.J.

    1994-08-01

    The restructuring of local distribution services is now the focus of the natural gas industry. It is the last major step in the ``reconstitution`` of the natural gas industry and a critical clement in realizing the full benefits of regulatory and market reforms that already have taken place in the wellhead and interstate markets. It could also be the most important regulatory initiative for most end-use customers because they are affected directly by the costs and reliability of distribution services. Several factors contribute to the current emphasis on distribution service restructuring. They include the unbundling and restructuring of upstream markets, a realization of the limitations of supply-side options (such as gas procurement oversight), and the increased diversity and volatility of gas demand facing local distribution companies. Local distribution service is not one but a series of activities that start with commodity gas procurement and extend to transportation, load balancing, storage, and metering and billing of services provided. There are also considerable differences in the economies of scale and scope associated with these various activities. Thus, a mixture of supply arrangements (such as a competitive market or a monopoly) is required for the most efficient delivery of local distribution services. A distinction must be made between the supply of commodity gas and the provision of a bundled distribution service. This distinction and identification of the best supply arrangements for various distribution service components are the most critical factors in developing appropriate restructuring policies. For most state public utility commissions the criteria for service restructuring should include pursuing the economies of scale and scope in gas distribution, differentiating and matching gas service reliability and quality with customer requirements, and controlling costs associated with the search, negotiation, and contracting of gas services.

  15. Mental health and primary care: an experience with community health agents in Salvador-BA

    Directory of Open Access Journals (Sweden)

    Noêmia Aragão Casais

    2009-12-01

    Full Text Available Objective: To share an experience of a link between primary care and mental health by means of matrix support. Method: A survey conducted from March to December 2007, in Pernambués neighborhood, District of Cabula-beiru, in Salvador - Bahia. The shared knowledge construction was carried out by residents of the Multidisciplinary Residency Program in Health from the Nucleus of Mental Health, State University of Bahia, with Community Health Agents (ACS. Meetings, discussions and domiciliary visits were applyed as sharing technics and tools with phonographic recording, photographic register and report. The obtained information were evaluated regarding their content and were divided into stages and categories. Results: We determined the following stages by means of the technique: approach, ties’ strengthening, teamwork and conclusion. The results were analyzed based on the ACS’ everyday interactivity for cooperation, thus obtaining the development of a critical spirit in the assesment of the relationship between primary care and mental health. Final Considerations: The exchange of experiences produced significant learning, besides health promotion for all those involved in the process: ACS, families cared for and residents.

  16. [Psychosocial stress environment and health workers in public health: Differences between primary and hospital care].

    Science.gov (United States)

    García-Rodríguez, Antonio; Gutiérrez-Bedmar, Mario; Bellón-Saameño, Juan Ángel; Muñoz-Bravo, Carlos; Fernández-Crehuet Navajas, Joaquín

    2015-01-01

    To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. Cross-sectional study with stratified random sampling. Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Dental Procedures in Primary Health Care of the Brazilian National Health System.

    Science.gov (United States)

    Mendes, Suellen R; Martins, Renata C; Matta-Machado, Antônio T G M; Mattos, Grazielle C M; Gallagher, Jennifer E; Abreu, Mauro H N G

    2017-12-01

    The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs) adhering to the second cycle of the 'National Programme for Improving Access and Quality of Primary Care' (PMAQ-AB) in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013-2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental needs deliver the lowest number of dental procedures. The need to expand the supply of prostheses and the early diagnosis of oral cancer in primary health care (PHC) is evident.

  18. Dental Procedures in Primary Health Care of the Brazilian National Health System

    Directory of Open Access Journals (Sweden)

    Suellen R. Mendes

    2017-12-01

    Full Text Available The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs adhering to the second cycle of the ‘National Programme for Improving Access and Quality of Primary Care’ (PMAQ-AB in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013–2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental need deliver the lowest number of dental procedures. The need to tackle inequalities and further shape the supply of appropriate primary health care (PHC is evident.

  19. Improving motivation among primary health care workers in Tanzania: a health worker perspective

    Directory of Open Access Journals (Sweden)

    Bygbjerg Ib Christian

    2006-03-01

    Full Text Available Abstract In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality. The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide. The primary issues arising pertain to complexities of multitasking in an environment of staff shortages, a desire for more structured and supportive supervision from managers, and improved transparency in career development opportunities. Further, suggestions were made for inter-facility exchanges, particularly on commonly referred cases. The discussion highlights the context of some of the problems identified in the results and suggests that some of the preferences presented by the health workers be discussed at policy level with a view to adding value to most services with minimum additional resources.

  20. Population health in New Zealand 2000–2013: From determinants of health to targets

    Directory of Open Access Journals (Sweden)

    Nicolette F Sheridan

    2015-03-01

    Full Text Available Objective: To determine how ‘population health’ has been understood in practice and policy and has influenced health system restructuring in New Zealand since 2000. Methods: Interviews in 2007–2008 with managers, clinicians, government policy advisors and academics were undertaken to explore the relationships between population health, determinants of health, and health system restructuring. This was augmented by a review of major government health policies from 2009 to 2013 to establish which notions of population health were reflected. Results: Population health shifted from a broad notion of health determinants to focus on a small number of quantifiable health targets driven by financial incentives. Meantime, an emphasis on ‘quality and safety’ impeded population health activities. District Health Board programmes to identify high risk individuals, by disease or hospital service utilisation, diverted attention from broader population health outcomes. District Health Boards were not held accountable for integrating a population health approach in service planning and did not initiate or lead intersectoral work. Community consultation was limited. Primary Health Organisations, although mandated to address population health, typically aligned with the small-business model of general practice making service integration difficult to achieve. In policy, ‘population health’ dropped from favour in the mid-2000s, although many documents, outside the health sector, carried forward these values. Conclusion: A progressively narrower focus on a small number of health targets and on organisational processes undermined earlier policy intentions and health system restructuring that sought to improve broader population health outcomes.

  1. Assessment of primary health care facilities' service readiness in Nigeria.

    Science.gov (United States)

    Oyekale, Abayomi Samuel

    2017-03-01

    Effective delivery of healthcare services requires availability of adequate infrastructure, diagnostic medical equipment, drugs and well-trained medical personnel. In Nigeria, poor funding and mismanagement often characterize healthcare service delivery thereby affecting coverage and quality of healthcare services. Therefore, the state of service delivery in Nigeria's health sector has come under some persistent criticisms. This paper analyzed service readiness of Primary Health Care (PHC) facilities in Nigeria with focus on availability of some essential drugs and medical equipment. Service Delivery Indicator (SDI) data for PHC in Nigeria were used. The data were collected from 2480 healthcare facilities from 12 states in the Nigeria's 6 geopolitical zones between 2013 and 2014. Data were analyzed with descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square regression. Medical disposables such as hand gloves and male condoms were reported to be available in 77.18 and 44.03% of all the healthcare facilities respectively, while immunization services were provided by 86.57%. Functional stethoscopes were reported by 77.22% of the healthcare facilities, while only 68.10% had sphygmomanometers. In the combined healthcare facilities, availability of some basic drugs such as Azithromycin, Nifedipine, Dexamethasone and Misoprostol was low with 10.48, 25.20, 21.94 and 17.06%, respectively, while paracetamol and folic acid both had high availability with 74.31%. Regression results showed that indices of drug and medical equipment availability increased significantly (p Nigeria and with presence of some power sources (electricity, generators, batteries and solar), but decreased among dispensaries/health posts. Travel time to headquarters and rural facilities significantly reduced indices of equipment availability (p Nigeria to ensure better equity in access to healthcare facilities, which would facilitate achievement of some health

  2. Nurse Leaders' Perceptions of Influence of Organizational Restructuring on Evidence-Informed Decision-Making.

    Science.gov (United States)

    Spiers, Judith A; Lo, Eliza; Hofmeyer, Anne; Cummings, Greta G

    2016-01-01

    To describe how organizational context and restructuring influenced nurse leaders' use of evidence in decision-making in their management practice. Qualitative descriptive study. Fifteen leaders at executive and front-line manager levels in one organization were interviewed using a semi-structured format. Inductive content analysis generated five main themes: leaders strove to keep relationships that preserve best decision-making ability; and sought the best knowledge to inform their decisions. However, a context of constant change; more scope; less autonomy; and decisional inertia in a sea of change had profound effects on their ability to employ evidence in decision-making. Evidence-informed decision-making is a dynamic social process highly influenced by political instability in work environments. Organizational restructuring creates threats to common decision-making strategies, including information flow, relationships and priority setting. Healthcare restructuring is now a global constant, and there is a need for hospital leaders to understand and mitigate the effect restructuring has on the ability of leaders to engage in evidence-informed decision-making. Strategies are proposed to manage uncertainty and support nurse leaders in their evidence-informed decision-making to deliver quality health services. This research provides an in-depth examination of how evidence-informed decision-making is influenced in the context of instability and uncertainty due to ever-present organizational restructuring.

  3. Depression in elderly primary health care clinic attendees in Ilorin ...

    African Journals Online (AJOL)

    Depression in the elderly presenting at primary care settings is usually under- detected by primary care physicians. This study assessed the prevalence of depression and the utility of the Geriatric Depression Scale (Short Form) in detecting depression in elderly patients in primary care populations in Ilorin, Nigeria. This was ...

  4. Severity of Mental Health Impairment and Trajectories of Improvement in an Integrated Primary Care Clinic

    Science.gov (United States)

    Bryan, Craig J.; Corso, Meghan L.; Corso, Kent A.; Morrow, Chad E.; Kanzler, Kathryn E.; Ray-Sannerud, Bobbie

    2012-01-01

    Objective: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments. Method: Data from 495 primary care…

  5. Pupils' Perceptions of Sex and Reproductive Health Education in Primary Schools in Tanzania: A Phenomenological Study

    Science.gov (United States)

    Kapinga, Orestes Silverius; Hyera, Daniel Frans

    2015-01-01

    This study explored pupils' perceptions of sex and reproductive health education in primary schools in Tanzania. Specifically, the study aimed at (i) exploring pupils' views on sex and reproductive health education in primary schools; (ii) determining opinions on the appropriateness of sex and reproductive health education for pupils in primary…

  6. HEALTH-CARE COSTS ASSOCIATED WITH DEPRESSIVE AND ANXIETY DISORDERS IN PRIMARY-CARE

    NARCIS (Netherlands)

    SIMON, G; ORMEL, J; VONKORFF, M; BARLOW, W

    Objective: The authors examined the overall health care costs associated with depression and anxiety among primary care patients. Method: Of 2,110 consecutive primary care patients in a health maintenance organization, 1,962 were screened with the 12-item General Health Questionnaire. A stratified

  7. Towards understanding governance issues in integration of mental health into primary health care in Uganda.

    Science.gov (United States)

    Mugisha, James; Ssebunnya, Joshua; Kigozi, Fred N

    2016-01-01

    There is a growing burden of mental illness in low income countries. The situation is further worsened by the high poverty levels in these countries, resulting in difficult choices for their health sectors as regards to responding to the burden of mental health problems. In Uganda, integration of mental health into primary health care (PHC) has been adopted as the most vital strategy for ensuring mental health service delivery to the general population. To identify governance related factors that promote/or hinder integration of mental health into PHC in Uganda. A qualitative research design was adopted at national and district level. A total of 18 Key informant interviews were conducted at both levels. Content thematic analysis was the main method of data analysis. There were positive gains in working on relevant laws and policies. However, both the mental health law and policy are still in draft form. There is also increased responsiveness/participation of key stakeholders; especially at national level in the planning and budgeting for mental health services. This however seems to be a challenge at both district and community level. In terms of efficiency, human resources, finances, medicines and technologies constitute a major drawback to the integration of mental health into PHC. Ethics, oversight, information and monitoring functions though reported to be in place, become weaker at the district level than at national level due to limited finances, human resources gaps and limited technical capacity. Other governance related issues are also reported in this study. There is some progress especially in the legal and policy arena to support integration of mental health into PHC in Uganda. However, adequate resources are still required to facilitate the effective functioning of all governance pillars that make integration of mental health into PHC feasible in Uganda.

  8. Mobilizing Lithuanian Health Professionals as Community Peer Leaders for AIDS Prevention: An International Primary Health Care Collaboration.

    Science.gov (United States)

    Norr, Kathleen F.; McElmurry, Beverly J.; Slutas, Frances M.; Christiansen, Carol D.; Misner, Susan J.; Marks, Beth A.

    2001-01-01

    Using primary health care and peer leadership models, U.S. nurses trained Lithuanian health professionals as community peer leaders in AIDS prevention. A national continuing education program is in place to sustain the initiative in Lithuania. (SK)

  9. [Preventive health care and health promotion: Which models for supporting the evolution of clinical practice in primary health care?].

    Science.gov (United States)

    Vanmeerbeek, Marc; Mathonet, Julien; Miermans, Marie-Christine; Lenoir, Anne-Laure; Vandoorne, Chantal

    2015-06-01

    Published operating models about preventive health care and health promotion in primary care were sought with the aim of (1) compiling a functional inventory; and (2) to formulate working hypotheses for the improvement of clinical practice towards more efficiency and more equity. Narrative literature review, using keywords related to the various prevention classes, health promotion, primary care, practice models and health care delivery. The diversity of models led to a multi-criteria analysis. Twelve models were selected. Their characteristics were unevenly distributed. The models, whose authors announce that they apply to prevention, mainly describe approaches that focus on individuals within physician-patient relationship, and take into account practice organization. Some socio-ecological and systems models illustrate health promotion: educational practice, group- or population-based targets, community environment and social determinants of health. There is little room for patients in elaborating the models, as they have little role in health care systems. The definitions of prevention, health promotion and patient education greatly differ from one model to another. Little is known about practical implementation of the models; assessment data are scarce. Some elements valued by health promotion could be integrated to health care: empowerment of citizens, addressing community environment; increased involvement in local health professionals' networks; integration of individual and collective approaches within the same health care facilities to address simultaneously individual customization, efficiency and equity objectives. These developments may call for adaptation in vocational training and continuous professional development: communication skills, awareness to public health concepts, and early and longitudinal exposure to community-based learning experiences for students. Copyright © 2015. Published by Elsevier Masson SAS.

  10. Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis.

    Science.gov (United States)

    Mugisha, James; Abdulmalik, Jibril; Hanlon, Charlotte; Petersen, Inge; Lund, Crick; Upadhaya, Nawaraj; Ahuja, Shalini; Shidhaye, Rahul; Mntambo, Ntokozo; Alem, Atalay; Gureje, Oye; Kigozi, Fred

    2017-01-01

    Mental, neurological and substance use disorders contribute to a significant proportion of the world's disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis. Three of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental

  11. Quality in primary health care services in sub-Sahara Africa: right or ...

    African Journals Online (AJOL)

    The Primary Health Care (PHC) system has been the foundation for the operation of the health system in most of Sub-Sahara Africa following the Alma Ata Declaration in 1978. Quality of care is an important determinant of health services utilization, and is a health outcome of public health importance. It is known that the ...

  12. Primary Health Care Theory to Practice: Experience of First-Year Nursing Students in Hong Kong.

    Science.gov (United States)

    Simpson, Peggy; Chan, Mun Che; Cheung, Lai Yin; Hui, Tze Shau; Li, Ka Ying; Tang, Hiu Tung; Tong, Hoi Ning; Wong, Sik Kwan; Wong, Po Ming

    2002-01-01

    Eight first-year nursing students in Hong Kong implemented a primary health care project involving health assessments of older adults. Clients improved health knowledge and were satisfied with assessments. Students demonstrated high competence in health assessment, needs assessment, evaluation strategies, and health promotion skills. (Contains 27…

  13. General practitioners' views on leadership roles and challenges in primary health care: a qualitative study

    OpenAIRE

    Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug; Frich, Jan C

    2017-01-01

    Objective To explore general practitioners? (GPs) views on leadership roles and leadership challenges in general practice and primary health care. Design We conducted focus groups (FGs) with 17 GPs. Setting Norwegian primary health care. Subjects 17 GPs who attended a 5 d course on leadership in primary health care. Results Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical...

  14. [Translation and adaptation of a questionnaire to assess patient safety in primary health care].

    Science.gov (United States)

    Marchon, Simone Grativol; Mendes Junior, Walter Vieira

    2015-07-01

    The objective of this study was to describe the translation and adaptation of the questionnaire used in the Primary Care International Study of Medical Errors (PCISME) for application in primary health care in a local health district in Rio de Janeiro State, Brazil. The process included organization of an expert panel that adapted the questionnaire using a modified Delphi method. The adapted instrument can help produce specific information on primary health care and strengthen initiatives to improve patient safety in Brazil.

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

    Science.gov (United States)

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

    2016-01-01

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

  16. The role of mental health in primary prevention of sexual and gender-based violence

    Directory of Open Access Journals (Sweden)

    Aník Gevers

    2014-09-01

    Full Text Available In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV. However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.

  17. The role of mental health in primary prevention of sexual and gender-based violence.

    Science.gov (United States)

    Gevers, Aník; Dartnall, Elizabeth

    2014-01-01

    In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.

  18. The role of mental health in primary prevention of sexual and gender-based violence.

    Science.gov (United States)

    Gevers, Aník; Dartnall, Elizabeth

    2014-12-01

    In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.

  19. Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya

    National Research Council Canada - National Science Library

    Ojakaa, David; Olango, Susan; Jarvis, Jordan

    2014-01-01

    .... This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively...

  20. Health-related quality of life of patients of Brazilian primary health care.

    Science.gov (United States)

    Ascef, Bruna de Oliveira; Haddad, João Paulo Amaral; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Silveira, Micheline Rosa

    2017-11-13

    To analyze the Health-Related Quality of Life (HRQoL) of patients of the primary health care of the Brazilian Unified Health System (SUS) and its associated factors. This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D) instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7%) and anxiety/depression (38.8%). About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.

  1. Health-related quality of life of patients of Brazilian primary health care

    Directory of Open Access Journals (Sweden)

    Bruna de Oliveira Ascef

    2017-11-01

    Full Text Available ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL of patients of the primary health care of the Brazilian Unified Health System (SUS and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7% and anxiety/depression (38.8%. About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.

  2. Using Systems Science for Population Health Management in Primary Care

    National Research Council Canada - National Science Library

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-01-01

    .... The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. Methods...

  3. Reorganizing and restructuring the human resources function

    OpenAIRE

    Alexandrina Mirela, Stan

    2010-01-01

    To determine what kind of skills (internal or external) of human resources are adequate organization can use human resources audit. Audit is an action guide that provides step by step consistency of human resources activities within the organization with legal regulations and informal practices. This paper aims to highlight the importance of human resources audit which is an essential activity and is basis for the reorganization and restructuring of human resources function.

  4. Restructuring of Financial Sector in Pakistan

    OpenAIRE

    Khan, Muhammad Arshad

    2002-01-01

    The process of financial sector restructuring started in Pakistan during early 1990s. For this purpose, international financial institutions, like World Bank and ADB, provided technical and financial resources. The objective of this exercise was to let financial system play its role in economic growth and development of the country in an efficient and competitive way. A lot of policy decisions have been made and implemented during the last decade to reduce distortions and to develop competiti...

  5. Deregulation and restructuring of the electric utility industry

    Energy Technology Data Exchange (ETDEWEB)

    Nixon, Hal [Utility Workers Union of America (UWUA), AFL-CIO, (United States)

    1997-12-31

    Federal and state policy makers are currently faced with the rapidly evolving issue of the restructuring and potential deregulation of the electric utility industry, a sector of the economy of huge importance through its sheer size and its impact on the daily life and livelihood of everyone. This paper describes eleven principles that must be adhered to in any restructuring of the electric industry. Adherence to the principle and positions outlined can help assure that the transition in this industry benefits all, not just a few, and that the general health and welfare of the people is protected and enhanced [Espanol] Los legisladores estatales y federales se estan enfrentando con el rapido y envolvente aspecto de la reestructuracion y desregulacion potencial de la industria electrica, un sector de la economia de enorme importancia por su tamano y su impacto en la vida diaria y los medios de vida. En esta ponencia se describen once principios y posiciones que deben ser considerados en cualquier reestructuracion de la industria electrica. El apego a los principios y posiciones comentados puede ayudar a asegurar que la transicion en esta industria deneficie a todos, no solo a unos cuantos, y que la salud general y bienestar de la gente sea protegida y mejorada

  6. [Use of ineffective practices in Primary Health Care: professional opinions].

    Science.gov (United States)

    Domínguez Bustillo, L; Barrasa Villar, J I; Castán Ruíz, S; Moliner Lahoz, F J; Aibar Remón, C

    2014-01-01

    To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  7. Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership.

    Science.gov (United States)

    Cummings, Greta; Hayduk, Leslie; Estabrooks, Carole

    2005-01-01

    A decade of North American hospital restructuring in the 1990s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care. To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which emotionally intelligent nursing leadership mitigated any of these impacts. The sample was drawn from all registered nurses in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (N = 6,526 nurses; 53% response rate). Thirteen leadership competencies (founded on emotional intelligence) were used to create 7 data sets reflecting different leadership styles: 4 resonant, 2 dissonant, and 1 mixed. The theoretical model was then estimated 7 times using structural equation modeling and the seven data sets. Nurses working for resonant leaders reported significantly less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration and teamwork with physicians, more satisfaction with supervision and their jobs, and fewer unmet patient care needs than did nurses working for dissonant leaders. Resonant leadership styles mitigated the impact of hospital restructuring on nurses, while dissonant leadership intensified this impact. These findings have implications for future hospital restructuring, accountabilities of hospital leaders, the achievement of positive patient outcomes, the development of practice environments, the emotional health and well-being of nurses, and ultimately patient care outcomes.

  8. Electricity restructuring : a comparative review. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Trebilcock, M.J. [Toronto Univ., ON (Canada). Faculty of Law; Hrab, R. [Panel on the Role of Government in Ontario, Toronto, ON (Canada)

    2004-03-01

    Power generation, transmission and distribution are the 3 main components of the electricity market. For many years, most jurisdictions chose to vertically integrate these segments into government or private monopolies. Price controls or rate of return regulations were commonly imposed by governments to prevent the abuse of monopoly power. However, inefficiencies with these arrangements led to poor investment decisions. As a result, many jurisdictions re-evaluated the structure of electricity markets. Restructuring was motivated by the desire to shift investment risk from consumers or taxpayers to producers and investors. The introduction of competitive electricity generation markets created a new sector in the industry. This sector was the retailing or selling of electricity to end-users by retail intermediaries. Although restructuring of the industry should offer more efficient pricing and better-informed consumption and investment decisions, there are many challenges in electricity reform. These challenges include pricing by incumbent generators, transmitters and distributors; discriminatory network access by monopoly transmitters and distributors; inelasticity of electricity supply and demand at peak times; lack of real-time price notification and response by consumers; stranded costs; and, political and consumer resistance to increases in retail prices. The time it takes to get a new power plant online is another issues that complicates new entry in the generation sector. The results of restructuring in Ontario, California, United Kingdom, Pennsylvania, New Jersey, Maryland, Alberta, and Australia were examined. These jurisdictions are trying to find a balance between competition and regulation. 91 refs., 2 figs.

  9. Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System.

    Science.gov (United States)

    Nascimento, Renata Cristina Rezende Macedo do; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Silveira, Micheline Rosa; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

    2017-11-13

    To characterize the polypharmacy in primary health care patients and to identify its associated factors. This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The variable of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson's Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p < 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test. The prevalence of polypharmacy among medicine users was 9.4% (95%CI 7.8-12.0) in the general population and 18.1% (95%CI 13.6-22.8) in older adults above 65 years old. We found statistically significant association between polypharmacy and age above 45 years, lower self-perception of health, presence of chronic diseases, having health insurance, care in emergency services, and region of the Country. South users presented the highest chances to polypharmacy. The most used medicines were those of the cardiovascular system, being compatible with the national epidemiological profile. Polypharmacy is a reality in the population met within the primary care of Brazilian Unified Health System and may be related to excessive or inappropriate use of medicines. The main challenge to qualify health care is to ensure that prescription of multiple medicines be appropriate and safe.

  10. Development of health equity indicators in primary health care organizations using a modified Delphi.

    Directory of Open Access Journals (Sweden)

    Sabrina T Wong

    Full Text Available The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care.Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114 using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63 over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1-9, where a higher score meant more importance.Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0 in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. In order to achieve health care equity, performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated "treatment" or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care.These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision and providers (e.g., reflexive practice, skill in working with the health effects of trauma.

  11. Health care reform and job satisfaction of primary health care physicians in Lithuania

    Directory of Open Access Journals (Sweden)

    Blazeviciene Aurelija

    2005-03-01

    Full Text Available Abstract Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%, working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9% and 176 women (92.1% participated in the research, among which 133 (69.6% were GPs and 58 (30.4% physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale. Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09, social status (3.36, and workload (3.93 turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

  12. Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia.

    Science.gov (United States)

    Bawakid, Khalid; Abdulrashid, Ola; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad

    2017-11-25

    Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p burnout. The patient's pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient's pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician's burnout.

  13. Research protocol: Management of obesity in patients with low health literacy in primary health care.

    Science.gov (United States)

    Faruqi, Nighat; Stocks, Nigel; Spooner, Catherine; El Haddad, Nouhad; Harris, Mark F

    2015-01-01

    Socioeconomically disadvantaged adults are both more likely to be obese and have lower levels of health literacy. Our trial evaluates the implementation and effectiveness of primary care nurses acting as prevention navigators to support obese patients with low health literacy to lose weight. A pragmatic cluster randomised trial will be conducted. Twenty practices in socioeconomically deprived areas, 10 each in Sydney and Adelaide, will be recruited and randomised to intervention and control groups. Twenty to 40 eligible obese patients aged 40-70 years with a BMI ≥ 30 kg/m(2) and with low health literacy will be enrolled per practice. The intervention is based on the '5As' of the chronic disease model approach - Assess, Advise, Agree, Assist and Arrange - and the recommendations of the 2013 Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. In the intervention practices, patients will be invited to attend a health check with the prevention navigator who will assess the patient's risk and provide brief advice, assistance with goal setting and referral navigation. Provider training and educational meetings will be held. The providers' attitudes to obesity, confidence in treating obesity and preventive care they provide to obese people with low health literacy will be evaluated through questionnaires and interviews. Patients' self-assessment of lifestyle risk factors, perception of preventive care received in general practice, health-related quality of life, and health literacy will be assessed in telephone interviews. Patients' anthropometric measures will be recorded and their health service usage will be determined via linkage to the Australian government-held medical and pharmaceutical data. Our trial will provide evidence for the effectiveness of practice nurses as prevention navigators to support better weight management for obese patients with low health literacy. This trial is

  14. Docent malaise and absenteeism: A work and health relation of the primary education teachers

    National Research Council Canada - National Science Library

    Maria Luiza Luongo Silveira

    2015-01-01

    This text presents a research partials results about the primary school teachers work and health at the municipal schools at the south zone of the Rio Grande do Sul state with respect to the health...

  15. The performance of occupational therapy in primary health care: a literature review

    National Research Council Canada - National Science Library

    Larissa Rebecca da Silva Cabral; Marília Meyer Bregalda

    2017-01-01

    Introduction: The primary health care comprises a set of individual and collective actions to protect and promote the health of users, and occupational therapy, in this context, acts in fostering social...

  16. Use of health tourism as a basis for improving physical condition of primary school age children

    National Research Council Canada - National Science Library

    Halyna Butenko; Nataliia Goncharova; Volodymyr Saienko; Hanna Tolchieva

    2017-01-01

      The article is devoted to explanation and elaboration of recreation and health-improving technology embracing health tourism means for the cohort of primary school age children after the school hours...

  17. Primary health care, selective or comprehensive, which way to go ...

    African Journals Online (AJOL)

    Data synthesis: Examination of principles behind PHC and practical experiences in PHC in the developing world. ... PHC programs have improved specific aspects of health, frequently at the expense of other health sectors, but fail to address an individual's health in holistic manner, or the health infrastructure of countries.

  18. Availability of essential medicines in primary health care of the Brazilian Unified Health System.

    Science.gov (United States)

    Nascimento, Renata Cristina Rezende Macedo do; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

    2017-11-13

    To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename - National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer

  19. Substance abuse and HIV risk behaviours amongst primary health ...

    African Journals Online (AJOL)

    Objective: To document prevalence of, and association between, substance use and HIV risk behaviours among primary care patients. Method: Cross-sectional survey. Four primary care clinics in Cape Town. We selected clinics using stratified sampling, and systematically selected 131 patients from attendance logs.

  20. Factors affecting the referral of primary health care doctors toward ...

    African Journals Online (AJOL)

    Hend Al-Namash

    2011-06-08

    Jun 8, 2011 ... Abstract Background: Few eligible candidates are referred from primary care for bariatric surgery in spite of improvement in its safety and efficacy. Objective: The aim of this study was to identify factors affecting primary care physicians' (PCPs) referral to bariatric surgery in morbid obesity. Methods: This ...

  1. Factors affecting the referral of primary health care doctors toward ...

    African Journals Online (AJOL)

    Background: Few eligible candidates are referred from primary care for bariatric surgery in spite of improvement in its safety and efficacy. Objective: The aim of this study was to identify factors affecting primary care physicians' (PCPs) referral to bariatric surgery in morbid obesity. Methods: This study is a cross-sectional ...

  2. Public health governance and primary care delivery : a triangulated study.

    OpenAIRE

    Marks, L; Cave, S.; Hunter, D.J.; Mason, J M; S. Peckham; Wallace, A.; Mason, A; Weatherly, H; Melvin, K.

    2011-01-01

    The government is committed to improving health and well-being and tackling health inequalities. PCTs and other commissioners are charged with maximising health improvement for their local populations, working in partnership. However, the effectiveness of a local public health system in addressing these tasks is influenced by how far PCTs and other commissioners prioritise public health in the context of a complex web of incentives and governance arrangements, some of which may conflict. In c...

  3. A primary care-based health needs assessment in inner city Dublin.

    LENUS (Irish Health Repository)

    O'Kelly, C M

    2012-02-01

    BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.

  4. Sustainable Methods of Funding Health Care in Primary and Secondary Care for the Elderly

    OpenAIRE

    Khan, Anwar

    2015-01-01

    Clinical commissioning is a current health care management model for primary, secondary, and long term health care needs n United Kingdom nowadays. Form on 1 April 2013, Primary care trusts (PCTs) and strategic health authorities (SHAs) have been abolished. Clinical Commissioning Groups (CCGs) work with local authorities to address the wider determinants of health that is used to help people make positive changes to their lifestyle. NHS England (formerly the NHS Commissioning Board) and CCGs ...

  5. Health communication in primary health care -a case study of ICT development for health promotion

    National Research Council Canada - National Science Library

    Mahmud, Amina Jama; Olander, Ewy; Eriksén, Sara; Haglund, Bo Ja

    2013-01-01

    .... However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention...

  6. Development of health equity indicators in primary health care organizations using a modified Delphi.

    Science.gov (United States)

    Wong, Sabrina T; Browne, Annette J; Varcoe, Colleen; Lavoie, Josée; Fridkin, Alycia; Smye, Victoria; Godwin, Olive; Tu, David

    2014-01-01

    The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114) using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63) over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1-9, where a higher score meant more importance. Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated "treatment" or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care. These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision) and providers (e.g., reflexive practice, skill in working with the health effects of trauma).

  7. Hospitalizations of children due to primary health care sensitive conditions in Pernambuco State, Northeast Brazil.

    Science.gov (United States)

    Carvalho, Suzana Costa; Mota, Eduardo; Dourado, Inês; Aquino, Rosana; Teles, Carlos; Medina, Maria Guadalupe

    2015-04-01

    Admissions due to primary health care sensitive conditions from 1999 to 2009 among children Health System's Hospital Information System, a negative binomial regression was applied to estimate rate ratio (RR) and 95%CI for the effect on primary health care sensitive condition rates (admissions/10,000 inhabitants) of the Family Health Program (FHP) coverage (%), some demographic variables and living conditions. Hospitalizations due to primary health care sensitive conditions represented 44.1% of 861,628 admissions and the rate declined from 557.6 to 318.9 (-42.8%), a reduction three times greater than the rate due to all other causes. Increased FHP coverage was protective against primary health care sensitive conditions (RR = 0.94; 95%CI: 0.89-0.99). A decline in hospitalizations due to primary health care sensitive conditions indicated improvements in health status and may be associated with the consolidation of primary health care. Studies on access and quality of primary health care in relation to child morbidity and hospitalizations are needed.

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

    Science.gov (United States)

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

    2017-02-01

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

  9. Multidisciplinary practice experience of nursing faculty and their collaborators for primary health care in Korea.

    Science.gov (United States)

    Kim, Mi Ja; Chung, Hyang-In Cho; Ahn, Yang Heui

    2008-03-01

    This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government's support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other's territory and expertise. Teamwork should be included in all health professions' curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health

  10. Restructuring, ownership and efficiency in the electricity industry

    Science.gov (United States)

    Shanefelter, Jennifer Kaiser

    The first chapter considers improvements in productive efficiency that can result from a movement from a regulated framework to one that allows for market-based incentives for industry participants. Specifically, I look at the case of restructuring in the electricity generation industry. Using data from the electricity industry, this analysis considers the total effect of restructuring on one input to the production process, labor, as reflected in employment levels, payroll per employee and aggregate establishment payroll. Using concurrent payroll and employment data from non-utility ("merchant") and utility generators in both restructured and nonrestructured states, I estimate the effect of market liberalization, comprising both new entry and state-level legislation, on employment and payroll in this industry. I find that merchant owners of divested generation assets employ significantly fewer people, but that the payroll per employee is not significantly different from what workers at utility-owned plants are paid. As a result, the new merchant owners of these plants have significantly lower aggregate payroll expenses. Decomposing the effect into a merchant effect and a divestiture effect, I find that merchant ownership is the primary driver of these results. As documented in Chapter 1, merchant power plants have lower overall payroll costs than plants owned by utilities. Employment at merchant power plants is characterized by reduced staffing levels but higher average payroll per employee. A hypothesis set forth in that paper is that merchant generators employ fewer workers at the lower end of the wage distribution, resulting in a higher average payroll per employee. The second chapter of this paper examines whether employment at nonutility power plants, that is, those that are either divested or native merchant power plants, is skewed towards more skilled labor. This chapter also considers the extent to which the difference in employment levels is the result of

  11. Primary Health Care in Nigeria: Strategies and constraints in ...

    African Journals Online (AJOL)

    organization of the Nigeria health structure to align with the new vision were made. ... within the health precinct include community mobilization, service integration and selected PHC programmes under the auspices of international collaborators.

  12. Essential Elements of a Collaborative Mental Health Training Program for Primary Care.

    Science.gov (United States)

    Giles, Lisa L; Martini, D Richard

    2017-10-01

    Mental health integration in primary care is based on creating an environment that encourages collaboration and supports appropriate care for patients and families while offering a full range of services. Training programs for primary care practitioners should include sessions on how to build and maintain such a practice along with information on basic mental health competencies. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Examining the Relationship between Teacher Organizational Commitment and School Health in Turkish Primary Schools

    Science.gov (United States)

    Sezgin, Ferudun

    2009-01-01

    The purpose of this study was to examine the relationships between teachers' perceptions of organizational commitment and school health in Turkish primary schools. The Organizational Commitment Scale and the Organizational Health Inventory were used to gather data from 323 randomly selected teachers employed in 20 primary schools in Ankara.…

  14. Measuring three aspects of motivation among health workers at primary level health facilities in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Miho Sato

    Full Text Available The threshold of 2.3 skilled health workers per 1,000 population, published in the World Health Report in 2006, has galvanized resources and efforts to attain high coverage of skilled birth attendance. With the inception of the Sustainable Development Goals (SDGs, a new threshold of 4.45 doctors, nurses, and midwives per 1,000 population has been identified. This SDG index threshold indicates the minimum density to respond to the needs of health workers to deliver a much broader range of health services, such as management of non-communicable diseases to meet the targets under Goal 3: Ensure healthy lives and promote well-being for all people of all ages. In the United Republic of Tanzania, the density of skilled health workers in 2012 was 0.5 per 1,000 population, which more than doubled from 0.2 per 1,000 in 2002. However, this showed that Tanzania still faced a critical shortage of skilled health workers. While training, deployment, and retention are important, motivation is also necessary for all health workers, particularly those who serve in rural areas. This study measured the motivation of health workers who were posted at government-run rural primary health facilities.We sought to measure three aspects of motivation-Management, Performance, and Individual Aspects-among health workers deployed in rural primary level government health facilities. In addition, we also sought to identify the job-related attributes associated with each of these three aspects. Two regions in Tanzania were selected for our research. In each region, we further selected two districts in which we carried out our investigation. The two regions were Lindi, where we carried out our study in the Nachingwea District and the Ruangwa District, and Mbeya, within which the Mbarali and Rungwe Districts were selected for research. All four districts are considered rural.This cross-sectional study was conducted by administering a two-part questionnaire in the Kiswahili

  15. Measuring three aspects of motivation among health workers at primary level health facilities in rural Tanzania.

    Science.gov (United States)

    Sato, Miho; Maufi, Deogratias; Mwingira, Upendo John; Leshabari, Melkidezek T; Ohnishi, Mayumi; Honda, Sumihisa

    2017-01-01

    The threshold of 2.3 skilled health workers per 1,000 population, published in the World Health Report in 2006, has galvanized resources and efforts to attain high coverage of skilled birth attendance. With the inception of the Sustainable Development Goals (SDGs), a new threshold of 4.45 doctors, nurses, and midwives per 1,000 population has been identified. This SDG index threshold indicates the minimum density to respond to the needs of health workers to deliver a much broader range of health services, such as management of non-communicable diseases to meet the targets under Goal 3: Ensure healthy lives and promote well-being for all people of all ages. In the United Republic of Tanzania, the density of skilled health workers in 2012 was 0.5 per 1,000 population, which more than doubled from 0.2 per 1,000 in 2002. However, this showed that Tanzania still faced a critical shortage of skilled health workers. While training, deployment, and retention are important, motivation is also necessary for all health workers, particularly those who serve in rural areas. This study measured the motivation of health workers who were posted at government-run rural primary health facilities. We sought to measure three aspects of motivation-Management, Performance, and Individual Aspects-among health workers deployed in rural primary level government health facilities. In addition, we also sought to identify the job-related attributes associated with each of these three aspects. Two regions in Tanzania were selected for our research. In each region, we further selected two districts in which we carried out our investigation. The two regions were Lindi, where we carried out our study in the Nachingwea District and the Ruangwa District, and Mbeya, within which the Mbarali and Rungwe Districts were selected for research. All four districts are considered rural. This cross-sectional study was conducted by administering a two-part questionnaire in the Kiswahili language. The first

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

    African Journals Online (AJOL)

    AJRH Managing Editor

    It creates a general awareness on human health in both the teachers and the pupils as well as members of the wider community; inculcates and promotes good health habits in school children and provides the children with the knowledge useful in taking decisions for themselves on health and well-being and ensures that.

  17. Quality of Family Planning Services in Primary Health Centers of ...

    African Journals Online (AJOL)

    Availability of resources was checked using provider interview and inventory checklist. Moreover, a total of 150 ... Hence, it is advisable that health managers of the health facilities and the district health office ensure improved availability of trained personnel, IEC materials and other supplies at the clinics. Keywords: Family ...

  18. Telemental health in Brazil: past, present and integration into primary care

    Directory of Open Access Journals (Sweden)

    Rodrigo Da Silva Dias

    2015-04-01

    Full Text Available Background Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research.

  19. Health benefits of primary care social work for adults with complex health and social needs: a systematic review.

    Science.gov (United States)

    McGregor, Jules; Mercer, Stewart W; Harris, Fiona M

    2018-01-01

    The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self-management of long-term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care. © 2016 John Wiley & Sons Ltd.

  20. [Mental health and primary care in Mexico. Opportunities and challenges].

    Science.gov (United States)

    Saavedra Solano, Nayelhi; Berenzon Gorn, Shoshana; Galván Reyes, Jorge

    2016-04-01

    To present the conditions that favour or limit the integration of mental health into health centres, based on the perceptions of health workers and on observations made by researchers. A study was conducted between April 2012 and February 2014 using a non-participant observation technique plus interviews with health professionals. Descriptive exploratory study conducted in 19 health centres in Mexico City. The selection of centres and participants was intentional, followed by the snowball technique in order to reach data saturation. Two guides were use, one for collecting information during the observation and the other one for interviews. The observations were registered in field notes, while the interviews were audio recorded. All collected information was stored in Word files. The analysis of field notes consisted of three levels of reading, and the interview analysis was based on "categorisation of meanings" proposed by Kvale (1996). The aspects that favour or limit the integration of mental health services involve three broad categories: a) programs and methods that organise services, b) infrastructure and material resources and, c) human and information resources. Actions targeted at including mental health into productivity reports and into already established goals, would contribute to the integration of mental health care, as well as promoting the idea that mental health is part of overall health, and to increase the public investment in health. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  1. Client/patient perceptions of achieving equity in primary health care: a mixed methods study

    OpenAIRE

    Akhavan, Sharareh; Tillgren, Per

    2015-01-01

    Introduction To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHC...

  2. Governance and Enterprise Restructuring - the case of Macedonia

    OpenAIRE

    Apostolov, Mico

    2011-01-01

    This paper is a case study of the Republic of Macedonia (Southeast Europe), which focuses on examining governance and enterprise restructuring. Governance and enterprise restructuring is already defined indicator in EBRD’s studies and transition reports, measuring the effective corporate governance and corporate control exercised through domestic financial institutions and markets, fostering market-driven restructuring. As of the beginning of the transition process, governance and enterp...

  3. [Nurse care in primary health care: diagnosis and follow-up of health problems].

    Science.gov (United States)

    Granollers Mercader, S; Pont Ribas, A

    1993-02-01

    To evaluate the results of nursing staff putting into practice a number of health prevention and promotion schemes, with particular emphasis on the follow-up of the health problems detected. A crossover study. SITE. A care unit of the Sant Just Desvern Primary Care team. A total of 136 people were seen. 58% were men and 42% women. Their average age was 39.30 +/- 16. The risk factors found were: tobacco, alcohol, exercise, arterial tension, cholesterol, weight, dental and oral hygiene, gynecological check-ups, self-examination of breasts and anti-tetanus, German measles and flu vaccinations. Using the clinical records it was found that 42.64% were smokers; 1.58% were alcoholics and 20.63% consumed an excessive amount of alcohol; 47.58% were sedentary; 17.09% were diagnosed with dyslipaemia; and 1.58% with hypertension. After the intervention, 18.96% gave up smoking and 14.28% of excessive drinkers managed to stop. 76.47% of women advised to attend the gynaecologist did so. 89.61% of patients completed the series of anti-tetanus vaccinations. The favorable response of the population to a periodic health check-up should be emphasised. The changes in life-style brought about after the detection and subsequent follow-up of health problems was extremely positive.

  4. Medical education and primary health care in Nigeria: the Sokoto University experience.

    Science.gov (United States)

    Akpala, C O

    1991-11-01

    Despite the acknowledgement and adoption of the Alma-Ata declaration by majority of the countries of the world as a strategy for achieving Health For All, medical educational systems often remain as ivory towers from the health service system. This traditional system of medical education does not adequately prepare doctors in developing countries for their expected leadership role in meeting the health needs for their communities through primary health care. In Nigeria, primary health care forms the basis for an official health policy aimed at meeting the health care needs of the entire population particularly those in the rural areas. This article, while highlighting the need for integration of medical education and the primary health care services, also examines the structural relationships between the two components at the Sokoto University in Nigeria, a West African country with one of the oldest medical educational system in the area.

  5. [Professional competencies in primary health care for attending to older adults].

    Science.gov (United States)

    Witt, Regina Rigatto; Roos, Maclaine de Oliveira; Carvalho, Nilson Maestri; Silva, Andria Machado da; Rodrigues, Carla Daiane Silva; Santos, Mariana Timmers Dos

    2014-12-01

    To identify and analyze the necessary competencies in primary health care for attending to older adults. An exploratory, descriptive, and quali-quantitative study was developed. Three rounds of the Delphi Technique were conducted with participants from primary health care services and a multidisciplinary committee. The first questionnaire asked participants to indicate the competencies needed for attending to older adults in primary health care. They were compiled into a list and added to a Likert Scale (from 1 to 5) for the second and third questionnaires. A consensus criterion of 70% was adopted. Twenty eight competencies were reached by consensus and were classified into twelve domains. The competencies reflect Brazilian health care policy and constitute a reference for professional health practice and education when caring for the older adult in primary health care.

  6. Alcohol consumption among the elderly primary health care patients: The impact of alcohol on overall health

    Directory of Open Access Journals (Sweden)

    Račić Maja

    2014-01-01

    Full Text Available Introduction: Alcoholism is the third most common psychiatric disorder among the elderly, yet it often goes undiagnosed in primary care setting. Objective: To estimate the prevalence of alcohol use disorders among elderly primary care patients in Bosnia and Herzegovina and to determine the presence of different health problems related to alcohol consumption. Method: The study was conducted in 10 family medicine practices. Family physicians randomly selected a group of 40 patients over 60 years of age registered with their practice. As a part of Comprehensive Geriatric Assessment, patients were asked to complete Alcohol Consumption Screening Questionnaire, Functional Status Questionnaire, Geriatric Depression Scale (GDS, Mini mental screening examination (MMSE, and Hamilton Anxiety Scale. Screening results were followed by additional clinical evaluation. To estimate the feasibility of Alcohol Consumption Screening Questionnaire, one family member or a caregiver of each patient was questioned about patient's habits and health problems. Results: Eighty-nine (22% patients were current drinkers. Of those, 59% were harmful drinkers, 26% hazardous and 15% nonhazardous drinkers. Women accounted for 27% of current drinkers. MMSE revealed dementia symptoms in 37%, and symptoms of mild cognitive impairment (MCI in 25% of current drinkers. Depression symptoms were found in 38% and anxiety symptoms in 6% of current drinkers. Functional status was decreased in hazardous and harmful drinkers. Conclusion: High percentage of older adults in Bosnia and Herzegovina is regular users of alcohol. Hazardous and harmful drinking is associated with significant morbidity. These findings demonstrate the usefulness and importance of the excess alcohol use screening in all primary care settings serving adults over age 60.

  7. How acceptable are primary health care nurse practitioners to Australian consumers?

    Science.gov (United States)

    Parker, Rhian; Forrest, Laura; Ward, Nathaniel; McCracken, James; Cox, Darlene; Derrett, Julie

    2013-01-01

    International evidence indicates that nurses working in primary care can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurse practitioners employed in primary health care perform some tasks previously exclusive to the GP role due to their advanced skills, knowledge and training. In November 2010 Medicare provider rights and Pharmaceutical Benefits Scheme rights were provided for nurse practitioners working in private practice, and in collaboration with a medical practitioner. However, there is limited evidence about how acceptable nurse practitioners are to Australian consumers and what knowledge consumers have of the nurse practitioner role in the delivery of primary health care. The aim of this study was to examine Australian health care consumers' perceptions of nurse practitioners working in primary health care. This paper reports on the results of seven focus groups (n = 77 participants) conducted around Australia. Focus groups participants were asked how acceptable nurse practitioners are as provides of primary health care. Although there was some confusion about the role of nurse practitioners and how this role differed from other primary health care nurses, participants in the focus groups were very positive about nurse practitioners and would find them acceptable in providing primary health care.

  8. Quality of Primary Health Care for children and adolescents living with HIV

    Directory of Open Access Journals (Sweden)

    Leticia do Nascimento

    Full Text Available Abstract Objective: to evaluate the quality of health care for children and adolescents living with HIV, among the different types of Primary Health Care services of Santa Maria, Rio Grande do Sul. Method: cross-sectional study, developed with 118 Primary Health Care professionals. The Primary Care Evaluation Instrument, Professional version, was used. For verification of the variables associated with the high score, Poisson Regression was used. Results: the professionals of the Family Health Strategy, when compared to those of the Primary Health Units, obtained a greater degree of orientation to primary care, both for the overall score and for the derived attributes score, as well as for the integrality and community orientation attributes. A specialization in Primary Health Care, other employment and a statutory work contract were associated with quality of care. Conclusion: the Family Health Strategy was shown to provide higher quality health care for children and adolescents living with HIV, however, the coverage is still low. The need was highlighted to expand this coverage and invest in vocational training directed toward Primary Care and making the professionals effective, through public selection procedure, as well as an improvement program that recognizes the care requirements, in these settings, of children and adolescents infected with HIV.

  9. Health facilitation in primary care seen from practice and education.

    Science.gov (United States)

    Thomson, Karen; Gripton, Jane; Lutchmiah, John; Caan, Woody

    'Valuing People: A New Strategy for Learning Disability for the 21st Century' (Department of Health, 2001a,b) aimed to introduce 'health facilitation' to improve the identification of health needs and access to appropriate care for people with learning disabilities. One London Borough took a leading role in implementing this new function, in the form of dedicated, full-time health facilitators. The authors examined the implementation and its impact, employing an innovative collaboration between professionals from practice, education and research. The clinical nurse involved was observed during her first year of health facilitation. The authors evaluated her impact on professionals, people with learning disabilities and the wider system of health. In some areas (for example, information technology) the health facilitator could make little progress in one year. However, she connected with a widening circle of local people and services, for example, in introducing health action plans for adults with a learning disability. Across the Borough some professionals became more aware of specific health issues in their local population.

  10. Recommendations from primary care providers for integrating mental health in a primary care system in rural Nepal.

    Science.gov (United States)

    Acharya, Bibhav; Tenpa, Jasmine; Thapa, Poshan; Gauchan, Bikash; Citrin, David; Ekstrand, Maria

    2016-09-19

    Globally, access to mental healthcare is often lacking in rural, low-resource settings. Mental healthcare services integration in primary care settings is a key intervention to address this gap. A common strategy includes embedding mental healthcare workers on-site, and receiving consultation from an off-site psychiatrist. Primary care provider perspectives are important for successful program implementation. We conducted three focus groups with all 24 primary care providers at a district-level hospital in rural Nepal. We asked participants about their concerns and recommendations for an integrated mental healthcare delivery program. They were also asked about current practices in seeking referral for patients with mental illness. We collected data using structured notes and analyzed the data by template coding to develop themes around concerns and recommendations for an integrated program. Participants noted that the current referral system included sending patients to the nearest psychiatrist who is 14 h away. Participants did not think this was effective, and stated that integrating mental health into the existing primary care setting would be ideal. Their major concerns about a proposed program included workplace hierarchies between mental healthcare workers and other clinicians, impact of staff turnover on patients, reliability of an off-site consultant psychiatrist, and ability of on-site primary care providers to screen patients and follow recommendations from an off-site psychiatrist. Their suggestions included training a few existing primary care providers as dedicated mental healthcare workers, recruiting both senior and junior mental healthcare workers to ensure retention, recruiting academic psychiatrists for reliability, and training all primary care providers to appropriately screen for mental illness and follow recommendations from the psychiatrist. Primary care providers in rural Nepal reported the failure of the current system of referral, which

  11. The motivational needs of primary health care nurses in a mine clinic setting

    OpenAIRE

    2013-01-01

    M.Cur. (Nursing Management) Motivation is a process that influence and directs behaviour in order to satisfy a need. Motivation of nurses is important in the primary health care environment since low levels of motivation among Primary Health Care (PHC) nurses; who are in a critical position in health service delivery; could have a negative impact on the achievement of high standards in the nursing profession. This situation is also relevant in a mine clinic setting. The main factor in moti...

  12. Evaluation of a Brief Marriage Intervention for Internal Behavioral Health Consultants in Primary Care

    Science.gov (United States)

    2016-09-01

    conduct Marriage Checkup for Primary Care to six Internal Behavioral Health Consultants (IBHCs) at four medical treatment facilities in the Air Force ...AWARD NUMBER: W81XWH-15-2-0025 TITLE: Evaluation of a Brief Marriage Intervention for Internal Behavioral Health Consultants in Primary Care...Sep 2015 - 31 Aug 2016 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Evaluation of a Brief Marriage Intervention for Internal Behavioral Health

  13. Optimization Specifications for CUDA Code Restructuring Tool

    KAUST Repository

    Khan, Ayaz

    2017-03-13

    In this work we have developed a restructuring software tool (RT-CUDA) following the proposed optimization specifications to bridge the gap between high-level languages and the machine dependent CUDA environment. RT-CUDA takes a C program and convert it into an optimized CUDA kernel with user directives in a configuration file for guiding the compiler. RTCUDA also allows transparent invocation of the most optimized external math libraries like cuSparse and cuBLAS enabling efficient design of linear algebra solvers. We expect RT-CUDA to be needed by many KSA industries dealing with science and engineering simulation on massively parallel computers like NVIDIA GPUs.

  14. Physicians’ Perceptions About the Quality of Primary Health Care Services in Transitional Albania

    Science.gov (United States)

    Kellici, Neritan; Dibra, Arvin; Mihani, Joana; Kellici, Suela; Burazeri, Genc

    2015-01-01

    Aim: To date, the available information regarding the quality of primary health care services in Albania is scarce. The aim of our study was to assess the quality of primary health care services in Albania based on physicians’ perceptions towards the quality of the services provided to the general population. Methods: A cross-sectional study was conducted in January-March 2013 including a representative sample of 132 physicians (59 men aged 41.3±6.9 years and 73 women aged 43.7±4.8 years; overall response rate: 132/150=88%) providing primary health care services in several polyclinics (health centers) of Tirana, the Albanian capital city. A structured self-administered and anonymous questionnaire was applied including physicians’ perceptions regarding different dimensions of the quality of primary health care. Binary logistic regression was used to assess the association of self-perceived quality of health care services with baseline characteristics of physicians. Results: Self-perceived adequate quality of health care services was positively related to the age of physicians, their working experience, female gender, a lower population served, and specialization in family medicine. Conclusion: Our findings provide useful evidence on the self-perceived quality of health services from primary health care physicians’ perspective in transitional Albania. Health authorities in Albania should implement suitable instruments to measure the quality of health care services at all levels. PMID:26005264

  15. Utilization of Primary Health Care Services in Jaba Local Government Area of Kaduna State Nigeria.

    Science.gov (United States)

    Otovwe, Agofure; Elizabeth, Sarki

    2017-07-01

    Primary health care was designed to provide accessible health care for all. However, most primary health care facilities are in various states of disrepair, catering for less than 20% of potential patients in the population. This study was designed to investigate the utilisation of primary health care services in Jaba Local Government Area of Kaduna State Nigeria. The study employed a cross-sectional study design conducted among 383 respondents utilising simple random sampling techniques. A pretested semi-structured questionnaire was administered to obtain information from respondents, while descriptive statistics was used to analyse the data. The results show that almost all of the respondents, 333(97.90%), were aware of the existence of primary health care services in their community. Furthermore, the majority of the respondents, 304(89.40%), utilized primary health care services while 293(86.20%) and 212(62.40%) were satisfied with the amount of charges for services and the supply of drugs respectively. According to the respondent, weak services in primary health care includes; personal hygiene and nutritional education, management of chronic diseases and cancer screening. Factors that influence the utilization of primary health care services according to the respondents were availability of trained personnel (AOR=1.828 95% CI=0.410-1.672), attitude of staffs (AOR=1.114 95% CI=0.527-2.355), waiting times (AOR=1.110 95% CI=0.584-2.224) and availability of diagnostic services (AOR=0.951 95% CI=0.472-1.918). The study highlighted the weaknesses in some of the services offered at the various primary health centres and the factors which can hinder the residents from patronizing primary health care services.

  16. Governance for Urban Health Equity: Mobilizing Demand for Primary ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The growth of urban slums in Bangladesh is creating a crisis in healthcare delivery. New research will identify opportunities to improve health care for the urban poor and involve communities more meaningfully in health governance. Rapid urbanization in developing countries is increasing pressure on cities to deliver ...

  17. Caregivers' satisfaction and supervision of primary health care ...

    African Journals Online (AJOL)

    This study assessed the level of clients' satisfaction with care received and the quality of supervision of child health services in selected PHC facilities of Nnewi, Nigeria. The study design was cross sectional. Four health facilities were selected by simple random sampling technique from a list of 12 public PHC facilities that ...

  18. Relevance of physiotherapy in primary health care | Hamzat | East ...

    African Journals Online (AJOL)

    Physiotherapy is often regarded as a second-contact health service suitable only for secondary and tertiary health facilities that are usually located in urban centres. Yet many patients who require the professional services of a physiotherapist are unable to access it either as a result of non-availability of physiotherapy ...

  19. The role of culture in primary health care

    African Journals Online (AJOL)

    1994-12-12

    Dec 12, 1994 ... Therefore health workers should realise that the traditional care system is important if PHC is to ... death. A health care system is a cultural system just as language or religion is. In every culture, illness, the ... medicine and its directives; scientific medicine is and has always been a foreign cultural idea.

  20. Patients‟ perceptions of primary health care services in the Eastern ...

    African Journals Online (AJOL)

    Within domains, significant gender differences were observed on selected items. Suggested health services‟ improvements included the improvement of the quality of basic amenities, more health care staff, improved communication, respect for patients‟ dignity and the availability of medicines. We conclude that quality ...