WorldWideScience

Sample records for therapy health care

  1. Occupational Therapy experience in family care in a primary health care service

    Directory of Open Access Journals (Sweden)

    Gisele Baissi

    2013-08-01

    Full Text Available Occupational therapy is presented as the core knowledge involved in the remodeling and strengthening of Primary Health Care in the Brazilian Unified Health Care System (Sistema Único de Saúde – SUS. In this study, we aimed to describe the interventions in the process of occupational therapy in supervised family care in a primary health care service in the municipality of Várzea Paulista, São Paulo state. In this case study, the moments of care were described and analyzed in light of narratives on the supervised practice of occupational therapy with a family. The results showed forms of intervention that characterize the process of occupational therapy focused on family health needs in favor of creativity and the role for changes in health practices in everyday life. Through the accomplishment of occupational activities directed to self-care, Occupational Therapy can aid families to cope with daily life adversity.

  2. Incorporating Yoga Therapy into Primary Care: The Casey Health Institute.

    Science.gov (United States)

    Ross, Alyson; Williams, Laurie; Pappas-Sandonas, Mary; Touchton-Leonard, Katharine; Fogel, David

    2015-01-01

    Individuals seek complementary and alternative medicine (CAM) for a variety of health conditions, and yoga is a popular CAM modality. Over the past few decades, yoga has become incorporated into hundreds of healthcare facilities, most commonly in large university medical centers. While research has shown yoga to be effective in reducing symptoms and improving outcomes in chronic health conditions, most patients seek yoga therapy on their own, as few primary care practitioners have incorporated yoga therapy into their practices. The purpose of this article is to describe the efforts of the Casey Health Institute to incorporate yoga therapy into their primary care integrative medicine center. At Casey Health, a full-time Clinical Yoga Specialist works alongside the physicians, nurses, and CAM providers in delivering care to a wide variety of patients. The majority of referrals to yoga therapy have been for pain-related musculoskeletal conditions, as well as hypertension, headaches, anxiety, depression, and sleep disturbances. Most patients attend weekly 60-minute individual sessions, and the Clinical Yoga Specialist stays in touch with the patient between appointments via telephone and email. T h e Clinical Yoga Specialist has become an integral part of Casey Health, participating in collaborative medical appointments in which two CAM practitioners provide simultaneous treatments to a patient. She also participates in the clinic's ongoing weight loss program. The Clinical Yoga Specialist spends one morning each week "floating" in the clinic, when she is on-call to the practitioners to assist in treatment and/or to introduce a yoga therapy experience to the patients. These brief interventions introduce the patients to the therapeutic benefits of yoga, while simultaneously demonstrating yoga's effectiveness to the healthcare providers. Casey Health has developed a unique teacher training program whose faculty includes senior Iyengar yoga teachers as well as physicians

  3. Mindfulness-based cognitive therapy for recurrent major depression: A 'best buy' for health care?

    Science.gov (United States)

    Shawyer, Frances; Enticott, Joanne C; Özmen, Mehmet; Inder, Brett; Meadows, Graham N

    2016-10-01

    While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up. Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost-utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost-utility acceptability curves. Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

    Science.gov (United States)

    Fogelberg, Donald J.; Halle, Ashley D.; Mroz, Tracy M.

    2017-01-01

    One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system. PMID:28027031

  6. Where and how does physical therapy fit? Integrating physical therapy into interprofessional HIV care.

    Science.gov (United States)

    deBoer, Heather; Andrews, Matthew; Cudd, Stephanie; Leung, Ellie; Petrie, Alana; Chan Carusone, Soo; O'Brien, Kelly K

    2018-03-13

    To investigate the role of physical therapy in HIV care from the perspective of people living with HIV and health care professionals with expertise in HIV care. We conducted a qualitative descriptive study using semistructured interviews (with health care professionals) and focus groups (with people living with HIV). We purposively sampled health care professionals and recruited people living with HIV in collaboration with an HIV-specialty hospital. We asked participants about their knowledge of and experiences with physical therapy, and perceptions of the physical therapy role in interprofessional HIV care. We analyzed data using content analytical techniques. Thirteen people living with HIV and 12 health care professionals conceptualized physical therapy as positively influencing independence and social participation, and as a valuable ally in interprofessional collaboration. The Framework of Physical Therapy Role in HIV Care consists of two components: (1) multidimensional and client-centered roles of physical therapy addressing physical, psychological and social health domains; and (2) contextual factors important to consider for the role of physical therapy: aging, episodic nature of HIV, multimorbidity, competing priorities, continuity of care, stigma, resource security and social isolation. The interaction between contextual factors and health domains can influence the role of physical therapy. The role of physical therapy in HIV is multidimensional and client-centered. This Framework can be used by rehabilitation professionals working with people living with HIV. Implications for Rehabilitation Participants living with HIV in this study experienced physical therapy as a means of addressing rehabilitation goals that positively influenced physical health and social participation. The role of physical therapy in HIV care is multidimensional and client-centered and can address health challenges in physical, social and psychological health domains. The presence

  7. Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review.

    Science.gov (United States)

    Schmid, W; Rosland, J H; von Hofacker, S; Hunskår, I; Bruvik, F

    2018-02-20

    The use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy's potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users' and providers' perspectives on music therapy in palliative care within one research article. A systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy's impact in palliative care to forward a comprehensive understanding of it's effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data. Twelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy. Both quantitative as well as qualitative research showed positive changes in

  8. Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals

    DEFF Research Database (Denmark)

    Johansen, Jens B; Mortensen, Peter T; Videbæk, Regitze

    2011-01-01

    Aims The aim of this study was to examine health-care professionals attitudes towards implantable cardioverter-defibrillator (ICD) therapy and issues discussed with patients. Methods and results Survey of 209 health-care professionals providing specialized treatment and care of ICD patients......-physicians. Physicians were less likely to believe that their personal attitude towards ICD treatment has no influence on how they deal professionally with patients (27.8 vs. 43.6%; P = 0.04). Physicians and non-physicians were equally positive towards ICD therapy as primary prophylaxis in ischaemic cardiomyopathy (87...... discussing ICD treatment with candidate patients. At the same time, physicians are more aware that their attitude towards ICD treatment may influence how they deal professionally with patients compared with non-physicians....

  9. Occupational Therapy and Primary Care: Updates and Trends

    Science.gov (United States)

    Mroz, Tracy M.; Fogelberg, Donald J.; Leland, Natalie E.

    2018-01-01

    As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care. PMID:29689169

  10. Project ‘play and tell’: occupational therapy in primary health care

    Directory of Open Access Journals (Sweden)

    Débora Barbosa e Alcântara

    2012-12-01

    Full Text Available This paper reports the experience of a “storytelling and playing” group that took place in a FamilyHealth Unit in Sao Carlos, State of Sao Paulo. The group was formed as from the evaluation of the occupationaltherapist in the context of Primary Health Care, which broadly considers the daily lives of the actors involved:children, one user of the system, and the health team. From the viewpoint of Occupational Therapy, with focuson the problems of the territory, interventions linking the following matters were proposed: individual care,collective care, and co-responsibility of the community and staff in pursuit of the resignificance of the everydaylives of the actors involved. This is a concrete example of paradigm shift from the existing health model to theprecepts of the Family Health Strategy, with the involvement of users and professionals from various areas.The occupational therapist identified different demands of the territory: the need for transformation of dailylife and routine of a user; the need for children’s leisure; and the desire of the health team to build this spacethrough a playroom. The possible combination of the user, children and the team’s everyday realities composedan intervention project based on the vision of the clinic expanded. The “playing and storytelling” was able toactually transform the health care model.

  11. Reimbursement of targeted cancer therapies within three different European health care systems

    NARCIS (Netherlands)

    Mihajlovic, Jovan; Dolk, C.; Postma, Maarten

    2014-01-01

    Objectives: To identify differences in the recommendations for targeted cancer therapies (TCT) in three distinctive European health care systems: Serbian, Scottish and Dutch, and to examine the role of cost effectiveness analyses (CEA) in such recommendations. Methods: A list of currently approved

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

    Science.gov (United States)

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

    2016-02-09

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

  13. Population Health and Occupational Therapy.

    Science.gov (United States)

    Braveman, Brent

    2016-01-01

    Occupational therapy practitioners play an important role in improving the health of populations through the development of occupational therapy interventions at the population level and through advocacy to address occupational participation and the multiple determinants of health. This article defines and explores population health as a concept and describes the appropriateness of occupational therapy practice in population health. Support of population health practice as evidenced in the official documents of the American Occupational Therapy Association and the relevance of population health for occupational therapy as a profession are reviewed. Recommendations and directions for the future are included related to celebration of the achievements of occupational therapy practitioners in the area of population health, changes to the Occupational Therapy Practice Framework and educational accreditation standards, and the importance of supporting, recognizing, rewarding, and valuing occupational therapy practitioners who assume roles in which direct care is not their primary function. Copyright © 2016 by the American Occupational Therapy Association, Inc.

  14. The knowledge of pregnant teenagers on Speech Therapy related to maternal-infant health care - doi:10.5020/18061230.2007.p207

    Directory of Open Access Journals (Sweden)

    Daniela Carvalho Neves

    2012-01-01

    Full Text Available This study had as its objective to investigate the knowledge of pregnant teenagers on Speech Therapy related to maternal-infant health care. A qualitative analysis was made based on a thematic investigation of the subject matter. Ten pregnant teenagers with chronological age between ten and nineteen years old joined in the survey. They found themselves around the fifth and ninth months of gestation age, being attended at the Center of Pregnant TeenagersAttention Care at Fortaleza General Hospital. The collection of data involved the application of a semi-structured interview broaching topics that could identify what the pregnant teenagers knew about Speech Therapy and maternal-infant care. Education interventions, related to Speech Therapy health promotion, were also accomplished. The results pointed out that the pregnant teenagers’ level of knowledge on aspects such as: food transition and utensils, oral habits, language stimulation and hearing loss detection, was still incipient and unsatisfactory. It is concluded that the knowledge of the pregnant teenagers on Speech Therapy related to maternal-infant health care was unsatisfactory, which demonstrates the importance of education interventions related to human communication health care for this studied sample.

  15. Music therapy in cardiac health care: current issues in research.

    Science.gov (United States)

    Hanser, Suzanne B

    2014-01-01

    Music therapy is a service that has become more prevalent as an adjunct to medical practice-as its evidence base expands and music therapists begin to join the cardiology team in every phase of care, from the most serious cases to those maintaining good heart health. Although applications of music medicine, primarily listening to short segments of music, are capable of stabilizing vital signs and managing symptoms in the short-term, music therapy interventions by a qualified practitioner are showing promise in establishing deeper and more lasting impact. On the basis of mind-body approaches, stress/coping models, the neuromatrix theory of pain, and entrainment, music therapy capitalizes on the ability of music to affect the autonomic nervous system. Although only a limited number of randomized controlled trials pinpoint the efficacy of specific music therapy interventions, qualitative research reveals some profound outcomes in certain individuals. A depth of understanding related to the experience of living with a cardiovascular disease can be gained through music therapy approaches such as nonverbal music psychotherapy and guided imagery and music. The multifaceted nature of musical responsiveness contributes to strong individual variability and must be taken into account in the development of research protocols for future music therapy and music medicine interventions. The extant research provides a foundation for exploring the many potential psychosocial, physiological, and spiritual outcomes of a music therapy service for cardiology patients.

  16. Challenges in mental health care in the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Consuelo Helena Aires de Freitas

    2011-06-01

    Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observationand questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to anenduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits andcommunity therapy.

  17. Perception of risk and communication among conventional and complementary health care providers involving cancer patients' use of complementary therapies: a literature review.

    Science.gov (United States)

    Stub, Trine; Quandt, Sara A; Arcury, Thomas A; Sandberg, Joanne C; Kristoffersen, Agnete E; Musial, Frauke; Salamonsen, Anita

    2016-09-08

    Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with

  18. Eudemonic Care: A Future Path for Occupational Therapy?

    Directory of Open Access Journals (Sweden)

    Charlotte l. Royeen

    2017-03-01

    Full Text Available The core tenets of occupational therapy date to ancient Greece. Philosophers and physicians alike promulgated that quality of life, or “eudemonia,” is at the center of both ethical and medical concern and can be attained through healthful engagement in meaningful occupation. In more recent times, there has been a strong call to return to the powerful implementation of the eudemonic moral philosophy in health care practice, especially in occupational therapy. Searches of recent occupational therapy research show that integration of wellness initiatives into rehabilitative treatment sessions can have a profound impact on the physical and emotional healthfulness of people with a wide variety of ailments. Accordingly, we put forth three self-reflection questions and 10 client-centered questions to use in occupational therapy assessment to promote eudemonic care.

  19. The Knowledge Level of Hypertension Patients for Drug Therapy in the Primary Health Care of Malang

    Directory of Open Access Journals (Sweden)

    Hananditia R. Pramestutie

    2016-04-01

    Full Text Available Hypertension is a persistent blood pressure in which systolic pressure ≥140 mmHg and diastolic pressure ≥90 mmHg. The knowledge that should be owned by patients with hypertension is the meaning, causes, symptoms and treatment of hypertension. This knowledge is important to support the success of hypertension therapy. The aim of this research was to determine the knowledge level of hypertension patients about their drug therapy in the primary health care of Malang. This research used observational study methods. The selection of the patients and the primary health care was done using non-random sampling technique (purposive sampling. The subject who meet the inclusion criteria were involved. The result of this study revealed that the patients with hypertension who have a sufficient level of knowledge were 69 respondents (72,63%. Patients who have a good criteria were 26 respondents (27,3763%. There is no patient with low level of knowledge in this research. The conclusion from this study is most patients with hypertension in Primary Health Care Malang have enough knowledge about their treatment.

  20. The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

    Directory of Open Access Journals (Sweden)

    Wye Lesley

    2009-03-01

    Full Text Available Abstract Background The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services. Methods We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations. Results Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources. Conclusion To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.

  1. Massage Therapy and Canadians’ Health Care Needs 2020: Proceedings of a National Research Priority Setting Summit

    Science.gov (United States)

    Dryden, Trish; Sumpton, Bryn; Shipwright, Stacey; Kahn, Janet; Reece, Barbara (Findlay)

    2014-01-01

    Background The health care landscape in Canada is changing rapidly as forces, such as an aging population, increasingly complex health issues and treatments, and economic pressure to reduce health care costs, bear down on the system. A cohesive national research agenda for massage therapy (MT) is needed in order to ensure maximum benefit is derived from research on treatment, health care policy, and cost effectiveness. Setting A one-day invitational summit was held in Toronto, Ontario to build strategic alliances among Canadian and international researchers, policy makers, and other stakeholders to help shape a national research agenda for MT. Method Using a modified Delphi method, the summit organizers conducted two pre-summit surveys to ensure that time spent during the summit was relevant and productive. The summit was facilitated using the principles of Appreciative Inquiry which included a “4D” strategic planning approach (defining, discovery, dreaming, designing) and application of a SOAR framework (strengths, opportunities, aspirations, and results). Participants Twenty-six researchers, policymakers, and other stakeholders actively participated in the events. Results Priority topics that massage therapists believe are important to the Canadian public, other health care providers, and policy makers and massage therapists themselves were identified. A framework for a national massage therapy (MT) research agenda, a grand vision of the future for MT research, and a 12-month action plan were developed. Conclusion The summit provided an excellent opportunity for key stakeholders to come together and use their experience and knowledge of MT to develop a much-needed plan for moving the MT research and professionalization agenda forward. PMID:24592299

  2. Massage therapy and canadians' health care needs 2020: proceedings of a national research priority setting summit.

    Science.gov (United States)

    Dryden, Trish; Sumpton, Bryn; Shipwright, Stacey; Kahn, Janet; Reece, Barbara Findlay

    2014-03-01

    The health care landscape in Canada is changing rapidly as forces, such as an aging population, increasingly complex health issues and treatments, and economic pressure to reduce health care costs, bear down on the system. A cohesive national research agenda for massage therapy (MT) is needed in order to ensure maximum benefit is derived from research on treatment, health care policy, and cost effectiveness. A one-day invitational summit was held in Toronto, Ontario to build strategic alliances among Canadian and international researchers, policy makers, and other stakeholders to help shape a national research agenda for MT. Using a modified Delphi method, the summit organizers conducted two pre-summit surveys to ensure that time spent during the summit was relevant and productive. The summit was facilitated using the principles of Appreciative Inquiry which included a "4D" strategic planning approach (defining, discovery, dreaming, designing) and application of a SOAR framework (strengths, opportunities, aspirations, and results). Twenty-six researchers, policymakers, and other stakeholders actively participated in the events. Priority topics that massage therapists believe are important to the Canadian public, other health care providers, and policy makers and massage therapists themselves were identified. A framework for a national massage therapy (MT) research agenda, a grand vision of the future for MT research, and a 12-month action plan were developed. The summit provided an excellent opportunity for key stakeholders to come together and use their experience and knowledge of MT to develop a much-needed plan for moving the MT research and professionalization agenda forward.

  3. Music Therapy in Palliative Care.

    Science.gov (United States)

    Warth, Marco; Keßler, Jens; Hillecke, Thomas K; Bardenheuer, Hubert J

    2015-11-13

    Music therapy has been used successfully for over 30 years as part of palliative care programs for severely ill patients. There is nonetheless a lack of high-quality studies that would enable an evidence-based evaluation of its psychological and physiological effects. In a randomized controlled trial, 84 hospitalized patients in palliative care were assigned to one of two treatment arms--music therapy and control. The music therapy intervention consisted of two sessions of live music-based relaxation exercises; the patients in the control group listened to a verbal relaxation exercise. The primary endpoints were self-ratings of relaxation, well-being, and acute pain, assessed using visual analog scales. Heart rate variability and health-related quality of life were considered as secondary outcomes. The primary data analysis was performed according to the intention-to-treat principle. Analyses of covariance revealed that music therapy was more effective than the control treatment at promoting relaxation (F = 13.7; p Music therapy did not differ from control treatment with respect to pain reduction (F = 0.4; p = 0.53), but it led to a significantly greater reduction in the fatigue score on the quality-of-life scale (F = 4.74; p = 0.03). Music therapy is an effective treatment with a low dropout rate for the promotion of relaxation and well-being in terminally ill persons undergoing palliative care.

  4. Reiki therapy: a nursing intervention for critical care.

    Science.gov (United States)

    Toms, Robin

    2011-01-01

    Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Most CAM therapies involve slow, calming techniques that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Complementary and alternative medicine-related research reveals that complementary therapies, such as Reiki, relieve pain and anxiety and reduce symptoms of stress such as elevated blood pressure and pulse rates. Patients and health care professionals alike have become increasingly interested in complementary and alternative therapies that do not rely on expensive, invasive technology, and are holistic in focus. Reiki is cost-effective, noninvasive, and can easily be incorporated into patient care. The purpose of this article is to examine the science of Reiki therapy and to explore Reiki as a valuable nursing intervention.

  5. Which Children Are Not Getting Their Needs for Therapy or Mobility Aids Met? Data From the 2009-2010 National Survey of Children With Special Health Care Needs.

    Science.gov (United States)

    McManus, Beth M; Prosser, Laura A; Gannotti, Mary E

    2016-02-01

    Pediatric rehabilitation therapy services and mobility aids have an important role in the health of children with special health care needs, and the Affordable Care Act (ACA) may increase coverage for these needs. Identifying the prevalence of and factors associated with therapy and mobility aid needs and unmet needs prior to the full implementation of the ACA will be useful for future evaluation of its impact. The purpose of this study was to identify the prevalence of and factors associated with caregiver perceived needs and unmet needs for therapy or mobility aids among children with special health care needs living in the United States. A cross-sectional, descriptive, multivariate analysis was conducted. The 2009-2010 National Survey of Children With Special Health Care Needs was used to identify a nationally representative sample of children with special health care needs with needs for therapy (weighted n=2,603,605) or mobility aids (weighted n=437,971). Odds of having unmet needs associated with child and family characteristics were estimated. Nearly 1 in 5 children with therapy needs had unmet needs, and nearly 1 in 10 children with mobility aid needs had unmet needs. Unmet needs were most strongly associated with how frequently the condition affected function and being uninsured in the previous year. Data were caregiver reported and not verified by clinical assessment. Survey data grouped physical therapy, occupational therapy, and speech therapy; analysis was not discipline specific. This evidence serves as a baseline about the future impact of the ACA. Pediatric rehabilitation professionals should be aware that children with special health care needs whose condition more frequently affects function and who have insurance discontinuity may need more support to meet therapy or mobility aid needs. © 2016 American Physical Therapy Association.

  6. The integration of occupational therapy into primary care: a multiple case study design

    Science.gov (United States)

    2013-01-01

    Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group

  7. [Health economics and antibiotic therapy].

    Science.gov (United States)

    Leclercq, P; Bigdéli, M

    1995-01-01

    In the field of antibiotic therapy, particularly the methods of economic evaluation hold one's attention within the wide range of health economics' applications. Several tools allow a comparison of the outcomes of alternative strategies and thereby guide choices to the most appropriate solutions. After a brief recall of the methods classically used to evaluate health care strategy, the authors stress the importance and difficulty of fixing and applying a correct and satisfactory procedure for evaluation. An evaluation example of antibiotic therapy allows to illustrate the application of the principles confronting a field in which competition is intense and economic stakes stay large--a fact which naturally yields to seek after objective decision making criteria. The health care policies drawn by public authorities as well as the marketing strategies of the health sector trade are partly based on such evaluations. If these techniques are not intended for the practitioner in the first place, they should not be indifferent to him since they influence health authorities and thereby indirectly affect the therapeutic freedom of the physician.

  8. Cost-effectiveness of cognitive-behavioural therapy for mental disorders: implications for public health care funding policy in Canada.

    Science.gov (United States)

    Myhr, Gail; Payne, Krista

    2006-09-01

    Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. We searched the literature for economic analyses of CBT in the treatment of mental disorders. We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

  9. Patient compliance with a health care provider referral for an occupational therapy lymphedema consult.

    Science.gov (United States)

    Dominick, Sally A; Natarajan, Loki; Pierce, John P; Madanat, Hala; Madlensky, Lisa

    2014-07-01

    Limited information exists on breast cancer patients' compliance to attend outpatient appointments with an occupational therapy (OT) lymphedema specialist. The objectives of this study were (1) to examine patient compliance with a health care provider referral for an OT lymphedema consult and (2) to identify potential barriers to compliance. A retrospective chart review of female breast cancer patients at the UC San Diego Health System was conducted. Electronic medical records were queried for breast cancer patients, who received a health care provider referral for an OT lymphedema consult between June 1, 2010 and December 31, 2011. Descriptive statistics and Fisher's exact chi-square tests were used to examine how specific participant characteristics were associated with attending an OT appointment. A total of 210 female patients received an OT referral from a health care provider related to their breast cancer diagnosis. Forty-three (20.5%) patients did not attend an OT appointment. Non-attenders were more likely to have had fewer lymph nodes removed (Pcancer patients attended recommended OT lymphedema consults, a substantial number of women might benefit from further education about OT for lymphedema prevention following breast cancer treatment. Further research to understand barriers to attendance is recommended, particularly among women with only sentinel nodes removed.

  10. Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases

    Science.gov (United States)

    Bulaj, Grzegorz; Ahern, Margaret M.; Kuhn, Alexis; Judkins, Zachary S.; Bowen, Randy C.; Chen, Yizhe

    2016-01-01

    Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products

  11. Health Economic Evaluation of Home and Hospital-Based Care in T2D Patients on Insulin Therapy.

    Science.gov (United States)

    Janati, Ali; Sarabchian, Mohamad Ali; Mohaghegh, Bahram; Aghmohamadzadeh, Naser; Seyedin, Hesam; Gholizadeh, Masumeh; Hasanpoor, Edris

    2017-11-01

    Type 2 Diabetes is a main concern of public health in contemporary world with remarkable mortality, delayed complications and health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for hospital services is care at home. Therefore, this study was aimed to evaluate the cost-effectiveness of home-based and hospital-based diabetes care. A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2 diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.

  12. Animal-assisted therapy: evaluation and implementation of a complementary therapy to improve the psychological and physiological health of critically ill patients.

    Science.gov (United States)

    DeCourcey, Mary; Russell, Anne C; Keister, Kathy J

    2010-01-01

    Animal-assisted therapy has gained widespread support in a variety of health care settings, including critical care units. This article seeks to review some of the current animal-assisted therapy, define a structured program, and evaluate the potential ability of the therapy to enhance the progress and health of our patients.

  13. Health care delivery in Malaysia: changes, challenges and champions

    Science.gov (United States)

    Thomas, Susan; Beh, LooSee; Nordin, Rusli Bin

    2011-01-01

    Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may need to manage and mobilize better health care services by providing better health care financing mechanisms. It is recommended that partnership between public and private sectors with the extension of traditional medicine complementing western medicine in medical therapy continues in the delivery of health care. PMID:28299064

  14. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  15. Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service Use.

    Science.gov (United States)

    Caicedo, Carmen

    This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  16. Production cost structure in US outpatient physical therapy health care.

    Science.gov (United States)

    Lubiani, Gregory G; Okunade, Albert A

    2013-02-01

    This paper investigates the technology cost structure in US physical therapy care. We exploit formal economic theories and a rich national data of providers to tease out implications for operational cost efficiencies. The 2008-2009 dataset comprising over 19 000 bi-weekly, site-specific physical therapy center observations across 28 US states and Occupational Employment Statistics data (Bureau of Labor Statistics) includes measures of output, three labor types (clinical, support, and administrative), and facilities (capital). We discuss findings from the iterative seemingly unrelated regression estimation system model. The generalized translog cost estimates indicate a well-behaved underlying technology structure. We also find the following: (i) factor demands are downwardly sloped; (ii) pair-wise factor relationships largely reflect substitutions; (iii) factor demand for physical therapists is more inelastic compared with that for administrative staff; and (iv) diminishing scale economies exist at the 25%, 50%, and 75% output (patient visits) levels. Our findings advance the timely economic understanding of operations in an increasingly important segment of the medical care sector that has, up-to-now (because of data paucity), been missing from healthcare efficiency analysis. Our work further provides baseline estimates for comparing operational efficiencies in physical therapy care after implementations of the 2010 US healthcare reforms. Copyright © 2012 John Wiley & Sons, Ltd.

  17. Web-based Therapy Plus Support by a Coach in Depressed Patients Referred to Secondary Mental Health Care: Randomized Controlled Trial.

    Science.gov (United States)

    Hatcher, Simon; Whittaker, Robyn; Patton, Murray; Miles, Wayne Sylvester; Ralph, Nicola; Kercher, Katharina; Sharon, Cynthia

    2018-01-23

    The evidence for the effectiveness of Web-based therapies comes mainly from nonclinical populations, with a few studies in primary care. There is little evidence from patients referred to secondary mental health care with depression. Adherence to Web-based therapies is often poor. One way to increase this is to create a new health service role of a coach to guide people through the therapy. This study aimed to test in people referred to secondary care with depression if a Web-based therapy (The Journal) supported by a coach plus usual care would be more effective in reducing depression compared with usual care plus an information leaflet about Web-based resources after 12 weeks. We conducted a randomized controlled trial with two parallel arms and a process evaluation that included structured qualitative interviews analyzed using thematic analysis. The coach had a background in occupational therapy. Participants were recruited face-to-face at community mental health centers. We recruited 63 people into the trial (intervention 35, control 28). There were no statistically significant differences in the change from baseline in Patient Health Questionnaire-9 (PHQ-9) scores at 12 weeks comparing The Journal with usual care (mean change in PHQ-9 score 9.4 in the intervention group and 7.1 in the control group, t 41 =1.05, P=.30; mean difference=2.3, 95% CI -2.1 to 6.7). People who were offered The Journal attended on average about one less outpatient appointment compared with usual care, although this difference was not statistically significant (intervention mean number of visits 2.8 (SD 5.5) compared with 4.1 (SD 6.7) in the control group, t 45 =-0.80, P=.43; mean difference=1.3, 95% CI -4.5 to 2.0). The process evaluation found that the mean number of lessons completed in the intervention group was 2.5 (SD=1.9; range=0-6) and the number of contacts with the coach was a mean of 8.1 (SD=4.4; range=0-17). The qualitative interviews highlighted the problem of engaging

  18. Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

    Science.gov (United States)

    Davitt, Joan K.

    2014-01-01

    Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

  19. Economic analyses in health care: an introduction to the methodology with an emphasis on radiation therapy

    International Nuclear Information System (INIS)

    Hayman, James; Weeks, Jane; Mauch, Peter

    1996-01-01

    Payers are increasingly interested in knowing whether they are receiving value for the dollars they spend on health care. Because economic analyses will be used as a means of evaluating radiation therapy, it is important that radiation oncologists understand the basic methodology employed in such analyses. This review article describes the four basic types of economic analyses: cost minimization, cost effectiveness, cost utility, and cost benefit. Specification of alternative therapies, choice of perspective of the analysis, measurements of costs and benefits, and the role of discounting and sensitivity analyses are discussed. Published economic analyses that pertain directly to treatment with radiation therapy are reviewed. Finally, we close with a brief discussion of the potential areas for future economic outcomes research in radiation oncology

  20. Decision Makers' Allocation of Home-Care Therapy Services: A Process Map

    Science.gov (United States)

    Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine

    2013-01-01

    ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

  1. Challenges in mental health care in the Family Health Strategy - doi:10.5020/18061230.2011.p102

    Directory of Open Access Journals (Sweden)

    Cinthia Mendonça Cavalcante

    2012-01-01

    Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observation and questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to an enduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits and community therapy

  2. Can naturopathy provide answers to the escalating health care costs in India?

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2015-04-01

    Full Text Available There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.

  3. Health care factors associated with survival among women with breast cancer on hormone therapy in Rio de Janeiro, Brazil, 2004 – 2010

    Directory of Open Access Journals (Sweden)

    Cláudia de Brito

    Full Text Available ABSTRACT Objectives To better understand the role that health care plays in breast cancer survival by investigating the effects that hormone therapy adherence and other select health care variables, adjusted for clinical and sociodemographic factors, had among a population of women in Rio de Janeiro, Brazil. Methods This was a longitudinal study based on secondary data of 5 861 women treated with hormone therapy (tamoxifen or aromatase inhibitors at the National Cancer Institute of Brazil (INCA, from 1 January 2004 – 29 October 2010. Four different sources of data were integrated for analysis: INCA Pharmacy Sector Dispensation System; Hospital-based Cancer Registry; Integrated Hospital System and INCA Absolute System; and Mortality Information System. Analyses explored the effects of adherence to hormone therapy, disease care aspects, and sociodemographic, behavioral, and clinical variables, on the time of survival, using Kaplan-Meier and Cox proportional hazards models. Results The general survival rate was 94% in the first year after initiation of hormone therapy, and 71% in the fifth year. The Cox model indicated a higher hazard of death among women smokers, with more hospitalizations, more exams, and, among those who used, who used only aromatase inhibitors, as hormone therapy modality. The hazard was lower among women with a partner (stable relationship, a high school or college education a family history of cancer, and those who were treated by a mastologist, oncologist, and/or psychotherapist, who underwent surgery, and who adhered to hormone therapy. Conclusions The study indicated more vulnerable sub-groups and the aspects of care that provide best results, bringing new knowledge to improve assistance to this group of women.

  4. Rural Indonesian health care workers' constructs of infection prevention and control knowledge.

    Science.gov (United States)

    Marjadi, Brahmaputra; McLaws, Mary-Louise

    2010-06-01

    Understanding the constructs of knowledge behind clinical practices in low-resource rural health care settings with limited laboratory facilities and surveillance programs may help in designing resource-appropriate infection prevention and control education. Multiple qualitative methods of direct observations, individual and group focus discussions, and document analysis were used to examine health care workers' knowledge of infection prevention and control practices in intravenous therapy, antibiotic therapy, instrument reprocessing, and hand hygiene in 10 rural Indonesian health care facilities. Awareness of health care-associated infections was low. Protocols were in the main based on verbal instructions handed down through the ranks of health care workers. The evidence-based knowledge gained across professional training was overridden by empiricism, nonscientific modifications, and organizational and societal cultures when resources were restricted or patients demanded inappropriate therapies. This phenomenon remained undetected by accreditation systems and clinical educators. Rural Indonesian health care workers would benefit from a formal introduction to evidence-based practice that would deconstruct individual protocols that include nonscientific knowledge. To achieve levels of acceptable patient safety, protocols would have to be both evidence-based and resource-appropriate. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  5. Health care practices in ancient Greece: The Hippocratic ideal

    Science.gov (United States)

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

    2014-01-01

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

  6. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

    Science.gov (United States)

    Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

    2014-10-01

    Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

  7. Occupational therapy practice in emergency care: Occupational therapists' perspectives.

    Science.gov (United States)

    Spang, Lisa; Holmqvist, Kajsa

    2015-01-01

    Emergency care takes place in a complex work environment that is characterized by critically ill patients, short hospital stays, and a wide variety of different healthcare professionals. Studies of occupational therapists' (OTs) experiences of working within emergency care have shown that they often experience difficulties in explaining the essence of occupational therapy and have to justify their approaches. Much effort has been made in Sweden to help OTs dispel the notion that occupational therapy is difficult to explain, and the aim of this study was to describe how Swedish OTs perceive their work in emergency care. A qualitative descriptive approach was taken, and 14 interviews were conducted with OTs working in emergency care. Qualitative content analysis was used to analyse the data. The overall theme that emerged was "Feeling established through deliberate occupation-based work". The underlying categories showed different strategies used by the OTs to provide occupational therapy in an emergency care context. Deliberate strategies were used to demonstrate the effectiveness of occupational therapy and its approaches to patients and other health care professionals, and this resulted in the OTs feeling both established and needed. Unlike the OTs in previous studies, the Swedish OTs experienced no difficulties in explaining occupational therapy and could make convincing arguments for their interventions. Parallel to their clinical work, the OTs worked with on-going development to find ways to improve their approaches. In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency care setting.

  8. Supporting our military families: a case for a larger role for occupational therapy in prevention and mental health care.

    Science.gov (United States)

    Cogan, Alison M

    2014-01-01

    More than 2 million U.S. military servicemembers have deployed to Afghanistan or Iraq since September 11, 2001. Unlike during prior conflicts, many servicemembers leave spouses and children behind. Long, multiple deployments cause strain on family at home, with new challenges arising when servicemembers return from combat and reintegrate into family and civilian life. In World Wars I and II, occupational therapy practitioners played a significant role in supporting servicemember reintegration. However, their presence in program delivery in this practice area is limited. Occupational therapy researchers and practitioners can make a valuable contribution by helping families tailor daily activities and routines to address challenges and optimize health and wellness. However, barriers such as reimbursement for services, workforce availability, and access to military families have limited the profession's full engagement. Advocacy is needed to help establish occupational therapy as a key component of the mental and preventive health care teams serving military servicemembers. Copyright © 2014 by the American Occupational Therapy Association, Inc.

  9. Investigation into health science students' awareness of occupational therapy: implications for interprofessional education.

    Science.gov (United States)

    Alotaibi, Naser; Shayea, Abdulaziz; Nadar, Mohammed; Abu Tariah, Hashem

    2015-01-01

    To investigate the level of awareness of the occupational therapy profession among final-year health sciences students at Kuwait University. This study utilized a survey targeting final-year students in the Health Sciences Center at Kuwait University schools of medicine, pharmacy, dentistry, and allied health sciences. The survey addressed awareness of occupational therapy, its scope of practice, work environments, and preference for learning more about the profession. Of the 244 surveys distributed, 132 were returned, for a 54% response rate. The proportion of those who knew about occupational therapy ranged from 94% (radiologic science) to a low of 17% (medicine). Most respondents learned about occupational therapy from colleagues (77.1%), rather than from their academic programs (28.1%). RESULTS indicated that about one fifth of students (21.4%) were unsure about the role of occupational therapists as members of the health care team. Preferences for learning more about the profession were consistent with interprofessional opportunities, such as observing an occupational therapy session (64.5%) and attending a workshop (63.6%) or presentation (59.8%). Although most respondents had some awareness of occupational therapy, specifics about its scope of practice and relevance to the health care team were lacking. Preferences for learning more about occupational therapy were consistent with the current trend for interprofessional education in health care. Implications for interprofessional education are presented.

  10. Health Professionals Special Pays Study: Report to Congress on Armed Forces Health Professionals Special Pays -- Other Health Care Providers

    National Research Council Canada - National Science Library

    Murphy, James F; Ogloblin, Peter; Mirick, Steven C; Buxton, Richard; Sevier, David M; McKelvy, Marcia; Rubino, Frank

    1988-01-01

    ... within the military health care system: dentistry, veterinary medicine, optometry, pharmacy, clinical psychology, physical therapy, occupational therapy, audiology, speech pathology, podiatry, social work, dietetics, and physician assistant...

  11. Comparison of health care resource utilization and costs among patients with GERD on once-daily or twice-daily proton pump inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Mody R

    2013-04-01

    Full Text Available Reema Mody,1 Debra Eisenberg,2 Likun Hou,2 Siddhesh Kamat,2 Joseph Singer,2 Lauren B Gerson3 1Takeda Pharmaceuticals International Inc, Deerfield, IL, 2HealthCore Inc, Wilmington, DE, 3Stanford University School of Medicine, Stanford, CA, USA Background: The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI therapy. Most patients with gastroesophageal reflux disease (GERD achieve symptom control on once-daily PPI therapy, but approximately 20%–30% require twice-daily dosing. Methods: Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRDSM during 2004–2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim. Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply, patients were classified as once-daily (dose ≤ 1.5 pills per day or twice-daily (≥1.5 PPI users. Results: The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05. More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001 than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%, outpatient visit (60% versus 49%, and office visit (48% versus 38% versus once-daily patients (P < 0.0001. Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001. Conclusion: Patients receiving twice-daily PPI therapy were likely to have more

  12. Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Patrice K. Nicholas

    2014-01-01

    Full Text Available Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013. Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013. This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n=775 that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.

  13. Systematic Information to Health-Care Professionals about Vaccination Guidelines Improves Adherence in Patients With Inflammatory Bowel Disease in Anti-TNFα Therapy

    DEFF Research Database (Denmark)

    Christensen, Katrine R; Steenholdt, Casper; Buhl, Sine S

    2015-01-01

    OBJECTIVES: Implementation of guidelines for prevention of infectious diseases during anti-TNFα therapy in patients with inflammatory bowel disease (IBD) is important but difficult. We investigated whether systematic information to health-care professionals about these guidelines improves patient...

  14. Initiation of antiretroviral therapy at rural primary health care clinics in KwaZulu Natal

    Directory of Open Access Journals (Sweden)

    Hilda Ganesen-Moothusamy

    2013-05-01

    Full Text Available South Africa bears the greatest burden of HIV infection globally with the most infected people living in KwaZulu-Natal (KZN. Decentralised medical care for HIV positive patients and antiretroviral therapy (ART delivery to primary health care facilities were proposed nationally to achieve adequate ART coverage for patients in need of treatment. This study described the HIV positive patients who accessed medical care and were initiated on ART at two existing government Primary Health Care (PHC clinics with no added donor support, in Ilembe, KZN. This was an observational descriptive study of ART initiation from 01 April 2008 to 30 April 2009. Data were collected from clinical records kept on site. HIV Testing and the pre-ART programmes which consisted of medical care prior to ART initiation are briefly described. Socio-economic, demographic and clinical characteristics of patients who were initiated on ART were sampled and described. A minority (2.95% of the study population tested for HIV of which 36.0%tested positive. Majority (60.0% of patients who joined the pre-ART programme care did not return. The ART sample consisted of 375 patients of whom 65.0%were women, 85.9%were unmarried, 61.6%were unemployed and 50.4%had a secondary level of education. Tuberculosis (TB prevalence and incidence at ART initiation were 22.1%and 14.7%respectively. The prevalence of Syphilis and Hepatitis B co-infections were 13.1%and 8.6 %respectively. Two thirds of female patients (66.4% received a Pap smear result of which the majority (62.3% were abnormal. Uptake for HIV testing followed by relevant CD4 testing was poor. High TB, Hepatitis B and Syphilis co-infection was noted amongst patients initiated on ART. Cervical cancer screening must be intensified. Although ART initiation with no added external resources was successful, record keeping was suboptimal.

  15. Impact of educational outreach intervention on enhancing health care providers' knowledge about statin therapy prescribing in Malaysian patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Elnaem, Mohamed Hassan; Nik Mohamed, Mohamad Haniki; Zaman Huri, Hasniza; Azarisman, Shah M

    2018-03-06

    Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process. This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge. This was a cross-sectional study based on educational outreach intervention targeting physicians and pharmacists in 1 major tertiary hospital in the state of Pahang, Malaysia. Participants responded to a 12-item, validated questionnaire both prior to and after the outreach educational program. Two sessions were conducted separately for 2 cohorts of pharmacists and physicians. The knowledge scores prior to and after the educational intervention were calculated and compared using a paired-samples t-test. The response rate to both pre-and post-educational outreach questionnaires was 91% (40/44). Prior to the intervention, around 84% (n37) of the participants decided to initiate statin therapy for both pre-assessment clinical case scenarios; however, only 27% (n12) could state the clinical benefits of statin therapy. Forty-five percent (n20) could state the drug to drug interactions, and 52.3% (n23) could identify the statin therapy that can be given at any time day/evening. The educational outreach program increased participants' knowledge scores of 1.450 (95% CI, 0.918 to 1.982) point, P health care providers' knowledge and beliefs about statin therapy. This type of intervention is considered effective for short-term knowledge enhancement. Further research is needed to test the long-term efficacy of such intervention. © 2018 John Wiley & Sons, Ltd.

  16. Health care providers' comfort with and barriers to care of transgender youth.

    Science.gov (United States)

    Vance, Stanley R; Halpern-Felsher, Bonnie L; Rosenthal, Stephen M

    2015-02-01

    To explore providers' clinical experiences, comfort, and confidence with and barriers to providing care to transgender youth. An online survey was administered to members of the Society for Adolescent Health and Medicine and the Pediatric Endocrine Society with items querying about clinical exposure to transgender youth, familiarity with and adherence to existing clinical practice guidelines, perceived barriers to providing transgender-related care, and comfort and confidence with providing transgender-related care. The response rate was 21.9% (n = 475). Of the respondents, 66.5% had provided care to transgender youth, 62.4% felt comfortable with providing transgender medical therapy, and 47.1% felt confident in doing so. Principal barriers to provision of transgender-related care were lack of the following: training, exposure to transgender patients, available qualified mental health providers, and insurance reimbursement. This study suggests that more training in transgender-related care, available qualified mental health providers, and insurance reimbursement for transgender-related care are needed. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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

    NARCIS (Netherlands)

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

    1996-01-01

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

  18. The home care teaching and learning process in undergraduate health care degree courses.

    Science.gov (United States)

    Hermann, Ana Paula; Lacerda, Maria Ribeiro; Maftum, Mariluci Alves; Bernardino, Elizabeth; Mello, Ana Lúcia Schaefer Ferreira de

    2017-07-01

    Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

  19. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Keenum Michael

    2006-08-01

    Full Text Available Abstract Background Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program or a form of chiropractic care (Flexion Distraction for chronic low back pain. Methods In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD or a form of physical therapy (EP. Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain. Results Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p Conclusion During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care.

  20. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    Science.gov (United States)

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  1. The rise and fall of dental therapy in Canada: a policy analysis and assessment of equity of access to oral health care for Inuit and First Nations communities.

    Science.gov (United States)

    Leck, Victoria; Randall, Glen E

    2017-07-20

    Inequality between most Canadians and those from Inuit and First Nations communities, in terms of both access to oral health care services and related health outcomes, has been a long-standing problem. Efforts to close this equity gap led to the creation of dental therapy training programs. These programs were designed to produce graduates who would provide services in rural and northern communities. The closure of the last dental therapy program in late 2011 has ended the supply of dental therapists and governments do not appear to have any alternative solutions to the growing gap in access to oral health care services between most Canadians and those from Inuit and First Nations communities. A policy analysis of the rise and fall of the dental therapy profession in Canada was conducted using historical and policy documents. The analysis is framed within Kingdon's agenda-setting framework and considers why dental therapy was originally pursued as an option to ensure equitable access to oral health care for Inuit and First Nations communities and why this policy has now been abandoned with the closure of Canada's last dental therapy training school. The closure of the last dental therapy program in Canada has the potential to further reduce access to dental care in some Inuit and First Nations communities. Overlaps between federal and provincial jurisdiction have contributed to the absence of a coordinated policy approach to address the equity gap in access to dental care which will exacerbate the inequalities in comparison to the general population. The analysis suggests that while a technically feasible policy solution is available there continues to be no politically acceptable solution and thus it remains unlikely that a window of opportunity for policy change will open any time soon. In the absence of federal government leadership, the most viable option forward may be incremental policy change. Provincial governments could expand the scope of practice for

  2. Activity monitoring systems in health care

    NARCIS (Netherlands)

    Kröse, B.; van Oosterhout, T.; van Kasteren, T.; Salah, A.A.; Gevers, T.

    2011-01-01

    This chapter focuses on activity monitoring in a home setting for health care purposes. First the most current sensing systems are described, which consist of wearable and ambient sensors. Then several approaches for the monitoring of simple actions are discussed, like falls or therapies. After

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

    Science.gov (United States)

    Soucy, Joelle N; Hadjistavropoulos, Heather D

    2017-12-01

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

  4. Seeking optimal renal replacement therapy delivery in intensive care units.

    Science.gov (United States)

    Kocjan, Marinka; Brunet, Fabrice P

    2010-01-01

    Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.

  5. Music therapy for palliative care: A realist review.

    Science.gov (United States)

    McConnell, Tracey; Porter, Sam

    2017-08-01

    Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation. We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works. A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation. Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.

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

    Science.gov (United States)

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

    2016-02-01

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

  7. Medication therapy disease management: Geisinger's approach to population health management.

    Science.gov (United States)

    Jones, Laney K; Greskovic, Gerard; Grassi, Dante M; Graham, Jove; Sun, Haiyan; Gionfriddo, Michael R; Murray, Michael F; Manickam, Kandamurugu; Nathanson, Douglas C; Wright, Eric A; Evans, Michael A

    2017-09-15

    Pharmacists' involvement in a population health initiative focused on chronic disease management is described. Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Referral to massage therapy in primary health care: a survey of medical general practitioners in rural and regional New South Wales, Australia.

    Science.gov (United States)

    Wardle, Jon L; Sibbritt, David W; Adams, Jon

    2013-01-01

    Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this study was to survey medical general practitioners (GPs) in rural and regional New South Wales, Australia, to identify their knowledge, attitudes, relationships, and patterns of referral to massage therapy in primary health care. A 27-item questionnaire was sent to all 1486 GPs currently practicing in rural and regional Divisions of General Practice in New South Wales, Australia. The survey had 5 general areas: the GP's personal use and knowledge of massage, the GP's professional relationships with massage practice and massage practitioners, the GP's specific opinions on massage, the GP's information-seeking behavior in relation to massage, and the GP's assumptions on massage use by patients in their local areas. A total of 585 questionnaires were returned completed, with 49 survey questionnaires returned as "no longer at this address" (response rate of 40.7%). More than three-quarters of GPs (76.6%) referred to massage therapy at least a few times per year, with 12.5% of GPs referring at least once per week. The GP being in a nonremote location (odds ratio [OR], 14.28; 95% confidence interval [CI], 3.7-50.0), graduating from an Australian medical school (OR, 2.03; 95% CI, 1.09-3.70), perceiving a lack of other treatment options (OR, 2.64; 95% CI, 1.15-6.01), perceiving good patient access to a wide variety of medical specialists (OR, 11.1; 95% CI, 1.7-50.0), believing in the efficacy of massage therapy (OR, 2.75; 95% CI, 1.58-4.78), experiencing positive results from patients using massage therapy previously (OR, 13.95; 95% CI, 5.96-32.64), or having prescribed any CAM previously (OR, 1.83; 95% CI, 1.03-3.27) were all independently predictive of increased referral to massage therapy among the GPs in this study. There appears to

  9. Seminar: Music Therapy in Dementia Care

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2009-01-01

    This seminar presents music therapy in person centered dementia care. In the first part focus is on research and documentation. How can short term music therapy document changes in symptoms of depression? Is Dementia Care Mapping a valid assessment tool for documenting group music therapy......? In the next part focus is on clinical music therapy – in group work as well as in individual work – and how the music therapist works in the interdisciplinary field....

  10. Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

    Directory of Open Access Journals (Sweden)

    Podlekareva Daria N

    2012-09-01

    Full Text Available Abstract Background State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators. Methods Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1 combination antiretroviral therapy (cART; 2 chemoprophylaxis; 3 frequency of laboratory monitoring; and 4 virological response to cART (proportion of patients with HIV-RNA 90% of time on cART. Results 7097 EuroSIDA patients were included from Northern (n = 923, Southern (n = 1059, West Central (n = 1290 East Central (n = 1366, Eastern (n = 1964 Europe, and Argentina (n = 495. Patients in Eastern Europe with a CD4 3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p Conclusions This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.

  11. Using the New Postacute Care Quality Measures to Demonstrate the Value of Occupational Therapy.

    Science.gov (United States)

    Sandhu, Sharmila; Furniss, Jeremy; Metzler, Christina

    As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy's distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection. Copyright © 2018 by the American Occupational Therapy Association, Inc.

  12. Prevention of health care-associated infections.

    Science.gov (United States)

    Hsu, Vincent

    2014-09-15

    Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin.

  13. The culture of massage therapy: valued elements and the role of comfort, contact, connection and caring.

    Science.gov (United States)

    Smith, Joanna M; Sullivan, S John; Baxter, G David

    2009-08-01

    To explore the attributes of the therapy encounter valued by repeat users of health-related massage therapy. A qualitative design with telephone focus group methodology was used. A total of 19 repeat users of massage therapy participated in three telephone focus groups where audiotaped semi-structured interviews were conducted. Telephone focus group with massage clients from a range of provincial and urban regions in New Zealand. Summary of reported themes of the massage experience. Data were thematically analysed using the general inductive approach. Six valued elements of the massage encounter (time for care and personal attention, engaging and competent therapist, trust partnership, holism and empowerment, effective touch and enhancing relaxation), four modulators (comfort, contact, connection and caring) and two themes relating to adding experiential value (enjoyment, escapism) characterize the massage therapy culture. The culture of massage therapy care incorporates a number of characteristics that are congruent with the complementary and alternative medicine approach to health. In addition, massage specific factors were identified. The humanistic aspects of the therapy encounter valued by clients offer insight into the growing use of massage therapy and the success of massage therapy outcomes.

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

    Science.gov (United States)

    Lake, James; Turner, Mason Spain

    2017-01-01

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

  15. Impact of media health campaign for primary health care among mothers in karachi

    International Nuclear Information System (INIS)

    Habibullah, S.

    2008-01-01

    To evaluate the knowledge, attitude and practice of media-based primary health care (i.e. Expanded Programme of Immunization, National Polio Day, oral rehydration therapy, breast feeding, contraceptive practices, modes of spread of hepatitis B, C, and HIV) among mothers with children under five years of age in an urban and a rural area of Karachi and changes in the same after community-based health education The study was conducted in two phases. In the first phase 600 mothers with children under five years of age were selected at random (300 urban and 300 rural) for the evaluation of knowledge, attitude and practice of media-based primary health care i.e. Expanded Programme of Immunization, National Polio Day, oral rehydration therapy, breast feeding, contraceptive practices and modes of spread of Hepatitis B, C and HIV. In the second phase, health education on the same components of primary health care was given by lady health workers of the area to the same community for one month. Data of 200 mothers (100 urban and 100 rural) was re-evaluated after three months, to find out if there was any change, in the same. All the three areas were given scores and grade. In this study, 58% were Sindhi speaking. The mean age of mothers was 29 years. Majority (91% urban and 45% rural mothers) had access to one or more media channels. The knowledge of media-based primary health care was poor (score=10.09) among all mothers but attitude (score=8.07) and practice (score=11.09) was good for the same in more than 70% mothers in both communities. In the second phase of the study, it was found that the knowledge of primary health care had not improved but attitude and practice was good as observed earlier in both communities. Despite the national media based health education of Primary Health Care for decades, knowledge of primary health care was poor among mothers (urban and rural) but attitude and practice was good. Age and exposure to one or more media channels was found

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

    Science.gov (United States)

    2011-12-01

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

  17. Implementing cognitive therapies into routine psychosis care: organisational foundations.

    Science.gov (United States)

    Dark, Frances; Whiteford, Harvey; Ashkanasy, Neal M; Harvey, Carol; Crompton, David; Newman, Ellie

    2015-08-05

    Treatment outcomes for people diagnosed with psychosis remain suboptimal due in part to the limited systematic application of evidence based practice (Adm Policy Ment Health, 36: 1-7, 2009) [1]. The Implementation science literature identifies a number of factors organisationally that need to be considered when planning to introduce a particular EBP. Profiling these organisational characteristics at baseline, prior to commencement of service reform can determine the focus of a subsequent implementation plan. This study examined the organisational baseline factors existing in two services promoting the routine use of cognitive interventions for psychosis. One of the services studied has since undertaken organisational structural reform to facilitate the greater uptake of Evidence Based Practice (EBP). The results of this study were used to design an implementation strategy to make cognitive therapies a part of routine psychosis care. One hundred-and-six mental health staff from two metropolitan mental health services in Australia was surveyed to ascertain their attitudes, competencies and interest in Cognitive Behavioural Therapy for psychosis (CBTp) and Cognitive Remediation Therapy (CRT). In addition perceptions of organisational values were profiled using the Organisational Culture Profile (OCP). Fifty five participants were excluded because they completed less than 50% of the survey. The final sample consisted of 51 participants. 48.1% of surveys were completed. Over 50% of staff were interested in CBTp and CRT approaches to psychosis. Staff were aware of existing CBTp and CRT programs but these were not uniformly available throughout the services. Fourteen percent of staff identified as CBT therapist and 35% were trained CRT facilitators. Only 12% of staff were receiving therapy specific supervision. The Organisational Culture Profile (OCP) at baseline revealed highest scores amongst leadership, planning, and humanistic workplace domains, with communication

  18. Expanding the Application of Group Interventions: Emergence of Groups in Health Care Settings

    Science.gov (United States)

    Drum, David; Becker, Martin Swanbrow; Hess, Elaine

    2011-01-01

    Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group…

  19. A model curriculum of health care informatics for Dutch higher professional education.

    Science.gov (United States)

    Aarts, J.

    1995-01-01

    This paper describes the results of a two year project to design a model curriculum of health care informatics for Dutch higher professional education. The core of the curriculum are sixteen modules which cover the broad range of medical informatics and which are closely related to the profiles of the professions involved (nursing, physiotherapy, speech therapy, occupational therapy and dietetics). The curriculum emphasizes the need of using structured data and information to perform tasks in health care delivery and management, for which modern information technology is indispensable. The model curriculum will enable faculty to redesign existing undergraduate programs and to select the contents they see appropriate. In this way we hope that the model curriculum will contribute to an innovative attitude of future graduating health care professionals. A new three year project just has started to develop learning materials using professional health care software based on the sixteen modules of the curriculum. PMID:8563329

  20. Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review.

    Science.gov (United States)

    Sangaleti, Carine; Schveitzer, Mariana Cabral; Peduzzi, Marina; Zoboli, Elma Lourdes Campos Pavone; Soares, Cassia Baldini

    2017-11-01

    During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork. The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included. The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded. The qualitative component of the review considered studies that

  1. A critical realist evaluation of a music therapy intervention in palliative care.

    Science.gov (United States)

    Porter, Sam; McConnell, Tracey; Clarke, Mike; Kirkwood, Jenny; Hughes, Naomi; Graham-Wisener, Lisa; Regan, Joan; McKeown, Miriam; McGrillen, Kerry; Reid, Joanne

    2017-12-08

    Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK). Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy's impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention. Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients' responses helped identify specific benefits for different types of patients. There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective.

  2. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design

    Directory of Open Access Journals (Sweden)

    Cully Jeffrey A

    2012-07-01

    Full Text Available Abstract Background Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. Methods This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1 to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases primary care patients and (2 to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200 or usual care (n = 120. Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points and

  3. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

    Science.gov (United States)

    Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

    2012-07-11

    Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews

  4. The role of culture in primary health care

    African Journals Online (AJOL)

    1994-12-12

    Dec 12, 1994 ... thrombolytic therapy may be beneficial although the risks of haemorrhage from areas of infarct may be substantial. The haemodynamic .... variety of ideas about health and physical care, and they also have a multitude of diet ...

  5. Disparities in Private Health Insurance Coverage of Skilled Care

    Directory of Open Access Journals (Sweden)

    Stacey A. Tovino

    2017-10-01

    Full Text Available This article compares and contrasts public and private health insurance coverage of skilled medical rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, speech-language pathology, and skilled nursing services (collectively, skilled care. As background, prior scholars writing in this area have focused on Medicare coverage of skilled care and have challenged coverage determinations limiting Medicare coverage to beneficiaries who are able to demonstrate improvement in their conditions within a specific period of time (the Improvement Standard. By and large, these scholars have applauded the settlement agreement approved on 24 January 2013, by the U.S. District Court for the District of Vermont in Jimmo v. Sebelius (Jimmo, as well as related motions, rulings, orders, government fact sheets, and Medicare program manual statements clarifying that Medicare covers skilled care that is necessary to prevent or slow a beneficiary’s deterioration or to maintain a beneficiary at his or her maximum practicable level of function even though no further improvement in the beneficiary’s condition is expected. Scholars who have focused on beneficiaries who have suffered severe brain injuries, in particular, have framed public insurance coverage of skilled brain rehabilitation as an important civil, disability, and educational right. Given that approximately two-thirds of Americans with health insurance are covered by private health insurance and that many private health plans continue to require their insureds to demonstrate improvement within a short period of time to obtain coverage of skilled care, scholarship assessing private health insurance coverage of skilled care is important but noticeably absent from the literature. This article responds to this gap by highlighting state benchmark plans’ and other private health plans’ continued use of the Improvement Standard in skilled care coverage decisions and

  6. Antidepressant Medication Management among Older Patients Receiving Home Health Care

    Science.gov (United States)

    Bao, Yuhua; Shao, Huibo; Bruce, Martha L.; Press, Matthew J.

    2014-01-01

    Objective Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. Methods Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients 65 or older who received HHC in 2006–7 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (vs. discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. Results About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10–20 percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. Conclusions Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions. PMID:25158915

  7. When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

    Science.gov (United States)

    Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

    2013-01-01

    Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

  8. Music therapy in palliative care: current perspectives.

    Science.gov (United States)

    O'Kelly, Julian

    2002-03-01

    As the music therapy profession has developed internationally over the last 25 years, so has its role in palliative care. Music is a highly versatile and dynamic therapeutic modality, lending itself to a variety of music therapy techniques used to benefit both those living with life-threatening illnesses and their family members and caregivers. This article will give a broad overview of the historical roots of music therapy and introduce the techniques that are employed in current practice. By combining a review of mainstream music therapy practice involving musical improvisation, song-writing and receptive/recreational techniques with case material from my own experience, this article aims to highlight the potential music therapy holds as an effective holistic practice for palliative care, whatever the care setting.

  9. [Physical therapy in pediatric primary care: a review of experiences].

    Science.gov (United States)

    de Sá, Miriam Ribeiro Calheiros; Thomazinho, Paula de Almeida; Santos, Fabiano Luiz; Cavalcanti, Nicolette Celani; Ribeiro, Carla Trevisan Martins; Negreiros, Maria Fernanda Vieira; Vinhaes, Marcia Regina

    2014-11-01

    To review pediatric physical therapy experiences described in the literature and to analyze the production of knowledge on physical therapy in the context of pediatric primary health care (PPHC). A systematic review was conducted according to the PRISMA criteria. The following databases were searched: MEDLINE, LILACS, SciELO, PubMed, Scopus and Cochrane; Brazilian Ministry of Health's CAPES doctoral dissertations database; and System for Information on Grey Literature in Europe (SIGLE). The following search terms were used: ["primary health care" and ("physical therapy" or "physiotherapy") and ("child" or "infant")] and equivalent terms in Portuguese and Spanish, with no restriction on publication year. Thirteen articles from six countries were analyzed and grouped into three main themes: professional dilemmas (three articles), specific competencies and skills required in a PPHC setting (seven articles), and practice reports (four articles). Professional dilemmas involved expanding the role of physical therapists to encompass community environments and sharing the decision-making process with the family, as well as collaborative work with other health services to identify the needs of children. The competencies and skills mentioned in the literature related to the identification of clinical and sociocultural symptoms that go beyond musculoskeletal conditions, the establishment of early physical therapy diagnoses, prevention of overmedication, and the ability to work as team players. Practice reports addressed stimulation in children with neurological diseases, respiratory treatment, and establishing groups with mothers of children with these conditions. The small number of studies identified in this review suggests that there is little knowledge regarding the roles of physical therapists in PPHC and possibly regarding the professional abilities required in this setting. Therefore, further studies are required to provide data on the field, along with a continuing

  10. CAM therapies among primary care patients using opioid therapy for chronic pain

    OpenAIRE

    Fleming, Sara; Rabago, David P; Mundt, Marlon P; Fleming, Michael F

    2007-01-01

    Abstract Background Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. Method A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to as...

  11. Antiretroviral therapy for adults infected with HIV: Guidelines for health care professionals from the Quebec HIV care committee.

    Science.gov (United States)

    Rouleau, Danielle; Fortin, Claude; Trottier, Benoît; Lalonde, Richard; Lapointe, Normand; Côté, Pierre; Routy, Jean-Pierre; Matte, Marie-France; Tsarevsky, Irina; Baril, Jean-Guy

    2011-01-01

    The appropriate use of antiretrovirals reduces morbidity and mortality caused by HIV infection. The present article provides health care professionals with a practical guide for the use of antiretrovirals. Therapy should be initiated based predominantly on clinical presentation and CD4 count, and should consist of three active drugs or at least two active drugs when this is not possible, as in cases of some treatment-experienced patients. This is the most effective way to achieve long-term suppression of viral replication. Selection of individual drugs in the regimen should consider the weight of the evidence supporting these choices, as well as their tolerability profiles and ease of use, the patients' comorbidities and treatment history. Treatment interruption is not recommended, either in aviremic patients or in those who have experienced virological failure. Instead, the therapeutic regimen should be adjusted to minimize side effects, promote adherence and suppress viral replication.

  12. Antiretroviral therapy for adults infected with HIV: Guidelines for health care professionals from the Quebec HIV care committee

    Science.gov (United States)

    Rouleau, Danielle; Fortin, Claude; Trottier, Benoît; Lalonde, Richard; Lapointe, Normand; Côté, Pierre; Routy, Jean-Pierre; Matte, Marie-France; Tsarevsky, Irina; Baril, Jean-Guy

    2011-01-01

    The appropriate use of antiretrovirals reduces morbidity and mortality caused by HIV infection. The present article provides health care professionals with a practical guide for the use of antiretrovirals. Therapy should be initiated based predominantly on clinical presentation and CD4 count, and should consist of three active drugs or at least two active drugs when this is not possible, as in cases of some treatment-experienced patients. This is the most effective way to achieve long-term suppression of viral replication. Selection of individual drugs in the regimen should consider the weight of the evidence supporting these choices, as well as their tolerability profiles and ease of use, the patients’ comorbidities and treatment history. Treatment interruption is not recommended, either in aviremic patients or in those who have experienced virological failure. Instead, the therapeutic regimen should be adjusted to minimize side effects, promote adherence and suppress viral replication. PMID:22654926

  13. Brief cognitive behavioral therapy compared to general practitioners care for depression in primary care: a randomized trial

    Science.gov (United States)

    2010-01-01

    Background Depressive disorders are highly prevalent in primary care (PC) and are associated with considerable functional impairment and increased health care use. Research has shown that many patients prefer psychological treatments to pharmacotherapy, however, it remains unclear which treatment is most optimal for depressive patients in primary care. Methods/Design A randomized, multi-centre trial involving two intervention groups: one receiving brief cognitive behavioral therapy and the other receiving general practitioner care. General practitioners from 109 General Practices in Nijmegen and Amsterdam (The Netherlands) will be asked to include patients aged between 18-70 years presenting with depressive symptomatology, who do not receive an active treatment for their depressive complaints. Patients will be telephonically assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to ascertain study eligibility. Eligible patients will be randomized to one of two treatment conditions: either 8 sessions of cognitive behavioral therapy by a first line psychologist or general practitioner's care according to The Dutch College of General Practitioners Practice Guideline (NHG- standaard). Baseline and follow-up assessments are scheduled at 0, 6, 12 and 52 weeks following the start of the intervention. Primary outcome will be measured with the Hamilton Depression Rating Scale-17 (HDRS-17) and the Patient Health Questionnaire-9 (PHQ-9). Outcomes will be analyzed on an intention to treat basis. Trial Registration ISRCTN65811640 PMID:20939917

  14. Safety and Efficacy in Early Insulin Initiation as Comprehensive Therapy for Patients with Type 2 Diabetes in Primary Health Care Centers

    Directory of Open Access Journals (Sweden)

    Agung Pranoto

    2015-04-01

    Full Text Available Aim: to analyze the safety and efficacy of early insulin initiation therapy for patients with type 2 diabetes mellitus (T2DM in primary health care provided by general practitioners (GPs in Surabaya, East Java, Indonesia. Methods: pre-post study of ninety nine diabetic patients without previous insulin treatment with HbA1c levels >8% were involved in this study. The study was conducted in 10 primary health care centers in Surabaya between October 2011 to June 2012. Each patient received insulin therapy for 12 weeks. Laboratory examination was performed for each patient including fasting plasma glucose (FPG, 2 hours post-prandial plasma glucose (2hPPG and HbA1c examination before and after the study. Self monitoring blood glucose (SMBG examination was conducted in order to adjust the insulin dose and prevent the incidence of hypoglycemia. Data was statistically analyzed using paired-T test. Results: FPG level was decreased from baseline data (209 mg/dL to 152.07 mg/dL at the end of the study (Δ56.93 mg/dl; p=0.0001. The average of 2hPPG level was also decreased from 313.00 mg/dl to 220.72 mg/dL (Δ 92.28 mg/dL; p=0.0001. HbA1c was reduced from 11.60% at baseline to 8.95% at the end of study (Δ 2.65%; p=0.0001. Hypoglycemia was found in 6 patients (6.06% in this study, but all events were mild and did not need to be admitted to hospital. Conclusion: the safety of insulin therapy iniatiation might be provided by GPs at primary health centers with significant efficacy and minimal side effects. Key words: insulin, general practioner, primary health center.

  15. Expectations of Health Care Professionals Regarding the Services

    Directory of Open Access Journals (Sweden)

    Somayeh Hanafi

    2015-10-01

    Full Text Available Background: The provision of accurate and timely drug information to health care professionals is an important mechanism to promote safe and effective drug therapy for patients. World’s Drug and Poison Information Centers (DPICs are mainly affiliated to hospitals, rather rarely with faculties of pharmacy or with faculties of medicine and other related organizations.Methods: Data was collected from a questionnaire which was distributed among 400 health care providers in April 2009. Data were analyzed using SPSS software (version 17.Results: Medical reference books and drug information textbooks (36.7% and expert colleagues (29.7% were the “most commonly” used drug information resources. In addition, 77.8% of respondents “almost never” use DPICs. About 77% of respondents were non- acquainted with these centers’ activities. Five expectations were considered ‘very important’ by respondents: Provide information on IV drugs incompatibilities (74%, Provide drug interaction information (70.1%, Provide new drugs information (56.5%, Education/training of health care professionals regarding rational drug therapy and prevention of medication errors (54.9%, Providing information on dosage forms of drugs available in Iran (53.5%.Conclusion: Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Considering “announcement of availability of drugs in pharmacy” as one of the activities of DPICs, shows that the health care professionals are not acquainted with real services of these centers. It shows an urgent need for culture building activities to introduce them to these centers services.

  16. Long-Term Care Services for Veterans

    Science.gov (United States)

    2017-02-14

    includes but is not limited to home physical , occupational, or speech therapy ; wound care; and intravenous (IV) care. A VA physician determines that a...restoring/rehabilitating the veteran’s health, such as skilled nursing care, physical therapy , occupational therapy , and IV therapy Same as HBPC... geriatric evaluation,  palliative care,  adult day health care,  homemaker/home health aide care,  respite care, Long-Term Care Services for

  17. Retrospective analysis of drug utilization, health care resource use, and costs associated with IFN therapy for adjuvant treatment of malignant melanoma

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-07-01

    Full Text Available ≥Ying Zhang,1 Trong Kim Le,1 James W Shaw,2 Srividya Kotapati31Center for Observational Research and Data Sciences, Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Hopewell, NJ, USA; 2Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Princeton, NJ, USA; 3Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Wallingford Center, CT, USABackground: This study examines real-world drug utilization patterns, health care resource use, and costs among patients receiving adjuvant treatment with IFN versus patients receiving no treatment ("observation" for malignant melanoma following surgery.Methods: A retrospective cohort study was conducted using administrative claims from Truven Health Analytics (MarketScan® to identify all adjuvant melanoma patients (aged ≥18 years diagnosed between June 2007 and June 2011 who had a lymph node dissection (ie, index surgery and were treated with IFN or subsequently observed. Health care resource use and costs of services were converted to 2012 US dollars and were evaluated and compared using multivariable regression.Results: Of 1,999 eligible subjects with melanoma surgery claims, 179 (9.0% were treated with IFN and 1,820 (91.0% were observed. The median duration (days and number of doses of IFN therapy were 73 and 36, respectively. Among IFN-treated patients, only 10.6% completed ≥80% of maintenance therapy. The total average cost for patients treated with IFN was US$60,755±$3,972 (n=179; significantly higher than for patients undergoing observation ($31,641±$2,471; P<0.0001. Similar trends were observed when evaluating total cost components, including melanoma-related and non-melanoma–related medical costs. Among the melanoma-related medical costs, outpatient services, including office visits and laboratory testing, represented between 33% and 53% of total costs and

  18. Horticultural therapy in dementia care: a literature review.

    Science.gov (United States)

    Blake, Marianne; Mitchell, Gary

    2016-01-20

    Aim To present a narrative review of the empirical literature on the use of horticultural therapy in dementia care. Method A comprehensive literature search, conducted in December 2014, resulted in the selection of 15 primary research articles for review. Of these, three used qualitative methods, five used quantitative methods and seven used mixed methodology. The articles were critically appraised, and the narrative synthesis used a thematic approach whereby prominent themes from the articles were grouped to form representative themes. Findings Three main themes emerged from the narrative synthesis: the emotional health of people living with dementia, their perceived self-identity and their levels of engagement. Conclusion Horticultural therapy can be beneficial. At a macro-level, it is an inexpensive therapy that does not require specialist training to deliver. At a micro-level, it enhances the wellbeing of people living with dementia. Recommendations are made to promote access to appropriate horticultural therapy for people living with dementia, and for further research in this area.

  19. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression

    Directory of Open Access Journals (Sweden)

    Cape John

    2010-06-01

    Full Text Available Abstract Background Psychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders. Methods Meta-analysis and meta-regression of randomized controlled trials of brief psychological therapies of adult patients with anxiety, depression or mixed common mental health problems treated in primary care compared to primary care treatment as usual. Results Thirty-four studies, involving 3962 patients, were included. Most were of brief cognitive behaviour therapy (CBT; n = 13, counselling (n = 8 or problem solving therapy (PST; n = 12. There was differential effectiveness between studies of CBT, with studies of CBT for anxiety disorders having a pooled effect size [d -1.06, 95% confidence interval (CI -1.31 to -0.80] greater than that of studies of CBT for depression (d -0.33, 95% CI -0.60 to -0.06 or studies of CBT for mixed anxiety and depression (d -0.26, 95% CI -0.44 to -0.08. Counselling for depression and mixed anxiety and depression (d -0.32, 95% CI -0.52 to -0.11 and problem solving therapy (PST for depression and mixed anxiety and depression (d -0.21, 95% CI -0.37 to -0.05 were also effective. Controlling for diagnosis, meta-regression found no difference between CBT, counselling and PST. Conclusions Brief CBT, counselling and PST are all effective treatments in primary care, but effect sizes are low compared to longer length treatments. The exception is brief CBT for anxiety, which has comparable effect sizes.

  20. Incorporating Cognitive Behavioural Therapy into a Public Health Care System: Canada and England Compared

    Directory of Open Access Journals (Sweden)

    Noushon Farmanara

    2016-06-01

    Full Text Available Since the second half of the 2000s, Canada and England have instituted differing reforms to address the inadequate provision and quality of mental health services in both nations. With growing evidence demonstrating the success and cost-effectiveness of psychotherapy, the English reform sought to expand the delivery of psychological services through the Improving Access to Psychological Therapies program (IAPT focusing on cognitive behavioural therapy (CBT. In contrast, Canadian interventions at the federal level were centred on knowledge exchange and advocacy, primarily through the Mental Health Commission of Canada. While significant improvements were made during this period to increase CBT access in England, there continues to be an insufficient availability of psychological services to meet the growing need in Canada. While a national roll-out akin to the IAPT program in England is unlikely in Canada, similar reforms could be initiated at the provincial level of government. Indeed, several provincial governments have acknowledged the need for an expansion of CBT services and, over the last decade, some have tried to make CBT techniques more widely accessible. We review the case of the Bounce Back program developed in British Columbia (BC to illustrate this potential in the Canadian context. Best practices indicate that care is needed beyond the provision of psychiatric services and pharmacotherapy alone, and the initial results of both the IAPT program and BC’s Bounce Back program strongly suggest that it is possible to provide these cost-effective services in a public system.

  1. Ostomy patients’ perception of the health care received

    Directory of Open Access Journals (Sweden)

    Candela Bonill-de las Nieves

    2017-12-01

    Full Text Available ABSTRACT Aim: to describe ostomy patient’s perception about health care received, as well as their needs and suggestions for healthcare system improvement. Method: qualitative phenomenological study was conducted, involving individual and semi-structured interviews on the life experiences of 21 adults who had a digestive stoma. Participants were selected following a purposive sampling approach. The analysis was based on the constant comparison of the data, the progressive incorporation of subjects and triangulation among researchers and stoma therapy nurses. The software Atlas.ti was used. Results: perception of health care received is closely related to the information process, as well as training for caring the stoma from peristomal skin to diet. It is worthy to point out the work performed by stoma care nurses ensuring support during all stages of the process. Conclusion: findings contribute to address the main patients’ needs (better prepared nurses, shorter waiting lists, information about sexual relation, inclusion of family members all along the process and recommendations for improving health care to facilitate their adaptation to a new status of having a digestive stoma.

  2. Antiretroviral therapy for adults infected with HIV: Guidelines for health care professionals from the Quebec HIV care committee

    Directory of Open Access Journals (Sweden)

    Danielle Rouleau

    2011-01-01

    Full Text Available The appropriate use of antiretrovirals reduces morbidity and mortality caused by HIV infection. The present article provides health care professionals with a practical guide for the use of antiretrovirals. Therapy should be initiated based predominantly on clinical presentation and CD4 count, and should consist of three active drugs or at least two active drugs when this is not possible, as in cases of some treatment-experienced patients. This is the most effective way to achieve long-term suppression of viral replication. Selection of individual drugs in the regimen should consider the weight of the evidence supporting these choices, as well as their tolerability profiles and ease of use, the patients’ comorbidities and treatment history. Treatment interruption is not recommended, either in aviremic patients or in those who have experienced virological failure. Instead, the therapeutic regimen should be adjusted to minimize side effects, promote adherence and suppress viral replication.

  3. Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals.

    Science.gov (United States)

    Bjerså, Kristofer; Stener Victorin, Elisabet; Fagevik Olsén, Monika

    2012-04-12

    Previous studies show an increased interest and usage of complementary and alternative medicine (CAM) in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. A total of 737 (42.0%) questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in such research. Half of the participants (55.8%) were

  4. Knowledge about complementary, alternative and integrative medicine (CAM among registered health care providers in Swedish surgical care: a national survey among university hospitals

    Directory of Open Access Journals (Sweden)

    Bjerså Kristofer

    2012-04-01

    Full Text Available Abstract Background Previous studies show an increased interest and usage of complementary and alternative medicine (CAM in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. Method A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. Result A total of 737 (42.0% questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in

  5. Mind the gap: gender differences in child special health care needs.

    Science.gov (United States)

    Leiter, Valerie; Rieker, Patricia P

    2012-07-01

    The gendered nature of special health care needs in childhood is an important yet understudied area. Although gendered differences in the prevalence of special health care needs have been documented, there is less knowledge about the factors which contribute to those differences. Two research questions guide this inquiry. First, is the gender gap consistent across child special health care need indicators? Second, to what extent is the gender gap in special health care needs driven by behavioral conditions? We use multiple indicators from the U.S. National Survey of Children's Health to expand our understanding about the dynamic relationship between gender and childhood health. There are clear gender differences in the prevalence of special health care needs. Boys are more likely than girls to have special health care needs overall and on the five separate components examined (medication, more care than typical, limitations, special therapies, and educational or behavioral problem). This gender gap is dynamic and varies by indicator; while behavioral conditions play a role, it remains even after controlling for behavioral conditions. The reasons for the gender differences appear to be both biological and social but much remains unknown about this pattern.

  6. Coverage for Gender-Affirming Care: Making Health Insurance Work for Transgender Americans.

    Science.gov (United States)

    Padula, William V; Baker, Kellan

    2017-08-01

    Many transgender Americans continue to remain uninsured or are underinsured because of payers' refusal to cover medically necessary, gender-affirming healthcare services-such as hormone therapy, mental health counseling, and reconstructive surgeries. Coverage refusal results in higher costs and poor health outcomes among transgender people who cannot access gender-affirming care. Research into the value of health insurance coverage for gender-affirming care for transgender individuals shows that the health benefits far outweigh the costs of insuring transition procedures. Although the Affordable Care Act explicitly protects health insurance for transgender individuals, these laws are being threatened; therefore, this article reviews their importance to transgender-inclusive healthcare coverage.

  7. [Job Satisfaction of Young Professionals in Health Care].

    Science.gov (United States)

    Ulrich, Gert; Homberg, Angelika; Karstens, Sven; Goetz, Katja; Mahler, Cornelia

    2017-05-29

    Background Job satisfaction in health care is currently important in view of workforce shortage in the health care area. The purpose of this study was to evaluate job satisfaction in young health professionals and to identify factors possibly influencing overall job satisfaction. Methods About one year after graduating from vocational training, a total of 579 graduates from various health care professions [Nursing (N), Nursing and Geriatric Nursing; Therapy (TP), Physical therapy and Logopaedics; Diagnostics (D), Diagnostic Radiography and Biomedical Science], were invited to participate in an online-survey. Job satisfaction was assessed with the 10-item Warr-Cook-Wall (WCW) job satisfaction questionnaire. Descriptive analysis of the WCW was performed, and the impact of various factors on job satisfaction was determined by stepwise linear regression analysis. Results In total, 189 graduates (N, n=121; TP, n=32; D, n=36) were included in data analysis (32.6% response rate). Overall job satisfaction in all young professionals was 4.9±1.6 (mean±SD) and was slightly higher in TP (5.4±1.4) compared with N (4.7±1.6) and D (5.0±1.5), respectively. Highest satisfaction was identified with "colleagues" and lowest satisfaction with "income" was identified in all professional groups. Colleagues and fellow workers showed the highest score of association regarding overall job satisfaction in regression analysis. Conclusions As a whole, our data suggest good to very good satisfaction in various WCW items of job satisfaction. "Colleagues" were shown to have a high impact on job satisfaction. To improve the attractiveness of job profiles in health care, the presented results may provide a valuable input regarding workforce shortage. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Self-care under the perspective of Occupational Therapy: analysis of scientific production

    Directory of Open Access Journals (Sweden)

    Regina Célia Titotto Castanharo

    2014-04-01

    Full Text Available This is an exploratory descriptive study aiming to explain how self-care has been addressed by Occupational Therapy (OT. Data collection was carried out by consulting LILACS, SciELO databases and national journals of Occupational Therapy. From 1994 to 2012, twelve articles published by occupational therapists were selected considering the following keywords on abstracts or full texts: occupational therapy, self-care, daily activities or daily life activities. The results were submitted to integrative review and thematic analysis. The categories evidenced were self-care and activities of daily life; autonomy and independence for self-care; and intervention of OT favoring self-care by the individual. The results showed different dimensions of self-care when associated with the individual and private autonomy as well as with professional interdisciplinary practices of OT. The intervention in this area is directed to human performance in the cycles of life, faced with situations of vulnerability, such as disease and social exclusion. Adaptations, modifications, assistive technology resources and/or functional rehabilitation are used to promote the independence of individuals, favoring autonomy and recovery routines. We observed similarities between the conceptions of self-care found in the scientific production of OT and in the Orem’s concepts (1971-2001. In general, health professionals can achieve benefits to the systematization of knowledge that underlie their practice when they articulate them with the knowledge systematized by other areas.

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

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

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

  10. Profiling health and health-related services for children with special health care needs with and without disabilities.

    Science.gov (United States)

    Houtrow, Amy J; Okumura, Megumi J; Hilton, Joan F; Rehm, Roberta S

    2011-01-01

    The aims of this study were to profile and compare the health and health services characteristics for children with special health care needs (CSHCN), with and without disabilities, and to determine factors associated with unmet need. Secondary data analysis of the 2005-2006 National Survey of Children with Special Health Care Needs was conducted. The sociodemographics, health, and health services of CSHCN with and without disabilities were compared. Multivariable logistic regression was employed to examine factors associated with unmet need for health services. Children from minority racial and ethnic groups and children living in or near poverty were over-represented among CSHCN with disabilities, compared with other CSHCN. Statistically higher percentages of CSHCN with disabilities had behavioral problems (39.6% vs 25.2%), anxiety/depressed mood (46.1% vs 24.0%), and trouble making/keeping friends (38.1% vs 15.6%) compared with other CSHCN. Thirty-two percent of CSHCN with disabilities received care in a medical home compared with 51% of other CSHCN. CSHCN with disabilities had higher rates of need and unmet need than other CSHCN for specialty care, therapy services, mental health services, home health, assistive devices, medical supplies, and durable medical equipment. The adjusted odds of unmet need for CSHCN with disabilities were 71% higher than for other CSHCN. CSHCN with disabilities had more severe health conditions and more health services need, but they less commonly received care within a medical home and had more unmet need. These health care inequities should be amenable to policy and health service delivery interventions to improve outcomes for CSHCN with disabilities. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  11. Supervising Family Therapy Trainees in Primary Care Medical Settings: Context Matters

    Science.gov (United States)

    Edwards, Todd M.; Patterson, Jo Ellen

    2006-01-01

    The purpose of this article is to identify and describe four essential skills for effective supervision of family therapy trainees in primary care medical settings. The supervision skills described include: (1) Understand medical culture; (2) Locate the trainee in the treatment system; (3) Investigate the biological/health issues; and (4) Be…

  12. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  13. Physical therapy 2.0: leveraging social media to engage patients in rehabilitation and health promotion.

    Science.gov (United States)

    Knight, Emily; Werstine, Robert J; Rasmussen-Pennington, Diane M; Fitzsimmons, Deborah; Petrella, Robert J

    2015-03-01

    Care for chronic conditions and noncommunicable diseases is dominating health systems around the globe. For physical therapists, this strain presents a substantial opportunity for engaging patients in health promotion and disease management in the years to come. Examples of social media being used to engage consumers in the business landscape are pervasive, and research reports suggest that patients are ready for social media to be incorporated into the way health care systems deliver care. We propose that leveraging the power and utility of existing technologies, such as social media, could innovate the way physical therapists engage patients in rehabilitation and health promotion practices, thus contributing to the evolution of the profession: Physical Therapy 2.0. To continue to be relevant in the community, physical therapist practice must respond to patients' needs and expectations. Incorporating social media into how physical therapists are both designing and delivering care holds potential for enhancing patient engagement in prescribed health behaviors and improving treatment outcomes. This conceptual article presents the perspective that physical therapists can utilize social media to enhance care delivery and treatment outcomes. © 2015 American Physical Therapy Association.

  14. A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi: effects on human resources and survival.

    Science.gov (United States)

    Makombe, Simon D; Jahn, Andreas; Tweya, Hannock; Chuka, Stuart; Yu, Joseph Kwong-Leung; Hochgesang, Mindy; Aberle-Grasse, John; Pasulani, Olesi; Schouten, Erik J; Kamoto, Kelita; Harries, Anthony D

    2007-11-01

    To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system. By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level. A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.

  15. Real-world Direct Health Care Costs for Metastatic Colorectal Cancer Patients Treated With Cetuximab or Bevacizumab-containing Regimens in First-line or First-line Through Second-line Therapy.

    Science.gov (United States)

    Johnston, Stephen; Wilson, Kathleen; Varker, Helen; Malangone-Monaco, Elisabetta; Juneau, Paul; Riehle, Ellen; Satram-Hoang, Sacha; Sommer, Nicolas; Ogale, Sarika

    2017-12-01

    The present study examined real-world direct health care costs for metastatic colorectal cancer (mCRC) patients initiating first-line (1L) bevacizumab (BEV)- or cetuximab (CET)-containing regimen in 1L or 1L-through-second-line (1L-2L) therapy. Using a large US insurance claims database, patients with mCRC initiating 1L BEV- or 1L CET-containing regimen from January 1, 2008 to September 30, 2014 were identified. The per-patient per-month (PPPM) all-cause health care costs (2014 US dollars) were measured during 1L therapy and, for patients continuing to a 2L biologic-containing regimen, 1L-2L therapy. Multivariable regression analyses were used to compare PPPM total health care costs between patients initiating a 1L BEV- versus 1L CET-containing regimen. A total of 6095 patients initiating a 1L BEV- and 453 initiating a 1L CET-containing regimen were evaluated for 1L costs; 2218 patients initiating a 1L BEV- and 134 initiating a 1L CET-containing regimen were evaluated for 1L-2L costs. In 1L therapy, 1L CET had adjusted PPPM costs that were $3135 (95% confidence interval [CI], $1174-$5040; P < .001) greater on average than 1L BEV. In 1L-2L therapy, 1L BEV-2L CET had adjusted PPPM costs that were $1402 (95% CI, $1365-$1442; P = .010) greater than those for 1L BEV-2L BEV, and 1L CET-2L BEV had adjusted PPPM costs that were $4279 (95% CI, $4167-$4400; P = .001) greater on average than those for 1L BEV-2L BEV. The adjusted PPPM cost differences for 1L BEV-2L other biologic or 1L CET-2L other biologic agent were numerically greater but statistically insignificant. PPPM total health care costs for 1L and 2L therapy tended to be greater for patients treated with 1L CET-containing regimens than for 1L BEV-containing regimens. Also, continuing treatment with BEV-containing regimens 1L-2L was less costly than switching between BEV and CET. The cost differences between BEV and CET hold important implications for treatment decisions of mCRC patients in real-world clinical

  16. Medication therapy management and condition care services in a community-based employer setting.

    Science.gov (United States)

    Johannigman, Mark J; Leifheit, Michael; Bellman, Nick; Pierce, Tracey; Marriott, Angela; Bishop, Cheryl

    2010-08-15

    A program in which health-system pharmacists and pharmacy technicians provide medication therapy management (MTM), wellness, and condition care (disease management) services under contract with local businesses is described. The health-system pharmacy department's Center for Medication Management contracts directly with company benefits departments for defined services to participating employees. The services include an initial wellness and MTM session and, for certain patients identified during the initial session, ongoing condition care. The initial appointment includes a medication history, point-of-care testing for serum lipids and glucose, body composition analysis, and completion of a health risk assessment. The pharmacist conducts a structured MTM session, reviews the patient's test results and risk factors, provides health education, discusses opportunities for cost savings, and documents all activities on the patient's medication action plan. Eligibility for the condition care program is based on a diagnosis of diabetes, hypertension, asthma, heart failure, or hyperlipidemia or elevation of lipid or glucose levels. Findings are summarized for employers after the initial wellness screening and at six-month intervals. Patients receiving condition care sign a customized contract, establish goals, attend up to four MTM sessions per year, and track their information on a website; employers may offer incentives for participation. When pharmacists recommend adjustments to therapy or cost-saving changes, it is up to patients to discuss these with their physician. A survey completed by each patient after the initial wellness session has indicated high satisfaction. Direct cost savings related to medication changes have averaged $253 per patient per year. Total cost savings to companies in the first year of the program averaged $1011 per patient. For the health system, the program has been financially sustainable. Key laboratory values indicate positive clinical

  17. CHAMP: Cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Murphy David

    2011-06-01

    Full Text Available Abstract Background Abnormal health anxiety, also called hypochondriasis, has been successfully treated by cognitive behaviour therapy (CBT in patients recruited from primary care, but only one pilot trial has been carried out among those attending secondary medical clinics where health anxiety is likely to be more common and have a greater impact on services. The CHAMP study extends this work to examine both the clinical and cost effectiveness of CBT in this population. Method/Design The study is a randomized controlled trial with two parallel arms and equal randomization of 466 eligible patients (assuming a 20% drop-out to an active treatment group of 5-10 sessions of cognitive behaviour therapy and to a control group. The aim at baseline, after completion of all assessments but before randomization, was to give a standard simple explanation of the nature of health anxiety for all participants. Subsequently the control group was to receive whatever care might usually be available in the clinics, which is normally a combination of clinical assessment, appropriate tests and reassurance. Those allocated to the active treatment group were planned to receive between 5 and 10 sessions of an adapted form of cognitive behaviour therapy based on the Salkovskis/Warwick model, in which a set of treatment strategies are chosen aimed at helping patients understand the factors that drive and maintain health anxiety. The therapy was planned to be given by graduate research workers, nurses or other health professionals trained for this intervention whom would also have their competence assessed independently during the course of treatment. The primary outcome is reduction in health anxiety symptoms after one year and the main secondary outcome is the cost of care after two years. Discussion This represents the first trial of adapted cognitive behaviour therapy in health anxiety that is large enough to test not only the clinical benefits of treatment but also

  18. What Makes Health Care Special?: An Argument for Health Care Insurance.

    Science.gov (United States)

    Horne, L Chad

    2017-01-01

    While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account. Health needs are not more important than other basic needs, but they are more unpredictable. I argue that citizens are owed access to insurance against health risks to provide stability in their future expectations and thus to protect their capacities for self-determination.

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

    Science.gov (United States)

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

    2015-06-20

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

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

    Directory of Open Access Journals (Sweden)

    Bradley Ryan

    2011-12-01

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

  1. Terapias complementarias en los cuidados: Humor y risoterapia Complementary therapies in the cares: humour and laugh

    Directory of Open Access Journals (Sweden)

    M. Carmen Ruiz Gómez

    2005-06-01

    Full Text Available Dentro de las terapias complementarias, la utilización de la risoterapia aporta beneficios tanto en la salud como en las situaciones de enfermedad, siendo un "instrumento de cuidados" barato y sin efectos secundarios. La tendencia actual hacia todo lo natural, las corrientes sobre cuidados de salud de las distintas culturas, unidas a las recomendaciones de la OMS a los enfermeros sobre la necesidad de utilizar los "métodos tradicionales y complementarios" para conseguir mejorar la salud de la población, hacen que la risoterapia sea una alternativa como instrumento opcional de cuidados. Planteamos una revisión bibliográfica con el objetivo de conocer la aplicación de la risoterapia en la salud y más concretamente en los cuidados enfermeros. Del análisis de los resultados podemos concretar que la risa se trabaja en diferentes ámbitos profesionales, no sólo en el sanitario. Es en el campo de la comunicación donde más se divulga esta terapia. Hemos encontrado pocas publicaciones de enfermería, pero muy valiosas ya que trabajan en el terreno de la investigación y de la docencia. Sería interesante que los profesionales de enfermería utilizaran esta terapia que mejora la calidad de los cuidados y ofrece un campo independiente propicio para la investigación.Related to complementary therapies, humour and laugh contribute to enhance health status and diminish illness situations. Humour as a therapy is an inexpensive tool in the patient care and it has not secondary effects in most cases. Current tendencies, either about natural ways to health or believes on health care of popular cultures, and who recommendations to patients in the use of traditional and complementary methods to improve population health, make humour and laugh an alternative therapy as an optional care tool. We have reviewed the literature with the aim of recognize the application of humour therapy on health and more specifically on nurse cares.On the basis of the review

  2. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  3. Professionalism in a digital age: opportunities and considerations for using social media in health care.

    Science.gov (United States)

    Gagnon, Kendra; Sabus, Carla

    2015-03-01

    Since the beginning of the millennium, there has been a remarkable change in how people access and share information. Much of this information is user-generated content found on social media sites. As digital technologies and social media continue to expand, health care providers must adapt their professional communication to meet the expectations and needs of consumers. This adaptation may include communication on social media sites. However, many health care providers express concerns that professional social media use, particularly interactions with patients, is ethically problematic. Social media engagement does not create ethical dissonance if best practices are observed and online communication adheres to terms of service, professional standards, and organizational policy. A well-executed social media presence provides health care providers, including physical therapists, the opportunity-and perhaps a professional obligation-to use social media sites to share or create credible health care information, filling a consumer void for high-quality online information on fitness, wellness, and rehabilitation. This perspective article provides a broad review of the emergence of social media in society and health care, explores policy implications of organizational adoption of health care social media, and proposes individual opportunities and guidelines for social media use by the physical therapy professional. © 2015 American Physical Therapy Association.

  4. Mixing online and face-to-face therapy: how to benefit from blended care in mental healthcare

    NARCIS (Netherlands)

    Wentzel, M.J.; van der Vaart, R.; Bohlmeijer, Ernst Thomas; van Gemert-Pijnen, Julia E.W.C.

    2016-01-01

    Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing

  5. Withholding or withdrawing therapy in intensive care units: improving interdisciplinary cooperation

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Ørding, Helle

    INTRODUCTION. Decisions regarding withholding or withdrawing therapy are common in the intensive care units. The health care professionals involved in the decision-making process do not always assess the situation identically, leading to potential conflicts. Studies have suggested that improving...... (conducted at two hospitals) with participation of primary care physicians, anaesthesiologists (both with and without ICU as their main workplace) and intensive care nurses. A total of 29 participated in the audits. The participants received beforehand three complicated cases (borrowed from other hospitals...... unit conflicts: the conflicus study. Am J Respir Crit Care Med180:853-860. (2) Halvorsen K, Forde R, Nortvedt P (2009) Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 53:10-17 GRANT ACKNOWLEDGMENT. The study was supported...

  6. Health care costs of adults treated for attention-deficit/hyperactivity disorder who received alternative drug therapies.

    Science.gov (United States)

    Wu, Eric Q; Birnbaum, Howard G; Zhang, Huabin F; Ivanova, Jasmina I; Yang, Elaine; Mallet, David

    2007-09-01

    Many therapies exist for treating adult attention-deficit/hyperactivity disorder (ADHD), also referred to as attention-deficit disorder (ADD), but there is no research regarding cost differences associated with initiating alternative ADD/ADHD drug therapies in adults. To compare from the perspective of a large self-insured employer the risk-adjusted direct health care costs associated with 3 alternative drug therapies for ADD in newly treated patients: extended-release methylphenidate (osmotic release oral system-MPH), mixed amphetamine salts extended release (MAS-XR), or atomoxetine. We analyzed data from a US claims database of 5 million beneficiaries from 31 large self-insured employers (1999-2004). Analysis was restricted to adults aged 18 to 64 years with at least 1 diagnosis of ADD/ADHD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 314.0x--attention deficit disorder; 314.00--attention deficit disorder without hyperactivity; or 314.01--attention-deficit disorder with hyperactivity) and at least 1 pharmacy claim for OROS-MPH, MAS-XR, or atomoxetine identified using National Drug Codes. In preliminary analysis, we calculated the duration of index ADHD drug therapy as time from index therapy initiation to a minimum 60-day gap. Because the median duration of index ADHD drug therapy was found to be approximately 90 days, the primary measures were total direct medical plus drug costs and medical-only costs computed over 6 months following therapy initiation. Adults were required to have continuous eligibility 6 months before and 6 months after their latest drug therapy initiation and no ADHD therapy during the previous 6 months. Cost was measured as the payment amount made by the health plan to the provider rather than billed charges, and it excluded patient copayments and deductibles. Medical costs included costs incurred for all-cause inpatient and outpatient/other services. Costs were adjusted for inflation to

  7. Nature Cure and Non-Communicable Diseases: Ecological Therapy as Health Care in India.

    Science.gov (United States)

    Alter, Joseph S; Nair, R M; Nair, Rukmani

    2017-12-07

    With rapidly increasing rates of non-communicable diseases, India is experiencing a dramatic public health crisis that is closely linked to changing lifestyles and the growth of the middle-class. In this essay we discuss how the practice of Nature Cure provides a way of understanding the scale and scope of the crisis, as it is embodied, and a way to understand key elements of a solution to problems that the crisis presents for institutionalized health care. As institutionalized in contemporary India, Nature Cure involves treatment and managed care using earth, air, sunlight, and water as well as a strict dietary regimen. In this regard, the essay shows how Nature Cure's bio-ecological orientation toward public health, which is grounded in the history of its modern incorporation into India, provides an expansionist, ecological model for holistic care that counters the reductionist logic of bio-medical pharmaceuticalization.

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

    Science.gov (United States)

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

    2011-08-01

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

  9. Unmet Need for Therapy Among Children with Autism Spectrum Disorder: Results from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs.

    Science.gov (United States)

    Benevides, Teal W; Carretta, Henry J; Lane, Shelly J

    2016-04-01

    We examined population-based trends in unmet need for therapy service in children with autism spectrum disorder (ASD) compared to other children with special health care needs (CSHCN), and identified factors associated with unmet need for therapy. A pooled cross-sectional comparison of the 2005-2006 and 2009-2010 waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN) was used. Weighted bivariate analyses were used to compare children ages 3-17 years with ASD (n = 5113) to other CSHCN (n = 71,294) on unmet need for therapy services. Survey weighted multivariate models were used to examine child, family, and contextual characteristics associated with unmet need. A greater percentage of children with ASD across both surveys were reported to need therapy than other children with CSHCN. Among children with a reported need, children with ASD were 1.4 times more likely to report an unmet need for therapy compared to other CSHCN (OR 1.42, 95 % CI 1.18-1.71). Variables significantly associated with unmet need for therapy services included not receiving a well-child visit in the past year (OR 5.81, CI 3.83-8.81), surveyed in 2009 (OR 1.42, CI 1.18-1.71), child being female (OR 1.27, CI 1.05-1.53), uninsured (OR 1.72, CI 1.15-2.56), and having greater functional limitation (OR 2.44, CI 1.80-3.34). Children with ASD require supportive services such as occupational, physical, and speech therapy but are less likely to receive such services than other CSHCN. Receiving a well-child visit in the past year was strongly associated with receipt of needed therapy services.

  10. KNOWLEDGE AND PRACTICES AMONGST HEALTH CARE PROVIDERS & CARE TAKERS REGARDING MANAGEMENT OF CHILDHOOD DIARRHOEA IN DEMONSTRATION DISTRICTS OF GUJARAT

    Directory of Open Access Journals (Sweden)

    Rupani Mihir

    2015-12-01

    Full Text Available Introduction:Diarrhoea Alleviation through Zinc and ORS Therapy (DAZT project was started in 6 demonstration districtsof Gujarat in 2011. Rationale: In addition to poor feeding/hygiene practices of caretakers, inappropriate prescription from providers and inadequate use of Zinc-ORS are challenges in diarrhoea management. Objectives:To understand prescription practices for childhood diarrhoea, assess knowledge about zinc therapy among health care providers & caretakers in the government/private sectors &assess knowledge about additional information to be provided to caretakersamong health care providers& its practice among care takers. Materials & Methods:Information was collected onstructured questionnaires by interviews of 127care providers&43 care takersin 6 districts.In addition, case records were reviewed for 228 prescriptions – all from government sector. Data collected was entered and analyzedusing Excel. Results:Based on records/interviews, government functionaries dispensed ORS in 97%& zinc in 90% cases of diarrhoea while, private providers prescribed itin 79% &71% respectively. Antibiotics were prescribed in 24% & 59%, anti-amoebic in 20.2% &64.7% in public& private sectors respectively.Knowledge of dosage and duration of zinc therapy was better among public sector providers than private sector ones. Amongst caretakers, 74.4% gave correct dose of zinc to their children but was given for 14 days in 67.4% of cases; common reasons for non-compliance were“improved condition”&“no need to continue”. Foradditional information, such as advice on continued feeding, giving more than usual fluid,hand washing& when to return back to health facility, the responses were better for government providers than private ones. Knowledge about this additional information was also poor amongst care takers. Conclusions:For all the parameters studied, responses were better amongst government providers than those from private sector. Demand

  11. Impact of medication adherence on health care utilization and productivity: self-reported data from a cohort of postmenopausal women on osteoporosis therapy.

    Science.gov (United States)

    Wade, Sally W; Satram-Hoang, Sacha; Nadkar, Aalok; Macarios, David; Tosteson, Anna N A

    2011-12-01

    Many pharmacologic agents are approved for the prevention and treatment of osteoporosis, which is common among postmenopausal women. Evidence exists relating treatment persistence to fracture risk. Less is known about treatment persistence and the use of health care service and individual productivity. This study was undertaken to describe health care use and productivity loss relative to osteoporosis medication persistence using women's self-reported data from the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US™), a large, longitudinal (October 2004-December 2009) osteoporosis cohort study of postmenopausal women. Analyses included women on pharmacologic osteoporosis therapy (alendronate, risedronate, ibandronate, calcitonin, raloxifene, or teriparatide) who provided health care use/productivity data collected using semiannual questionnaires over 1 year of follow-up. Participant characteristics, use, and productivity metrics were summarized. Logistic regression models and generalized linear models were used to examine use, time missed from usual activities, number of days spent in bed, and lost work time relative to treatment persistence, adjusting for potential confounders. At entry, of the 2528 women studied (91% white, 3.1% Hispanic/Latino, 2.3% African American/black, 1.1% Asian, and 2.1% American Indian/Native Alaskan, Native Hawaiian/Pacific Islander, or other; mean age, 64.6 [range, 37-97] years), 43.1% had osteoporosis and 23.4% had a previous fracture. After adjustment, subjects who switched therapies during follow-up were more likely to have had any kind of diagnostic testing (95.2% of switchers vs 91.2% of persistent subjects and 88.9% of discontinuers, P work loss (n = 852 employed subjects) by treatment persistence were not significant. Use of diagnostic testing differed significantly by osteoporosis treatment status. Compared with women who persisted with treatment, primary care provider visits were less

  12. A project investigating music therapy referral trends within palliative care: an Australian perspective.

    Science.gov (United States)

    Horne-Thompson, Anne; Daveson, Barbara; Hogan, Bridgit

    2007-01-01

    The purpose of this project is to analyze music therapy (MT) referral trends from palliative care team members across nine Australian inpatient and community-based palliative care settings. For each referral 6 items were collected: referral source, reason and type; time from Palliative Care Program (PCP) admission to MT referral; time from MT referral to death/discharge; and profile of referred patient. Participants (196 female, 158 male) were referred ranging in age from 4-98 years and most were diagnosed with cancer (91%, n = 323). Nurses (47%, n = 167) referred most frequently to music therapy. The mean average time in days for all referrals from PCP admission to MT referral was 11.47 and then 5.19 days to time of death. Differences in length of time to referral ranged from 8.19 days (allied health staff) to 43.75 days (families). Forty-eight percent of referrals (48.5%, n = 172) were completed when the patient was rated at an Eastern Cooperative Oncology Group Performance (ECOG) of three. Sixty-nine percent (n = 244) were living with others at the time of referral and most were Australian born. Thirty-six percent (36.7%, n = 130) were referred for symptom-based reasons, and 24.5% (n = 87) for support and coping. Implications for service delivery of music therapy practice, interdisciplinary care and benchmarking of music therapy services shall be discussed.

  13. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis

    Science.gov (United States)

    Miccio, Robin Streit; Parikh, Bijal

    2017-01-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment–related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals. PMID:28845677

  14. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis.

    Science.gov (United States)

    Cowen, Virginia S; Miccio, Robin Streit; Parikh, Bijal

    2017-10-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment-related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals.

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

    Science.gov (United States)

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

    2015-12-16

    In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals' acquired experiences of barriers and facilitators that people with common mental disorders face when seeking mental health care services in Rwanda. A qualitative approach was applied and data was collected from six focus group discussions (FGDs) conducted in October 2012, including a total of 43 health care professionals, men and women in different health professions. The FGDs were performed at health facilities at different care levels. Data was analyzed using manifest and latent content analysis. The emerging theme "A constant struggle to receive mental health care for mental disorders" embraced a number of barriers and few facilitators at individual, family, community and structural levels that people faced when seeking mental health care services. Identified barriers people needed to overcome were: Poverty and lack of family support, Fear of stigmatization, Poor community awareness of mental disorders, Societal beliefs in traditional healers and prayers, Scarce resources in mental health care and Gender imbalance in care seeking behavior. The few facilitators to receive mental health care were: Collaboration between authorities and organizations in mental health and having a Family with awareness of mental disorders and health insurance. From a public health perspective, this study revealed important findings of the numerous barriers and the few facilitating factors available to people seeking health for mental disorders. Having a supportive family with awareness of mental disorders who also were equipped with a health insurance was perceived as vital for

  16. What Aspects of Personal Care Are Most Important to Patients Undergoing Radiation Therapy for Prostate Cancer?

    International Nuclear Information System (INIS)

    Foley, Kimberley A.; Feldman-Stewart, Deb; Groome, Patti A.; Brundage, Michael D.; McArdle, Siobhan; Wallace, David; Peng, Yingwei; Mackillop, William J.

    2016-01-01

    Purpose/Objective: The overall quality of patient care is a function of the quality of both its technical and its nontechnical components. The purpose of this study was to identify the elements of nontechnical (personal) care that are most important to patients undergoing radiation therapy for prostate cancer. Methods and Materials: We reviewed the literature and interviewed patients and health professionals to identify elements of personal care pertinent to patients undergoing radiation therapy for prostate cancer. We identified 143 individual elements relating to 10 aspects of personal care. Patients undergoing radical radiation therapy for prostate cancer completed a self-administered questionnaire in which they rated the importance of each element. The overall importance of each element was measured by the percentage of respondents who rated it as “very important.” The importance of each aspect of personal care was measured by the mean importance of its elements. Results: One hundred eight patients completed the questionnaire. The percentage of patients who rated each element “very important” ranged from 7% to 95% (mean 61%). The mean importance rating of the elements of each aspect of care varied significantly: “perceived competence of caregivers,” 80%; “empathy and respectfulness of caregivers,” 67%; “adequacy of information sharing,” 67%; “patient centeredness,” 59%; “accessibility of caregivers,” 57%; “continuity of care,” 51%; “privacy,” 51%; “convenience,” 45%; “comprehensiveness of services,” 44%; and “treatment environment,” 30% (P<.0001). Neither age nor education was associated with importance ratings, but the patient's health status was associated with the rating of some elements of care. Conclusions: Many different elements of personal care are important to patients undergoing radiation therapy for prostate cancer, but the 3 aspects of care that most believe are most important are these: the perceived

  17. What Aspects of Personal Care Are Most Important to Patients Undergoing Radiation Therapy for Prostate Cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Foley, Kimberley A. [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Feldman-Stewart, Deb [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Groome, Patti A. [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Brundage, Michael D. [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Cancer Centre of Southeastern Ontario, Kingston, Ontario (Canada); McArdle, Siobhan [Cancer Centre of Southeastern Ontario, Kingston, Ontario (Canada); Wallace, David [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Peng, Yingwei [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Mathematics and Statistics, Queen' s University, Kingston, Ontario (Canada); Mackillop, William J., E-mail: William.mackillop@krcc.on.ca [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Cancer Centre of Southeastern Ontario, Kingston, Ontario (Canada)

    2016-02-01

    Purpose/Objective: The overall quality of patient care is a function of the quality of both its technical and its nontechnical components. The purpose of this study was to identify the elements of nontechnical (personal) care that are most important to patients undergoing radiation therapy for prostate cancer. Methods and Materials: We reviewed the literature and interviewed patients and health professionals to identify elements of personal care pertinent to patients undergoing radiation therapy for prostate cancer. We identified 143 individual elements relating to 10 aspects of personal care. Patients undergoing radical radiation therapy for prostate cancer completed a self-administered questionnaire in which they rated the importance of each element. The overall importance of each element was measured by the percentage of respondents who rated it as “very important.” The importance of each aspect of personal care was measured by the mean importance of its elements. Results: One hundred eight patients completed the questionnaire. The percentage of patients who rated each element “very important” ranged from 7% to 95% (mean 61%). The mean importance rating of the elements of each aspect of care varied significantly: “perceived competence of caregivers,” 80%; “empathy and respectfulness of caregivers,” 67%; “adequacy of information sharing,” 67%; “patient centeredness,” 59%; “accessibility of caregivers,” 57%; “continuity of care,” 51%; “privacy,” 51%; “convenience,” 45%; “comprehensiveness of services,” 44%; and “treatment environment,” 30% (P<.0001). Neither age nor education was associated with importance ratings, but the patient's health status was associated with the rating of some elements of care. Conclusions: Many different elements of personal care are important to patients undergoing radiation therapy for prostate cancer, but the 3 aspects of care that most believe are most important are these: the

  18. Art, dance, and music therapy.

    Science.gov (United States)

    Pratt, Rosalie Rebollo

    2004-11-01

    Art, dance, and music therapy are a significant part of complementary medicine in the twenty-first century. These creative arts therapies contribute to all areas of health care and are present in treatments for most psychologic and physiologic illnesses. Although the current body of solid research is small compared with that of more traditional medical specialties, the arts therapies are now validating their research through more controlled experimental and descriptive studies. The arts therapies also contribute significantly to the humanization and comfort of modern health care institutions by relieving stress, anxiety, and pain of patients and caregivers. Arts therapies will greatly expand their role in the health care practices of this country in the twenty-first century.

  19. The role of technology in reducing health care costs. Final project report

    Energy Technology Data Exchange (ETDEWEB)

    Sill, A.E.; Warren, S.; Dillinger, J.D.; Cloer, B.K.

    1997-08-01

    Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. This study was conducted by implementing both top-down and bottom-up strategies. The top-down approach used prosperity gaming methodology to identify future health care delivery needs. This effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements. The bottom-up approach identified and ranked interventional therapies employed in existing care delivery systems for a host of health-related conditions. Economic analysis formed the basis for development of care pathway interaction models for two of the most pervasive, chronic disease/disability conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Societal cost-benefit relationships based on these analyses were used to evaluate the effect of emerging technology in these treatment areas. 17 figs., 48 tabs.

  20. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals’ challenges

    Science.gov (United States)

    2018-01-01

    Background The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children. Aim To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics. Setting The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa. Methodology The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell’s data analysis spiral. We used Lincoln and Guba’s model to ensure trustworthiness. Ethical standards were applied. Results Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level. Conclusion Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level. PMID:29781680

  1. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals' challenges.

    Science.gov (United States)

    Williams, Margaret; Van Rooyen, Dalena R M; Ricks, Esmeralda J

    2018-03-12

     The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children.  To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics.  The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa.  The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell's data analysis spiral. We used Lincoln and Guba's model to ensure trustworthiness. Ethical standards were applied.  Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level.  Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

  2. Experience in health care organization for victims of Chernobyl accident under conditions of spatial hospitals

    International Nuclear Information System (INIS)

    Nadezhina, N.M.

    1990-01-01

    Experience in organization of health care for victims of Chernobyl accidents under conditions of spatial hospitals are discussed taking into account patients with residual contamination of skin and clothe. A necessity of well-adjusted organization activites, including an inpatient clinic with well-equipped reception, dosimetric, haryological and bacteriological laboratories, an intensive care department, a surgical (burn) department, a blood transfusion laboratory and equipment for plasmopheresis and hemosorption is marked. Therapy of such patients should be developed along the following lines: 1) prevention and therapy of infectious complications; 2) blood cell substitution therapy; 3) bone marrow transplantation; 4) detoxicating therapy; 5) correction of water-electrolyte metabolism; 6) therapy of local radiation injuries

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

    Science.gov (United States)

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

    2017-01-01

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

  4. Health care professionals' familiarity with non-pharmacological strategies for managing cancer pain.

    Science.gov (United States)

    Zaza, C; Sellick, S M; Willan, A; Reyno, L; Browman, G P

    1999-01-01

    Many studies have confirmed unnecessary suffering among cancer patients, due to the inadequate use of analgesic medication and other effective interventions. While pharmacological treatments are appropriately the central component of cancer pain management, the under-utilization of effective nonpharmacological strategies (NPS) may contribute to the problem of pain and suffering among cancer patients. The purpose of this study was to determine health care professionals' familiarity with, and perceptions regarding, NPS for managing cancer pain, and to assess their interest in learning more about NPS as adjuncts to pharmacological analgesics. Two-hundred and fourteen health care professionals were surveyed at two cancer treatment centres in Ontario, Canada. The self-report questionnaire included questions regarding 11 psychological strategies (e.g. imagery) and eight other NPS (e.g. acupuncture). The response rate was 67% (141/214). Subjects were found to be the least familiar with autogenic training, operant conditioning, and cognitive therapy. Other than radiation and surgery, subjects most commonly reported recommending support groups (67%), imagery (54%), music or art therapy (49%) and meditation (43%) for managing cancer pain. Participants were most interested in learning more about acupuncture, massage therapy, therapeutic touch, hypnosis, and biofeedback. Participants were somewhat familiar with most of the 19 NPS presented; however, they use or recommend few NPS for managing cancer pain. Health professionals' interest in NPS has important implications for the supportive care of cancer patients.

  5. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial.

    Science.gov (United States)

    Tyrer, Peter; Cooper, Sylvia; Salkovskis, Paul; Tyrer, Helen; Crawford, Michael; Byford, Sarah; Dupont, Simon; Finnis, Sarah; Green, John; McLaren, Elenor; Murphy, David; Reid, Steven; Smith, Georgina; Wang, Duolao; Warwick, Hilary; Petkova, Hristina; Barrett, Barbara

    2014-01-18

    Health anxiety has been treated by therapists expert in cognitive behaviour therapy with some specific benefit in some patients referred to psychological services. Those in hospital care have been less often investigated. Following a pilot trial suggesting efficacy we carried out a randomised study in hospital medical clinics. We undertook a multicentre, randomised trial on health anxious patients attending cardiac, endocrine, gastroenterological, neurological, and respiratory medicine clinics in secondary care. We included those aged 16-75 years, who satisfied the criteria for excessive health anxiety, and were resident in the area covered by the hospital, were not under investigation for new pathology or too medically unwell to take part. We used a computer-generated random scheme to allocate eligible medical patients to an active treatment group of five-to-ten sessions of adapted cognitive behaviour therapy (CBT-HA group) delivered by hospital-based therapists or to standard care in the clinics. The primary outcome was change in health anxiety symptoms measured by the Health Anxiety Inventory at 1 year and the main secondary hypothesis was equivalence of total health and social care costs over 2 years, with an equivalence margin of £150. Analysis was by intention to treat. The study is registered with controlled-trials.com, ISRCTN14565822. Of 28,991 patients screened, 444 were randomly assigned to receive either adapted cognitive behaviour therapy (CBT-HA group, 219 participants) or standard care (standard care group, 225), with 205 participants in the CBT-HA group and 212 in the standard care group included in the analyses of the primary endpoints. At 1 year, improvement in health anxiety in the patients in the CBT-HA group was 2·98 points greater than in those in the standard care group (95% CI 1·64-4·33, pbehaviour therapy achieved normal levels of health anxiety compared with those in the control group (13·9% vs 7·3%; odds ratio 2·15, 95% CI 1·09-4

  6. 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.

  7. Wound care matrices for chronic leg ulcers: role in therapy

    Directory of Open Access Journals (Sweden)

    Sano H

    2015-07-01

    Full Text Available Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed “extracellular matrix replacement therapies”. The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use

  8. Health care operations management

    NARCIS (Netherlands)

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

    2012-01-01

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

  9. Psychological therapy for inpatients receiving acute mental health care: A systematic review and meta-analysis of controlled trials.

    Science.gov (United States)

    Paterson, Charlotte; Karatzias, Thanos; Dickson, Adele; Harper, Sean; Dougall, Nadine; Hutton, Paul

    2018-04-16

    The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates. A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms 'inpatient', 'psychological therapy', and 'acute'. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses. Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant. The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and

  10. Digital Mental Health - Innovations in Consumer Driven Care.

    Science.gov (United States)

    Ackerman, Mary Lou; Virani, Tazim; Billings, Barry

    2017-01-01

    Barriers such as stigma and access issues prevent 60% of Canadians with mental health issues from seeking help. Saint Elizabeth Health Care's IntelligentCare™ Platform supports a range of digital health solutions for holistic health including three specific innovations: a secure social networking tool, an artificial intelligence-driven assistant that uses conversational cognitive behaviour therapy techniques, and a mobile mindfulness meditation application that generates personalized meditation suggestions. People use these self-help tools to cope with their mental health challenges. Healthcare providers are encouraged to explore the benefits and drawbacks of digital solutions for mental health, and consider the new skills, ethical implications and research opportunities that are needed when supporting patients who use these digital tools. © 2017 Longwoods Publishing.

  11. Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

    Science.gov (United States)

    Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

    2017-07-21

    Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and

  12. [Models of care and classification of "Children with special health care needs-CSHCN": Recommendations from the CSHCN Committee, Chilean Paediatric Society].

    Science.gov (United States)

    Flores Cano, Juan Carlos; Lizama Calvo, Macarena; Rodríguez Zamora, Natalie; Ávalos Anguita, María Eugenia; Galanti De La Paz, Mónica; Barja Yañez, Salesa; Becerra Flores, Carlos; Sanhueza Sepúlveda, Carolina; Cabezas Tamayo, Ana María; Orellana Welch, Jorge; Zillmann Geerdts, Gisela; Antilef, Rosa María; Cox Melane, Alfonso; Valle Maluenda, Marcelo; Vargas Catalán, Nelson

    2016-01-01

    "Children with special health care needs" (CSHCN) is an emerging and heterogeneous group of paediatric patients, with a wide variety of medical conditions and with different uses of health care services. There is consensus on how to classify and assess these patients according to their needs, but not for their specific diagnosis. Needs are classified into 6 areas: a) specialised medical care; b) use or need of prescription medication; c) special nutrition; d) dependence on technology; e) rehabilitation therapy for functional limitation; and f) special education services. From the evaluation of each area, a classification for CSHCN is proposed according to low, medium, or high complexity health needs, to guide and distribute their care at an appropriate level of the health care system. Low complexity CSHCN should be incorporated into Primary Care services, to improve benefits for patients and families at this level. It is critical to train health care professionals in taking care of CSHCN, promoting a coordinated, dynamic and communicated work between different levels of the health care system. Compliance with these guidelines will achieve a high quality and integrated care for this vulnerable group of children. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Health care use of patients with osteoarthritis of the hip or knee after implementation of a stepped-care strategy: an observational study.

    Science.gov (United States)

    Smink, Agnes J; Dekker, Joost; Vliet Vlieland, Thea P M; Swierstra, Bart A; Kortland, Joke H; Bijlsma, Johannes W J; Teerenstra, Steven; Voorn, Theo B; Bierma-Zeinstra, Sita M A; Schers, Henk J; van den Ende, Cornelia H M

    2014-06-01

    To enhance guideline-based nonsurgical management of osteoarthritis (OA), a multidisciplinary stepped-care strategy has been implemented in clinical practice. This study aimed to describe health care use after implementation of this strategy and to identify factors related to such use at multiple levels. For this 2-year observational prospective cohort, patients with symptomatic hip or knee OA were included by their general practitioner. Activities aligned with patients and health care providers were executed to implement the strategy. Health care use was described as the cumulative percentage of "users" for each modality recommended in the strategy. Determinants were identified at the level of the patient, general practitioner, and practice using backward stepwise logistic multilevel regression models. Three hundred thirteen patients were included by 70 general practitioners of 38 practices. Their mean ± SD age was 64 ± 10 years and 120 (38%) were men. The most frequently used modalities were education, acetaminophen, lifestyle advice, and exercise therapy, which were used by 242 (82%), 250 (83%), 214 (73%), and 187 (63%) patients, respectively. Fourteen percent of the overweight patients reported being treated by a dietician. Being female, having an active coping style, using the booklet "Care for Osteoarthritis," and having limitations in functioning were recurrently identified as determinants of health care use. After implementation of the stepped-care strategy, most recommended nonsurgical modalities seem to be well used. Health care could be further improved by providing dietary therapy in overweight patients and making more efforts to encourage patients with a passive coping style to use nonsurgical modalities. Copyright © 2014 by the American College of Rheumatology.

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

    Science.gov (United States)

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

    2018-02-01

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

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

    Science.gov (United States)

    Blue, Christine; Riggs, Sheila

    2016-06-01

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

  16. Health Care Delivery.

    Science.gov (United States)

    Starfield, Barbara

    1987-01-01

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

  17. Gender and Sexual Health: Care of Transgender Patients.

    Science.gov (United States)

    Hayon, Ronni

    2016-10-01

    Transgender and gender-nonconforming individuals experience significant health disparities. They are more likely to use drugs and alcohol, smoke, be diagnosed with HIV infection or other sexually transmitted infections, and experience depression or attempt suicide. Many also experience discrimination within the health care system. Office-level strategies to create a safe and affirming space for gender-expansive patients include posting of a nondiscrimination statement, use of intake forms that ask about current gender identity and birth-assigned sex, provision of gender-neutral restrooms, and staff training in use of appropriate language. Hormone or surgical therapy can be initiated for patients with persistent gender dysphoria who are of age and have the capacity to make informed decisions, and have reasonable control of coexisting medical and psychiatric conditions. Estrogens, antiandrogens, and progestins are used for feminization, and testosterone for masculinization. Hormone treatment should be followed by careful monitoring for potential adverse effects. Surgical options include male-to-female and female-to-male procedures. The family physician may need to provide a referral letter, preoperative and postoperative examinations and care, and advocacy with health insurance providers. Preventive care for transgender patients includes counseling for cardiovascular health, cancer screening, provision of appropriate contraception, and screening for sexually transmitted infections. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

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

    Science.gov (United States)

    Dwinnells, Ronald; Misik, Lauren

    2017-10-01

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

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

    Science.gov (United States)

    2011-01-01

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

  20. Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs

    OpenAIRE

    Fries, Kathleen S; Bowers, Donna M; Gross, Margo; Frost, Lenore

    2013-01-01

    Kathleen S Fries,1 Donna M Bowers,2 Margo Gross,3 Lenore Frost31Nursing Program, 2Department of Physical Therapy and Human Movement Science, 3Graduate Program in Occupational Therapy, College of Health Professions, Sacred Heart University, Fairfield, CT, USAIntroduction: Interprofessional collaboration among health care professionals yields improved patient outcomes, yet many students in health care programs have limited exposure to interprofessional collaboration in the classroom and in clin...

  1. How can eHealth enhance adherence to cancer therapy and supportive care?

    Directory of Open Access Journals (Sweden)

    Bateman Emma H.

    2016-01-01

    Full Text Available eHealth is currently a hot topic, but is certainly not a new one. The use of communications technology to relay health-related information or provide medical services has been around since the advent of this technology. It has been primarily over the last decade that eHealth has seen a global expansion, due to the far-reaching capabilities of the Internet and the widespread use of wireless technology. This paper will outline what eHealth is, what adherence is, and how eHealth can help with adherence, in cancer and supportive care particularly. It will discuss the current state of the art, and project into the future.

  2. Health Care Seeking Behavior among Caregivers of Sick Children Who Had Cerebral Malaria in Northwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Edwin E. Eseigbe

    2012-01-01

    Full Text Available Cerebral malaria is a significant cause of childhood morbidity in our region. The challenges of effective management include time and quality of treatment. The study appraised the health care seeking behavior of caregivers of sick children who developed cerebral malaria, in Zaria, northwestern Nigeria. Caregivers indentified were parents 29 (87.9% and grandparents 4 (12.1%. Most of them were in the upper social classes. Health care options utilized before presentation at our facility were formal health facility 24 (72.7%, patent medicine seller 12 (36.4%, home treatment 10 (30.3%, and herbal concoction 6 (18.2% with majority 24 (72.7% using more than one option. Antimalarial therapy was instituted in 25 (75.6% of the cases. Mortality was significantly associated with the use of herbal concoction, treatment at a formal health facility and patent medicine seller, multiple convulsions, age less than 5 years, and noninstitution of antimalarial therapy before presentation. The study showed use of inappropriate health care options by caregivers and highlighted the need to pursue an awareness drive among caregivers on the use of health care options.

  3. [Health care networks].

    Science.gov (United States)

    Mendes, Eugênio Vilaça

    2010-08-01

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

  4. Do unmet needs differ geographically for children with special health care needs?

    Science.gov (United States)

    Fulda, Kimberly G; Johnson, Katandria L; Hahn, Kristen; Lykens, Kristine

    2013-04-01

    The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

  5. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  6. Attitudes and preferences on the use of mobile health technology and health games for self-management: interviews with older adults on anticoagulation therapy.

    Science.gov (United States)

    Lee, Jung-Ah; Nguyen, Annie Lu; Berg, Jill; Amin, Alpesh; Bachman, Mark; Guo, Yuqing; Evangelista, Lorraine

    2014-07-23

    Older adults are at substantial risk for cardiovascular disorders that may require anticoagulation therapy. Those on warfarin therapy report dissatisfaction and reduced quality of life (QOL) resulting from the treatment. Advances in the area of mobile health (mHealth) technology have resulted in the design and development of new patient-centric models for the provision of personalized health care services to improve care delivery. However, there is a paucity of research examining the effectiveness of mHealth tools on knowledge, attitudes, and patient satisfaction with treatment, as well as self-management, adherence to therapy, and QOL in older adults with chronic illness conditions requiring long-term warfarin therapy. The objective of the study was to explore the attitudes and preferences of older adults on warfarin therapy regarding the use of mHealth technology and health games to gain skills for self-management. We conducted group and individual interviews with patients (60 years or older) on warfarin therapy at two anticoagulation clinics affiliated with an academic medical center. We held 4 group and 2 individual interviews, resulting in 11 patient participants and 2 family caregiver participants. We used structured questions on three topic areas including medication self-management strategies, mHealth technology use, and health games for exercise. We demonstrated some commercial health apps related to medication management, vitamin K content of food, and a videogame for balance exercise. Discussions were audiotaped and transcribed verbatim. Common themes were drawn using content analysis. The participants reported awareness of the importance of staying on schedule with warfarin therapy. They also acknowledged that negative experiences of friends or family members who were taking warfarin influenced their desire to keep on schedule with warfarin therapy. In addition, the participants expressed that the use of mHealth technology may be helpful for medication

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

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

  8. Ethnic minority youth in youth mental health care : utilization and dropout

    NARCIS (Netherlands)

    Haan, Anna Marte de

    2014-01-01

    This thesis focuses on differences between ethnic groups in youth mental health care (YMHC). Three subjects are elaborated: utilization of YMHC, given diagnoses in YMHC, and premature termination (dropout) of therapy in YMHC. The utilization of YMHC services is unequally distributed over different

  9. Gender Disparities in Osteoarthritis-Related Health Care Utilization Before Total Knee Arthroplasty.

    Science.gov (United States)

    Bawa, Harpreet S; Weick, Jack W; Dirschl, Douglas R

    2016-10-01

    Women older than 50 years have higher prevalence of knee osteoarthritis (OA) and experience greater functional disability than men. No studies have examined large populations to identify knee OA-related health care utilization differences. The purpose of this investigation was to evaluate gender differences in the utilization of OA-related health care resources in the 12 months preceding total knee arthroplasty (TKA). Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefit databases were reviewed from 2005 to 2012. Subjects were included if they underwent TKA, had associated diagnosis of lower leg OA, and were continuously in the database for 12 months preceding TKA. Patient-specific OA-related health care utilization was identified. Multivariate logistic regression analysis controlling for age, region, and Charlson Comorbidity Index was performed to isolate the influence of gender. A total of 244,059 patients with a mean age of 64.8 years consisting of 61.2% women were included. Multivariate logistic regression adjusted odds ratios showed that when compared to men, women were 30%, 20%, 31%, 18%, 19%, 29%, and 39%, more likely to receive a narcotic analgesic, nonnarcotic analgesics, corticosteroid injection, hyaluronic acid injection, knee magnetic resonance imaging, a physical therapy evaluation, and occupational therapy evaluation in the 12 months preceding TKA, respectively. Women have a significantly higher utilization of knee OA-related health care in the 12 months preceding TKA. Although the precise cause for this discrepancy in care cannot be determined from this study, it highlights a potential bias in management of advanced knee OA and directions for further investigation. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Experiences of community health agents in the care of the elderly affected by chronic diseases

    Directory of Open Access Journals (Sweden)

    Marinês Tambara Leite

    2016-01-01

    Full Text Available Objective: to understand which are the experiences of community health agents in the care of patients with chronic diseases. Methods: qualitative research carried out through the interview of 20 community health agents. Data were analyzed following the steps of content analysis. Results: the care for the elderly has limitations due to their low educational level, resistance to adhere to drug therapy and low frequency of visits to health facilities. Another reason is the aging process in itself that may compromise the ability of self-care and the development of daily activities. Conclusion: difficulties of community health agents were identified in the care of elderly people with chronic diseases due to low adherence to treatment and to the health service.

  11. Green Care: a Conceptual Framework. A Report of the Working Group on the Health Benefits of Green Care

    OpenAIRE

    Berget, B.; Braastad, B.; Burls, A.; Elings, M.; Hadden, Y.; Haigh, R.; Hassink, J.; Haubenhofer, D.K.

    2010-01-01

    ‘Green Care’ is a range of activities that promotes physical and mental health and well-being through contact with nature. It utilises farms, gardens and other outdoor spaces as a therapeutic intervention for vulnerable adults and children. Green care includes care farming, therapeutic horticulture, animal assisted therapy and other nature-based approaches. These are now the subject of investigation by researchers from many different countries across the world.

  12. Massage therapy for home care patients using the health insurance system in Japan.

    Science.gov (United States)

    Kondo, H; Ogawa, S; Nishimura, H; Ono, A

    2018-02-01

    To clarify the status of home care massage services provided to patients. This will help in understanding how many patients utilize this service and the circumstances under which treatment is provided. A retrospective study. Fifty-four acupuncture, moxibustion, and massage clinics. Participants were patients who had received home care massage for six months or more. We collected a total of 1587 responses from these 54 massage clinics; of these, 1415 responses (mean age = 79.1 ± 11.5 years) were valid (valid response rate 89.2%). Actual patients and actual care services. The most common disorder observed among patients who utilized home care massage services was cerebrovascular disease (at approximately 36%), while the second most common were arthropathy-related disorders (16.3%). Although most patients received massage, approximately 30% received manual therapy (e.g. manual correction) and hot fomentation as part of thermotherapy. Notably, only around 10% of patients received massage alone; the majority received treatment in combination with range of motion and muscle-strengthening exercises. This study helped to clarify the actual state of patients receiving home care massage and the details of the massage services provided. This study clearly showed the treatment effectiveness of massage, which can be used by home medical care stakeholders to develop more effective interventions. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Frank, S R

    2000-04-01

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

  14. The effects of massage therapy on pain management in the acute care setting.

    Science.gov (United States)

    Adams, Rose; White, Barb; Beckett, Cynthia

    2010-03-17

    Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona-a nonprofit community hospital serving a large rural area of northern Arizona. A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 - 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t(52) = 12.43, r = .67, d = 1.38, p massage therapy into the acute care setting creates overall positive results in the patient's ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process.

  15. Consumer Directed Health Care

    OpenAIRE

    John Goodman

    2006-01-01

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

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

    Science.gov (United States)

    Mitchell, Penny

    2009-02-01

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

  17. Operations management in health care.

    Science.gov (United States)

    Henderson, M D

    1995-01-01

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

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

    Science.gov (United States)

    Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

    2011-01-01

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

  19. Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial

    Directory of Open Access Journals (Sweden)

    Severens Johan L

    2008-06-01

    Full Text Available Abstract Background Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost- effectiveness of online computerised cognitive behavioural therapy for depression in primary care. Methods/Design In a randomised trial we will compare (a computerised cognitive behavioural therapy with (b treatment as usual by a GP, and (c computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65 will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000. Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life

  20. Evidence-based practice in women's health: hormone therapy for women at menopause.

    Science.gov (United States)

    Rousseau, M E

    2001-01-01

    Women's health providers, especially midwives, must take into account the known benefits and risks, as well as the "unknown," when recommending the use of hormone therapy for menopausal women, especially as it relates to heart disease, breast cancer, impaired cognition, and osteoporosis. The most recent evidence available from various studies about the benefits and risks of estrogen and hormone therapy at menopause suggests that, although hormone therapy may be protective in some women against heart disease and osteoporosis, evidence is less certain about the benefits of hormone protection against impaired cognition and the risks of breast cancer with use. The clinical approach used by midwives in which individualizing care based on each woman's health status history as well as preferences is highly appropriate for women in the perimenopausal and menopausal period.

  1. Multidisciplinary perspectives of music therapy in adult palliative care.

    Science.gov (United States)

    O'Kelly, Julian; Koffman, Jonathan

    2007-04-01

    Music therapy aims to provide holistic support to individuals through the sensitive use of music by trained clinicians. A recent growth in music therapy posts in UK palliative care units has occurred despite a paucity of rigorous research. To explore the role of music therapy within multidisciplinary palliative care teams, and guide the future development of the discipline. In-depth qualitative interviews with 20 multidisciplinary colleagues of music therapists, based in five UK hospices. Analysis of interview material revealed a number of themes relevant to the study aims. Music therapy was valued by most interviewees; however there exists some lack of understanding of the role of the music therapist, particularly amongst nurses. Emotional, physical, social, environmental, creative and spiritual benefits of music therapy were described, with some benefits perceived as synergistic, arising from collaborations with other disciplines. Interviewees found experiencing or witnessing music therapy is effective in developing an understanding of the discipline. Music therapy is an appropriate therapeutic intervention for meeting the holistic needs of palliative care service users. More understanding and integration of music therapy could be encouraged with collaborative work, educational workshops, and the utilization of environmentally focused techniques. The study merits further research to explore and develop these findings.

  2. An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

    Science.gov (United States)

    Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

    2017-07-11

    proportional (non dominance), whereas the distribution of oxytocics, anti-retroviral therapy (ART) and anti-hypertensive drugs was pro-rich, with the 45 degree line dominating the concentration curve for ART. This study has shown there are inequities in the distribution of health care inputs across public primary care facilities. This highlights the need to ensure a better coordinated and equitable distribution of inputs through regular monitoring of the availability of health care inputs and strengthening of reporting systems.

  3. Resilient health care

    DEFF Research Database (Denmark)

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

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

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

    DEFF Research Database (Denmark)

    Daysal, N. Meltem; Orsini, Chiara

    2015-01-01

    We examine how new medical information on drug safety impacts preventive health care use. We exploit the release of the findings of the Women’s Health Initiative Study (WHIS) – the largest randomized controlled trial of women’s health – which demonstrated in 2002 the health risks associated...... with the long-term use of hormone replacement therapy (HRT). We first show that, after the release of the WHIS findings, HRT use dropped sharply among post-menopausal women. We then estimate the spillover effects of the WHIS findings on preventive care by means of a difference-in-differences methodology...... comparing changes in preventive care use among 60 to 69 year-old women (who have high rates of HRT use) with the change among women aged 75 and above (who have much lower rates of HRT use). Using data from the Behavioral Risk Factor Surveillance System for the period 1998–2007, we find that women aged 60...

  5. Electroconvulsive therapy: Promoting awareness among primary care physicians.

    Science.gov (United States)

    Sicher, Sarah; Gedzior, Joanna

    2016-04-01

    This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers. © The Author(s) 2016.

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

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

    2013-01-01

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

  8. CAM therapies among primary care patients using opioid therapy for chronic pain

    Directory of Open Access Journals (Sweden)

    Mundt Marlon P

    2007-05-01

    Full Text Available Abstract Background Complementary and alternative medicine (CAM is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. Method A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. Results Patients were treated for a variety of pain problems including low back pain (38.4%, headaches (9.9%, and knee pain (6.5%; the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248, chiropractic treatment (17.8%, n = 162, acupuncture (7.6%, n = 69, yoga (6.1%, n = 55, herbs and supplements (6.8%, n = 62, and prolotherapy (5.9%, n = 54. CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8% and prolotherapy (87.7%, whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. Conclusion This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied.

  9. CAM therapies among primary care patients using opioid therapy for chronic pain.

    Science.gov (United States)

    Fleming, Sara; Rabago, David P; Mundt, Marlon P; Fleming, Michael F

    2007-05-16

    Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. Patients were treated for a variety of pain problems including low back pain (38.4%), headaches (9.9%), and knee pain (6.5%); the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248), chiropractic treatment (17.8%, n = 162), acupuncture (7.6%, n = 69), yoga (6.1%, n = 55), herbs and supplements (6.8%, n = 62), and prolotherapy (5.9%, n = 54). CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8%) and prolotherapy (87.7%), whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied.

  10. Health care in the Netherlands.

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    Science.gov (United States)

    Sorrell, Jeanne M

    2009-01-01

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

  12. Review of occupational exposure patterns in Indian Health Care Facilities

    International Nuclear Information System (INIS)

    Senthilkumar, M.; Nehru, R.M.; Sonawane, A.U.

    2016-01-01

    Monitoring of individual radiation is a prime part of the radiation protection programme. The primary justification for monitoring helps achieve and demonstrate an appropriate level of protection and can demonstrate compliance with regulatory requirements, contribute to the control of operations and design of installations. Atomic Energy (Radiation Protection) Rules 2004 advocates that radiation surveillance is mandatory for all radiation workers. The largest group of individuals exposed occupationally to artificial radiation sources is that employed in health care facilities such as Diagnostic Radiology, Radiation Therapy and Nuclear Medicine. In this work, a comprehensive analysis was carried out on occupational exposure data for the period 2000 to 2014 to bring a measure of radiation protection infrastructure quality in health care facilities

  13. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Scott, Michael T. [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (United States); Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States)

    2016-10-01

    Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P<.0001). With a >16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation

  14. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.

    Science.gov (United States)

    Scott, Michael T; Todd, Kimberly E; Oakley, Heather; Bradley, Julie A; Rotondo, Ronny L; Morris, Christopher G; Klein, Stuart; Mendenhall, Nancy P; Indelicato, Daniel J

    2016-10-01

    To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of "$[(anesthesia cost to payer during radiation therapy course/6) - (CCLS expense to payer/N)]" per child (N) treated with radiation therapy, where N equals the number of children aged 3 to 12

  15. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

    International Nuclear Information System (INIS)

    Scott, Michael T.; Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P.; Indelicato, Daniel J.

    2016-01-01

    Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P 16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation therapy, where N

  16. Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting.

    Science.gov (United States)

    Suzuki, Cibele; Lopes da Silva, Nilceia; Kumar, Praveen; Pathak, Purnima; Ong, Siew Hwa

    2017-08-01

    Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross

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

    Science.gov (United States)

    Rahmani, Zuhal; Brekke, Mette

    2013-05-06

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

  18. HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C.

    LENUS (Irish Health Repository)

    Flint, S R

    2011-04-01

    This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

  19. Improving eye care in the primary health care setting

    Directory of Open Access Journals (Sweden)

    M de Wet

    2000-09-01

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

  20. The therapeutic relationship in e-therapy for mental health: a systematic review.

    Science.gov (United States)

    Sucala, Madalina; Schnur, Julie B; Constantino, Michael J; Miller, Sarah J; Brackman, Emily H; Montgomery, Guy H

    2012-08-02

    E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Our objective in this study was to systematically review the therapeutic relationship in e-therapy. We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance-a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

  1. Respiratory Home Health Care

    Science.gov (United States)

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

  2. Out-of-Pocket and Health Care Spending Changes for Patients Using Orally Administered Anticancer Therapy After Adoption of State Parity Laws.

    Science.gov (United States)

    Dusetzina, Stacie B; Huskamp, Haiden A; Winn, Aaron N; Basch, Ethan; Keating, Nancy L

    2017-11-09

    proportion of prescription fills for orally administered therapy without copayment increased from 15.0% to 53.0%, more than double the increase (12.3%-18.0%) in plans not subject to parity (P < .001). The proportion of patients with out-of-pocket spending of more than $100 per month increased from 8.4% to 11.1% compared with a slight decline from 12.0% to 11.7% in plans not subject to parity (P = .004). In plans subject to parity laws, estimated monthly out-of-pocket spending decreased by $19.44 at the 25th percentile, by $32.13 at the 50th percentile, and by $10.83 at the 75th percentile but increased at the 90th ($37.19) and 95th ($143.25) percentiles after parity (all P < .001, controlling for changes in plans not subject to parity). Parity laws did not increase 6-month total spending for users of any anticancer therapy or for users of oral anticancer therapy alone. While oral chemotherapy parity laws modestly improved financial protection for many patients without increasing total health care spending, these laws alone may be insufficient to ensure that patients are protected from high out-of-pocket medication costs.

  3. Marketing health care to employees: the structure of employee health care plan satisfaction.

    Science.gov (United States)

    Mascarenhas, O A

    1993-01-01

    Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing.

  4. 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.

  5. The effect of horticultural therapy on the quality of life of palliative care patients.

    Science.gov (United States)

    Lai, Claudia Kam-Yuk; Lau, Carmen Ka-Yan; Kan, Wai Yin; Lam, Wai Man; Fung, Connie Yuen Yee

    2017-01-01

    Palliative care patients experience a variety of needs and perceive their quality of life as being only fair. This study adopted a single-group repeated-measure design to investigate the effect of horticultural therapy on the quality of life of palliative care patients using the Quality of Life Concern in End of Life Questionnaire. Significant differences in the domains of "existential distress" and "health care concern" were observed immediately postintervention and at 4 weeks postintervention, respectively. No other significant differences were seen in the other domains or in the total mean score of the outcome measure.

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

    Science.gov (United States)

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

    2016-02-01

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

  7. Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases.

    Science.gov (United States)

    Heins, Marianne J; Korevaar, Joke C; Hopman, Petra E P C; Donker, Gé A; Schellevis, François G; Rijken, Mieke P M

    2016-03-15

    The number of cancer survivors is steadily increasing and these patients often experience long-lasting health problems. To make care for cancer survivors sustainable for the future, it would be relevant to put the effects of cancer in this phase into perspective. Therefore, the authors compared health-related quality of life (HRQOL) and health care use among cancer survivors with that of patients with chronic diseases. Patients diagnosed at age >18 years with a cancer with a 5-year survival rate > 20% and no distant metastases at the time of diagnosis and patients aged >18 years with physician-diagnosed somatic chronic diseases without cancer were sent a questionnaire. HRQOL was measured with the RAND-36, a measure of HRQOL. Self-reported health care use was measured for general practitioner care, specialist care, rehabilitative care, physical therapy, ambulatory mental health care, and occupational health care. A total of 601 cancer survivors and 1052 patients with chronic diseases without cancer were included in the current study. Multimorbidity was observed in 63% of the cancer survivors and 61% of the patients with chronic diseases. The HRQOL of the cancer survivors was significantly better than that of patients with chronic diseases after adjustment for age and sex. For the mental functioning subscale, no significant differences were found between the 2 groups. Cancer survivors were found to be less likely to have visited a general practitioner or cardiologist compared with patients with chronic diseases. When considering physical HRQOL and health care use, cancer survivors appear to fare better than the average patient with chronic diseases. No difference in mental functioning was observed in the current study. © 2016 American Cancer Society.

  8. Music as a health promoting agent in dementia care. Results from a Norwegian/Danish context

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Stige, Brynjulf

    and how music is implemented in activities and daily care as well as in music therapy sessions. Results The various perspectives on music as a health promoting agent in dementia care are documented in the Norwegian/Danish book Musikkterapi og Eldrehelse (Music therapy and elderly health) published in June......Introduction According to The United Nations Principles, older persons should have access to cultural and recreational resources of society. Musical memory is remarkably well-maintained despite loss of other cognitive functions in dementia, and the use of music activities, caregiver singing, social...... dancing and music listening with iPods is increasingly implemented. Therefore, it is important to consider why and how music as a cultural and recreational resource is integrated in dementia care. Methods In the period from 2008-20014 the University of Bergen coordinated a collaborative network...

  9. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  10. Improving Pain Care with Project ECHO in Community Health Centers.

    Science.gov (United States)

    Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas

    2017-10-01

    Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.

  11. Integrating Community Health Workers (CHWs) into Health Care Organizations.

    Science.gov (United States)

    Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam

    2017-10-01

    Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.

  12. Toward a Broader Role for Occupational Therapy in Supportive Oncology Care.

    Science.gov (United States)

    Sleight, Alix G; Duker, Leah I Stein

    2016-01-01

    Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. Copyright © 2016 by the American Occupational Therapy Association, Inc.

  13. Health care employee perceptions of patient-centered care.

    Science.gov (United States)

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

    2015-03-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

  14. Well-Being Therapy in Dutch mental health care

    NARCIS (Netherlands)

    Meulenbeek, Petrus Antonius Maria

    2017-01-01

    Relapse after treatment of mental disorders is a major problem. Enhancing psychological well-being and resilience may reduce the risk of relapse in patients with mental disorders. Well-being therapy tries to address these factors. The original model of well-being therapy was developed by the Italian

  15. Alternative health care consultations in Ontario, Canada: A geographic and socio-demographic analysis

    Directory of Open Access Journals (Sweden)

    Eby Jeanette

    2011-06-01

    Full Text Available Abstract Background An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province. Methods Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005 for people aged 18 or over (n = 32,598 who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1 all consultations (2 massage therapy (3 acupuncture, and (4 homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use. Results In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met. Conclusions The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to

  16. Controversies in faith and health care.

    Science.gov (United States)

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

    2015-10-31

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

  17. 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

  18. Mapping the route to medication therapy management documentation and billing standardization and interoperabilility within the health care system: meeting proceedings.

    Science.gov (United States)

    Millonig, Marsha K

    2009-01-01

    To convene a diverse group of stakeholders to discuss medication therapy management (MTM) documentation and billing standardization and its interoperability within the health care system. More than 70 stakeholders from pharmacy, health information systems, insurers/payers, quality, and standard-setting organizations met on October 7-8, 2008, in Bethesda, MD. The American Pharmacists Association (APhA) organized the invitational conference to facilitate discussion on strategic directions for meeting current market need for MTM documentation and billing interoperability and future market needs for MTM integration into electronic health records (EHRs). APhA recently adopted policy that specifically addresses technology barriers and encourages the use and development of standardized systems for the documentation and billing of MTM services. Day 1 of the conference featured six foundational presentations on health information technology (HIT) trends, perspectives on MTM from the profession and the Centers for Medicare & Medicaid Services, health care quality and medication-related outcome measures, integrating MTM workflow in EHRs, and the current state of MTM operalization in practice. After hearing presentations on day 1 and having the opportunity to pose questions to each speaker, conference participants were divided into three breakout groups on day 2. Each group met three times for 60 minutes each and discussed five questions from the perspective of a patient, provider, or payer. Three facilitators met with each of the groups and led discussion from one perspective (i.e., patient, provider, payer). Participants then reconvened as a complete group to participate in a discussion on next steps. HIT is expected to assist in delivering safe, effective, efficient, coordinated care as health professionals strive to improve the quality of care and outcomes for individual patients. The pharmacy profession is actively contributing to quality patient care through MTM services

  19. A Comparison of Health Care Resource Utilization and Costs for Patients with Allergic Rhinitis on Single-Product or Free-Combination Therapy of Intranasal Steroids and Intranasal Antihistamines.

    Science.gov (United States)

    Harrow, Brooke; Sedaghat, Ahmad R; Caldwell-Tarr, Amanda; Dufour, Robert

    2016-12-01

    Allergic rhinitis (AR) is a common condition that can be treated with a number of different therapies. Treatments such as intranasal antihistamines (INAs) and intranasal steroids (INSs) are widely used by AR patients. For some allergy sufferers, a combination of therapies, specifically an INA and an INS, is required to address their symptoms. A new treatment, the formulation of azelastine hydrochloride and fluticasone pro-pionate used as a single spray (MP-AzeFlu), has become available for AR patients who need both types of treatment. In this regard, the comparison with the alternative concomitant use of INAs and INSs is of interest. The current study examines the health care resource utilization and costs for each cohort. To examine the resource utilization and costs associated with AR for patients treated with MP-AzeFlu or concurrent therapy with single-ingredient INA and INS sprays (free-combination therapy). A retrospective administrative claims study for commercially insured patients from a large U.S. health plan was performed. Patients with an AR diagnosis and a prescription claim for MP-AzeFlu or free-combination therapy between September 1, 2012, and September 30, 2013, were identified. Patients were aged at least 12 years at index date (first prescription fill for intranasal therapy) and were required to have 12 months pre-index and 6 months post-index of continuous enrollment. Health care resource utilization and costs were assessed for the post-index period. The cohorts were adjusted on baseline demographic and clinical characteristics using inverse propensity treatment weights. Other covariates, prescriber specialty, product switching during the post-index period, and pre-index total costs were included in the regression models measuring outcomes. One clinical characteristic of interest was the presence of asthma as comorbidity. A subset analysis of AR patients with asthma was also performed. All-cause-related pharmacy fills as well as pharmacy, medical

  20. Nursing care update: Internal radiation therapy

    International Nuclear Information System (INIS)

    Lowdermilk, D.L.

    1990-01-01

    Internal radiation therapy has been used in treating gynecological cancers for over 100 years. A variety of radioactive sources are currently used alone and in combination with other cancer treatments. Nurses need to be able to provide safe, comprehensive care to patients receiving internal radiation therapy while using precautions to keep the risks of exposure to a minimum. This article discusses current trends and issues related to such treatment for gynecological cancers.20 references

  1. Association of functional limitation with health care needs and experiences of children with special health care needs.

    Science.gov (United States)

    Nageswaran, Savithri; Silver, Ellen Johnson; Stein, Ruth E K

    2008-05-01

    The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs. We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences. Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation. Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.

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

    Science.gov (United States)

    King, Michael W

    2017-11-01

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

  3. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization.

    Science.gov (United States)

    Kumar, Nitin; Conwell, Darwin L; Thompson, Christopher C

    2014-11-01

    Infected walled-off pancreatic necrosis (WOPN) is a complication of acute pancreatitis requiring intervention. Surgery is associated with considerable morbidity. Percutaneous catheter drainage (PCD), initial therapy in the step-up approach, minimizes complications. Direct endoscopic necrosectomy (DEN) has demonstrated safety and efficacy. We compared outcome and health care utilization of DEN versus step-up approach. This was a matched cohort study using a prospective registry. Twelve consecutive DEN patients were matched with 12 step-up approach patients. Outcomes were clinical resolution after primary therapeutic modality, new organ failure, mortality, endocrine or exocrine insufficiency, length of stay, and health care utilization. Clinical resolution in 11 of 12 patients after DEN versus 3 of 12 step-up approach patients after PCD (P endocrine insufficiency, and shorter length of stay (P < 0.05). Health care utilization was lower after DEN by 5.2:1 (P < 0.01). Direct endoscopic necrosectomy may be superior to step-up approach for WOPN with suspected or established infection. Primary PCD generally delayed definitive therapy. Given the higher efficacy, shorter length of stay, and lower health care utilization, DEN could be the first-line therapy for WOPN, with primary PCD for inaccessible or immature collections.

  4. Benchmarking HIV health care

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda

    2012-01-01

    ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care we...... document pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for assessment and benchmarking the clinical management of HIV-patients in any setting worldwide....

  5. 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

  6. Pain, music creativity and music therapy in palliative care.

    Science.gov (United States)

    O'Callaghan, C C

    1996-01-01

    An analysis of the music therapy literature yields numerous reports to support the role of music in the alleviation of pain in palliative care. Four theoretical perspectives that support why many patients report reduced pain sensation after music therapy include: the psychological relationship between music and pain; the psychophysiological theory; spinal mechanisms involved in pain modulation; and the role of endorphins. Considerations significant to the use of music in pain relief include how music, used inappropriately, can aggravate pain sensation. Case studies, which include the use of creative music therapy techniques, point to the efficacy of music therapy in alleviating the pain experiences of both palliative care patients and their significant others.

  7. The retailing of health care.

    Science.gov (United States)

    Paul, T; Wong, J

    1984-01-01

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

  8. The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

    Science.gov (United States)

    Pierre-Louis, Bosny J; Moore, Angelo D; Hamilton, Jill B

    2015-09-01

    The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty

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

    Science.gov (United States)

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

    1996-01-01

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

  10. Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs

    Directory of Open Access Journals (Sweden)

    Fries KS

    2013-02-01

    Full Text Available Kathleen S Fries,1 Donna M Bowers,2 Margo Gross,3 Lenore Frost31Nursing Program, 2Department of Physical Therapy and Human Movement Science, 3Graduate Program in Occupational Therapy, College of Health Professions, Sacred Heart University, Fairfield, CT, USAIntroduction: Interprofessional collaboration among health care professionals yields improved patient outcomes, yet many students in health care programs have limited exposure to interprofessional collaboration in the classroom and in clinical and service-learning experiences. This practice gap implies that students enter their professions without valuing interprofessional collaboration and the impact it has on promoting positive patient outcomes.Aim: The aim of this study was to describe the interprofessional experiences of students in health care professional programs as they collaborated to provide health care to Guatemalan citizens over a 7-day period.Methods: In light of the identified practice gap and a commitment by college administration to fund interprofessional initiatives, faculty educators from nursing, occupational therapy, and physical therapy conducted a qualitative study to explore a service-learning initiative focused on promoting interprofessional collaboration. Students collaborated in triads (one student from each of the three disciplines to provide supervised health care to underserved Guatemalan men, women, children, and infants across a variety of community and health care settings. Eighteen students participated in a qualitative research project by describing their experience of interprofessional collaboration in a service-learning environment. Twice before arriving in Guatemala, and on three occasions during the trip, participants reflected on their experiences and provided narrative responses to open-ended questions. Qualitative content analysis methodology was used to describe their experiences of interprofessional collaboration.Results: An interprofessional service

  11. Youth with special health care needs: transition to adult health care services.

    Science.gov (United States)

    Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N

    2013-12-01

    Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

  12. Music therapy for end-of-life care: An updated systematic review.

    Science.gov (United States)

    McConnell, Tracey; Scott, David; Porter, Sam

    2016-10-01

    Music therapy during palliative and end-of-life care is well established and positive benefits for patients have been reported. Assess the effectiveness of music therapy versus standard care alone or standard care in combination with other therapies for improving psychological, physiological and social outcomes among adult patients in any palliative care setting. In order to update an existing Cochrane systematic review, we searched MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, ClinicalTrials.gov register and Current Controlled Trials register to identify randomised or quasi-randomised controlled trials published between 2009 and April 2015. Nine electronic music therapy journals were searched from 2009 until April 2015, along with reference lists and contact was made with key experts in music therapy. Only studies published in English were eligible for inclusion. Two reviewers independently screened titles, abstracts, assessed relevant studies for eligibility, extracted data and judged risk of bias for included studies. Disagreements were resolved through discussion with a third reviewer. Data were synthesised in Revman using the random effects model. Heterogeneity was assessed using I(2). Three studies were included in the review. Findings suggest that music therapy may be effective for helping to reduce pain in palliative care patients (standard mean deviation = -0.42, 95% confidence interval = -0.68 to -0.17, p = 0.001). Available evidence did not support the use of music therapy to improve overall quality of life in palliative care. While this review suggests that music therapy may be effective for reducing pain, this is based on studies with a high risk of bias. Further high-quality research is required. © The Author(s) 2016.

  13. Hormone Replacement Therapy: MedlinePlus Health Topic

    Science.gov (United States)

    ... of hormone therapy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Hormone Replacement Therapy ... Estrogen overdose Types of hormone therapy Related Health Topics Menopause National Institutes of Health The primary NIH ...

  14. Development and efficacy of music therapy techniques within palliative care.

    Science.gov (United States)

    Clements-Cortés, Amy

    2016-05-01

    Music therapy is increasingly becoming an intervention used in palliative care settings around the globe. While the specialty of palliative care music therapy is relatively young having emerged in the late 1980s, there is a strong and growing body of evidence demonstrating its efficacy in assisting a variety of issues common at end-of-life. There are multiple music therapy techniques that are implemented with clients in palliative care and they can be categorized in four broad areas: receptive, creative, recreative and combined. These techniques will be presented with respect to their development by clinicians as supported by the descriptive and research literature. Information is also provided on the use of music therapy in facilitating the grieving and bereavement process. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. 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

  16. Perspectives on music therapy in adult cancer care: a hermeneutic study.

    Science.gov (United States)

    Olofsson, Anne; Fossum, Bjöörn

    2009-07-01

    To explore perspectives on music therapy as a nursing intervention in adult cancer care and to expand and integrate knowledge and understanding about music therapy as an adjunctive intervention in adult cancer nursing care. Published nursing articles. Medical and nursing journals have reported on research related to music and its effect as a nursing intervention. However, this research often lacks a musical context (i.e., knowledge and understanding from a musical perspective). Music therapy is not a consistent concept. Perspectives on the meanings of music therapy vary according to knowledge and scientific orientation. The perspective may influence the character and methodology of the music therapy intervention as well as the understanding of its results. To fully develop music therapy as an adjunct intervention in adult cancer care, interdisciplinary cooperation between nurses and music therapists should be supported on clinical and educational levels.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Electroconvulsive therapy and nursing care.

    LENUS (Irish Health Repository)

    Kavanagh, Adam

    2011-04-27

    Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. It is, therefore, essential that nurses possess sufficient information to help patients make rational and informed treatment decisions and be able to care for both the clinical and psychological needs of patients treated with ECT. This review outlines the nursing role in ECT and summarizes the main aspects of contemporary ECT practice relevant to general and psychiatric nursing practice.

  19. Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

    Science.gov (United States)

    Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

    2015-04-01

    Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey.

    Science.gov (United States)

    Eva, Gail; Morgan, Deidre

    2018-05-01

    Occupational therapists play an integral role in the care of people with life-limiting illnesses. However, little is known about the scope of occupational therapy service provision in palliative care across Europe and factors influencing service delivery. This study aimed to map the scope of occupational therapy palliative care interventions across Europe and to explore occupational therapists' perceptions of opportunities and challenges when delivering and developing palliative care services. A 49-item online cross-sectional survey comprised of fixed and free text responses was securely hosted via the European Association for Palliative Care website. Survey design, content and recruitment processes were reviewed and formally approved by the European Association for Palliative Care Board of Directors. Descriptive statistics and thematic analysis were used to analyse data. Setting/respondents: Respondents were European occupational therapists whose caseload included palliative care recipients (full-time or part-time). In total, 237 valid responses were analysed. Findings demonstrated a consistency in occupational therapy practice in palliative care between European countries. Clinician time was prioritised towards indirect patient care, with limited involvement in service development, leadership and research. A need for undergraduate and postgraduate education was identified. Organisational expectations and understanding of the scope of the occupational therapy role constrain the delivery of services to support patients and carers. Further development of occupational therapy in palliative care, particularly capacity building in leadership and research activities, is warranted. There is a need for continuing education and awareness raising of the role of occupational therapy in palliative care.

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

    African Journals Online (AJOL)

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

  2. Alcohol dependence and health care utilization in African Americans.

    Science.gov (United States)

    Marshall, Vanessa J; Kalu, Nnenna; Kwagyan, John; Scott, Denise M; Cain, Gloria E; Hill, Karen; Hesselbrock, Victor; Ferguson, Clifford L; Taylor, Robert E

    2013-01-01

    Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non-alcohol-dependent African Americans. A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non-alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. Xl Test and analysis of variance were used to analyze the data. Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p<.001), loss of consciousness (p=.001), and sexually transmitted diseases: (p<.001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p<.001). This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups.

  3. Hope for health and health care.

    Science.gov (United States)

    Stempsey, William E

    2015-02-01

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

  4. 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.

  5. Engaging men in health care.

    Science.gov (United States)

    Malcher, Greg

    2009-03-01

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

  6. Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

    Science.gov (United States)

    Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

    2018-04-01

    As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Health care reforms.

    Science.gov (United States)

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

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

  8. Health promotion in supplementary health care: outsourcing, microregulation and implications for care.

    Science.gov (United States)

    Silva, Kênia Lara; Sena, Roseni Rosângela; Rodrigues, Andreza Trevenzoli; Araújo, Fernanda Lopes; Belga, Stephanie Marques Moura Franco; Duarte, Elysângela Dittz

    2015-01-01

    to analyze health promotion programs in the supplementary health care. This was a multiple case study with a qualitative approach whose data were obtained from interviews with coordinators of providers contracted by the corporations of health insurance plans in Belo Horizonte, Minas Gerais. The data were submitted to Critical Discourse Analysis. Home care has been described as the main action in the field of health promotion transferred to the providers, followed by management of patients and cases, and the health education.groups. The existence of health promotion principles is questionable in all programs. Outsourcing is marked by a process with a division between cost and care management. Implications of this process occur within admission and interventions on the needs of the beneficiaries. Statements revealed rationalization of cost, restructuring of work, and reproduction of the dominant logic of capital accumulation by the health insurance companies.

  9. Integrative Care Therapies and Physiological and Pain-related Outcomes in Hospitalized Infants

    OpenAIRE

    Hathaway, Elizabeth E.; Luberto, Christina M.; Bogenschutz, Lois H.; Geiss, Sue; Wasson, Rachel S.; Cotton, Sian

    2015-01-01

    Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcome...

  10. Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

    Directory of Open Access Journals (Sweden)

    Natalie A. DiPietro

    2014-01-01

    Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Paper

  11. The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women.

    Science.gov (United States)

    Clayton, Anita H; Goldstein, Irwin; Kim, Noel N; Althof, Stanley E; Faubion, Stephanie S; Faught, Brooke M; Parish, Sharon J; Simon, James A; Vignozzi, Linda; Christiansen, Kristin; Davis, Susan R; Freedman, Murray A; Kingsberg, Sheryl A; Kirana, Paraskevi-Sofia; Larkin, Lisa; McCabe, Marita; Sadovsky, Richard

    2018-04-01

    The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments. Copyright © 2017 Mayo Foundation for Medical

  12. Insulin therapy waste produced in the households of people with diabetes monitored in Primary Care

    Directory of Open Access Journals (Sweden)

    Gilmara Holanda da Cunha

    Full Text Available ABSTRACT Objective: To analyze the insulin therapy waste disposal produced in the households of people with diabetes mellitus (DM. Method: Cross-sectional study with 105 Primary Care patients. Socio-demographic and clinical variables and insulin therapy practice were analyzed through the absolute and relative frequencies, Fisher's exact test and prevalence ratio (PR. Results: The association between types of insulin (60.0%, administered with a disposable syringe attached to a needle (80.9%, and a high percentage of reuse and disposal in normal household waste (57.1% stood out. The professionals who most frequently provided guidance to people with diabetes were the nurses. Patients who had received instructions about disposal were 21 times more likely to dispose of waste properly than those who had not (PR 21.5; P 0.05. Conclusion: People with diabetes served in Primary Health Care require guidance and material resources to carry out the appropriate disposal of insulin therapy waste.

  13. Organizing emotions in health care.

    Science.gov (United States)

    Mark, Annabelle

    2005-01-01

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

  14. US health care crisis.

    Science.gov (United States)

    Cirić, Ivan

    2013-01-01

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

  15. Complementary and Alternative Medicine use in oncology: A questionnaire survey of patients and health care professionals

    LENUS (Irish Health Repository)

    Chang, Kah Hoong

    2011-05-24

    Abstract Background We aimed to investigate the prevalence and predictors of Complementary and Alternative Medicine (CAM) use among cancer patients and non-cancer volunteers, and to assess the knowledge of and attitudes toward CAM use in oncology among health care professionals. Methods This is a cross-sectional questionnaire survey conducted in a single institution in Ireland. Survey was performed in outpatient and inpatient settings involving cancer patients and non-cancer volunteers. Clinicians and allied health care professionals were asked to complete a different questionnaire. Results In 676 participants including 219 cancer patients; 301 non-cancer volunteers and 156 health care professionals, the overall prevalence of CAM use was 32.5% (29.1%, 30.9% and 39.7% respectively in the three study cohorts). Female gender (p < 0.001), younger age (p = 0.004), higher educational background (p < 0.001), higher annual household income (p = 0.001), private health insurance (p = 0.001) and non-Christian (p < 0.001) were factors associated with more likely CAM use. Multivariate analysis identified female gender (p < 0.001), non-Christian (p = 0.001) and private health insurance (p = 0.015) as independent predictors of CAM use. Most health care professionals thought they did not have adequate knowledge (58.8%) nor were up to date with the best evidence (79.2%) on CAM use in oncology. Health care professionals who used CAM were more likely to recommend it to patients (p < 0.001). Conclusions This study demonstrates a similarly high prevalence of CAM use among oncology health care professionals, cancer and non cancer patients. Patients are more likely to disclose CAM usage if they are specifically asked. Health care professionals are interested to learn more about various CAM therapies and have poor evidence-based knowledge on specific oncology treatments. There is a need for further training to meet to the escalation of CAM use among patients and to raise awareness of

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

    OpenAIRE

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

    2015-01-01

    BACKGROUND: In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals' acquired experiences of barriers and facilitators that people with common m...

  17. Awareness of doctors of health care and possible therapy methods for alcohol and drug dependant patients in Latvia

    Directory of Open Access Journals (Sweden)

    Dave V.

    2012-10-01

    Full Text Available Aim is to investigate the knowledge of Latvian doctors about addiction treatment and healthcare possibilities in Latvia, to compare which methods are the best known to physicians, and which are offered to addicted patients. Work material and methods. Questionnaire was developed by researchers themselves, it contains 14 questions (about demographical data, treatment methods and their application. 250 questionnaires were distributed, 158 (63, 2% were received. Results. Average age of participants – 43.7 years. 31,0% of respondents are psychiatrists, 13,3% – addiction specialists, 34,8% – other specialists (general practitioners, internists, health care doctors, neurologists and others, 12,0% – psychotherapists, 4,4% – surgeons, 1,9% – dentists and 1,9% – paediatricians. The best known were detoxification (98,2% and suggestion (892% methods. The least known methods for drug addicts were substitution therapy (73,4% and rehabilitation communities (73,4%. The most recommended treatment method was Minnesota programme – 108 (68,4% and detoxification 99 (62,7%, the least recommended – substitution therapy – 29 (18,5%. Conclusions. 17,1% of respondents do not meet patients with addiction problems, but 20,3% of respondents don’t recommend any of treatment methods. Although 73%-98% of respondents have information about treatment methods, only 18%-68% of respondents offer them.

  18. Patterns of care study and evidence based medicine for radiation therapy. Prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Katsumasa; Mitsuhashi, Norio

    2002-01-01

    In Japan, where the mortality rate of prostate cancer is lower than in Western countries, there is little evidence of radiation therapy for prostate cancer. Therefore, we have to refer to the evidence of radiation therapy from Western countries, but we should pay attention to the differences of cultural, racial, or social background between Japan and Western countries. The Patterns of Care Study (PCS) was conducted in Japan and extramural audits were performed for 50 randomly selected institutions. Detailed information of 311 prostate cancer patients without distant metastases and other cancers, who were treated with radiation therapy in 1996-1998, was collected. In this article, the results of PCS for primary prostate cancer were shown, with a review of literature for the appropriate choice of radiation therapy. This study was supported by the Grantin-Aid for Cancer Research from Ministry of Health, Labor and Welfare (10-17). (author)

  19. Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

    Directory of Open Access Journals (Sweden)

    Frida Eek

    2009-01-01

    Full Text Available Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT. Methods. Postal questionnaire (n = 13 604 and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.

  20. Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

    Science.gov (United States)

    Eek, Frida; Merlo, Juan; Gerdtham, Ulf; Lithman, Thor

    2009-01-01

    Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire (n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group. PMID:19936124

  1. Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

    International Nuclear Information System (INIS)

    Eek, F.; Merlo, J.; Gerdtham, U.; Lithman, T.

    2010-01-01

    Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire (n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.

  2. HIV-positive patients’ perceptions of care received at a selected antiretroviral therapy clinic in Vhembe district, South Africa

    Directory of Open Access Journals (Sweden)

    Tshifhiwa V. Ndou

    2016-04-01

    Full Text Available Background: Patients’ experiences are a reflection of what has happened during the care process and, therefore, provide information about the performance of health care professional workers. They refer to the process of care provision at the antiretroviral therapy (ART sites. Aim and setting: This article explored the perceptions of HIV-positive patients of care received at the Gateway Clinic of the regional hospital that provides antiretroviral treatment in the Vhembe district. Methods: A qualitative, explorative and descriptive design was used. A non-probability, convenient sampling method was used to select 20 HIV-positive patients who were above 18 years of age. In-depth individual interviews were used to collect data. Data were analysed through Tech’s open coding method. Results: One theme and two sub-themes emerged, namely positive experiences related to the environment and attitudes of health professionals, and negative experiences concerning the practices by health care providers. Conclusion: Patients’ perceptions of quality of, and satisfaction with, health care may affect health outcomes. Recommendations are made to consider, practice and strengthen the protocols, the standard operating procedures and the principles of infection control in the health facilities. Keywords: Human Immunodeficiecy Virus, Antiretroviral Treatment, HIV positive, Limpopo

  3. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

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

  4. [Costs of maternal-infant care in an institutionalized health care system].

    Science.gov (United States)

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

    1998-01-01

    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

  5. Play therapy as a mental health intervention for children and adolescents.

    Science.gov (United States)

    Rye, Nina

    2008-01-01

    Play therapy is a child-centred therapy for children between the ages of 3 and 16 years who have mental health and/or other difficulties. The play therapist works one to one with the child, allowing children to explore their inner emotional world in almost any way they choose in the play room. The therapist sets a few necessary behavioural limits in order to safeguard physical and emotional safety during the weekly sessions. Children from all kinds of families come for play therapy. Some have witnessed domestic violence, or experienced abuse or other trauma. Some have conflicted relationships with the parents or carers arising out of insecure attachment and/or other issues. Provided that the child has some level of symbolic play, play therapy has the potential to help. The other provisos are that the home environment is sufficiently supportive at a basic level, and that the parent or carer is willing to support therapy. Children typically have play therapy for between two and 12 months, depending on the complexity of their difficulties. Play therapists analyse sessions and track changes to determine when to plan the ending with the child. Play therapists come from a range of professions and undertake full-time or part-time training in play therapy leading to a post-qualifying diploma or Master's degree. Qualified play therapists work in, or undertake work for, Child and Adolescent Mental Health (CAMH) services, Children's Services (Social Care), schools, and voluntary sector agencies.

  6. Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

    Science.gov (United States)

    Duker, Leah I. Stein

    2016-01-01

    Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. PMID:27295001

  7. Health care reforms

    Directory of Open Access Journals (Sweden)

    Marušič Dorjan

    2016-09-01

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

  8. [Challenges of an integrative and personalised health care for health economics and the insurance system].

    Science.gov (United States)

    Schoch, Goentje-Gesine; Würdemann, E

    2014-11-01

    "Stratifying medicine" is a topic of increasing importance in the public health system. There are several questions related to "stratifying medicine". This paper reconsiders definitions, opportunities and risks related to "stratifying medicine" as well as the main challenges of "stratifying medicine" from the perspective of a public health insurance. The application of the term and the definition are important points to discuss. Terms such as "stratified medicine", "personalised medicine" or "individualised medicine" are used. The Techniker Krankenkasse prefers "stratifying medicine", because it usually means a medicine that tailors therapy to specific groups of patients by biomarkers. OPPORTUNITIES AND RISKS: "Stratifying medicine" is associated with various hopes, e. g., the avoidance of ineffective therapies and early detection of diseases. But "stratifying medicine" also carries risks, such as an increase in the number of cases by treatment of disease risks, a duty for health and the weakening of the criteria of evidence-based medicine. The complexity of "stratifying medicine" is a big challenge for all involved parties in the health system. A lot of interrelations are still not completely understood. So the statutory health insurance faces the challenge of making innovative therapy concepts accessible in a timely manner to all insured on the one hand but on the other hand also to protect the community from harmful therapies. Information and advice to patients related to "stratifying medicine" is of particular importance. The equitable distribution of fees for diagnosis and counselling presents a particular challenge. The solidarity principle of public health insurance may be challenged by social and ethical issues of "stratifying medicine". "Stratifying medicine" offers great potential to improve medical care. However, false hopes must be avoided. Providers and payers should measure chances and risks of "stratifying medicine" together for the welfare of the

  9. Exploring Multiple Identities as a Health Care Ethnographer

    Directory of Open Access Journals (Sweden)

    Alison Ledger MPhil, RMT

    2010-09-01

    Full Text Available Previous discussions about the role of the ethnographer have weighed the advantages and disadvantages of occupying insider or outsider positions, or dual practitioner-researcher identities. In the author's experience, additional identities can come to the fore when a seasoned health professional returns to the field as a novice ethnographer. In this article she reflects on ways in which she shifted between the identities of researcher, therapist, friend, and student in her ethnography about music therapy service development. These experiences are presented to reveal the inherent complexity of the researcher role and to encourage health care ethnographers to consider ways in which they can hold multiple identities in their own research.

  10. The ethical self-fashioning of physicians and health care systems in culturally appropriate health care.

    Science.gov (United States)

    Shaw, Susan J; Armin, Julie

    2011-06-01

    Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.

  11. Secondary Traumatic Stress, Culture and Stigma: Barriers to Self-Initiated Care in the Military Mental Health and Spiritual Care Provider Populations

    Science.gov (United States)

    2012-04-01

    caregivers have been actively and productively engaged long before the attacks of 9/11, having provided mental health and spiritual care to military...Secondary Traumatic Stress or Simply Burnout ? Effect of Trauma Therapy on Mental Health Professionals,” Australian and New Zealand Journal of Psychiatry...24. 77 Ibid., 24. 78 Ben-Zeev et al., “DSM-V and the Stigma of Mental Illness ,” 319. 79 Britt et al., “The Stigma of Mental Health Problems in

  12. The effects of light therapy on depression and sleep disruption in older adults in a long-term care facility.

    Science.gov (United States)

    Wu, Mann-Chian; Sung, Huei-Chuan; Lee, Wen-Li; Smith, Graeme D

    2015-10-01

    This study aims to evaluate the effect of light therapy on depression and sleep disruption in older adults residing in a long-term care facility. Psychological morbidity is a problem commonly seen in older adults residing in long-term care facilities. Limited research has addressed the effect of light therapy on depression in this population. A quasi-experimental pretest and posttest design was used. Thirty-four participants in the experimental group received light therapy by sitting in front of a 10000-lux light box 30 min in the morning, three times a week for 4 weeks. Thirty-one participants in the control group received routine care without light therapy. Depression was measured by Geriatric Depression Scale-Short Form at baseline and week 4. After receiving 4 weeks of light therapy, the mean depression score in the experimental group decreased from 7.24 (SD3.42) at pretest to 5.91 (SD 3.40) at posttest, and had a significant reduction (t = 2.22, P = 0.03). However, there was no significant difference in depression score and sleep disruption between the experimental group and control group. Light therapy might have the potential to reduce depressive symptoms and sleep disruption and may be a viable intervention to improve mental health of older adults in the long-term care facilities. © 2014 Wiley Publishing Asia Pty Ltd.

  13. OCCUPATIONAL THERAPY EXPERIENCES IN THE FAMILY HEALTH SUPPORT CENTERS (NASF IN THE DISTRITO FEDERAL

    Directory of Open Access Journals (Sweden)

    Kelly Ranyelle Alves Araujo

    2013-09-01

    Full Text Available To support and expand the care attention and the health management in primary care, in particular the Family Health Strategy, it was created the Family Health Support Centers (NASF. The NASF accounts with several professionals, including occupational therapists, who develop different activities, including health promotion, holistic care and psychosocial rehabilitation. The aim of this article is to discuss from practical experience in a NASF in the metropolitan region of Brasilia how students and practitioners of occupational therapy falls within that service, identifying the main limitations and the work that advances the health care setting. Results: The students and occupational therapist service sought to develop an integrated and intersectoral. Actions were part of the home visits, group approaches with different community groups, active search for users and partnerships in the community. Thus, the work is still very limited assistance and connected to the matricial point of view, as recommended. We conclude that, despite the NASF be a new field of labor for occupational therapists, the actions of social inclusion, empowerment and citizenship developed can encourage healthy habits, but practices need to be revised to follow the proposal of this device.

  14. Exploring the role of occupational therapy in caring for cancer survivors in Australia: A cross sectional study.

    Science.gov (United States)

    Buckland, Nicole; Mackenzie, Lynette

    2017-10-01

    With increasing rates of cancer survival in Australia, more people are living with long-term side effects of cancer and its treatment, and cancer survivorship is now considered a distinct phase of cancer care. While occupational therapists play an integral role in multidisciplinary care for people with chronic conditions, there is little evidence documenting the occupational therapy role for people living with chronic cancer-related conditions. This study aimed to explore the views of Australian occupational therapists about current practice and what constitutes best practice for cancer survivors. A cross-sectional online survey was developed and distributed via emailed invitations to the Occupational Therapy Australia membership to collect responses from occupational therapists in a range of locations and practice settings around Australia. A total of 204 completed surveys were returned (response rate of 4%). More than 70% (n = 143) of respondents worked with people with cancer at least sometimes and most worked in acute (13.8%, n = 28) or community (11.2%, n = 23) settings. Participants rated equipment provision as the most common intervention (94%, n = 192), followed by energy conservation (91%, n = 185) and pressure care (78%, n = 160). Lack of funding for occupational therapy positions and a lack of recognition of the role of occupational therapy by health professionals and consumers were identified as key barriers to survivorship care. Research is needed to provide evidence supporting the role and practice of occupational therapy with cancer survivors. Collaborative work with multidisciplinary teams is needed to develop long-term routine treatment pathways that include occupational therapy interventions. © 2017 Occupational Therapy Australia.

  15. Assessing the Capacity of the US Health Care System to Use Additional Mechanical Ventilators During a Large-Scale Public Health Emergency.

    Science.gov (United States)

    Ajao, Adebola; Nystrom, Scott V; Koonin, Lisa M; Patel, Anita; Howell, David R; Baccam, Prasith; Lant, Tim; Malatino, Eileen; Chamberlin, Margaret; Meltzer, Martin I

    2015-12-01

    A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use. We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level. Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning. The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems' capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need.

  16. What is the health care product?

    Science.gov (United States)

    France, K R; Grover, R

    1992-06-01

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

  17. Fostering a strategic alliance between patients' associations and health care professionals.

    Science.gov (United States)

    Mosconi, Paola; Colombo, Cinzia

    2010-01-01

    The Laboratory for Medical Research and Consumer Involvement was established in 2005 at Mario Negri Institute, a nonprofit institute for pharmacological research, as a consequence of the increasing interest in boosting citizens' and patients' involvement in the health care debate. It has developed several projects with patients' associations, researchers, and clinicians. Its objectives are to foster a strategic alliance among health care professionals, patients, and their organizations, developing activities with different levels of involvement. Among the laboratory' s activities, the PartecipaSalute project has organized training courses for consumers, published a Web site disseminating evidence-based information and critical appraisal tools, and collected research priorities set by patients. Two consensus conferences have been organized, one dealing with brain injury patients' assistance and the other with hormone therapy and menopause. The quality of health information covered by different sources (press articles, Web sites, and brochures) has also been assessed. Seventy consumers attended the training courses from 2006 to 2008, and between January 2008 and June 2009 the PartecipaSalute Web site registered a mean of 30 500 single visits monthly. At the consensus conference Informing women on hormone replacement therapy, 7 members of the 14-member panel defining the final recommendations were lay people. Other data from the laboratory's main activities are given in this article. The criteria for selecting patients and their organizations, the methods of involvement, and evaluation of the impact of the activities are still open questions. We are now developing ways of evaluating our activities, and trying to boost citizens' and patients' participation in decisional settings, concerning health care assistance and research studies.

  18. Optimizing Health Care Environmental Hygiene.

    Science.gov (United States)

    Carling, Philip C

    2016-09-01

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

  19. Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals.

    Science.gov (United States)

    Faithfull, S; Samuel, Carol; Lemanska, Agnieszka; Warnock, Clare; Greenfield, Diana

    2016-01-01

    Cancer survival is increasing as patients live longer with a cancer diagnosis. This success has implications for health service provision in that increasing numbers of adults who have received cancer therapy are requiring monitoring and long-term health care by a wide range of practitioners. Given these recent trends there is a need to explore staff perceptions and confidence in managing the consequences of cancer diagnosis and treatment in cancer survivors to enhance an integrated cancer service delivery. This study examines the self-reported perceptions of competence in nurses and professionals allied to medicine providing survivorship services caring for adults after cancer treatment in both secondary and primary care. A cross sectional survey of the adult cancer workforce using a self-assessment tool for assessing confidence in providing long-term cancer patient management. This study was a health service evaluation. The study was conducted within the United Kingdom. Respondents were 618 health care professionals of these 368 were specialist adult cancer nurses in oncology and the community setting and 250 cancer allied health professionals. The survey tool was developed with experts in cancer management, nurses professionals allied to medicine such as physiotherapists and dieticians, educationalists, patient groups as well as health service managers. Competence was assessed in 4 domains clinical practice, symptom management, care co-ordination and proactive management. Perceptions of training needs were also ascertained. Data were collected using an Internet survey distributed through cancer services, community settings and professional institutions. In total 618 practitioners who responded were providing services for adults' 1-year post cancer therapy. Practitioners felt confident in managing psychosocial care and communicating with patients. Deficits in self-reported confidence were found in long-term medications management, care planning, long-term and

  20. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Gavin Andrews

    Full Text Available BACKGROUND: Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT, but access to this therapy is limited. OBJECTIVE: Review evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term. METHOD: Systematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted. PRINCIPAL FINDINGS: 22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13, and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial. CONCLUSIONS: Computerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000030077.

  1. The Impact of the Medicare-Eligible Retiree Health Care Fund on Navy Military Treatment Facilities’ Demand-to-Capacity Solution

    Science.gov (United States)

    2012-03-01

    Physical Therapy, Optometry, Audiology, Tele-Dermatology and Eyes, Nose & Throat (ENT); (3) Dental Care, i.e., General Dentistry , Oral Surgery...Physical Therapy, Chiropractic, Optometry, Audiology, Public Health and Eyes, Nose & Throat (ENT); (3) Dental Care, including General Dentistry ...guidelines. Version 3.2. Unified biostatistical utility. Retrieved September 14, 2010, from http://www.dtic.mil/whs/directives/corres/pdf/601517p.pdf

  2. Occupational therapy students' contribution to occasions of service during practice placements in health settings.

    Science.gov (United States)

    Rodger, Sylvia; Stephens, Elizabeth; Clark, Michele; Ash, Susan; Graves, Nicholas

    2011-12-01

    Currently in the Australian higher education sector, the productivity benefits of occupational therapy clinical education placements are a contested issue. This article will report results of a study that developed a methodology for documenting time use during placements and investigated the productivity changes associated with occupational therapy clinical education placements in Queensland, Australia. Supervisors' and students' time use during placements and how this changed for supervisors compared to pre- and post-placement is also presented. Using a cohort survey design, participants were students from two Queensland universities, and their supervisors employed by Queensland Health. Time use was recorded in 30 minute blocks according to particular categories. There was a significant increase in supervisors' time spent in patient care activities (F = 94.011(2,12.37 df) , P increasing between pre- and during placement (P = 0.028). There was a significant decrease in supervisors' time spent in placement activities (F = 5.133(2,19.18 df) , P = 0.016) from during to post-placement. Students spent more time than supervisors in patient care activities while on placement. A novel method for reporting productivity and time-use changes during clinical education programs for occupational therapy has been applied. Supervisors spent considerable time in assessing and managing students and their clinical education role should be seen as core business in standard occupational therapy practice. This paper will contribute to future assessments of the economic impact of student placements for allied health disciplines. © 2011 The Authors. Australian Occupational Therapy Journal © 2011 Occupational Therapy Australia.

  3. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis

    Directory of Open Access Journals (Sweden)

    Larissa Schwarzkopf

    2014-06-01

    Full Text Available Background: Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. Methods: We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. Results: In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. Conclusion: Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care.

  4. Multidisciplinary program for stress-related disease in primary health care

    Directory of Open Access Journals (Sweden)

    Eva Ekvall Hansson

    2009-05-01

    Full Text Available Eva Ekvall Hansson1, Eva Håkansson2, Annelie Raushed2, Anders Håkansson1 1Lund University, Department of Clinical Sciences in Malmö/General Practice, Malmö, Sweden; 2Primary Health Care Malmö, SwedenObjective: To describe a multidisciplinary program, given by an occupational therapist and a physiotherapist, for patients with stress-related disease in primary health care and to measure the effect of this program in terms of self-perceived health, degree of burnout, physical activity, symptoms, recreational activities, and psychological and physical well-being.Method: Retrospective study.Results: At measures after three months, the thirteen patients included in this study had improved in self-estimated health, measured with EuroQol-5D Visual Analogue Scale (p = 0.000, and in degree of burnout, measured with the Shirom–Melamed Burnout Questionnaire (p = 0.001. There was also a decrease in presence of headache, in physical activity and in satisfaction with leisure time, although not statistically significant. After six months, the improvements remained for all measures except physical activity. The patients were also satisfied with the program to a high degree, measured with Client Satisfaction Questionnaire (median 3.7.Conclusion: This descriptive study shows that a stress-management program, provided by a team including an occupational therapist and a physiotherapist in primary health care, is both feasible and effective in terms of self-estimated health, degree of burnout, and patient satisfaction. Keywords: stress-related health, burnout, occupational therapy, physiotherapy

  5. 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.

  6. Integrated primary health care in Australia.

    Science.gov (United States)

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

    2009-10-14

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

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

    Science.gov (United States)

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

    2015-01-01

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

  8. Animal-Assisted Therapy in Pediatric Palliative Care.

    Science.gov (United States)

    Gilmer, Mary Jo; Baudino, Marissa N; Tielsch Goddard, Anna; Vickers, Donna C; Akard, Terrah Foster

    2016-09-01

    Animal-assisted therapy is an emerging complementary strategy with an increasing presence in the literature. Limited studies have been conducted with children, particularly those with life-threatening and life-limiting conditions. Although outcomes show promise in decreasing suffering of children receiving palliative care services, more work is needed to validate evidence to support implementation of animal-assisted therapy with this vulnerable population. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers

    Directory of Open Access Journals (Sweden)

    Rannou François

    2011-07-01

    Full Text Available Abstract Background The expectations of patients for managing pain induced by exercise and mobilization (PIEM have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. Methods We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women and 14 care providers (6 women: 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. Results Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. Conclusion PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.

  10. Towards Sustainable Health Care Organizations

    Directory of Open Access Journals (Sweden)

    Mauro ROMANELLI

    2017-09-01

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

  11. The evolution of biotechnology and its impact on health care.

    Science.gov (United States)

    Evens, Ronald; Kaitin, Kenneth

    2015-02-01

    For more than three decades the field of biotechnology has had an extraordinary impact on science, health care, law, the regulatory environment, and business. During this time more than 260 novel biotechnology products were approved for over 230 indications. Global sales of these products exceeded $175 billion in 2013 and have helped sustain a vibrant life sciences sector that includes more than 4,600 biotech companies worldwide. In this article we examine the evolution of biotechnology during the past three decades and the profound impact that it has had on health care through four interrelated and interdependent tracks: innovations in science, government activity, business development, and patient care. The future impact of biotechnology is promising, as long as the public and private sectors continue to foster policies and provide funds that lead to scientific breakthroughs; governments continue to offer incentives for private-sector biotech innovation; industry develops business models for cost-effective research and development; and all stakeholders establish policies to ensure that the therapeutic advances that mitigate or cure medical conditions that currently have inadequate or no available therapies are accessible to the public at a reasonable cost. Project HOPE—The People-to-People Health Foundation, Inc.

  12. New Roles for Pharmacists in Community Mental Health Care: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Maria Rubio-Valera

    2014-10-01

    Full Text Available Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1 the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2 the pharmacists’ role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3 barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists’ attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.

  13. Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

    Directory of Open Access Journals (Sweden)

    AlBuhairan FS

    2014-09-01

    Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

  14. [Strengthening primary health care: a strategy to maximize coordination of care].

    Science.gov (United States)

    de Almeida, Patty Fidelis; Fausto, Márcia Cristina Rodrigues; Giovanella, Lígia

    2011-02-01

    To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumer driven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.

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

    Directory of Open Access Journals (Sweden)

    Lacreisha Ejike-King

    2014-04-01

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

  16. How to achieve care coordination inside health care organizations

    DEFF Research Database (Denmark)

    Prætorius, Thim; C. Becker, Markus

    2015-01-01

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

  17. Design of an instrument to measure the quality of care in Physical Therapy.

    Science.gov (United States)

    Cavalheiro, Leny Vieira; Eid, Raquel Afonso Caserta; Talerman, Claudia; Prado, Cristiane do; Gobbi, Fátima Cristina Martorano; Andreoli, Paola Bruno de Araujo

    2015-01-01

    To design an instrument composed of domains that would demonstrate physical therapy activities and generate a consistent index to represent the quality of care in physical therapy. The methodology Lean Six Sigma was used to design the tool. The discussion involved seven different management groups staff. By means of brainstorming and Cause & Effect Matrix, we set up the process map. Five requirements composed the quality of care index in physical therapy, after application of the tool called Cause & Effect Matrix. The following requirements were assessed: physical therapist performance, care outcome indicator, adherence to physical therapy protocols, measure whether the prognosis and treatment outcome was achieved and Infrastructure. The proposed design allowed evaluating several items related to physical therapy service, enabling customization, reproducibility and benchmarking with other organizations. For management, this index provides the opportunity to identify areas for improvement and the strengths of the team and process of physical therapy care.

  18. Health Care Reform: a Socialist Vision

    Directory of Open Access Journals (Sweden)

    Martha Livingston

    2010-04-01

    Full Text Available At first glance, it doesn't seem as though socialism and health-care reform have a whole lot to do with each other. After all, the most visible "left" position in the current discussion of health-care reform merely advocates for the government to assume the function of national insurer, leaving the delivery of health care - from its often-questionable content to its hierarchical relationships - firmly in place. As such, a single payer, Medicare-for-All insurance program is a modest, even tepid reform. Those of us on the left who have been active in the single payer movement have always seen it as a steppingstone toward health-care justice: until the question of access to care is solved, how do we even begin to address not only health care but also health inequities? How, for example, can working-class Americans, Americans of color, and women demand appropriate, respectful, humane, first-rate care when our ability to access any health-care services at all is so tightly constrained?

  19. The 'ripple effect': Towards researching improvisational music therapy in dementia care homes.

    Science.gov (United States)

    Pavlicevic, Mercédès; Tsiris, Giorgos; Wood, Stuart; Powell, Harriet; Graham, Janet; Sanderson, Richard; Millman, Rachel; Gibson, Jane

    2015-09-01

    Increased interest in, and demand for, music therapy provision for persons with dementia prompted this study's exploration of music therapists' strategies for creating musical communities in dementia care settings, considering the needs and resources of people affected by dementia. Focus group discussions and detailed iterative study of improvisational music therapy work by six experienced practitioners clarify the contextual immediacy and socio-musical complexities of music therapy in dementia care homes. Music therapy's 'ripple effect', with resonances from micro (person-to-person musicking), to meso (musicking beyond 'session time') and macro level (within the care home and beyond), implies that all who are part of the dementia care ecology need opportunities for flourishing, shared participation, and for expanded self-identities; beyond 'staff', 'residents', or 'being in distress'. On such basis, managers and funders might consider an extended brief for music therapists' roles, to include generating and maintaining musical wellbeing throughout residential care settings. © The Author(s) 2013.

  20. Gender disparities in health care.

    Science.gov (United States)

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

    2012-01-01

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

  1. Gender and communication style in general practice: differences between women's health care and regular health care.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.

    1998-01-01

    Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender

  2. Health care law versus constitutional law.

    Science.gov (United States)

    Hall, Mark A

    2013-04-01

    National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

  3. THE EFFECT OF FAMILY THERAPY WITH SPIRITUAL APPROACH TOWARD FAMILY’S HEALTH BELIEF MODEL IN TAKING CARE OF PATIENT WITH SCHIZOPHRENIA

    Directory of Open Access Journals (Sweden)

    Ah. Yusuf

    2017-04-01

    Full Text Available Introduction: Schizophrenia is the problem with kognitive, mal-adaptive thought and behavior. Family who have a member with mental disorder can experience serious conflict, become an objective and subjective burden, blame each other, get involved in hostility among family members. Various negative effect faced by family can caused by wrong family’s health belief model about Schizophrenia, hence the failure on choosing the treatment and taking care of patient at home. Someone with severe stress will seek comfort and strength from God. But so far, the most effective spiritual models to improve the health belief model of the family in caring for patients with schizophrenia has not been found. Method: Design used in this study was experimental (pre post test control group design. The population was every family of patient with mental disorder in Menur Mental Hospital along the year of 2010, chosen by alocation simple random. Samples were 13 persons in each treatment and control group. The intervention was given in 60–120 minute in 8 times meeting with average interval about 1 week. Data analysis was done using paired t-test and independent t-test. Results: There were significant changes in total of family’s health belief model (p=0,004, there was significantly change in aspects of (1 perceptions about bene fi ts (p=0,009, (2 perception about barriers (p=0,035 and perception about self efficacy (p=0,002. There were no significant changing in perception about susceptibility and severity (p=0,052. Discussion: Family believes that all events experienced by the patient and the family is God's will, hoping the patient can be more independent, and believe mental disorders can be changed for the better. The conclusion of this study is that family therapy with a spiritual approach can improve the health belief model of the family in caring for patients with mental disorders.

  4. Quality Improvement in Athletic Health Care.

    Science.gov (United States)

    Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

    2017-11-01

      Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

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

    Science.gov (United States)

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

    2016-11-01

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

  6. Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada.

    Science.gov (United States)

    Rachlis, Beth; Burchell, Ann N; Gardner, Sandra; Light, Lucia; Raboud, Janet; Antoniou, Tony; Bacon, Jean; Benoit, Anita; Cooper, Curtis; Kendall, Claire; Loutfy, Mona; Wobeser, Wendy; McGee, Frank; Rachlis, Anita; Rourke, Sean B

    2017-07-01

    Continuous HIV care supports antiretroviral therapy initiation and adherence, and prolongs survival. We investigated the association of social determinants of health (SDH) and subsequent retention in HIV care in a clinical cohort in Ontario, Canada. The Ontario HIV Treatment Network Cohort Study is a multi-site cohort of patients at 10 HIV clinics. Data were collected from medical charts, interviews, and via record linkage with the provincial public health laboratory for viral load tests. For participants interviewed in 2009, we used three-category multinomial logistic regression to identify predictors of retention in 2010-2012, defined as (1) continuous care (≥2 viral loads ≥90 days in all years; reference category); (2) discontinuous care (only 1 viral load/year in ≥1 year); and (3) a gap in care (≥1 year in 2010-2012 with no viral load). In total, 1838 participants were included. In 2010-2012, 71.7% had continuous care, 20.9% had discontinuous care, and 7.5% had a gap in care. Discontinuous care in 2009 was predictive (p Health Ontario Laboratories; REB: Research Ethics Board; SDH: social determinants of health; US: United States.

  7. Health care and equity in India.

    Science.gov (United States)

    Balarajan, Y; Selvaraj, S; Subramanian, S V

    2011-02-05

    In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Using mixed methods in music therapy health care research

    DEFF Research Database (Denmark)

    Bonde, Lars Ole

    2015-01-01

    »Mixed methods« (or »multiple methods») is a fairly new concept in music therapy research. It is inspired by recent methodological developments in social science, covering the interaction of quantitative and qualitative methods in one and the same research study. Mixed methods are not the same...... as the diversity or pluralism of methods advocated by many scholars who are critical towards the principles of evidence-based medicine. This article presents a concrete example of mixed methods in music therapy research: a psycho-social study of music therapy with female cancer survivors. Problems related...

  9. Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcers: A Health Technology Assessment

    Science.gov (United States)

    Lambrinos, Anna; Chan, Brian; Wells, David; Holubowich, Corinne

    2017-01-01

    Background About 15% to 25% of people with diabetes will develop a foot ulcer. These wounds are often resistant to healing; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes. If an ulcer does not heal with standard wound care, other therapeutic interventions are offered, one of which is hyperbaric oxygen therapy (HBOT). However, the effectiveness of this therapy is not clearly known. The objectives of this health technology assessment were to assess the safety, clinical effectiveness, and cost-effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers. We also investigated the preferences and perspectives of people with diabetic foot ulcers through lived experience. Methods We performed a review of the clinical and economic literature for the effectiveness and cost-effectiveness of hyperbaric oxygen therapy, as well as the budget impact of HBOT from the perspective of the Ministry of Health and Long-Term Care. We assessed the quality of the body of clinical evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. To better understand the preferences, perspectives, and values of patients with diabetic foot ulcers and their experience with HBOT, we conducted interviews and administered an online survey. Results Seven randomized controlled trials and one nonrandomized controlled trial met the inclusion criteria. Comparing standard wound care plus HBOT with standard wound care alone, we found mixed results for major amputation rates (GRADE quality of evidence: low), a significant difference in favour of standard wound care plus HBOT on ulcers healed (GRADE quality of evidence: low), and no difference in terms of adverse events (GRADE quality of evidence: moderate). There is a large degree of uncertainty associated with the evaluation of the cost-effectiveness of standard wound

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

    Science.gov (United States)

    2012-12-01

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

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

    African Journals Online (AJOL)

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

  12. Clinical Problems in Community Mental Health Care for Patients with Severe Borderline Personality Disorder

    NARCIS (Netherlands)

    Koekkoek, B.; van Meijel, B.; Schene, A.; Hutschemaekers, G.

    2009-01-01

    The objective of this research was to assess the problems that professionals perceive in the community mental health care for patients with severe borderline personality disorder that do not fit into specialized therapy. A group of national experts (n = 8) participated in a four-phase

  13. Health economics of insomnia therapy: implications for policy.

    Science.gov (United States)

    Botteman, Marc

    2009-09-01

    Chronic primary insomnia is a major public health problem causing significant burden for those affected. Rising health care costs may cause increased financial pressures on governments and private payers, forcing stricter cost-control measures and, as a result, insomnia, often considered a lifestyle condition, may not receive the proper attention it deserves. In order to highlight the benefits that can be achieved through successful treatment of insomnia, there is a need for further comparative studies of existing and emerging treatments, cost burden of illness and cost-effectiveness analyses. Health economic assessment of insomnia and its treatments is an emerging area. The development of comprehensive assessment of insomnia treatments, however, has been hindered by complexities and gaps in the available data. Health economic models of insomnia, such as the one detailed here, should enable researchers to better address the effects of different treatments on clinical and economic measures for insomnia and related comorbidities. It is apparent that research into the cost-effectiveness of therapies for insomnia is in its infancy and further work is needed.

  14. Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

    Science.gov (United States)

    Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas

    2017-03-01

    Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

  15. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

    2016-01-01

    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

  16. Attending Unintended Transformations of Health Care Infrastructure

    DEFF Research Database (Denmark)

    Wentzer, Helle; Bygholm, Ann

    2007-01-01

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

  17. "I'm Home(screen)!": Social Media in Health Care Has Arrived.

    Science.gov (United States)

    Housman, Laura T

    2017-11-01

    In more than a decade, the adoption and use of some type of social media among American adults has risen from 5% in 2005 to nearly 70% in 2016. The reigning social media platform by usage, Facebook, has 142% more American adult users than the second most utilized social media platform, Instagram, which was purchased by Facebook in March 2012. Of the 68% of American adult Facebook users, more than three quarters visit the site daily. Although social media applications (apps) such as Facebook and Instagram are the clear draw among users, health care apps are beginning to gain traction as well. In 2017, 32% of consumers now have at least 1 health app on their smartphones or tablets, doubling over the past 4 years. Although having an app should not be confused with using an app, having an app downloaded and available for use is a step closer to ongoing adoption. Mobile apps in health care are being used for ordering and scheduling health care services, as well as tracking and managing aspects of health and wellness. An incredible opportunity now exists to connect and leverage social media to enhance the impact of health care, particularly in the areas of drug development, clinical trial recruitment, and therapy administration and adherence, in which dose reminders, sharing of side effects and response, and the accessibility of patients to one another has both a context and a platform. This commentary serves as an introduction to the ways that social media and mobile health care apps are being used in real-world settings as tools to advance the development and effectiveness of clinical therapeutics. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

  18. The Oral Health Care Manager in a Patient-Centered Health Facility.

    Science.gov (United States)

    Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

    2016-06-01

    The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Diaspora, disease, and health care.

    Science.gov (United States)

    Wick, Jeannette Y; Zanni, Guido R

    2007-03-01

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

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

    Science.gov (United States)

    Pallegedara, Asankha; Grimm, Michael

    2018-04-26

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

  1. 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

  2. Health care entrepreneurship: financing innovation.

    Science.gov (United States)

    Grazier, Kyle L; Metzler, Bridget

    2006-01-01

    Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.

  3. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

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

  4. Dealing with Health and Health Care System Challenges in China: assessing health determinants and health care reforms

    NARCIS (Netherlands)

    H. Zhang (Hao)

    2017-01-01

    markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect

  5. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    OpenAIRE

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

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the H...

  6. Rationalising health care in india : Challenges & strategies

    Directory of Open Access Journals (Sweden)

    K I Mathai

    2014-01-01

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

  7. Oral Health in Electroconvulsive Therapy: A Neglected Topic.

    Science.gov (United States)

    Muzyka, Brian C; Glass, Magdalena; Glass, Oliver M

    2017-03-01

    Psychiatric medications may have serious and untoward adverse effects such as blurred vision, restlessness, agranulocytosis, muscle rigidity, and tremors. When compared to medications, electroconvulsive therapy (ECT) is becoming a more acceptable treatment due to its efficacy, tolerability, and minimal adverse effect profile. Oral trauma can be an ECT-related adverse effect. We reviewed the published literature on oral health and dental protection in patients undergoing ECT, and found that there are deficits in all guidelines on dental protection during ECT. Dental assessment and treatment before and after ECT is warranted. Given the increased risk of poor oral health in psychiatric patients, and the continued evolution of ECT as a mainstay treatment, it is important that studies be conducted to determine the optimal method of oral protection. If adequate care can be ensured, the risks of ECT-induced oral trauma will be minimized.

  8. Health federalism: the role of health care professionals in Nepal.

    Science.gov (United States)

    Dulal, R K

    2009-01-01

    Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.

  9. Health care need

    DEFF Research Database (Denmark)

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

    2006-01-01

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

  10. Health care utilization

    DEFF Research Database (Denmark)

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

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

  11. Solidarity as a national health care strategy.

    Science.gov (United States)

    West-Oram, Peter

    2018-05-02

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

  12. The Future of Home Health Care

    Science.gov (United States)

    Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

    2016-01-01

    The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

  13. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

  14. Health Care Personnel Perception of the Privacy of Electronic Health Records.

    Science.gov (United States)

    Saito, Kenji; Shofer, Frances S; Saberi, Poune; Green-McKenzie, Judith

    2017-06-01

    : Health care facilities are increasingly converting paper medical records to electronic health records. This study investigates the perception of privacy health care personnel have of electronic health records. A pilot tested, anonymous survey was administered to a convenience sample of health care personnel. Standard summary statistics and Chi-square analysis were used to assess differences in perception. Of the 93% (96/103) who responded, 65% were female and 43% white. The mean age was 44.3 years. Most (94%) felt that Medical Record privacy was important and one-third reported they would not seek care at their workplace if Electronic Health Records were used. Efforts to assure and communicate the integrity of electronic health records are essential toward reducing deterrents for health care personnel to access geographically convenient and timely health care.

  15. Health Literacy and Communication Quality in Health Care Organizations

    Science.gov (United States)

    Wynia, Matthew K.; Osborn, Chandra Y.

    2011-01-01

    The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their health care organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers. PMID:20845197

  16. Planning for health care transitions: results from the 2005-2006 National Survey of Children With Special Health Care Needs.

    Science.gov (United States)

    Lotstein, Debra S; Ghandour, Reem; Cash, Amanda; McGuire, Elizabeth; Strickland, Bonnie; Newacheck, Paul

    2009-01-01

    Many youth with special health care needs have difficulties transferring to adult medical care. To address this, the Maternal and Child Health Bureau has made receipt of transition services a core performance outcome for community-based systems of care for youth with special health care needs. In this article we describe the results for the transition core outcome from the 2005-2006 National Survey of Children With Special Health Care Needs. We also describe changes in the measurement strategy for this outcome since the first National Survey of Children With Special Health Care Needs in 2001. In the nationally representative, cross-sectional 2005-2006 National Survey of Children With Special Health Care Needs, parent or guardian respondents of 18198 youth with special health care needs (aged 12-17) were asked if they have had discussions with their child's health care providers about (1) future adult providers, (2) future adult health care needs, (3) changes in health insurance, and (4) encouraging their child to take responsibility for his or her care. All 4 components had to be met for the youth to meet the overall transition core outcome. Those who had not had transition discussions reported if such discussions would have been helpful. Overall, 41% of youth with special health care needs met the core performance outcome for transition. Forty-two percent had discussed shifting care to an adult provider, 62% discussed their child's adult health care needs, and 34% discussed upcoming changes in health insurance. Most (78%) respondents said that providers usually or always encourage their child to take responsibility for his or her health. Non-Hispanic black or Hispanic race/ethnicity, lower income level, not speaking English, and not having a medical home reduced the odds of meeting the transition core outcome. Current performance on the transition core outcome leaves much room for improvement. Many parents feel that having transition-related discussions with their

  17. [Intercultural health care policy from the perspective of health care providers and Mapuche clients].

    Science.gov (United States)

    Alarcón, Ana María; Astudillo, Paula; Barrios, Sara; Rivas, Edith

    2004-09-01

    Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. To explore the perception in providers and Mapuche clients about intercultural health. A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

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

    Science.gov (United States)

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

    2018-04-23

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

  19. Evidence for Mental Health Occupational Therapy

    Directory of Open Access Journals (Sweden)

    Danielle Hitch

    2015-09-01

    Full Text Available This article reports on the evidence for mental health occupational therapy in peer-reviewed journals from 2000 to 2013. Descriptive and inductive methods were used to address this question, with evidence from CINAHL, OTDBase, PSYCInfo, SCOPUS, and Google Scholar® included. Many articles (n = 1,747 were found that met the inclusion and exclusion criteria. A total of 47 different methods were used to develop evidence for mental health occupational therapy, and evidence appeared in 300 separate peer-reviewed journals. It takes on average 7 months for an article to progress from submission to acceptance, and a further 7 months to progress from acceptance to publication. More than 95% of articles published between 2000 and 2002 were cited at least once in the following decade, and around 70% of these citations were recorded in non-occupational therapy journals. The current evidence base for mental health occupational therapy is both substantial and diverse.

  20. Initiation of antiretroviral therapy at rural primary health care clinics in KwaZulu Natal

    Directory of Open Access Journals (Sweden)

    Hilda Ganesen-Moothusamy

    2013-05-01

    Full Text Available South Africa bears the greatest burden of HIV infection globally with the most infected people living in KwaZulu-Natal (KZN. Decentralised medical care for HIV positive patients and antiretroviral therapy (ART delivery to primary health care facilities were proposed nationally to achieve adequate ART coverage for patients in need of treatment. This study described the HIV positive patients who accessed medical care and were initiated on ART at two existing government Primary Health Care (PHC clinics with no added donor support, in Ilembe, KZN. This was an observational descriptive study of ART initiation from 01 April 2008 to 30 April 2009. Data were collected from clinical records kept on site. HIV Testing and the pre-ART programmes which consisted of medical care prior to ART initiation are briefly described. Socio-economic, demographic and clinical characteristics of patients who were initiated on ART were sampled and described. A minority (2.95% of the study population tested for HIV of which 36.0% tested positive. Majority (60.0% of patients who joined the pre-ART programme care did not return. The ART sample consisted of 375 patients of whom 65.0% were women, 85.9% were unmarried, 61.6% were unemployed and 50.4% had a secondary level of education. Tuberculosis (TB prevalence and incidence at ART initiation were 22.1% and 14.7% respectively. The prevalence of Syphilis and Hepatitis B co-infections were 13.1% and 8.6 % respectively. Two thirds of female patients (66.4% received a Pap smear result of which the majority (62.3% were abnormal. Uptake for HIV testing followed by relevant CD4 testing was poor. High TB, Hepatitis B and Syphilis co-infection was noted amongst patients initiated on ART. Cervical cancer screening must be intensified. Although ART initiation with no added external resources was successful, record keeping was suboptimal. Suid-Afrika dra die grootste las van MIV-infeksie ter wêreld met die meeste besmette mense in Kwa

  1. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Wagner, Lis; Hall, Elisabeth O.C.

    2007-01-01

    into self-care as a significant health resource of elders with different health status. It suggests that an elder's self-care ability is determined by the interaction of various sub-resources and conditions and emphasizes the constantly evolving nature of self-care. The framework may be of use in clinical......AIM: To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource. BACKGROUND: Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance...... of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care. METHOD...

  2. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

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

  3. Integrated occupational health care at sea

    DEFF Research Database (Denmark)

    Jensen, Olaf Chresten

    2011-01-01

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

  4. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals’ challenges

    Directory of Open Access Journals (Sweden)

    Margaret Williams

    2018-03-01

    Conclusion: Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

  5. The effect of massage therapy on occupational stress of Intensive Care Unit nurses.

    Science.gov (United States)

    Nazari, Fateme; Mirzamohamadi, Mojtaba; Yousefi, Hojatollah

    2015-01-01

    One of the main causes of stress in the lives of people is their jobs. Occupational stress is causing a wide range of significant issues in health and community services. Nursing is the most stressful profession in the health services. Massage therapy is one way of coping with stress. This study was conducted to determine the effect of massage therapy on stress in nurses. This study was a clinical trial on 66 male and female nurses working in intensive care units (dialysis, ICU, and CCU) of Isfahan University of Medical Sciences, Iran, in 2013. Participants were selected according to the aims and inclusion criteria of the study. Then, they were randomly divided into experimental and control groups. The Occupational Stress Inventory (OSI) (Osipow and Spokane, 1987) was completed by participants of the two groups before, immediately after, and 2 weeks after the intervention. General Swedish massage was performed on participants of the experimental group for 25 min in each session, twice a week for 4 weeks. Data were analyzed by descriptive and inferential statistics [Chi-square, t-test, and repeated measures analysis of variance (ANOVA)] using SPSS software. Results showed that the difference in overall mean occupation stress scores between experimental and control groups 2 weeks after the intervention was significant (P < 0.001). According to the results, it is recommended that massage, as a valuable noninvasive method, be used for nurses in intensive care units to reduce their stress, promote mental health, and prevent the decrease in quality of nursing work life.

  6. [The ethics of health care organization].

    Science.gov (United States)

    Goic, Alejandro

    2004-03-01

    Health care organization is not only a technical issue. Ethics gives meaning to the medical profession's declared intent of preserving the health and life of the people while honoring their intelligence, dignity and intimacy. It also induces physicians to apply their knowledge, intellect and skills for the benefit of the patient. In a health care system, it is important that people have insurance coverage for health contingencies and that the quality of the services provided be satisfactory. People tend to judge the medical profession according to the experience they have in their personal encounter with physicians, health care workers, hospitals and clinics. Society and its political leaders must decide upon the particular model that will ensure the right of citizens to a satisfactory health care. Any health care organization not founded on humanitarian and ethical values is doomed tofailure. The strict adherence of physicians to Hippocratic values and to the norms of good clinical practice as well as to an altruistic cooperative attitude will improve the efficiency of the health care sector and reduce its costs. It is incumbent upon society to generate the conditions where by the ethical roots of medical care can be brought to bear upon the workings of the health care system. Every country must strive to provide not only technically efficient medical services, but also the social mechanisms that make possible a humanitarian interaction between professionals and patients where kindness and respect prevail.

  7. Primary care and behavioral health practice size: the challenge for health care reform.

    Science.gov (United States)

    Bauer, Mark S; Leader, Deane; Un, Hyong; Lai, Zongshan; Kilbourne, Amy M

    2012-10-01

    We investigated the size profile of US primary care and behavioral health physician practices since size may impact the ability to institute care management processes (CMPs) that can enhance care quality. We utilized 2009 claims data from a nationwide commercial insurer to estimate practice size by linking providers by tax identification number. We determined the proportion of primary care physicians, psychiatrists, and behavioral health providers practicing in venues of >20 providers per practice (the lower bound for current CMP practice surveys). Among primary care physicians (n=350,350), only 2.1% of practices consisted of >20 providers. Among behavioral health practitioners (n=146,992) and psychiatrists (n=44,449), 1.3% and 1.0% of practices, respectively, had >20 providers. Sensitivity analysis excluding single-physician practices as "secondary" confirmed findings, with primary care and psychiatrist practices of >20 providers comprising, respectively, only 19.4% and 8.8% of practices (difference: Pestimate practice census for a high-complexity, high-cost behavioral health condition; only 1.3-18 patients per practice had claims for this condition. The tax identification number method for estimating practice size has strengths and limitations that complement those of survey methods. The proportion of practices below the lower bound of prior CMP studies is substantial, and care models and policies will need to address the needs of such practices and their patients. Achieving a critical mass of patients for disorder-specific CMPs will require coordination across multiple small practices.

  8. Changing trends in health care tourism.

    Science.gov (United States)

    Karuppan, Corinne M; Karuppan, Muthu

    2010-01-01

    Despite much coverage in the popular press, only anecdotal evidence is available on medical tourists. At first sight, they seemed confined to small and narrowly defined consumer segments: individuals seeking bargains in cosmetic surgery or uninsured and financially distressed individuals in desperate need of medical care. The study reported in this article is the first empirical investigation of the medical tourism consumer market. It provides the demographic profile, motivations, and value perceptions of health care consumers who traveled abroad specifically to receive medical care. The findings suggest a much broader market of educated and savvy health care consumers than previously thought. In the backdrop of the health care reform, the article concludes with implications for health care providers.

  9. Investments and costs of oral health care for Family Health Care

    Directory of Open Access Journals (Sweden)

    Márcia Stefânia Ribeiro Macêdo

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding

  10. Investments and costs of oral health care for Family Health Care

    Science.gov (United States)

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

  11. Changing the Care Process: A New Concept in Iranian Rural Health Care

    Directory of Open Access Journals (Sweden)

    Abbas Abbaszadeh, RN, BSCN, PhD

    2013-03-01

    Conclusion: The findings of this study indicate that the process of health care in Iranian rural society is changing rapidly with community health workers encountering new challenges. There is diminished efficiency in responding to the changing care process in Iran's rural society. Considering this change in process of care, therefore, the health care system should respond to these new challenges by establishing new health care models.

  12. Acceptance and commitment therapy (ACT) for clinically distressed health care workers: Waitlist-controlled evaluation of an ACT workshop in a routine practice setting.

    Science.gov (United States)

    Waters, Cerith S; Frude, Neil; Flaxman, Paul E; Boyd, Jane

    2018-03-01

    To examine the effects of a 1-day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting. A quasi-controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self-referral date. Participants were 35 health care workers who had self-referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre-intervention and 3 months post-intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3 months later. At 3 months post-intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d = 1.41). Across the 3-month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non-reactivity. These findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers. A 1-day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers. The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental

  13. EVALUATION OF HEALTH CARE QUALITY

    Directory of Open Access Journals (Sweden)

    Zlatko Fras

    2002-12-01

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

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

    Data.gov (United States)

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

  15. Radiation therapy: model standards for determination of need

    International Nuclear Information System (INIS)

    Lagasse, L.G.; Devins, T.B.

    1982-03-01

    Contents: Health planning process; Health care requirements (model for projecting need for megavoltage radiation therapy); Operational objectives (manpower, megavoltage therapy and treatment planning equipment, support services, management and evaluation of patient care, organization and administration); Compliance with other standards imposed by law; Financial feasibility and capability; Reasonableness of expenditures and costs; Relative merit; Environmental impact

  16. »CRIME AND PUNISHMENT« IN THE MENOPAUSAL HEALTH CARE

    Directory of Open Access Journals (Sweden)

    Ivan Fistonić

    2018-02-01

    Full Text Available Background. In the past thirty years, there has been a significant rise of public and private health institutions’ interest in the prediction and management of medical risks. The need of risk management is a direct consequence of the growing number of legal actions against medical malpractice. The concept of risk management involves three basic processes: risk identification, risk analysis, and risk management. Risk includes an evaluation of vulnerability and management of events that could potentially endanger the operation of a health institution, comprising a balance between the consequential costs of medical malpractice and the costs of risk reduction (anticipation. Thus the potential financial consequences of risk exposure are crucial in the formation of diagnostic and treatment protocols, whereas improvement of the quality of medical care as well as patient protection are the primary aims of risk management. Conclusions. Postmenopausal health care is not an exempt when considering possible erorrs in medication or medical process per se. On the orther hand menopausal medicine is not only hormonal replacement therapy but also bunch of complementary and alternative specialities involved in the healing process where error could be easily achieved.

  17. Health promotion in connection to the health care students

    Directory of Open Access Journals (Sweden)

    S. Kyuchukova

    2017-09-01

    Full Text Available The activities of health promotion for the students in health care specialties is organized and managed by the teacher process. During the training communication skills are acquired. It is the time for preparing students for work in counseling and patient education, collecting and providing health information - promotive function in the process of care (1. We assumed that these opportunities could be used in our work with children deprived of parental care. We set a goal to explore experiences, attitudes and ideas about students’ participation in health care in health promotion in the community of children and individuals. The study found that students are aware of the social importance of the knowledge acquired during the training and are convinced of the need to support adolescents to develop a responsible attitude towards their own health.

  18. The Beck Initiative: A Partnership to Implement Cognitive Therapy in a Community Behavioral Health System

    Science.gov (United States)

    Stirman, Shannon Wiltsey; Buchhofer, Regina; McLaulin, J. Bryce; Evans, Arthur C.; Beck, Aaron T.

    2010-01-01

    The Beck Initiative is a partnership between researchers and clinicians at a large university and an urban behavioral health managed care system. Both partners share a commitment to ensuring that consumers in the community have access to competently delivered, individualized, evidence-based mental health care and that the providers who serve them have the support they need to deliver high-quality evidence-based treatments. Central features of the program are individualized training and consultation in cognitive therapy for each provider agency and policies to promote the sustainability of the initiative and its continuing evolution to meet the needs of providers and consumers. PMID:19797367

  19. Czechoslovakia's changing health care system.

    Science.gov (United States)

    Raffel, M W; Raffel, N K

    1992-01-01

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

  20. Implementation of co-trimoxazole preventive therapy policy for malaria in HIV-infected pregnant women in the public health facilities in Tanzania.

    Science.gov (United States)

    Kamuhabwa, Appolinary Ar; Gordian, Richard; Mutagonda, Ritah F

    2016-01-01

    In 2011, Tanzania adopted a policy for provision of daily co-trimoxazole prophylaxis to HIV-infected pregnant women for prevention of malaria and other opportunistic infections. As per the policy, HIV-infected pregnant women should not be given sulfadoxine-pyrimethamine (SP) for intermittent preventive therapy. The challenges associated with this policy change and the extent to which the new policy for prevention of malaria in pregnant women coinfected with HIV was implemented need to be assessed. To assess the implementation of malaria-preventive therapy policy among HIV-infected pregnant women in the public health facilities in Dar es Salaam, Tanzania. The study was conducted in Kinondoni Municipality, Dar es Salaam, Tanzania, from January 2015 to July 2015. Three hundred and fifty-three HIV-infected pregnant women who were attending antenatal clinics (ANCs) and using co-trimoxazole for prevention of malaria were interviewed. Twenty-six health care workers working at the ANCs were also interviewed regarding provision of co-trimoxazole prophylaxis to pregnant women. A knowledge scale was used to grade the level of knowledge of health care providers. Focus group discussions were also conducted with 18 health care workers to assess the level of implementation of the policy and the challenges encountered. Twenty-three (6.5%) pregnant women with known HIV serostatus were using co-trimoxazole for prevention of opportunistic infections even before they became pregnant. Out of the 353 HIV-infected pregnant women, eight (2.5%) were coadministered with both SP and co-trimoxazole. Sixty (16.7%) pregnant women had poor adherence to co-trimoxazole prophylaxis. Out of the 26 interviewed health care providers, 20 had high level of knowledge regarding malaria-preventive therapy in HIV-infected pregnant women. Lack of adequate supply of co-trimoxazole in health facilities and inadequate training of health care providers were among the factors causing poor implementation of co

  1. The Child Health Care System in Italy.

    Science.gov (United States)

    Corsello, Giovanni; Ferrara, Pietro; Chiamenti, Gianpietro; Nigri, Luigi; Campanozzi, Angelo; Pettoello-Mantovani, Massimo

    2016-10-01

    Pediatric care in Italy has been based during the last 40 years on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. The pediatric health care system in Italy is part of the national health system. It is made up of 3 main levels of intervention: first access/primary care, secondary care/hospital care, and tertiary care based on specialty hospital care. This overview will also include a brief report on neonatal care, pediatric preventive health care, health service accreditation programs, and postgraduate training in pediatrics. The quality of the Italian child health care system is now considered to be in serious danger because of the restriction of investments in public health caused both by the 2008 global and national economic crisis and by a reduction of the pediatric workforce as a result of progressively insufficient replacement of specialists in pediatrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Attending unintended transformations of health care infrastructure

    Directory of Open Access Journals (Sweden)

    Helle Wentzer

    2007-11-01

    Full Text Available Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results: This paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion: The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes.

  3. No Racial Difference in Rehabilitation Therapy Across All Post-Acute Care Settings in the Year Following a Stroke.

    Science.gov (United States)

    Skolarus, Lesli E; Feng, Chunyang; Burke, James F

    2017-12-01

    Black stroke survivors experience greater poststroke disability than whites. Differences in post-acute rehabilitation may contribute to this disparity. Therefore, we estimated racial differences in rehabilitation therapy utilization, intensity, and the number of post-acute care settings in the first year after a stroke. We used national Medicare data to study 186 168 elderly black and white patients hospitalized with a primary diagnosis of stroke in 2011. We tabulated the proportion of stroke survivors receiving physical, occupational, and speech and language therapy in each post-acute care setting (inpatient rehabilitation facility, skilled nursing facility, and home health agency), minutes of therapy, and number of transitions between settings. We then used generalized linear models to determine whether racial differences in minutes of physical therapy were influenced by demographics, comorbidities, thrombolysis, and markers of stroke severity. Black stroke patients were more likely to receive each type of therapy than white stroke patients. Compared with white stroke patients, black stroke patients received more minutes of physical therapy (897.8 versus 743.4; P rehabilitation therapy utilization or intensity after accounting for patient characteristics. It is unlikely that differences in rehabilitation utilization or intensity are important contributors to racial disparities in poststroke disability. © 2017 American Heart Association, Inc.

  4. Child Health Care Services in Austria.

    Science.gov (United States)

    Kerbl, Reinhold; Ziniel, Georg; Winkler, Petra; Habl, Claudia; Püspök, Rudolf; Waldhauser, Franz

    2016-10-01

    We describe child health care in Austria, a small country in Central Europe with a population of about 9 million inhabitants of whom approximately 1.7 million are children and adolescents under the age of 20 years. For children and adolescents, few health care indicators are available. Pediatric and adolescent health provision, such as overall health provision, follows a complex system with responsibilities shared by the Ministry of Health, 19 social insurance funds, provinces, and other key players. Several institutions are affiliated with or cooperate with the Ministry of Health to assure quality control. The Austrian public health care system is financed through a combination of income-based social insurance payments and taxes. Pediatric primary health care in Austria involves the services of general pediatricians and general practitioners. Secondary care is mostly provided by the 43 children's hospitals; tertiary care is (particularly) provided in 4 state university hospitals and 1 private university hospital. The training program of residents takes 6 years and is completed by a final examination. Every year, this training program is completed by about 60 residents. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Perioperative Care of the Transgender Patient.

    Science.gov (United States)

    Smith, Francis Duval

    2016-02-01

    Transgender patients are individuals whose gender identity is not related to their biological sex. Assuming a new gender identity that does not conform to societal norms often results in discrimination and barriers to health care. The exact number of transgender patients is unknown; however, these patients are increasingly seen in health care. Transgender individuals may experience provider-generated discrimination in health care facilities, including refusal of service, disrespect, and abuse, which contribute to depression and low self-esteem. Transgender therapies include mental health counseling for depression and low self-esteem, hormone therapy, and sex reassignment surgery. Health care professionals require cultural competence, an understanding of the different forms of patient identification, and adaptive approaches to care for transgender patients. VA (Veterans Affairs) hospitals provide a model for the care for transgender patients and staff. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  6. Adolescent Health Care in School-Based Health Centers. Position Statement

    Science.gov (United States)

    National Assembly on School-Based Health Care, 2008

    2008-01-01

    School-based health centers (SBHCs) are considered one of the most effective strategies for delivering preventive care, including reproductive and mental health care services, to adolescents--a population long considered difficult to reach. National Assembly on School-Based Health Care (NASBHC) recommends practices and policies to assure…

  7. Health Literacy and Access to Care

    Science.gov (United States)

    Janke, Alex

    2016-01-01

    Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forego needed care or to report difficulty finding a provider, even after controlling for other factors including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after controlling for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way. PMID:27043757

  8. Health insurance and health care in India: a supply-demand perspective

    OpenAIRE

    Perianayagam, Arokiasamy; Goli, Srinivas

    2013-01-01

    India’s health care and health financing provision is characterized by too little Government spending on health, meager health insurance coverage, declining public health care use contrasted by highest levels of private out-of-pocket health spending in the world. To understand the interconnectedness of these disturbing outcomes, this paper envisions a theoretical framework of health insurance and health care revisits the existing health insurance schemes and assesses the health insurance cove...

  9. Toward a Caring Curriculum: Can Occupational Therapy Be Taught in a Caring Context?

    Science.gov (United States)

    Battaglia, James

    2016-01-01

    Caring is often cited as the central component of many health care professions. It is also identified as an equally important factor in patient physical and emotional recovery. In examining health care education, however, curriculum is becoming increasingly focused on the development of technical competence and skill with little focus on the…

  10. Health Care Provider Value Chain

    OpenAIRE

    Kawczynski , Lukasz; Taisch , Marco

    2009-01-01

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

  11. Use, misuse and non-use of health care assistants: understanding the work of health care assistants in a hospital setting.

    Science.gov (United States)

    Spilsbury, Karen; Meyer, Julienne

    2004-11-01

    This study is concerned with understanding the work of non-registered nurses (health care assistants) in a UK hospital setting. There are increasing numbers of health care assistants employed by the National Health Service in the UK to support registered nurses providing nursing care. However, little is known about the make-up of the health care assistant workforce and the changing nature of their role. This study addresses some of these gaps in the research-based literature. A single case study design using mixed methods (survey, interviews, participant observations, focus groups and documents) was used to generate an in-depth account of health care assistants' work in one organization. The study is built upon what health care assistants say they do, compared with what they actually do in practice. It explores how and whether the work of health care assistants is adequately supervised, tensions between the work of health care assistants and registered nurses and the subsequent effects on teamwork and patient care. There are policy expectations associated with the work of health care assistants. However, this study reveals significant deviations from these goals. The workplace arena and the negotiations between health care assistants and registered nurses that take place within it, actively shape the health care assistants' work. Findings suggest dynamic patterns of use, misuse and non-use of the health care assistants as a resource to patient care. The changing roles of registered nurses have direct implications for the roles of health care assistants: as registered nurses take on extra duties and responsibilities they are conceding some of their role to health care assistants. This has implications for nurse managers. The competence of health care assistants to carry out nursing work needs to be reassessed and there also needs to be ongoing monitoring and supervision of their work to maximize, and further develop, their contribution to patient care and to ensure

  12. Health care: economic impact of caring for geriatric patients.

    Science.gov (United States)

    Rich, Preston B; Adams, Sasha D

    2015-02-01

    National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Acceptance and commitment group therapy for health anxiety

    DEFF Research Database (Denmark)

    Eilenberg, Trine

    2013-01-01

    Health anxiety (or hypochondriasis) is prevalent, may be persistent and disabling for the sufferers and associated with high societal costs. Acceptance and Commitment Therapy (ACT) is a new third-wave behavioral cognitive therapy that has not yet been tested in health anxiety. 34 consecutive Danish...... patients with severe health anxiety were referred from general practitioners or hospital departments and received a ten session ACT group therapy. Patients were followed-up by questionnaires for 6 months. There were significant reductions in health anxiety, somatic symptoms and emotional distress at 6...

  14. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial.

    Science.gov (United States)

    Obreli-Neto, Paulo Roque; Marusic, Srecko; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Renovato, Rogério Dias; Pilger, Diogo; Cuman, Roberto Kenji Nakamura; Pereira, Leonardo Régis Leira

    2015-01-01

    Most diabetic and hypertensive patients, principally the elderly, do not achieve adequate disease control and consume 5%-15% of annual health care budgets. Previous studies verified that pharmaceutical care is useful for achieving adequate disease control in diabetes and hypertension. To evaluate the economic cost and the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of pharmaceutical care in the management of diabetes and hypertension in elderly patients in a primary public health care system in a developing country. A 36-month randomized controlled clinical trial was performed with 200 patients who were divided into a control group (n = 100) and an intervention group (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. The intervention and control groups were compared with regard to the direct costs of health services (i.e., general practitioner, specialist, nurse, and pharmacist appointments; emergency room visits; and drug therapy costs) and the ICER per QALY. These evaluations used the health system perspective. No statistically significant difference was found between the intervention and control groups in total direct health care costs ($281.97 ± $49.73 per patient vs. $212.28 ± $43.49 per patient, respectively; P = 0.089); pharmaceutical care added incremental costs of $69.60 (± $7.90) per patient. The ICER per QALY was $53.50 (95% CI = $51.60-$54.00; monetary amounts are given in U.S. dollars). Every clinical parameter evaluated improved for the pharmaceutical care group, whereas these clinical parameters remained unchanged in the usual care group. The difference in differences (DID) tests indicated that for each clinical parameter, the patients in the intervention group improved more from pre to post than the control group (P < 0.001). While pharmaceutical

  15. Digital health care: where health care, information technology, and the Internet converge.

    Science.gov (United States)

    Frank, S R; Williams, J R; Veiel, E L

    2000-01-01

    The digital health care industry applies information technologies to facilitate communications, commerce, transactions, business problem solving, and enhanced decision making for one or more groups that supply, consume, or finance health care services and products. The variation among companies is significant, but each one attempts to leverage information technology to drive sustainable evolutionary change. In an overview of the industry, a framework is provided to understand the maze of business plans.

  16. Health care consumerism movement takes a step forward.

    Science.gov (United States)

    Thompson, Michael; Cutler, Charles M

    2010-01-01

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

  17. Health care in China: improvement, challenges, and reform.

    Science.gov (United States)

    Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

    2013-02-01

    Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

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

    Science.gov (United States)

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

    2016-06-01

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

  19. Functioning of primary health care in opinion of managers of primary health care units.

    Science.gov (United States)

    Bojar, I; Wdowiak, L; Kwiatosz-Muc, M

    2006-01-01

    The aim of the research is to get to know opinions of primary health care managers concerning working of primary health care and concerning quality of medical services offered by family doctors out-patient clinics. The research among managers of primary health care units took place in all out-patient clinics in Lublin province. Research instrument was survey questionnaire of authors own construction. Results were statistically analyzed. From 460 surveys sent, 108 questionnaires were accepted to analysis. Majority of managers of out-patient clinics of primary health care is satisfied with the way and the quality of work of employed staff. In opinion of 71.3% of managers access to family doctor services is very good. Availability of primary health care services is better estimated by managers of not public units. The occupied local provide comfortable work for the staff in opinion of 78.5% of surveyed managers of out-patient clinics. Managers estimate the level of their services as very good (37.96%) and good (37.96%) comparing to other such a subjects present in the market. Internal program of improving quality is run in 22% of out-patient clinics, which were investigated. Managers of primary health care units assess the quality of their services as good and very good. They estimate positively the comfort and politeness in serving patients as well as technical status of equipment and the lodging. They assess availability of their services as very good. Large group of managers of family doctors practices recognizes neighborhood practices as a competitors.

  20. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

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

  1. Promoting coordination in Norwegian health care

    Directory of Open Access Journals (Sweden)

    Tor I. Romøren

    2011-10-01

    Full Text Available   Introduction: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.Policy practice: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.Discussion: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.

  2. Nigerian health care: A quick appraisal

    Directory of Open Access Journals (Sweden)

    Yau Zakari Lawal

    2017-01-01

    Full Text Available Qualitative health care is a fundamental right of all citizens of a given country. How this health care is delivered depends significantly on the economy, dedication, and quality of the health-care providers and the political will of the government of the country. Health care may be public run or organized by private health-care providers. We can also have an intercalated program where there is public–private partnership. Whichever way this basic fundamental human right is delivered, sustainability, affordability, and accessibility are vital to its success. The Nigerian health-care delivery can be broadly classified into two; the hitherto existing traditional medicine and the modern orthodox medicine which came to our shores with the arrival of the European colonialists. The traditional system is still patronized by most Nigerians and is known by different linguistic terminologies such as the “Wanzami” or Barber in Hausa and the “Babalawo” in Yoruba language. Traditional birth attendants also exist in all communities in Nigeria complemented by herbalist and spiritualists of different shades and callings. It is our aim to give a brief account of our observations on the Nigerian health-care system with a view to correcting the challenges by the government and the public in general.

  3. Associations and foundations in the field of health care and their role in the health system of Poland.

    Science.gov (United States)

    Piotrowicz, Maria; Cianciara, Dorota

    2013-01-01

    The article presents data on associations and foundations active in health care field in Poland, on the basis of a review of research done by Klon/Jawor Association and the Central Statistical Office. The article also applies to the issue of cooperation between NGOs and governmental adminstration in the health area and identifies lacking information that is necessary for better planning of national health policy. In Poland there are about three thousand associations and foundations whose main focus is the health care. In 2010, they accounted for about 7% of all non-governmental organizations. Results of representative nationwide surveys from 2008 and 2010 indicate that the NGO's active in the field of health care have, in most cases, legal form of associations. Almost half of the organizations declared national or international scope of action. Headquarters of most organizations were mainly in the cities, and only, one in twenty in the village. Most organizations were located in the mazowieckie province and a significant fraction of them was in Warsaw itself. Organizations were stood out by a relatively large number of personnel on the background of the entire NGO sector. Half of the organizations employed paid workers, the majority also collaborated with volunteers who were not members of the organization. More than a third of organizations dealt with the rehabilitation, therapy and long-term care, and about 1/3 dealt with prevention, health promotion and education, and blood donations. World Health Organization indicates the need for systematic collection of data about the role of the nongovernmental sector in health. In Poland, legal regulations require the public institutions and organizations to cooperate with NGOs to achieve health objectives. In spite of relevant data on NGOs in the field of health care in Poland, the necessary information to assess their potential are still lacking. Recognition of the capacity and limitations ofNGOs could enable better

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

    Science.gov (United States)

    Gould, Stephen J.

    1988-01-01

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

  5. Care for children with special health care needs in a managed care system: a patient satisfaction survey.

    Science.gov (United States)

    Flynn, J M; Bravo, C J; Reyes, O

    2001-09-01

    In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.

  6. The future of health insurance for children with special health care needs.

    Science.gov (United States)

    Newacheck, Paul W; Houtrow, Amy J; Romm, Diane L; Kuhlthau, Karen A; Bloom, Sheila R; Van Cleave, Jeanne M; Perrin, James M

    2009-05-01

    Because of their elevated need for services, health insurance is particularly important for children with special health care needs. In this article we assess how well the current system is meeting the insurance needs of children with special health care needs and how emerging trends in health insurance may affect their well-being. We begin with a review of the evidence on the impact of health insurance on the health care experiences of children with special health care needs based on the peer-reviewed literature. We then assess how well the current system meets the needs of these children by using data from 2 editions of the National Survey of Children With Special Health Care Needs. Finally, we present an analysis of recent developments and emerging trends in the health insurance marketplace that may affect this population. Although a high proportion of children with special health care needs have insurance at any point in time, nearly 40% are either uninsured at least part of the year or have coverage that is inadequate. Recent expansions in public coverage, although offset in part by a contraction in employer-based coverage, have led to modest but significant reductions in the number of uninsured children with special health care needs. Emerging insurance products, including consumer-directed health plans, may expose children with special health care needs and their families to greater financial risks. Health insurance coverage has the potential to secure access to needed care and improve the quality of life for these children while protecting their families from financially burdensome health care expenses. Continued vigilance and advocacy for children and youth with special health care needs are needed to ensure that these children have access to adequate coverage and that they fare well under health care reform.

  7. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

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

  8. Occupational Health for Health Care Providers

    Science.gov (United States)

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

  9. Animal-Assisted Therapy for Improving Human Health

    Directory of Open Access Journals (Sweden)

    Sibel Cevizci

    2009-06-01

    Full Text Available ABSTRACT Animal Assisted Therapy (AAT or Pet Therapy is an adjunctive therapy by taking advantage of human and animal interaction, activate the physiological and psychological mechanisms, initiate positive changes improving health in metabolism. In recent years, this interaction are in use to treat psychological and psychiatric disorders such as stress, depression, loneliness, pervasive developmental disorders affect negatively to human health. Furthermore, AAT has been increasingly used to improve quality of life, hypertension, cardiovascular diseases, chronic illnesses such as cancer and AIDS. The aim of this paper is to identify AAT by reviewing human and animal interaction, evaluate how AAT has a scientific background from past to now. Also, we aim to give some information about the risks, institutional applications, some factors referring AAT’s mechanism of action and chronic diseases, psychological and physical improvements provided with animal assisted therapies. The therapy results will be evaluated more advisable providing AAT is being applied with public health specialist, veterinarian, physician, psychologist, psychiatrist and veterinary public health experts who are monitor applications. Especially, the psychosomatic effects result from physical, emotional and play mechanism of action of HDT can be used for improving quality of life in individuals with chronic diseases. In Turkey, there is no any investigation which have been performed in this scientific field. It is quitely important to evaluate the benefits of this therapy accurately and to select various methods proper to diseases. Consequently, it is obvious that AAT will be considered by the healthcare services as a supportive therapy process for improving human health in Turkey and needs further studies. [TAF Prev Med Bull 2009; 8(3.000: 263-272

  10. Music therapy perspectives in palliative care education.

    Science.gov (United States)

    Porchet-Munro, S

    1993-01-01

    Major strides have been made in expanding the content of professional education in palliative care to include a focus on attitudes which nurture compassionate care as well as on knowledge and skills. However, accessing the emotional spheres--for instance the fear and helplessness of caregivers--remains a challenge. The inclusion of music therapy techniques as a teaching modality, with an emphasis on emotional experience and nonverbal expression, is suggested to address the latter and to enhance affective growth and learning.

  11. eHealth and quality in health care: implementation time

    NARCIS (Netherlands)

    Ossebaard, Hans Cornelis; van Gemert-Pijnen, Julia E.W.C.

    2016-01-01

    The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new

  12. Women's self-perception and self-care practice: implications for health care delivery.

    Science.gov (United States)

    Mendias, E P; Clark, M C; Guevara, E B

    2001-01-01

    Mexican American women experience unique health care needs related to integration of Mexican and American cultures. To learn how to better promote self-care practices and service utilization in women of Mexican origin living in Texas, researchers used a qualitative approach to interview a convenience sample of 11 low-income women attending a health clinic. Researchers collected narrative data about the women's perceptions of health, wellness, and self-care. Using the matrix approach described by Miles and Huberman, we organized findings around women's roles, including participants' descriptions of themselves, their health and wellness awareness, self-care practices for health/illness and wellness/nonwellness, barriers to self-care, origin of self-care practices, and perceptions of life control. Implications for health planning and service delivery are presented.

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

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder

    2011-01-01

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

  14. Health care in rural areas.

    Science.gov (United States)

    Nath, L M

    1994-02-01

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

  15. National Health-Care Reform

    Science.gov (United States)

    2009-03-24

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

  16. Care of children with disabilities in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Thaís Giudice Schultz

    2016-07-01

    Full Text Available Objective: This article describes an experience report that aimed to present perceptions on the care of children with disabilities in the Family Health Strategy (FHS, showing its limits and potentials based on the experience of participation in the program ‘PET-Saúde’. Method: Data were collected from field notes which recorded the monitoring of the care process offered to children with disabilities by the FHS teams. The study was conducted in a health facility in the city of Rio de Janeiro for one year. Results: Content analysis results listed the two main themes that composed the issues of concern for child care in this experience: the coordination of health care and the family and community orientation as the core for child care in the FHS. Conclusion: Despite the weakness in compliance with these categories, which are principles and fundamentals of the FHS, this is a privileged space with regard to care practices for children with disabilities.

  17. Using appreciative inquiry to transform health care.

    Science.gov (United States)

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

    2013-08-01

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

  18. Discrimination against older women in health care.

    Science.gov (United States)

    Belgrave, L L

    1993-01-01

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

  19. Care Preferences Among Middle-Aged and Older Adults With Chronic Disease in Europe: Individual Health Care Needs and National Health Care Infrastructure.

    Science.gov (United States)

    Mair, Christine A; Quiñones, Ana R; Pasha, Maha A

    2016-08-01

    The purpose of this study is to expand knowledge of care options for aging populations cross-nationally by examining key individual-level and nation-level predictors of European middle-aged and older adults' preferences for care. Drawing on data from the Survey of Health, Ageing and Retirement in Europe and the Organisation for Economic Co-operation and Development, we analyze old age care preferences of a sample of 6,469 adults aged 50 and older with chronic disease in 14 nations. Using multilevel modeling, we analyze associations between individual-level health care needs and nation-level health care infrastructure and preference for family-based (vs. state-based) personal care. We find that middle-aged and older adults with chronic disease whose health limits their ability to perform paid work, who did not receive personal care from informal sources, and who live in nations with generous long-term care funding are less likely to prefer family-based care and more likely to prefer state-based care. We discuss these findings in light of financial risks in later life and the future role of specialized health support programs, such as long-term care. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Boundaries and e-health implementation in health and social care

    Directory of Open Access Journals (Sweden)

    King Gerry

    2012-09-01

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

  1. Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study.

    Science.gov (United States)

    Oda, Anna; Tuck, Andrew; Agic, Branka; Hynie, Michaela; Roche, Brenda; McKenzie, Kwame

    2017-05-03

    Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support. Copyright 2017, Joule Inc. or its licensors.

  2. Health care agreements as a tool for coordinating health and social services

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Strandberg-Larsen, Martin; Vrangbaek, Karsten

    2014-01-01

    of general practitioners (n = 700/853). RESULTS: The health care agreements were considered more useful for coordinating care than the previous health plans. The power relationship between the regional and municipal authorities in drawing up the agreements was described as more equal. Familiarity......INTRODUCTION: In 2007, a substantial reform changed the administrative boundaries of the Danish health care system and introduced health care agreements to be signed between municipal and regional authorities. To assess the health care agreements as a tool for coordinating health and social...... with the agreements among general practitioners was higher, as was the perceived influence of the health care agreements on their work. DISCUSSION: Health care agreements with specific content and with regular follow-up and systematic mechanisms for organising feedback between collaborative partners exemplify...

  3. [Calculation of workers' health care costs].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2006-01-01

    In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference

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

    Science.gov (United States)

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

    2015-08-01

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

  5. If it quacks like a duck: reviewing health care providers' speech restrictions under the first prong of Central Hudson.

    Science.gov (United States)

    Fultz, Shawn L

    2013-01-01

    The First Amendment protects the speech of health care providers. This protection can limit states' abilities to protect patients from harmful therapies involving speech, such as sexual orientation change efforts. Because providers' speech is more similar to commercial speech than traditional political discourse, it is possible to create a First Amendment review analysis that better balances states' police powers with providers' First Amendment rights. Under a "single-prong" approach, the first prong of Central Hudson can be used to identify quackery, which is analogous to false or misleading commercial speech and would therefore be outside the protection of the First Amendment. Because health care must be tailored to individual patients, restrictions on speech that survive the first prong of Central Hudson would be subject to strict scrutiny in order to leave the therapeutic decision to the provider and her patient, and maintain consistency with current jurisprudence. This Comment examines litigation from California's attempted ban on sexual orientation change therapy to illustrate the conflicts created by the current approach to First Amendment review of health care provider speech. This Comment then demonstrates the benefit of the proposed single-prong approach, including how it simultaneously protects patients from harm while protecting health care providers' speech.

  6. The Healthy People 2010 outcomes for the care of children with special health care needs: an effective national policy for meeting mental health care needs?

    Science.gov (United States)

    Spears, Amanda P

    2010-05-01

    To assess the effectiveness of the Maternal and Child Health Bureau's (MCHB) Six Core Outcomes for children with special health care needs (CSHCN) as indicators in measuring the degree to which mental health care needs are met. This study analyzes data from the 2001 National Survey of Children with Special Health Care Needs for 9,748 CSHCN who needed mental health care. Bivariate and logistic analyses were employed to investigate the impact of the MCHB's Six Core Outcomes on the probability of having an unmet need for mental health services. Of the 2.3 million CSHCN in the U.S. who needed mental health care in 2001, almost one-fifth did not receive all of the mental health services that they needed. Ultimately, eight Outcomes and sub-categories of Outcomes were considered. Sixty-one percent of CSHCN with a need for mental health care had care that fulfills six of the eight considered Outcomes. Logistic analysis indicates that individual fulfillment of each of the Core Outcomes and fulfillment of additional Outcomes have a significant association with reducing the probability of having an unmet mental health care need for CSHCN. This study is the first attempt to apply the Six Core Outcomes to meeting the needs for mental health care among CSHCN. Estimates of unmet need for mental health care suggest that efforts can be made to improve access for CSHCN. The initial estimates generated by this study indicate that the MCHB Outcomes are important in meeting children's mental health needs and are important indicators for informing MCHB policy.

  7. Adult care transitioning for adolescents with special health care needs: a pivotal role for family centered care.

    Science.gov (United States)

    Duke, Naomi N; Scal, Peter B

    2011-01-01

    To examine the relationship between having a usual source of care, family centered care, and transition counseling for adolescents with special health care needs. Data are from 18,198 parents/guardians, of youth aged 12-17 years, who participated in the 2005-2006 National Survey of Children With Special Health Care Needs. Linear and logistic regression models were used to define relationships between parent report of identification of a usual place and provider of medical care for their child and counseling on four transition issues: transfer to adult providers, review of future health needs, maintaining health insurance in adulthood, and youth taking responsibility for care. The direct mediating effect of family centered care was evaluated. Youth having a usual source of care (vs. not) were more likely to receive counseling on future health needs (47.4 vs. 33.6%, P needs (56.3 vs. 39.6%, P needs and 94.9% of the effect of a usual source of care on encouragement to take responsibility for care. Study findings support the development of health care delivery models focusing on family centered care to the same degree as other health care access issues.

  8. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial.

    Science.gov (United States)

    Weersing, V Robin; Brent, David A; Rozenman, Michelle S; Gonzalez, Araceli; Jeffreys, Megan; Dickerson, John F; Lynch, Frances L; Porta, Giovanna; Iyengar, Satish

    2017-06-01

    Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations. To examine whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care. This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse, intellectual disability, or unstable serious physical illness. The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level clinicians. The ARC families received personalized referrals to mental health care and check-in calls to support accessing care from master's-level coordinators. The primary outcome was clinically significant improvement on the Clinical Global Impression-Improvement scale (score ≤2). Secondary outcomes included the Pediatric Anxiety Rating Scale, Children's Depression Rating Scale-Revised, and functioning. A total of 185 patients were enrolled in the study (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n = 95), compared with those in

  9. Professional values, technology and future health care: The view of health care professionals in The Netherlands

    NARCIS (Netherlands)

    M.E. Nieboer; A.M. van Hout; Joost van Hoof; Sil Aarts; Eveline Wouters

    2014-01-01

    Perceptions and values of care professionals are critical in successfully implementing technology in health care. The aim of this study was threefold: (1) to explore the main values of health care professionals, (2) to investigate the perceived influence of the technologies regarding these values,

  10. Music therapy in pediatric palliative care: family-centered care to enhance quality of life.

    Science.gov (United States)

    Lindenfelser, Kathryn J; Hense, Cherry; McFerran, Katrina

    2012-05-01

    Research into the value of music therapy in pediatric palliative care (PPC) has identified quality of life as one area of improvement for families caring for a child in the terminal stages of a life-threatening illness. This small-scale investigation collected data in a multisite, international study including Minnesota, USA, and Melbourne, Australia. An exploratory mixed method design used the qualitative data collected through interviews with parents to interpret results from the PedsQL Family Impact Module of overall parental quality of life. Parents described music therapy as resulting in physical improvements of their child by providing comfort and stimulation. They also valued the positive experiences shared by the family in music therapy sessions that were strength oriented and family centered. This highlighted the physical and communication scales within the PedsQL Family Impact Module, where minimal improvements were achieved in contrast to some strong results suggesting diminished quality of life in cognitive and daily activity domains. Despite the significant challenges faced by parents during this difficult time, parents described many positive experiences in music therapy, and the overall score for half of the parents in the study did not diminish. The value of music therapy as a service that addresses the family-centered agenda of PPC is endorsed by this study.

  11. Restructuring American health care financing: first of all, do no harm!

    Science.gov (United States)

    Berk, P D

    1993-07-01

    Health care costs are climbing throughout the western world. Aging populations and the costs of advanced technology are the principal forces behind much of this global increase. No country has yet succeeded in containing these growing costs other than by some form of rationing. A variety of experimental strategies, including managed competition, are being considered or tested, but none is clearly effective. American health care expenditures differ, not in that they are rising, but in their enormously high starting point. Among other things, our higher costs reflect administrative costs of more than 20%, double those of Canada and nearly triple the European average; a malpractice system that, whatever its possible advantages, costs more than 10 times as much as it pays out to the injured; the enormous medical costs of poverty; maldistribution of physician specialties and incomes; and reimbursement systems that eliminate consumer input and oversight. Restructuring the system of health care financing to bring administrative costs in line with those of other nations could save at least $70 billion annually; another $25 billion or more could be saved by replacing the malpractice system with more cost-effective alternatives. These savings could defray the costs of insuring all those not now covered, without increasing either costs to the middle class, through taxation of benefits, or total health care expenditures. With all Americans covered, the necessary restructuring of the system of health care delivery could be conducted without the current pressure for immediate drastic reform, which carries with it the risk of serious error. In dealing with the sick, physicians are taught to apply two maxims: "primum non nocere" or "first of all, do no harm!"; and the rule of therapeutic restraint. The latter states that a severe chronic illness may respond better, and with fewer complications, to gradual corrective measures than to highly aggressive therapy. Both rules could well

  12. Health care technology as a policy issue

    NARCIS (Netherlands)

    Banta, H.D.

    1994-01-01

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

  13. Health care and equity in India

    Science.gov (United States)

    Balarajan, Yarlini; Selvaraj, S; Subramanian, S V

    2011-01-01

    India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population. PMID:21227492

  14. An analysis of integrated health care for Internet Use Disorders in adolescents and adults.

    Science.gov (United States)

    Lindenberg, Katajun; Szász-Janocha, Carolin; Schoenmaekers, Sophie; Wehrmann, Ulrich; Vonderlin, Eva

    2017-12-01

    Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.

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

    Science.gov (United States)

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

    2013-06-01

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

  16. Use of a radiation therapy treatment planning computer in a hospital health physics program

    International Nuclear Information System (INIS)

    Addison, S.J.

    1984-01-01

    An onsite treatment planning computer has become state of the art in the care of radiation therapy patients, but in most installations the computer is used for therapy planning a diminutive amount of the day. At St. Mary's Hospital, arrangements have been negotiated for part time use of the treatment planning computer for health physics purposes. Computerized Medical Systems, Inc. (CMS) produces the Modulex radiotherapy planning system which is programmed in MUMPS, a user oriented language specially adapted for handling text string information. St. Mary's Hospital's CMS computer has currently been programmed to assist in data collection and write-up of diagnostic x-ray surveys, meter calibrations, and wipe/leak tests. The computer is setup to provide timely reminders of tests and surveys, and billing for consultation work. Programs are currently being developed for radionuclide inventories. Use of a therapy planning computer for health physics purposes can enhance the radiation safety program and provide additional grounds for the acquisition of such a computer system

  17. Mindfulness-based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care.

    Science.gov (United States)

    Lilja, Josefine L; Zelleroth, Clara; Axberg, Ulf; Norlander, Torsten

    2016-10-01

    This study examined the effectiveness of mindfulness-based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle- and high-income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence-based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person-centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre-test to post-test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  18. [How to promote the respect of good infusion practices by meeting health care professionals?].

    Science.gov (United States)

    Le Reste, C; Fiedler, A; Dubois, S; Dewailly, A; Le Du, I; Cogulet, V

    2016-05-01

    Health care professionals often forget that there are risks associated with infusion therapy even if it is a common care. In order to assess this practice and to draw potential improvement actions, an audit of local gravity-flow intravenous infusion practices was conducted. The audit, based on a grid including 66 items from the medical prescription to the end of the infusion therapy administration, was conducted in the 6 units which use the most gravity-flow intravenous infusion devices. A multidisciplinary working group was created to decide and organize priority corrective measures in order to improve infusion practices and quality of healthcare. The audit enabled to observe 90hours of nurse's practices (96 infusions) and highlighted heterogeneity in infusion, in some cases inappropriate infusion practices and misuse of infusion devices. We found 4 main issues: labelling infusion therapy, training of health care professionals on good practices, support the purchase of infusion pumps and standardize perfusion line. An interactive educational program for nurses (workshops) was organized to enhance the respect of good practices: infusion identification at any time, respect of hygiene rules, flow rate regulation by counting drops, appropriate use of pumps and flow rate regulators. The audit drew up work priorities. The workshops made easier exchanges between professionals and had a warm welcome that's why it is essential to carry on such training. This collaborative approach between pharmacists, nurses, hygienists and biomedical technicians contribute to drug management improvement and promote optimal patient care. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  19. Knowledge and pharmaceutical care practice regarding inhaled therapy among registered and unregistered pharmacists: an urgent need for a patient-oriented health care educational program in Iraq

    Directory of Open Access Journals (Sweden)

    Abdulameer SA

    2018-03-01

    Full Text Available Shaymaa Abdalwahed Abdulameer Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq Background: Inadequate inhaled aerosol device demonstration and technique by health care professionals can lead to poor disease control. The aims of this study were to develop and validate Knowledge of Aerosol Tool (KAT among registered and unregistered pharmacists and to assess the pharmaceutical care practice among registered pharmacists.Methods: The KAT and pharmaceutical care practice questionnaires were developed and modified from previous reports, then an observational cross-sectional study with a convenience sample size of 340 was carried out among registered and unregistered pharmacists. The validation process included face validity and reliability, and item analysis was carried out.Results: The results showed good face validity and reliability with Cronbach’s alpha test and Pearson’s correlation coefficient for test–retest of 0.637 and 0.440, respectively. The KAT item difficulty index for most items was between 0.130 and 0.667. The total KAT scores for registered and unregistered pharmacists were 10.13±3.152 and 8.29±2.930, respectively, which revealed inadequate pharmacist knowledge of inhaled aerosol device technique and therapies. In addition, only 38.38% of the total sample was found to have a high KAT level score. The results showed higher KAT scores among males, pharmacists with a family history of respiratory disease, and pharmacists with a master’s degree. For the registered pharmacists, there were positive correlations between the total KAT score and the total pharmaceutical care practice score and the average number of patients with a respiratory disease seen by the pharmacist weekly, respectively. Moreover, there was a positive correlation between the total KAT score and its aerosol administration subscale with pharmacotherapy care and comorbid disease management practice care.Conclusion: The KAT showed good validity

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

    Science.gov (United States)

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

    2016-02-01

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

  1. Ethical thinking and discrimination in health care

    Directory of Open Access Journals (Sweden)

    Aleksander Mlinšek

    2012-02-01

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

  2. Ways of Doing: Restorative Practices, Governmentality, and Provider Conduct in Post-Apartheid Health Care.

    Science.gov (United States)

    Harris, Bronwyn; Eyles, John; Goudge, Jane

    2016-01-01

    In this article, we consider the conduct of post-apartheid health care in a policy context directed toward entrenching democracy, ensuring treatment-adherent patients, and creating a healthy populace actively responsible for their own health. We ask how tuberculosis treatment, antiretroviral therapy, and maternal services are delivered within South Africa's health system, an institutional site of colonial and apartheid injustice, and democratic reform. Using Foucauldian and post-Foucauldian notions of governmentality, we explore provider ways of doing to, for, and with patients in three health subdistricts. Although restorative provider engagements are expected in policy, older authoritarian and paternalistic norms persist in practice. These challenge and reshape, even 'undo' democratic assertions of citizenship, while producing compliant, self-responsible patients. Alongside the need to address pervasive structural barriers to health care, a restorative approach requires community participation, provider accountability, and a health system that does with providers as much as providers who do with patients.

  3. Cross-cultural barriers to health care.

    Science.gov (United States)

    Vidaeff, Alex C; Kerrigan, Anthony J; Monga, Manju

    2015-01-01

    Culturally sensitive health care represents a real ethical and practical need in a Western healthcare system increasingly serving a multiethnic society. This review focuses on cross-cultural barriers to health care and incongruent aspects from a cultural perspective in the provision of health care. To overcome difficulties in culturally dissimilar interactions and eventually remove cross-cultural barriers to health care, a culturally sensitive physician considers his or her own identity, values, and beliefs; recognizes the similarities and differences among cultures; understands what those similarities and differences mean; and is able to bridge the differences to accomplish clear and effective communication.

  4. Family focused grief therapy: The therapy of choice in palliative care

    Directory of Open Access Journals (Sweden)

    Klikovac Tamara

    2017-01-01

    Full Text Available Palliative care refers to offering physical, psychosocial and spiritual care to patients who are suffering from life threatening diseases. It also includes providing psychological support for family members and other close relations during the period of illness (anticipatory grief and in the period of bereavement and mourning after the patient's death. The choice of therapy during the process of bereavement and mourning is Family Focused Grief Therapy (FFGT. FFGT is a brief, focused and time-limited psychotherapeutic model of intervention belonging to family psychotherapy which is specified for the families that face a life threatening disease of a family member. FFGT, with some modifications, can be applied in work with the families who are facing a terminal illness of younger family members - a child or an adolescent. FFGT typically comprises of 7 to 9 sessions lasting for 90 minutes, which are arranged flexibly across 9 to 18 months, depending on the needs of each family individually. It is important to emphasize that the frequency and number of sessions in each phase depend on the specific features and needs of each particular family. The intervention aim of FFGT is to prevent the complications of bereavement by enhancing the functioning of the family, through exploration of its cohesion, communications (of thoughts and feelings, and handling of conflict. The story of illness and the related grief is shared in the process. The creator of this model is Dr David Kissane, a psychiatrist and a family psychotherapist from Melbourne, Australia, who also worked at the Memorial Sloan Kettering Cancer Centre in New York. The main aims of this article are, on the one hand, to introduce this very useful model of the family therapy to the professional community in Serbia and, on the other, to introduce a conceptual and practical frame of palliative care.

  5. Conscientious objection in health care

    Directory of Open Access Journals (Sweden)

    Kuře Josef

    2016-12-01

    Full Text Available The paper deals with conscientious objection in health care, addressing the problems of scope, verification and limitation of such refusal, paying attention to ideological agendas hidden behind the right of conscience where the claimed refusal can cause harm or where such a claim is an attempt to impose certain moral values on society or an excuse for not providing health care. The nature of conscientious objection will be investigated and an ethical analysis of conscientious objection will be conducted. Finally some suggestions for health care policy will be proposed.

  6. Dual Loyalty in Prison Health Care

    Science.gov (United States)

    Stöver, Heino; Wolff, Hans

    2012-01-01

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

  7. Islamic Cultures: Health Care Beliefs and Practices.

    Science.gov (United States)

    Kemp, Charles

    1996-01-01

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

  8. High and rising health care costs.

    Science.gov (United States)

    Ginsburg, Paul B

    2008-10-01

    The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

  9. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law.

  10. Health care financing and the sustainability of health systems.

    Science.gov (United States)

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-09-15

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

  11. Health care engineering management.

    Science.gov (United States)

    Jarzembski, W B

    1980-01-01

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

  12. eHealth as the Next-Generation Perinatal Care: An Overview of the Literature.

    Science.gov (United States)

    van den Heuvel, Josephus Fm; Groenhof, T Katrien; Veerbeek, Jan Hw; van Solinge, Wouter W; Lely, A Titia; Franx, Arie; Bekker, Mireille N

    2018-06-05

    Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable

  13. Pressure ulcer care: nutritional therapy need not add to costs.

    NARCIS (Netherlands)

    Schols, J.M.G.A.; Kleijer, C.N.; Lourens, C.

    2003-01-01

    Fewer patients with pressure ulcers in Dutch nursing homes receive nutritional therapy via sip feeds, possibly because of cost concerns. But this therapy would not cost more if it reduced the duration of nursing care by even one day, this paper argues.

  14. Health Care Services

    Science.gov (United States)

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

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

    International Nuclear Information System (INIS)

    Al-Khatib, Issam A.; Sato, Chikashi

    2009-01-01

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

  16. Health Care Employee Perceptions of Patient-Centered Care: A Photovoice Project

    Science.gov (United States)

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L.

    2015-01-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspective is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, several areas for improvement were identified. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. PMID:25274626

  17. Oral care of the cancer patient receiving radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Holtzhausen, T [Medical Univ. of Southern Africa, Pretoria (South Africa). Dept. of Community Dentistry

    1982-07-01

    Radiation therapy is frequently being used for the patient with oral cancer. The survival rate is increasing, due to more effective treatment technique. The question of whether any teeth should be extracted, the mode of therapy and the side effects of radiation like Xerostomia, caries, stomatitis, trismus and osteo-radionecrosis and also post radiation care are discussed.

  18. Teaching Health Care in Introductory Economics

    Science.gov (United States)

    Cutler, David M.

    2017-01-01

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

  19. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era.

    Science.gov (United States)

    Patterson, T F; Andriole, V T

    1997-09-01

    Profound physiologic and anatomic changes of the urinary tract during pregnancy contribute to the increased risk for symptomatic urinary tract infection in women with bacteriuria. Asymptomatic bacteriuria is the major risk factor for developing symptomatic UTIs during pregnancy and may be associated with adverse effects on maternal and fetal health. Because most symptomatic UTIs develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All pregnant women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy should be given to women with bacteriuria and clearance of bacteriuria should be documented after therapy is complete. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a urologic evaluation after delivery.

  20. Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms.

    Science.gov (United States)

    Haux, Reinhold; Howe, Jurgen; Marschollek, Michael; Plischke, Maik; Wolf, Klaus-Hendrik

    2008-06-01

    Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Summarizing outcomes of literature analyses and results from own research projects in this field. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

  1. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Wagner, Lis; Hall, Elisabeth O.C.

    2007-01-01

    into self-care as a significant health resource of elders with different health status. It suggests that an elder's self-care ability is determined by the interaction of various sub-resources and conditions and emphasizes the constantly evolving nature of self-care. The framework may be of use in clinical...... practice, policy-making and research into health care of frail or robust elders.......AIM: To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource. BACKGROUND: Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance...

  2. Insurance + Access ≠ Health Care: Typology of Barriers to Health Care Access for Low-Income Families

    Science.gov (United States)

    DeVoe, Jennifer E.; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A.

    2007-01-01

    PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, “Is there anything else you would like to tell us?” Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere. PMID:18025488

  3. Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety

    DEFF Research Database (Denmark)

    Hoffmann, Ditte; Rask, Charlotte Ulrikka; Hedman-Lagerlöf, Erik

    2018-01-01

    , prevalent disorder associated with increased health care utilization. Still, there is a lack of easily accessible specialized treatment for severe health anxiety. OBJECTIVE: The aims of this paper were to (1) describe the development and setup of a new internet-delivered acceptance and commitment therapy (i...... sample size of the study limited the robustness of the findings. Therefore, the findings should be replicated in a randomized controlled trial. Potentially, iACT may increase availability and accessibility of specialized treatment for health anxiety. TRIAL REGISTRATION: Danish Data Protection Agency...

  4. Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

    Science.gov (United States)

    Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

    2016-05-01

    Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements.

  5. The Quiet Health Care Revolution.

    Science.gov (United States)

    Herzlinger, Regina

    1994-01-01

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

  6. The carbon footprint of Australian health care.

    Science.gov (United States)

    Malik, Arunima; Lenzen, Manfred; McAlister, Scott; McGain, Forbes

    2018-01-01

    Carbon footprints stemming from health care have been found to be variable, from 3% of the total national CO 2 equivalent (CO 2 e) emissions in England to 10% of the national CO 2 e emissions in the USA. We aimed to measure the carbon footprint of Australia's health-care system. We did an observational economic input-output lifecycle assessment of Australia's health-care system. All expenditure data were obtained from the 15 sectors of the Australian Institute of Health and Welfare for the financial year 2014-15. The Australian Industrial Ecology Virtual Laboratory (IELab) data were used to obtain CO 2 e emissions per AUS$ spent on health care. In 2014-15 Australia spent $161·6 billion on health care that led to CO 2 e emissions of about 35 772 (68% CI 25 398-46 146) kilotonnes. Australia's total CO 2 e emissions in 2014-15 were 494 930 kilotonnes, thus health care represented 35 772 (7%) of 494 930 kilotonnes total CO 2 e emissions in Australia. The five most important sectors within health care in decreasing order of total CO 2 e emissions were: public hospitals (12 295 [34%] of 35 772 kilotonnes CO 2 e), private hospitals (3635 kilotonnes [10%]), other medications (3347 kilotonnes [9%]), benefit-paid drugs (3257 kilotonnes [9%]), and capital expenditure for buildings (2776 kilotonnes [8%]). The carbon footprint attributed to health care was 7% of Australia's total; with hospitals and pharmaceuticals the major contributors. We quantified Australian carbon footprint attributed to health care and identified health-care sectors that could be ameliorated. Our results suggest the need for carbon-efficient procedures, including greater public health measures, to lower the impact of health-care services on the environment. None. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

  7. [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.

  8. Integration of Massage Therapy in Outpatient Cancer Care.

    Science.gov (United States)

    Cowen, Virginia S; Tafuto, Barbara

    2018-03-01

    Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all-not even provision of information about massage to patients through the center website. The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care.

  9. Health care policy and community pharmacy: implications for the New Zealand primary health care sector.

    Science.gov (United States)

    Scahill, Shane; Harrison, Jeff; Carswell, Peter; Shaw, John

    2010-06-25

    The aim of our paper is to expose the challenges primary health care reform is exerting on community pharmacy and other groups. Our paper is underpinned by the notion that a broad understanding of the issues facing pharmacy will help facilitate engagement by pharmacy and stakeholders in primary care. New models of remuneration are required to deliver policy expectations. Equally important is redefining the place of community pharmacy, outlining the roles that are mooted and contributions that can be made by community pharmacy. Consistent with international policy shifts, New Zealand primary health care policy outlines broad directives which community pharmacy must respond to. Policymakers are calling for greater integration and collaboration, a shift from product to patient-centred care; a greater population health focus and the provision of enhanced cognitive services. To successfully implement policy, community pharmacists must change the way they think and act. Community pharmacy must improve relationships with other primary care providers, District Health Boards (DHBs) and Primary Health Organisations (PHOs). There is a requirement for DHBs to realign funding models which increase integration and remove the requirement to sell products in pharmacy in order to deliver services. There needs to be a willingness for pharmacy to adopt a user pays policy. General practitioners (GPs) and practice nurses (PNs) need to be aware of the training and skills that pharmacists have, and to understand what pharmacists can offer that benefits their patients and ultimately general practice. There is also a need for GPs and PNs to realise the fiscal and professional challenges community pharmacy is facing in its attempt to improve pharmacy services and in working more collaboratively within primary care. Meanwhile, community pharmacists need to embrace new approaches to practice and drive a clearly defined agenda of renewal in order to meet the needs of health funders, patients

  10. The effect of an occupational therapy mental health day treatment centre on the use of inpatient services in the Western Cape, South Africa.

    Science.gov (United States)

    Engelbrecht, Riekie; Plastow, Nicola; Botha, Ulla; Niehaus, Djh; Koen, Liezl

    2018-04-27

    The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24 months before and after attendance at the centre, using the hospital's electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal-Wallis test, Wilcoxon Signed Ranks test and Mann-Whitney U test. There was a significant decrease in the number of admissions (z = -4.093, p = 0.00) and the number of days spent in hospital (z = -4.730, p = 0.00). Participants were admitted to psychiatric care 33 times less in the 24 months' post-intervention, indicating a medium effect (r = 0.436). They also spend 2569 days less in hospital, indicating a large effect (r = 0.504). The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa. Implications for Rehabilitation Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers. The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible.

  11. Health and Disability: Partnerships in Health Care

    Science.gov (United States)

    Tracy, Jane; McDonald, Rachael

    2015-01-01

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

  12. Implementation of co-trimoxazole preventive therapy policy for malaria in HIV-infected pregnant women in the public health facilities in Tanzania

    Directory of Open Access Journals (Sweden)

    Kamuhabwa AAR

    2016-12-01

    Full Text Available Appolinary AR Kamuhabwa, Richard Gordian, Ritah F Mutagonda Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Background: In 2011, Tanzania adopted a policy for provision of daily co-trimoxazole prophylaxis to HIV-infected pregnant women for prevention of malaria and other opportunistic infections. As per the policy, HIV-infected pregnant women should not be given sulfadoxine-pyrimethamine (SP for intermittent preventive therapy. The challenges associated with this policy change and the extent to which the new policy for prevention of malaria in pregnant women coinfected with HIV was implemented need to be assessed. Aim: To assess the implementation of malaria-preventive therapy policy among HIV-infected pregnant women in the public health facilities in Dar es Salaam, Tanzania. Methodology: The study was conducted in Kinondoni Municipality, Dar es Salaam, Tanzania, from January 2015 to July 2015. Three hundred and fifty-three HIV-infected pregnant women who were attending antenatal clinics (ANCs and using co-trimoxazole for prevention of malaria were interviewed. Twenty-six health care workers working at the ANCs were also interviewed regarding provision of co-trimoxazole prophylaxis to pregnant women. A knowledge scale was used to grade the level of knowledge of health care providers. Focus group discussions were also conducted with 18 health care workers to assess the level of implementation of the policy and the challenges encountered. Results: Twenty-three (6.5% pregnant women with known HIV serostatus were using co-trimoxazole for prevention of opportunistic infections even before they became pregnant. Out of the 353 HIV-infected pregnant women, eight (2.5% were coadministered with both SP and co-trimoxazole. Sixty (16.7% pregnant women had poor adherence to co-trimoxazole prophylaxis. Out of the 26 interviewed health care providers, 20 had high

  13. Curing a meagre health care system by lean methods--translating 'chains of care' in the Swedish health care sector.

    Science.gov (United States)

    Trägårdh, Björn; Lindberg, Kajsa

    2004-01-01

    The purpose of this article is to discuss what happens when work embedded in a 'meagre' organizational context is changed by lean production-related methods. The article is based on studies of seven lean production-inspired projects in the Swedish health care sector, a sector already poor due to organizational slack. The projects were directed to develop 'health care chains', an organizational concept regarded as a way to rationalize health care organizations as well as to develop them, i.e. increase productivity, quality from a customer perspective and quality of working conditions. The article analyses the projects from an interpretative perspective and discusses how modem management models with ambitions to concurrently rationalize and develop organizations--e.g. lean production and health care chains--are used in a 'meagre' organizational field. As an outcome, a model is presented that explores what is beyond simple imitations and unique translations of ideas when a new concept is implemented in local organizations.

  14. Transforming health care delivery through consumer engagement, health data transparency, and patient-generated health information.

    Science.gov (United States)

    Sands, D Z; Wald, J S

    2014-08-15

    Address current topics in consumer health informatics. Literature review. Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions.

  15. Applications of Light Emitting Diodes in Health Care.

    Science.gov (United States)

    Dong, Jianfei; Xiong, Daxi

    2017-11-01

    Light emitting diodes (LEDs) have become the main light sources for general lighting, due to their high lumen efficiency and long life time. Moreover, their high bandwidth and the availability of diverse wavelength contents ranging from ultraviolet to infrared empower them with great controllability in tuning brightness, pulse durations and spectra. These parameters are the essential ingredients of the applications in medical imaging and therapies. Despite the fast advances in both LED technologies and their applications, few reviews have been seen to link the controllable emission properties of LEDs to these applications. The objective of this paper is to bridge this gap by reviewing the main control techniques of LEDs that enable creating enhanced lighting patterns for imaging and generating effective photon doses for photobiomodulation. This paper also provides the basic mechanisms behind the effective LED therapies in treating cutaneous and neurological diseases. The emerging field of optogenetics is also discussed with a focus on the application of LEDs. The multidisciplinary topics reviewed in this paper can help the researchers in LEDs, imaging, light therapy and optogenetics better understand the basic principles in each other's field; and hence to stimulate the application of LEDs in health care.

  16. Current Care and Investigational Therapies in Achondroplasia.

    Science.gov (United States)

    Unger, Sheila; Bonafé, Luisa; Gouze, Elvire

    2017-04-01

    The goal of this review is to evaluate the management options for achondroplasia, the most common non-lethal skeletal dysplasia. This disease is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications. Achondroplasia is the most common non-lethal skeletal dysplasia. It is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications.

  17. FastStats: Home Health Care

    Science.gov (United States)

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

  18. Competence of health care providers on care of newborns at birth in ...

    African Journals Online (AJOL)

    Introduction: This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns' care at birth. Methods: Ten health care providers took care of three hundred and thirty-five pregnant women ...

  19. Parity for mental health and substance abuse care under managed care.

    Science.gov (United States)

    Frank, Richard G.; McGuire, Thomas G.

    1998-12-01

    BACKGROUND: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. AIMS: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. METHOD: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. RESULTS: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less

  20. Journal of Community Medicine and Primary Health Care

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care. ... environmental health, clinical care, health planning and management, health policy, health ... non-communicable diseases within the Primary Health Care system in the Federal ... Assessment of occupational hazards, health problems and safety practices of petrol ...

  1. Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

    Science.gov (United States)

    Wajid, Abdul; White, Franklin; Karim, Mehtab S

    2013-01-01

    As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains

  2. Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

    Directory of Open Access Journals (Sweden)

    Abdul Wajid

    Full Text Available BACKGROUND: As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH services in two areas with different levels of service in Punjab, Pakistan. METHODS: A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA. Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. RESULTS: The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. CONCLUSIONS: Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an

  3. Improvisation as an adaptive strategy for occupational therapy practice.

    Science.gov (United States)

    Krusen, Nancy E

    2012-01-01

    ABSTRACT As health care environments become increasingly complex, practitioners must develop new adaptive skills to master practice. The idea of using theatrical improvisation (improv) in health care is relatively new. Occupational therapy students were taught a module of improvisational techniques as part of an academic seminar, learning improvisation rules, and enacting solutions to typical daily professional challenges. The purpose of this article is to recommend improvisational techniques as an adaptive skill to effectively blend art and science for occupational therapy practice in fast-paced and unpredictable health care environments.

  4. Corporate moral responsibility in health care.

    Science.gov (United States)

    Wilmot, S

    2000-01-01

    The question of corporate moral responsibility--of whether it makes sense to hold an organisation corporately morally responsible for its actions, rather than holding responsible the individuals who contributed to that action--has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom (UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially amoral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish.

  5. Health Care Access Among Deaf People.

    Science.gov (United States)

    Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes

    2016-01-01

    Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Use of Mental Health Care and Unmet Needs for Health Care Among Lesbian and Bisexual Chinese-, Korean-, and Vietnamese-American Women.

    Science.gov (United States)

    Hahm, Hyeouk Chris; Lee, Jieha; Chiao, Christine; Valentine, Anne; Lê Cook, Benjamin

    2016-12-01

    This study examined associations between sexual orientation of Asian-American women and receipt of mental health care and unmet need for health care. Computer-assisted self-interviews were conducted with 701 unmarried Chinese-, Korean-, and Vietnamese-American women ages 18 to 35. Multivariate regression models examined whether lesbian and bisexual participants differed from exclusively heterosexual participants in use of mental health care and unmet need for health care. After the analyses controlled for mental health status and other covariates, lesbian and bisexual women were more likely than exclusively heterosexual women to have received any past-year mental health services and reported a greater unmet need for health care. Sexual-minority women were no more likely to have received minimally adequate care. Given the high rates of mental health problems among Asian-American sexual-minority women, efforts are needed to identify and overcome barriers to receipt of adequate mental health care and minimize unmet health care needs.

  7. Congenital Heart Disease: Guidelines of Care for Children with Special Health Care Needs.

    Science.gov (United States)

    Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

    These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…

  8. Patterns of clinical care in radiation therapy in the United States

    International Nuclear Information System (INIS)

    Kramer, S.

    1984-01-01

    Results of the first nationwide evaluation of radiation therapy in the United States with respect to its quality and accessibility are presented. The Patterns of Care Study (PCS) is financially supported by the National Cancer Institute and has served as a model for other oncology-related disciplines. The PCS has determined criteria by which to evaluate radiation therapy care in 10 disease sites in which curative radiation therapy plays a major role. The sampling design identified the institution to be surveyed and included all types of practice in the U.S. This paper examines results related to carcinomas of the cervix, larynx and prostate

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

    Directory of Open Access Journals (Sweden)

    Neda Kabiri

    2015-08-01

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

  10. Predictors of Adolescent Health Care Utilization

    Science.gov (United States)

    Vingilis, Evelyn; Wade, Terrance; Seeley, Jane

    2007-01-01

    This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…

  11. World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

    Science.gov (United States)

    Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

    2018-02-01

    The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

  12. Consumer subjectivity and U.S. health care reform.

    Science.gov (United States)

    West, Emily

    2014-01-01

    Health care consumerism is an important frame in U.S. health care policy, especially in recent media and policy discourse about federal health care reform. This article reports on qualitative fieldwork with health care users to find out how people interpret and make sense of the identity of "health care consumer." It proposes that while the term consumer is normally understood as a descriptive label for users who purchase health care and insurance services, it should actually be understood as a metaphor, carrying with it a host of associations that shape U.S. health care policy debates in particular ways. Based on interviews with 36 people, patient was the dominant term people used to describe themselves, but consumer was the second most popular. Informants interpreted the health care consumer as being informed, proactive, and having choices, but there were also "semiotic traps," or difficult-to-resolve tensions for this identity. The discourse of consumerism functions in part as code for individual responsibility, and therefore as a classed moral discourse, with implications for U.S. health care policy.

  13. Transition care for children with special health care needs.

    Science.gov (United States)

    Davis, Alaina M; Brown, Rebekah F; Taylor, Julie Lounds; Epstein, Richard A; McPheeters, Melissa L

    2014-11-01

    Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. Copyright © 2014 by the American Academy of Pediatrics.

  14. The importance of health information technology in care coordination and transitional care.

    Science.gov (United States)

    Cipriano, Pamela F; Bowles, Kathryn; Dailey, Maureen; Dykes, Patricia; Lamb, Gerri; Naylor, Mary

    2013-01-01

    Care coordination and transitional care services are strategically important for achieving the priorities of better care, better health, and reduced costs embodied in the National Strategy for Quality Improvement in Health Care (National Quality Strategy [NQS]). Some of the most vulnerable times in a person’s care occur with changes in condition as well as movement within and between settings of care. The American Academy of Nursing (AAN) believes it is essential to facilitate the coordination of care and transitions by using health information technology (HIT) to collect, share, and analyze data that communicate patient-centered information among patients, families, and care providers across communities. HIT makes information accessible, actionable, timely, customizable, and portable. Rapid access to information also creates efficiencies in care by eliminating redundancies and illuminating health history and prior care. The adoption of electronic health records (EHRs) and information systems can enable care coordination to be more effective but only when a number of essential elements are addressed to reflect the team-based nature of care coordination as well as a focus on the individual’s needs and preferences. To that end, the AAN offers a set of recommendations to guide the development of the infrastructure, standards, content, and measures for electronically enabled care coordination and transitions in care as well as research needed to build the evidence base to assess outcomes of the associated interventions.

  15. System impact research - increasing public health and health care system performance.

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Interventions directed to system features of public health and health care should increase health and welfare of patients and population. To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the

  16. Cognitive systems engineering in health care

    CERN Document Server

    Bisantz, Ann M; Fairbanks, Rollin J

    2014-01-01

    Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...

  17. Primary health care in India.

    Science.gov (United States)

    Deodhar, N S

    1982-03-01

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

  18. Rural migration and health care

    DEFF Research Database (Denmark)

    Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn

    This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...... up with a more deepgoing review of the relatively small number of studies, which explicitly deal with settlement preferences related to access to health care....

  19. Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia.

    Science.gov (United States)

    Kaindjee-Tjituka, Francina; Sawadogo, Souleymane; Mutandi, Graham; Maher, Andrew D; Salomo, Natanael; Mbapaha, Claudia; Neo, Marytha; Beukes, Anita; Gweshe, Justice; Muadinohamba, Alexinah; Lowrance, David W

    2017-01-01

    Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid ( p = 0.1); 95.6% and 98.1% of results were received by the patient ( p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day ( p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results ( p lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries.

  20. 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.

  1. The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health

    OpenAIRE

    Fink, Per; ?rnb?l, Eva; Christensen, Kaj Sparle

    2010-01-01

    BACKGROUND: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. METHODOLOGY/PRINCIPAL FINDINGS: 1785 consecutive primary care patients aged 18-65 consulting their family p...

  2. The behavioral economics of health and health care.

    Science.gov (United States)

    Rice, Thomas

    2013-01-01

    People often make decisions in health care that are not in their best interest, ranging from failing to enroll in health insurance to which they are entitled, to engaging in extremely harmful behaviors. Traditional economic theory provides a limited tool kit for improving behavior because it assumes that people make decisions in a rational way, have the mental capacity to deal with huge amounts of information and choice, and have tastes endemic to them and not open to manipulation. Melding economics with psychology, behavioral economics acknowledges that people often do not act rationally in the economic sense. It therefore offers a potentially richer set of tools than provided by traditional economic theory to understand and influence behaviors. Only recently, however, has it been applied to health care. This article provides an overview of behavioral economics, reviews some of its contributions, and shows how it can be used in health care to improve people's decisions and health.

  3. Students' perspectives to health care services in lithuania

    OpenAIRE

    Brancevič, Jolita

    2016-01-01

    Students' Perspectives to Health Care Services in Lithuania Introduction. The Rights of Patients and Compensation for the Damage to Their Health Act defines health care services as safe and effective means to take care of health, identify, diagnose and treat diseases and provide nursing services. The aims set out in a policy of health care services are fairly broad and, among others, include the improvement of both the quality and the availability of health care services. The issues of increa...

  4. Primary health care in the Southern Mediterranean region.

    NARCIS (Netherlands)

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

    1998-01-01

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

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

    OpenAIRE

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

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

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

    NARCIS (Netherlands)

    Brink-Muinen, A. van den

    1997-01-01

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

  7. Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs.

    Science.gov (United States)

    Ganz, Michael L; Tendulkar, Shalini A

    2006-06-01

    To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.

  8. Survey of Michigan dentists and radiation oncologists on oral care of patients undergoing head and neck radiation therapy.

    Science.gov (United States)

    Patel, Yoshita; Bahlhorn, Hannah; Zafar, Saniya; Zwetchkenbaum, Samuel; Eisbruch, Avraham; Murdoch-Kinch, Carol Anne

    2012-07-01

    Oral complications of radiation therapy for head and neck cancer (HNC) are associated with a significant decline in oral health-related quality of life (OHQOL). The dentist, working with the radiation oncologist and the rest of the health care team, plays an important role in the prevention and management of these complications, but patients do not always receive care consistent with current guidelines. This study investigated barriers to recommended care. There is variability in knowledge and practice among dentists and radiation oncologists regarding the dental management of patients treated with head and neck radiotherapy (HNRT), and inadequate communication and collaboration between members of the patient's health care team contribute to inconsistencies in application of clinical care guidelines. There is on interest and need for continuing dental (CDE) and medical education (CME) on this topic. A questionnaire was developed to assess dentists' knowledge and practice of dental management of HNC patients and their interest in CDE on this topic. All members of the Michigan Dental Association (MDA) with email addresses were asked to complete the survey online, and a random sample of MDA members without email addresses was invited to complete a paper version of the same survey. All Michigan members of the American Society for Radiation Oncology (ASTRO) were invited to complete an online version of the survey modified for radiation oncologists. The response rate for dentists was 47.9% and radiation oncologists was 22.3%. Of the dentists who responded, 81% reported that a major barrier to providing dental treatment before radiotherapy was a lack of time between initial dental consultation and the start of radiation; inadequate communication between health care providers was blamed most frequently for this. Ten percent of the dentists and 25% of the radiation oncologists reported that they did not treat HNC patients because they lacked adequate training, and 55% of

  9. Factors influencing the type of health problems presented by women in general practice: differences between women's health care and regular health care.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Bensing, J.M.

    1996-01-01

    Objective: Differences between health problems presented by women (aged 20-45) to female "women's health care" doctors and both female and male regular health care doctors were investigated. This article explores the relationship of patients' roles (worker, partner, or parent) and the type of health

  10. Public health capacity in the provision of health care services.

    Science.gov (United States)

    Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick

    2015-12-01

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

  11. Do governance choices matter in health care networks?: an exploratory configuration study of health care networks

    Science.gov (United States)

    2013-01-01

    Background Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. Methods The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Results Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Conclusions Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness. PMID:23800334

  12. Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

    Science.gov (United States)

    Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

    Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

  13. Factors associated with health care access and outcome.

    Science.gov (United States)

    Paek, Min-So; Lim, Jung-Won

    2012-01-01

    This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

  14. The ethics of advertising for health care services.

    Science.gov (United States)

    Schenker, Yael; Arnold, Robert M; London, Alex John

    2014-01-01

    Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.

  15. Music therapy in dementia care and neuro-rehabilitation

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2017-01-01

    medication. Music therapists,who play a role in staff training and supervision, and not only in direct music therapy practice, bring new important dimensions to how music therapy discipline is understood and how it is integrated in interdisciplinary work........ Then she turns her head away and wipes away a tear, clearly moved by his singing. In line with the increasing interest in applying music in medical care, the healing power of music has been recently highlighted in journals such as the Scientific American (Thompson & Schlaug 2015) and Musicae Scientiae...... (Croom 2015). In an article published in the journal Nature, the “surprising preservation of musical memory” in persons with Alzheimer’s Disease is explained (Jacobsen et al. 2015: 2439). The common goal for the dementia field is to advance and develop the culture of care. The music therapist may engage...

  16. The Thai-Australian Health Alliance: developing health management capacity and sustainability for primary health care services.

    Science.gov (United States)

    Briggs, D S; Tejativaddhana, P; Cruickshank, M; Fraser, J; Campbell, S

    2010-11-01

    There have been recent calls for a renewed worldwide focus on primary health care. The Thai-Australian Health Alliance addresses this call by developing health care management capability in primary health care professionals in rural Thailand. This paper describes the history and current activities of the Thai-Australian Health Alliance and its approaches to developing health care management capacity for primary care services through international collaborations in research, education and training over a sustained time period. The Alliance's approach is described herein as a distributed network of practices with access to shared knowledge through collaboration. Its research and education approaches involve action research, multi-methods projects, and evaluative studies in the context of workshops and field studies. WHO principles underpin this approach, with countries sharing practical experiences and outcomes, encouraging leadership and management resource networks, creating clearing houses/knowledge centres, and harmonising and aligning partners with their country's health systems. Various evaluations of the Alliance's activities have demonstrated that a capacity building approach that aligns researchers, educators and health practitioners in comparative and reflective activities can be effective in transferring knowledge and skills among a collaboration's partners. Project participants, including primary health care practitioners, health policy makers and academics embraced the need to acquire management skills to sustain primary care units. Participants believe that the approaches described herein were crucial to developing the management skills needed of health care professionals for rural and remote primary health care. The implementation of this initiative was challenged by pre-existing low opinions of the importance of the management role in health care, but with time the Alliance's activities highlighted for all the importance of health care management

  17. Health care agreements as a tool for coordinating health and social services

    Directory of Open Access Journals (Sweden)

    Andreas Rudkjøbing

    2014-12-01

    Full Text Available Introduction: In 2007, a substantial reform changed the administrative boundaries of the Danish health care system and introduced health care agreements to be signed between municipal and regional authorities. To assess the health care agreements as a tool for coordinating health and social services, a survey was conducted before (2005–2006 and after the reform (2011.Theory and methods: The study was designed on the basis of a modified version of Alter and Hage's framework for conceptualising coordination. Both surveys addressed all municipal level units (n = 271/98 and a random sample of general practitioners (n = 700/853.Results: The health care agreements were considered more useful for coordinating care than the previous health plans. The power relationship between the regional and municipal authorities in drawing up the agreements was described as more equal. Familiarity with the agreements among general practitioners was higher, as was the perceived influence of the health care agreements on their work.Discussion: Health care agreements with specific content and with regular follow-up and systematic mechanisms for organising feedback between collaborative partners exemplify a useful tool for the coordination of health and social services.Conclusion: There are substantial improvements with the new health agreements in terms of formalising a better coordination of the health care system.

  18. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    Science.gov (United States)

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

  19. Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies.

    Science.gov (United States)

    Einstein, David J; DeSanto-Madeya, Susan; Gregas, Matthew; Lynch, Jessica; McDermott, David F; Buss, Mary K

    2017-09-01

    Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model's implementation. Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P 7 days before death-a core Quality Oncology Practice Initiative metric-was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

  20. Wealth and antenatal care use: implications for maternal health care utilisation in Ghana.

    Science.gov (United States)

    Arthur, Eric

    2012-08-06

    The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the