1
|
Fathoni M, Rachmawati TA, Dewi ES, Djati AP, Lestari S, Yusuf A, Waluyo CS. The preparedness of disaster among nurses in community health centers in rural areas during the COVID-19 pandemic in Malang City. Enferm Clin 2022; 32:S54-S57. [PMID: 35935732 PMCID: PMC9344195 DOI: 10.1016/j.enfcli.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/26/2022] [Indexed: 11/23/2022]
Abstract
Positive COVID-19 cases in Malang City, Indonesia continue to increase. Until 04 August 2021, the COVID-19 update shows 3301 positive cases with 7754 cured and 832 deaths. This study aims to identify nurses preparedness in rural area community health centers during the COVID-19 pandemic in Malang for self-control to implement health protocol. This study intends to provide insights on controlling COVID-19 spread in Malang, Indonesia. This research is a quantitative study with correlative analytic observational design and a cross-sectional approach involving 120 nurses from 16 primary health centers. The results of the bivariate analysis using gamma correlation test are: knowledge factors (p = 0.005; r = 0.35), attitude (p = 0.000; r = 0.46), means of infrastructure (p = 0.000; r = 0.54), and self-control (p = 0.000; r = 0.52) for the quarantined COVID-19 patients. Knowledge, attitude, infrastructure, and safe house factors can influence self-control for COVID-19. In rural areas, health education-as education and empowerment for patient self-control-is an effort to encourage them to obey health protocol during the pandemic. Nurse readiness and preparedness during the pandemic is crucial for strengthening the assertive behavior commitment through self-control. This ensures the community's awareness of the importance of complying with health protocols for the common good. Mental nursing intervention needs to be added as a part of psychosocial therapy for the community's social problems, primarily in reducing the pressure due to the social distancing enforcement to control and prevent COVID-19 spread.
Collapse
Affiliation(s)
- Mukhamad Fathoni
- Department of Nursing, Faculty of Health, Universitas Brawijaya, Malang, Indonesia
- Universitas Brawijaya, Malang, Indonesia
| | | | - Elvira Sari Dewi
- Department of Nursing, Faculty of Health, Universitas Brawijaya, Malang, Indonesia
| | | | | | - Ah Yusuf
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | |
Collapse
|
2
|
Tessler I, Cohen O, Shochat I, Teitelbaum T, Dagan O, Meir A, Jaffe A, Avior G. Outcomes of the Bethesda system for reporting thyroid cytopathology in community- vs. institution-performed cytology. Am J Otolaryngol 2022; 43:103341. [PMID: 34968817 DOI: 10.1016/j.amjoto.2021.103341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/21/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Despite the important role of the community in the assessment and risk stratification of patients with thyroid nodules, evidence-based data on the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) performance in community clinics is lacking. We aim to evaluate BSRTC performance of aspirations taken in community clinics compared with primary referral center. METHODS Patients who underwent thyroid surgery between 2013 and 2018 at our institution were divided according to the fine needle aspirations (FNA) settings: community FNA (cFNA) vs. institutional FNA (iFNA). Demographics, BSRTC results and final pathology were collected. Diagnostic values were calculated for BSRTC categories (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]), and were compared between the groups. RESULTS A total of 268 nodules were included in the study; 77% (207) cFNA and 23% (61) iFNA. Patients in the community were younger (51.7 ± 15.1 vs. 56.6 years±14.8, p = 0.03) and with less epidemiology risk factors for thyroid cancer (1.9% vs 13.1%, p < 0.001). cFNA malignancy rate for BSRTC I-VI was 0%, 6.4%, 11.8%, 32.1%, 91.6% and 93.8% respectively. Best sensitivity was found for BSRTC III-VI in both groups (88% and 83%, cFNAs and iFNAs, respectively). Overall best performance was obtained for BSRTC V-VI for both groups (cfNA: 85%, 97%, 93%, 94% and 93%; iFNAs: 81%, 100%, 100%, 87% and 91%, for sensitivity, specificity, PPV, NPV and accuracy, respectively). CONCLUSIONS Community-performed FNAs demonstrate acceptable BSRTC distribution and malignancy rates, comparable with a primary referral academic hospital. This supports the universality of the BSRTC 2017 and its recommendations also in the community.
Collapse
Affiliation(s)
- Idit Tessler
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Oded Cohen
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Isaac Shochat
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Tali Teitelbaum
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Or Dagan
- Otorhinolaryngology and Head & Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | - Alona Meir
- Faculty of Medicine, Technion, Haifa, Israel; Department of Pathology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Anat Jaffe
- Faculty of Medicine, Technion, Haifa, Israel; Endocrinology and Diabetes Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Galit Avior
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
3
|
Abstract
BACKGROUND Quantifying health care quality has long presented a challenge to identifying the relationship between provider level quality and cost. However, growing focus on quality improvement has led to greater interest in organizational performance, prompting payers to collect various indicators of quality that can be combined at the provider level. OBJECTIVE To explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality. RESEARCH DESIGN Using the Uniform Data System collected by the Bureau of Primary Care, we constructed composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015-2018. We explored different weighting schemes and different combinations of individual quality indicators constructed at the intermediate domain levels of chronic condition control, screening, and medication management. We used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors. We examined the sensitivity of results to different weighting schemes and to combining individual quality indicators at the overall level compared with the intermediate domain level. RESULTS Both overall and domain level composites performed well in the estimations. Average cost of a medical visit was negatively associated with quality, although the magnitude of the effect varied across weighting schemes. CONCLUSION Efforts toward improvement of primary health care quality delivered in CHCs need not involve greater cost.
Collapse
Affiliation(s)
| | - Qian Luo
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Avi Dor
- Milken Institute School of Public Health, George Washington University, Washington, DC
| |
Collapse
|
4
|
Spencer AE, Platt RE, Bettencourt AF, Serhal E, Burkey MD, Sikov J, Vidal C, Stratton J, Polk S, Jain S, Wissow L. Implementation of Off-Site Integrated Care for Children: A Scoping Review. Harv Rev Psychiatry 2020; 27:342-353. [PMID: 31714465 PMCID: PMC7374937 DOI: 10.1097/hrp.0000000000000239] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. METHODS We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). RESULTS We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models. CONCLUSIONS Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.
Collapse
|
5
|
Liu Y, Kong Q, Wang S, Zhong L, van de Klundert J. The impact of hospital attributes on patient choice for first visit: evidence from a discrete choice experiment in Shanghai, China. Health Policy Plan 2020; 35:267-278. [PMID: 31830248 PMCID: PMC7152730 DOI: 10.1093/heapol/czz159] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 01/09/2023] Open
Abstract
The underutilization of primary care in urban China threatens the efficiency and effectiveness of the Chinese health system. To guide patient flow to primary care, the Chinese government has rolled out a sequence of health care reforms which improve the affordability, the infrastructure and workforce of the primary care system. However, these measures have not yielded the desired effect on the utilization of primary care, which is lowest in urban areas. It is unclear how the factors identified to influence facility choice in urban China are actually impacting choice behaviour. We conducted a discrete choice experiment to elicit the quantitative impact of facility attributes when choosing a health care facility for first visit and analysed how the stated choice varies with these attributes. We found that the respondents placed different weights on the identified attributes, depending on whether they perceived their condition to be minor or severe. For conditions perceived as minor, the respondents valued visit time, equipment and medical skill most. For conditions perceived as severe, they placed most importance on equipment, travel time and facility size. We found that for conditions perceived as minor, only 14% preferred visiting a facility over opting out, a percentage which would more than double to 37% if community health centres were maximally improved. For conditions perceived as severe, improvements in community health centres may almost double first visits to primary care, mostly from patients who would otherwise choose higher-level facilities. Our findings suggest that for both severity conditions, improvements to medical equipment and medical skill at community health centres in urban China can effectively direct patient flow to primary care and promote the efficiency and effectiveness of the urban health system.
Collapse
Affiliation(s)
- Yun Liu
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Qingxia Kong
- Rotterdam School of Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Shan Wang
- Lingnan College, Sun Yat-sen University, 135 Xingang Xi Road, J.T. Wu Hall 320, Guangzhou 510275, China
| | - Liwei Zhong
- School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, 650 Songjiang Road, Shanghai 201620, China
| | - Joris van de Klundert
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
- Prince Mohammad Bin Salman College, 7682 Hejaz Boulevard, Unit No. 1, BayLaSun, King Abdullah Economic City 23965-2609, Kingdom of Saudi Arabia
| |
Collapse
|
6
|
Boodram B, Kaufmann M, Aronsohn A, Hamlish T, Peregrine Antalis E, Kim K, Wolf J, Rodriguez I, Millman AJ, Johnson D. Case Management and Capacity Building to Enhance Hepatitis C Treatment Uptake at Community Health Centers in a Large Urban Setting. Fam Community Health 2020; 43:150-160. [PMID: 32079971 DOI: 10.1097/fch.0000000000000253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An estimated 4.1 million people in the United States are infected with hepatitis C virus (HCV). In 2014, the Hepatitis C Community Alliance to Test and Treat (HepCCATT) collaborative was formed to address hepatitis C in Chicago. From 2014 to 2017, the HepCCATT Case Management Program case managed 181 HCV-infected people and performed on-site capacity building at a 6-site community health center (CHC) that produced codified protocols, which were translated into a telehealth program to build capacity within CHCs to deliver hepatitis C care. HepCCATT's innovative approach to addressing multilevel barriers is a potential model for increasing access to hepatitis C care and treatment.
Collapse
Affiliation(s)
- Basmattee Boodram
- School of Public Health (Dr Boodram and Ms Kaufmann) and Cancer Center (Dr Hamlish), University of Illinois at Chicago; Department of Internal Medicine, University of Michigan, Ann Arbor and Sarcoma Alliance for Research Through Collaboration, Ann Arbor, Michigan (Dr Peregrine Antalis); University of Chicago Medicine, Chicago, Illinois (Drs Aronsohn and Johnson and Ms Rodriguez); Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania (Ms Kim); Caring Ambassadors Program, Inc, Chicago, Illinois (Ms Wolf); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Millman)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Rieselbach RE, Epperly T, Nycz G, Shin P. Community Health Centers Could Provide Better Outsourced Primary Care for Veterans. J Gen Intern Med 2019; 34:150-153. [PMID: 30291603 PMCID: PMC6318188 DOI: 10.1007/s11606-018-4691-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 08/31/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
The "VA Mission Act of 2018" will expand the current "Choice Program" legislation of 2014, which has enabled outsourcing of VA care to private physicians. As the ranks of Veteran patients swell, Congress intended that the Mission Act will help relieve the VHA's significant access problems. We contend that this new legislation will have negative consequences for veterans by diverting support from our VA system of 1300 hospitals and clinics. We recommend modification of this legislation, promoting much greater utilization of Community Health Centers (CHCs) for veterans outsourced primary care. In support of this proposal, we describe (1) features of the "VA Mission Act" relevant to outsourcing, (2) the challenges of the present "Choice Program" and likely future obstacles with the new legislation, and (3) the advantages of expanding CHC VA outsourced primary care. This policy would focus more on providing specialized care for veterans in the VA system, while coordinating with CHCs for the necessary expanded outsourced, holistic primary care. We conclude that failure to develop an incremental, cost-effective alternative as described herein represents a potential threat to adequate future support of our VA hospital system, and thus outstanding care for our veterans.
Collapse
Affiliation(s)
| | - Ted Epperly
- Family Medicine Residency of Idaho, Boise, ID, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Greg Nycz
- Family Health Center of Marshfield, Marshfield, WI, USA
| | - Peter Shin
- Health Policy and Management, George Washington University, Washington, DC, USA
- Geiger Gibson Program in Community Health, RCHN Community Health Foundation, New York, NY, USA
| |
Collapse
|
8
|
Abstract
Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients' characteristics, communication between patients and HCPs, the prioritization of patients' basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.
Collapse
Affiliation(s)
- Timothy Joseph Sowicz
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 2 VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
9
|
Rieselbach RE, Epperly T, Friedman A, Keahey D, McConnell E, Nichols K, Nycz G, Roberts J, Schmader K, Shin P, Shtasel D. A New Community Health Center/Academic Medicine Partnership for Medicaid Cost Control, Powered by the Mega Teaching Health Center. Acad Med 2018; 93:406-413. [PMID: 28930763 DOI: 10.1097/acm.0000000000001901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community health centers (CHCs), a principal source of primary care for over 24 million patients, provide high-quality affordable care for medically underserved and lower-income populations in urban and rural communities. The authors propose that CHCs can assume an important role in the quest for health care reform by serving substantially more Medicaid patients. Major expansion of CHCs, powered by mega teaching health centers (THCs) in partnership with regional academic medical centers (AMCs) or teaching hospitals, could increase Medicaid beneficiaries' access to cost-effective care. The authors propose that this CHC expansion could be instrumental in limiting the added cost of Medicaid expansion via the Affordable Care Act (ACA) or subsequent legislation. Nevertheless, expansion cannot succeed without developing this CHC-AMC partnership both (1) to fuel the currently deficient primary care provider workforce pipeline, which now greatly limits expansion of CHCs; and (2) to provide more CHC-affiliated community outreach sites to enhance access to care. The authors describe the current status of Medicaid and CHCs, plus the evolution and vulnerability of current THCs. They also explain multiple features of a mega THC demonstration project designed to test this new paradigm for Medicaid cost control. The authors contend that the demonstration's potential for success in controlling costs could provide help to preserve the viability of current and future expanded state Medicaid programs, despite a potential ultimate decrease in federal funding over time. Thus, the authors believe that the new AMC-CHC partnership paradigm they propose could potentially facilitate bipartisan support for repairing the ACA.
Collapse
Affiliation(s)
- Richard E Rieselbach
- R.E. Rieselbach is professor emeritus of medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and past president, Association of Program Directors in Internal Medicine. T. Epperly is president and chief executive officer, Family Medicine Residency of Idaho, clinical professor of family medicine, University of Washington School of Medicine, Seattle, Washington, and past president and board chair, American Academy of Family Physicians. A. Friedman is professor emeritus of pediatrics, past vice president, Health Sciences, and former dean, University of Minnesota Medical School, Minneapolis, Minnesota, and former board chair, American Board of Pediatrics. D. Keahey is chief advocacy and research officer, Physician Assistant Education Association, and adjunct associate professor, University of Utah School of Medicine, Utah Physician Assistant Program, Salt Lake City, Utah; ORCID: http://orcid.org/0000-0003-3107-3678. E. McConnell is associate professor, Duke University School of Nursing, clinical nurse specialist and nurse scientist, Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Durham, North Carolina, director, Center of Excellence in Geriatric Nursing Education, and codirector, Health Resources and Services Administration-funded Duke Geriatric Workforce Enhancement Program; ORCID: http://orcid.org/0000-0002-2896-8596. K. Nichols is professor of internal medicine and dean, Chicago College of Medicine, Downers Grove, Illinois, past president, American Osteopathic Association, and president, Institute of Medicine of Chicago; ORCID: http://orcid.org/0000-0002-4960-4118. G. Nycz is executive director, Family Health Center of Marshfield, Inc., Marshfield, Wisconsin; ORCID: http://orcid.org/0000-0001-6151-0336. J. Roberts is professor and former dean, School of Pharmacy, and director, Center for Interprofessional Practice and Education, University of Wisconsin-Madison, Madison, Wisconsin; ORCID: http://orcid.org/0000-0002-2309-7621. K. Schmader is professor of medicine and chief, Division of Geriatrics, Department of Medicine, Duke University Medical Center, director, Geriatric Research, Education and Clinical Center, and associate chief of staff, Geriatrics and Extended Care, Department of Veterans Affairs Medical Center, Durham, North Carolina. P. Shin is associate professor, Health Policy and Management, George Washington University, Washington, DC, and director, Geiger Gibson Program in Community Health, RCHN Community Health Foundation. D. Shtasel is founding director, Kraft Family National Center for Leadership and Training in Community Health, Massachusetts General Hospital Michele and Howard J. Kessler Chair in Public and Community Psychiatry, and associate professor of psychiatry, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-8932-8066
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Agréus L, Johansson C. [Waiting time – no necessary evil]. Lakartidningen 2017; 114:ETSU. [PMID: 28949396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
11
|
Wahed T, Alam A, Sultana S, Rahman M, Alam N, Martens M, Somrongthong R. Barriers to sexual and reproductive healthcare services as experienced by female sex workers and service providers in Dhaka city, Bangladesh. PLoS One 2017; 12:e0182249. [PMID: 28759575 PMCID: PMC5536311 DOI: 10.1371/journal.pone.0182249] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 07/14/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to identify the barriers female sex workers (FSWs) in Bangladesh face with regard to accessing sexual and reproductive health (SRH) care, and assess the satisfaction with the healthcare received. METHODS Data were collected from coverage areas of four community-based drop-in-centers (DICs) in Dhaka where sexually transmitted infection (STI) and human immunovirus (HIV) prevention interventions have been implemented for FSWs. A total of 731 FSWs aged 15-49 years were surveyed. In addition, in-depth interviews (IDIs) were conducted with 14 FSWs and 9 service providers. Respondent satisfaction was measured based on recorded scores on dignity, privacy, autonomy, confidentiality, prompt attention, access to social support networks during care, basic amenities, and choice of institution/care provider. RESULTS Of 731 FSWs, 353 (51%) reported facing barriers when seeking sexual and reproductive healthcare. Financial problems (72%), shame about receiving care (52.3%), unwillingness of service providers to provide care (39.9%), unfriendly behavior of the provider (24.4%), and distance to care (16.9%) were mentioned as barriers. Only one-third of the respondents reported an overall satisfaction score of more than fifty percent (a score of between 9 and16) with formal healthcare. Inadequacy or lack of SRH services and referral problems (e.g., financial charge at referral centers, unsustainable referral provision, or unknown location of referral) were reported by the qualitative FSWs as the major barriers to accessing and utilizing SRH care. CONCLUSIONS These findings are useful for program implementers and policy makers to take the necessary steps to reduce or remove the barriers in the health system that are preventing FSWs from accessing SRH care, and ultimately meet the unmet healthcare needs of FSWs.
Collapse
Affiliation(s)
- Tasnuva Wahed
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
- Research to Policy Limited, Mirpur, Dhaka, Bangladesh
- * E-mail: (RS); (TW)
| | - Anadil Alam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Salima Sultana
- HIV/AIDS Sector, Save the Children, Gulshan, Dhaka, Bangladesh
| | - Monjur Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Nazmul Alam
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Monika Martens
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
- * E-mail: (RS); (TW)
| |
Collapse
|
12
|
Vacirca J. Jeffrey Vacirca on How the COA Advocates for Community Oncology Practices and Patients. Oncology (Williston Park) 2017; 31:518-520. [PMID: 28712095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
13
|
Akhabue E, Rittner SS, Carroll JE, Crawford PM, Dant L, Laws R, Leo MC, Puro J, Persell SD. Implications of American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus Among Several US Networks of Community Health Centers. J Am Heart Assoc 2017; 6:JAHA.117.005627. [PMID: 28673901 PMCID: PMC5586289 DOI: 10.1161/jaha.117.005627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Little is known about statin underutilization among diabetes mellitus patients cared for in community health centers, which tend to serve socioeconomically disadvantaged populations. Implications of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear. Methods and Results We included 32 440 adults (45% male, 63% nonwhite, 29% uninsured/Medicaid) aged 40 to 75 years with diabetes mellitus who received care within 16 community health center groups in 11 states in the Community Health Applied Research Network during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel 2001 and ACC/AHA 2013 guidelines. More patients’ treatments were concordant with the ACC/AHA (52.8%) versus the National Cholesterol Education Program Adult Treatment Panel (36.2%) guideline. Female sex was associated with lower concordance for both (odds ratio [OR] 0.90, CI 0.85‐0.94; and OR 0.84, CI 0.80‐0.88, respectively). Being insured, an Asian/Pacific Islander, or primarily Spanish speaking were associated with greater concordance for both guidelines: 35.5% (11 526/32 440) were concordant with neither guideline, the majority (79.7%) having no statin prescribed; 28.2% (9168/32 440) were concordant with ACC/AHA but not the National Cholesterol Education Program Adult Treatment Panel. 8.7% of these patients had a low‐density lipoprotein cholesterol >160 mg/dL despite having a moderate‐ or high‐intensity statin prescribed. And 11.6% (3772/32 440) were concordant with the National Cholesterol Education Program Adult Treatment Panel but not with ACC/AHA. Most of these patients had a low‐density lipoprotein cholesterol between 70 and 99 mg/dL with no or a low‐intensity statin prescribed. Conclusions Opportunities exist to improve cholesterol management in diabetes mellitus patients in community health centers. Addressing care gaps could improve cardiovascular disease prevention in this high‐risk population.
Collapse
Affiliation(s)
- Ehimare Akhabue
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Reesa Laws
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Center for Primary Care Innovation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
14
|
Salvadori P. [Integrated patient-centered care in Community Health Centers in Italy: performance evaluation]. Ig Sanita Pubbl 2016; 72:555-560. [PMID: 28214908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In Italy, a "Casa della Salute" (or "House of Health"), translated for the purposes of this article as Community Health Center (CHC), is a public center (of the national public healthcare system), where one can find allocated all primary community healthcare services centered on prevention, treatment and rehabilitation of the citizen in the same physical space, including general practitioner offices, outpatient specialist clinics, and social services. CHCs assure patient-centered primary care services and are the ideal place for applying the Chronic Care Model. We compared inpatient admission rates for all diseases and for chronic diseases, pharmaceutical and specialist expenditure, spending for implants and emergency room admissions, among persons assigned to General Practitioners (GPs) who work in CHCs compared with those in the same geographical area followed by GPs not working in a CHC. Subjects cared for in CHCs showed lower levels of hospital admission and emergency room access. Slight increases in the consumption of drugs and specialist resources, including consultation and diagnostic tests, were observed, due to increased taking charge of chronic cases in CHCs.
Collapse
Affiliation(s)
- Piero Salvadori
- Direttore Unità Operativa Complessa Organizzazione Servizi Sanitari Territoriali, Azienda USL Toscana Centro, sede di Empoli, Italia
| |
Collapse
|
15
|
Laamanen R, Ovretveit J, Sundell J, Simonsen-Rehn N, Suominen S, Brommels M. Client perceptions of the performance of public and independent not-for-profit primary healthcare. Scand J Public Health 2016; 34:598-608. [PMID: 17132593 DOI: 10.1080/14034940600585820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: To compare primary healthcare (PHC) provided by an independent not-for-profit organization (INPO) with that provided by two public municipal organizations (MO1 and MO2), in terms of clients' perceptions of performance, acceptance, and trust. Methods: A survey using a pre-tested questionnaire to all clients visiting a health centre (HC) doctor or nurse during one week in 2000 (n=511, 51% response rate) and 2002 (n=275, 47%). The data were analysed by descriptive statistics and cumulative logistic regression analysis. Results: The INPO differed from both publicly provided services in accessibility, consistency of service, and outcomes. Clients reported lower trust in HC provided by public organizations compared with the INPO. Trust was higher if clients also reported experiencing ``very good'' or ``moderate'' organizational access — or if general satisfaction was ``very high'' or ``moderate'' or if they experienced outcomes as ``very good'' or ``moderate'' compared with the ``very poor or low'' situation. Women reported lower trust in HC than men. When the family doctor was included in the same logistic regression model with the service provider, only the family doctor was a significant explanatory variable. Reported acceptance of private alternative service providers among clients was similar between the study organizations. Conclusions: Clients of the INPO generally rated the service more positively than clients of publicly provided services. The results indicate that trust in HC depends more on a family doctor system than a service provider.
Collapse
Affiliation(s)
- Ritva Laamanen
- Department of Public Health, University of Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
16
|
Grisanti SM, Boyd LD, Rainchuso L. An Assessment Model for Evaluating Outcomes in Federally Qualified Health Centers' Dental Departments: Results of a 5 Year Study. J Dent Hyg 2016; 90 Suppl 1:22-32. [PMID: 27458315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this report was to establish baseline data on 10 oral health performance indicators over 5 fiscal years (2007 to 2008 through 2011 to 2012) for an Iowa health center. The baseline data provides an assessment model and reports outcomes based on the use of the model. Performance indicators show evidence of provider performance, accountability to stakeholders and provide the benchmarks required for dental management to develop future goals to improve oral health outcomes for atrisk populations. METHODS Using descriptive statistic, this report extrapolated data from the Iowa Health Center's computer management systems software, HealthPro, and Centricity electronic medical records, and analyzed using IBM® SPSS® 19. This report describes the change in utilization for number and type of visits for uninsured and Medicaid patients over 5 fiscal years (a fiscal year is measured from November 1 through October 31). RESULTS The number of patients receiving at least 1 dental visit in a measurement year showed n=81,673 procedures with 21% (17,167) being unduplicated patients. Preventive averaged 46%, restorative 18%, urgent care 22% and other procedures 14%. CONCLUSION Federally qualified health centers (FQHCs) with a dental component serve populations with the greatest health disparities. This population includes ethnic and racial minorities, uninsured, underinsured, rural residents, Medicaid and Medicare. Establishing baseline data for FQHCs provides a foundational tool that will allow dental management to analyze successes as well as deficiencies in the goal to provide increased utilization to oral health care for at-risk populations.
Collapse
|
17
|
Udivitchenko OV, Meskov DO, Berseneva EA. [The experience of functioning of diabetic retinopathy room of municipal medical institution]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2016; 24:111-114. [PMID: 29553213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The diabetic retinopathy rooms are relatively new interdisciplinary structure in the medical care system. The evaluation of sufficiency of the number of this type of medical service for all patients with diabetes mellitus is lacking. The article presents calculation of required number of diabetic retinopathy rooms based on analysis of actual normative base, epidemiological data and experience of functioning of such rooms kind of rooms in municipal medical institution. It is established that for the room assisting particular population of patients with diabetes mellitus workload in average makes up to 1.87 visits per patient annually. The structure and authorized number of diabetic retinopathy rooms specified by actual normative documents, can be considered as sufficient only under condition that primary screening of diabetic retinopathy will be implemented at least to certain percentage of patients by ophthalmologists outside diabetic retinopathy rooms. This condition is to be considered during development of routing of referral of patients with diabetes mellitus to diabetic retinopathy rooms and other ophthalmologists of polyclinic network for full coverage of patients with screening for retinopathy and other affections of organ of vision under diabetes mellitus.
Collapse
|
18
|
Seidu S, Walker NS, Bodicoat DH, Davies MJ, Khunti K. A systematic review of interventions targeting primary care or community based professionals on cardio-metabolic risk factor control in people with diabetes. Diabetes Res Clin Pract 2016; 113:1-13. [PMID: 26972954 DOI: 10.1016/j.diabres.2016.01.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/14/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes. RESEARCH DESIGN AND METHODS A systematic review of randomised controlled trials evaluating the effectiveness of interventions targeting primary care or community based professionals on diabetes and cardiovascular risk factor control. We conducted searches in MEDLINE database from inception up to 27th September 2015. We also retrieved articles related to diabetes from the Cochrane EPOC database and EMBASE and scanned bibliographies for key articles. RESULTS There was heterogeneity in terms of interventions and participants amongst the 30 studies (39,439 patients) that met the inclusion criteria. Nine of the studies focused on general or family practitioners, five on pharmacists, three on nurses and one each on dieticians and community workers. Twelve studies targeted multi-disciplinary teams. Educational interventions did not seem to have a positive impact on HbA1c, systolic blood pressure or lipid profiles. The use of telemedicine, clinician reminders and feedback showed mixed results but there was a level of consistency in improvement in HbA1c when multifaceted interventions on multidisciplinary teams were implemented. Targeting general or family physicians was largely ineffective in improving the cardiovascular risk factors considered, except when using a computer application on insulin handling of type 2 diabetes or customised simulated cases with feedbacks. Similarly, interventions targeting nurses did not improve outcomes compared to standard care. CONCLUSIONS Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control.
Collapse
Affiliation(s)
- S Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - N S Walker
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK
| | - D H Bodicoat
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
| | - M J Davies
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
| | - K Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
| |
Collapse
|
19
|
Alhassan RK, Nketiah-Amponsah E, Spieker N, Arhinful DK, Ogink A, van Ostenberg P, Rinke de Wit TF. Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana. PLoS One 2015; 10:e0142389. [PMID: 26619143 PMCID: PMC4664410 DOI: 10.1371/journal.pone.0142389] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/21/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. PURPOSE This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. METHODS A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. FINDINGS Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. CONCLUSION Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.
Collapse
Affiliation(s)
- Robert Kaba Alhassan
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
- * E-mail:
| | | | | | - Daniel Kojo Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Alice Ogink
- PharmAccess Foundation, Amsterdam, Netherlands
| | - Paul van Ostenberg
- Joint Commission International (JCI), Chicago, Illinois, United States of America
| | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands
- PharmAccess Foundation, Amsterdam, Netherlands
| |
Collapse
|
20
|
Gold R, Hollombe C, Bunce A, Nelson C, Davis JV, Cowburn S, Perrin N, DeVoe J, Mossman N, Boles B, Horberg M, Dearing JW, Jaworski V, Cohen D, Smith D. Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies. Implement Sci 2015; 10:144. [PMID: 26474759 PMCID: PMC4609090 DOI: 10.1186/s13012-015-0333-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. METHODS/DESIGN This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. DISCUSSION Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02325531.
Collapse
Affiliation(s)
- Rachel Gold
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Celine Hollombe
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Arwen Bunce
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | | | - James V Davis
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Stuart Cowburn
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Nancy Perrin
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| | - Jennifer DeVoe
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
- Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Ned Mossman
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Bruce Boles
- Kaiser Permanente Care Management Institute, 1 Kaiser Plaza, 16 L, Oakland, CA, 94612, USA.
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, 2101 East Jefferson Street 3 West, Rockville, MD, 20852, USA.
| | - James W Dearing
- College of Communication Arts and Sciences, Michigan State University, 404 Wilson Road, 473, East Lansing, MI, 48824, USA.
| | - Victoria Jaworski
- Multnomah County Public Health Department, 426 SW Stark St, 8th Floor, Portland, OR, 97204, USA.
| | - Deborah Cohen
- Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - David Smith
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA.
| |
Collapse
|
21
|
Beach J, Oates J. Revalidation: The professional development discussion. Community Pract 2015; 88:22-25. [PMID: 26489247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The professional development discussion (PDD) will be an essential component of revalidation with the Nursing and Midwifery Council. The Unite/CPHVA professional officers who participated in the pilot found the PDD to be the most beneficial part of the revalidation process. This article explores the experience of a PDD from both the revalidatee and the fellow registrant perspective. It goes on to make recommendations for ensuring an effective PDD.
Collapse
|
22
|
Revalidation issues highlighted in case studies. Community Pract 2015; 88:18-20. [PMID: 26489246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
23
|
Grisanti SM, Boyd LD, Rainchuso L. An Assessment Model for Evaluating Outcomes in Federally Qualified Health Centers' Dental Departments: Results of a 5 Year Study. J Dent Hyg 2015; 89:247-257. [PMID: 26304949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this report was to establish baseline data on 10 oral health performance indicators over 5 fiscal years (2007 to 2008 through 2011 to 2012) for an Iowa health center. The baseline data provides an assessment model and reports outcomes based on the use of the model. Performance indicators show evidence of provider performance, accountability to stakeholders and provide the benchmarks required for dental management to develop future goals to improve oral health outcomes for at-risk populations. METHODS Using descriptive statistic, this report extrapolated data from the Iowa Health Center's computer management systems software, HealthPro, and Centricity electronic medical records, and analyzed using IBM® SPSS® 19. This report describes the change in utilization for number and type of visits for uninsured and Medicaid patients over 5 fiscal years (a fiscal year is measured from November 1 through October 31). RESULTS The number of patients receiving at least 1 dental visit in a measurement year showed n=81,673 procedures with 21% (17,167) being unduplicated patients. Preventive averaged 46%, restorative 18%, urgent care 22% and other procedures 14%. CONCLUSION Federally qualified health centers (FQHCs) with a dental component serve populations with the greatest health disparities. This population includes ethnic and racial minorities, uninsured, underinsured, rural residents, Medicaid and Medicare. Establishing baseline data for FQHCs provides a foundational tool that will allow dental management to analyze successes as well as deficiencies in the goal to provide increased utilization to oral health care for at-risk populations.
Collapse
|
24
|
Sun X, Li Y, Liu S, Lou J, Ding Y, Liang H, Gu J, Jing Y, Fu H, Zhang Y. Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey. PLoS One 2015; 10:e0125469. [PMID: 25950172 PMCID: PMC4423872 DOI: 10.1371/journal.pone.0125469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/24/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The performance of community health service centers (CHSCs) has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China. METHODS A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model. RESULTS We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM). The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance. CONCLUSIONS It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.
Collapse
Affiliation(s)
- Xiaoming Sun
- School of Public Health, Public Health Security Key Laboratory of Ministry of Education, Fudan University, Shanghai, China
- Pudong Institute for Health Development, Shanghai, China
- Health and Family Planning Commission of Pudong new district, Shanghai, China
| | - Yanting Li
- School of Public Health, Public Health Security Key Laboratory of Ministry of Education, Fudan University, Shanghai, China
- Pudong Institute for Health Development, Shanghai, China
| | - Shanshan Liu
- Pudong Institute for Health Development, Shanghai, China
| | - Jiquan Lou
- Pudong Institute for Health Development, Shanghai, China
| | - Ye Ding
- Pudong Institute for Health Development, Shanghai, China
| | - Hong Liang
- Pudong Institute for Health Development, Shanghai, China
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Jianjun Gu
- Health and Family Planning Commission of Pudong new district, Shanghai, China
| | - Yuan Jing
- Pudong Institute for Health Development, Shanghai, China
| | - Hua Fu
- School of Public Health, Public Health Security Key Laboratory of Ministry of Education, Fudan University, Shanghai, China
| | - Yimin Zhang
- Pudong Institute for Health Development, Shanghai, China
- School of Social Development and Public Policy, Fudan University, Shanghai, China
- * E-mail:
| |
Collapse
|
25
|
Bailey MJ, Goodman-Bacon A. The War on Poverty's Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans. Am Econ Rev 2015; 105:1067-1104. [PMID: 25999599 PMCID: PMC4436657 DOI: 10.1257/aer.20120070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This paper uses the rollout of the first Community Health Centers (CHCs) to study the longer-term health effects of increasing access to primary care. Within ten years, CHCs are associated with a reduction in age-adjusted mortality rates of 2 percent among those 50 and older. The implied 7 to 13 percent decrease in one-year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor/non-poor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has longer-term benefits, even for populations with near universal health insurance. (JEL H75, I12, I13, I18, I32, I38, J14).
Collapse
Affiliation(s)
- Martha J. Bailey
- Department of Economics, University of Michigan, 611 Tappan Street, Ann Arbor, Michigan 48109
| | - Andrew Goodman-Bacon
- Department of Economics, University of Michigan, 611 Tappan Street, Ann Arbor, Michigan 48109
| |
Collapse
|
26
|
Zulin YV, Kalinichenko AV, Bortsov VA, Romanenko MY, Kulikovskaia IV. [The expert evaluation of enhancement of organization of functioning of territorial polyclinic]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2015; 23:32-34. [PMID: 26012277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The planning of optimizing activities of out-patient service is appropriate to carry out examination of opinions of administrators of ambulatory medical organizations. The expertise of 70 head physicians and their deputies of treatment activities of ambulatory medical organizations of Novosibirsk determined directions of optimization of functioning of territorial polyclinic. The applied activities resulted in decreasing of indicators of period of visiting, and level of social deadaptation of patients. The number of treated patients increased both in polyclinic and day-stay hospital. The average duration of treatment in day-stay hospital and numbers of calls of emergency care ambulance on the territory ofpolyclinic attendance decreased
Collapse
|
27
|
Moushey E, Shomo A, Elder N, O'Dea C, Rahner D. Community partnered projects: residents engaging with community health centers to improve care. Fam Med 2014; 46:718-723. [PMID: 25275284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Important residency curricular elements, including scholarship, quality improvement (QI), and community health, often exist as independent components. We developed a curriculum to train residents to become community-responsive physicians that included longitudinal care at a community health center (CHC) with a unique community-partnered project (CPP). We evaluated outcomes of one CPP and delineated challenges in implementing the curriculum. METHODS After performing a needs assessment, the resident-CHC team designed a QI intervention to improve documentation of smoking status and cessation counseling. A chart review of 100 random patients assessed pre- and post-intervention documentation. Patient focus groups were held to guide the development of the final intervention, which included medical assistant (MA) education, appropriate patient education materials, and a visual communication system for MAs and providers. Curriculum evaluation via interviews with residency and community partners was done periodically throughout the 2-year process. RESULTS Focus group participants saw clinicians as a resource for quitting but did not want to talk about quitting at every visit. We reviewed 317 patient visits pre-QI intervention and 191 post-QI intervention. There were no significant changes in the percent of visits where smoking status was documented (82% versus 79%); however, smoking cessation counseling during office visits increased significantly (19% to 54%). Key challenges included academic-community communication and resident scheduling and availability. CONCLUSIONS In this CPP curriculum, residents made a difference in practice outcomes, and ongoing attention to challenges assisted with the project's success, possibly enhancing residents' likelihood of incorporating QI and principles of community health into their future careers.
Collapse
Affiliation(s)
- Erin Moushey
- Department of Family and Community Medicine, University of Cincinnati and The Christ Hospital/University of Cincinnati Family Medicine Residency
| | | | | | | | | |
Collapse
|
28
|
Holmberg S, Ekström H. [Primary health care in Kronoberg before and after the care choice. More satisfied patients ... the staff think it got worse]. Lakartidningen 2014; 111:1128-1130. [PMID: 25072077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
29
|
Norlund L, Norlund P, Nilsson S, Skov-Poulsen K, Karlsson P, Nordin G. [Point of care analyses are not used uniformly in primary health care. Equalis survey shows that volume and the type of tests performed varies between different health care centers]. Lakartidningen 2014; 111:1054-1056. [PMID: 25129913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
30
|
Olmedo B, Miranda E, Cordon O, Pettker CM, Funai EF. Improving maternal health and safety through adherence to postpartum hemorrhage protocol in Latin America. Int J Gynaecol Obstet 2014; 125:162-5. [PMID: 24548891 DOI: 10.1016/j.ijgo.2013.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/14/2013] [Accepted: 01/17/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine provider compliance with protocols for the prevention of postpartum hemorrhage and provider characteristics associated with adherence and non-adherence. METHODS A multicenter descriptive study was conducted involving 78 direct observations of provider-implemented protocols and 52 interviews with Peruvian maternal healthcare providers at 4 Peruvian clinical sites representing the local, regional, and national levels of care. Parturient participants planning a normal vaginal delivery were 17-49 years of age and 34-42 weeks pregnant. Primary outcomes were compared using χ2 testing, while quantitative survey data were evaluated using means, standard deviations, and Student t test or analysis of variance for statistical significance. RESULTS There were 3 significant differences between the national, regional, and local levels of care: adherence to all 3 interventions (P<0.001); professional experience (P<0.04); and retention of healthcare providers (P<0.001). There were no differences in provider training (P<0.097), and the retention of experienced healthcare providers was not associated with greater adherence to protocols. There were no significant differences in parturient characteristics. CONCLUSION Individual characteristics and institutional beliefs may have more influence than experience or training on adherence to protocols for prevention of postpartum hemorrhage; addressing these biases may improve patient safety in Peru and throughout Latin America.
Collapse
Affiliation(s)
- Benjamin Olmedo
- Yale Physician Associate Program, Yale University School of Medicine, New Haven, USA.
| | - Eva Miranda
- US Agency for International Development, USAID|Peru|Quality Health Care, Lima, Peru
| | - Oscar Cordon
- US Agency for International Development, USAID|Peru|Quality Health Care, Lima, Peru
| | - Christian M Pettker
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, USA
| | - Edmund F Funai
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, USA
| |
Collapse
|
31
|
Gwede CK, Davis SN, Quinn GP, Koskan AM, Ealey J, Abdulla R, Vadaparampil ST, Elliott G, Lopez D, Shibata D, Roetzheim RG, Meade CD. Making it work: health care provider perspectives on strategies to increase colorectal cancer screening in federally qualified health centers. J Cancer Educ 2013; 28:777-783. [PMID: 23943277 PMCID: PMC3864594 DOI: 10.1007/s13187-013-0531-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health care providers' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. A mixed methods design consisting of in-depth interviews, focus groups, and a short survey is used in this study. The participants of this study are 17 health care providers practicing in FQHCs in the Tampa Bay area. Test-specific patient impediments and motivations were identified including fear of abnormal findings, importance of offering less invasive fecal occult blood tests, and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education. Findings readily inform the design of educational materials and interventions to increase CRCS in FQHCs.
Collapse
Affiliation(s)
- Clement K Gwede
- Division of Cancer Prevention and Control, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Gustafsson EB, Melander E, Johansson PJH. [MRSA in primary health care facilities]. Lakartidningen 2013; 110:949-950. [PMID: 23745501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
34
|
Laditka JN, Laditka SB, Lowe KB. Promoting cognitive health: a web site review of health systems, public health departments, and senior centers. Am J Alzheimers Dis Other Demen 2012; 27:600-8. [PMID: 23007288 PMCID: PMC10911579 DOI: 10.1177/1533317512460564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Growing evidence suggests that healthy behaviors such as being physically active, having a heart healthy diet, and being socially involved may promote cognitive health. The United States has recently begun encouraging such behaviors for that purpose. To help evaluate the diffusion of this policy, we sought to measure a baseline of activity in this area. We examined Web sites of 156 large health care systems, the health departments of all 50 states and the 20 largest US cities, and 181 nationally accredited senior centers, to identify information, products, programs, or services recommended for cognitive health. Among health care systems, 40% promoted cognitive health: 24% recommended mental activity, 20% healthy diets, 20% physical activity, and 16% social involvement. Among health departments, 30% promoted cognitive health in the same ways. Among senior centers, 21% offered strategies, primarily mental activity. Results suggest emerging activity in this area and opportunities for continued development.
Collapse
Affiliation(s)
- James N Laditka
- Department of Public Health Sciences, University of North Carolina, Charlotte, NC 28223, USA.
| | | | | |
Collapse
|
35
|
Schwartz KA. One rural Federally Qualified Health Center's journey with North Carolina's Improving Performance in Practice (IPIP) program. N C Med J 2012; 73:470-471. [PMID: 23617163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kim A Schwartz
- Roanoke Chowan Community Health Center, Ahoskie, North Carolina 27910, USA.
| |
Collapse
|
36
|
Lévesque JF, Feldman DE, Lemieux V, Tourigny A, Lavoie JP, Tousignant P. Variations in patients' assessment of chronic illness care across organizational models of primary health care: a multilevel cohort analysis. Healthc Policy 2012; 8:e108-e123. [PMID: 23968619 PMCID: PMC3517876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models. METHODS We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis. RESULTS The mean PACIC score was low at 2.5 on a scale of 1 to 5. PACIC scores were highest among patients affiliated with family medicine groups (mean, 2.78) and lowest for contact models (mean, 2.35). Patients with arthritis and older persons generally reported a lower assessment of chronic care. CONCLUSION Family medicine groups represent an integrated model of PHC associated with higher levels of achievement in chronic care. Variations across PHC organizations suggest that some models are more appropriate for improving management of chronic illness.
Collapse
Affiliation(s)
- Jean-Frédéric Lévesque
- Scientific Director, Institut National de Santé Publique du Québec, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, QC.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
OBJECTIVE To develop and evaluate survey questions that assess processes of care relevant to Patient-Centered Medical Homes (PCMHs). RESEARCH DESIGN We convened expert panels, reviewed evidence on effective care practices and existing surveys, elicited broad public input, and conducted cognitive interviews and a field test to develop items relevant to PCMHs that could be added to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician & Group (CG-CAHPS) 1.0 Survey. Surveys were tested using a 2-contact mail protocol in 10 adults and 33 pediatric practices (both private and community health centers) in Massachusetts. A total of 4875 completed surveys were received (overall response rate of 25%). ANALYSES We calculated the rate of valid responses for each item. We conducted exploratory factor analyses and estimated item-to-total correlations, individual and site-level reliability, and correlations among proposed multi-item composites. RESULTS Ten items in 4 new domains (Comprehensiveness, Information, Self-Management Support, and Shared Decision-Making) and 4 items in 2 existing domains (Access and Coordination of Care) were selected to be supplemental items to be used in conjunction with the adult CG-CAHPS 1.0 Survey. For the child version, 4 items in each of 2 new domains (Information and Self-Management Support) and 5 items in existing domains (Access, Comprehensiveness-Prevention, Coordination of Care) were selected. CONCLUSIONS This study provides support for the reliability and validity of new items to supplement the CG-CAHPS 1.0 Survey to assess aspects of primary care that are important attributes of PCMHs.
Collapse
|
38
|
Jahangoshai Rezaee M, Moini A, Haji-Ali Asgari F. Unified Performance Evaluation of Health Centers with Integrated Model of Data Envelopment Analysis and Bargaining Game. J Med Syst 2012; 36:3805-15. [PMID: 22544456 DOI: 10.1007/s10916-012-9853-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/02/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Mustafa Jahangoshai Rezaee
- Department of Industrial Engineering, Iran University of Science and Technology, P.O.Box:1684613114, Tehran, Iran.
| | | | | |
Collapse
|
39
|
Abstract
OBJECTIVE To assess the medico-professional quality of consultations by analysing textual data from patient records. DESIGN Qualitative analyse of textual data. SETTING Four primary health care centres using electronic patient records (EPR) in Finland. SUBJECTS EPR and paired questionnaires of 175 consultations filled in by GPs and their patients independently. MAIN OUTCOME MEASURES Medico-professional quality of consultations, quality of care of acute respiratory infections, and hypertension. RESULTS The medico-professional quality of the consultations was quite good. However, 9% of the records could not been assessed at all because of missing or poor documentation and 9% were assessed as poor. The treatment of acute respiratory infections and hypertension is not in line with current care guidelines. Smoking habits or other health behaviour or lifestyle factors were seldom recorded. CONCLUSIONS The medico-professional quality of the consultation was quite good. Quality improvement is needed in the treatment of acute respiratory infections and hypertension. User-friendly EPR systems would improve the content of patient records.
Collapse
Affiliation(s)
- Maisa Kuusela
- Department of General Practice, University of Turku, Finland.
| | | | | | | | | |
Collapse
|
40
|
Dahrouge S, Hogg W, Tuna M, Russell G, Devlin RA, Tugwell P, Kristjansson E. Age equity in different models of primary care practice in Ontario. Can Fam Physician 2011; 57:1300-1309. [PMID: 22084464 PMCID: PMC3215613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess whether the model of service delivery affects the equity of the care provided across age groups. DESIGN Cross-sectional study. SETTING Ontario. PARTICIPANTS One hundred thirty-seven practices, including traditional fee-for-service practices, salaried community health centres (CHCs), and capitation-based family health networks and health service organizations. MAIN OUTCOME MEASURES To compare the quality of care across age groups using multilevel linear or logistic regressions. Health service delivery measures and health promotion were assessed through patient surveys (N = 5111), which were based on the Primary Care Assessment Tool, and prevention and chronic disease management were assessed, based on Canadian recommendations for care, through chart abstraction (N = 4108). RESULTS Older individuals reported better health service delivery in all models. This age effect ranged from 1.9% to 5.7%, and was larger in the 2 capitation-based models. Individuals aged younger than 30 years attending CHCs had more features of disadvantage (ie, living below the poverty line and without high school education) and were more likely than older individuals to report discussing at least 1 health promotion subject at the index visit. These differences were deemed an appropriate response to greater needs in these younger individuals. The prevention score showed an age-sex interaction in all models, with adherence to recommended care dropping with age for women. These results are largely attributable to the fact that maneuvers recommended for younger women are considerably more likely to be performed than other maneuvers. Chronic disease management scores showed an inverted U relationship with age in fee-for-service practices, family health networks, and health service organizations but not in CHCs. CONCLUSION The salaried model might have an organizational structure that is more conducive to providing appropriate care across age groups. The thrust toward adopting capitation-based payment is unlikely to have an effect on age disparities.
Collapse
Affiliation(s)
- Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, ON.
| | | | | | | | | | | | | |
Collapse
|
41
|
Ostroumova MN, Mnuskina MM. [The practical experience of quality control organization in the laboratory of Municipal consultative diagnostic center 1 of St. Petersburg]. Klin Lab Diagn 2011:46-48. [PMID: 22195458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The article specifies the functioning of quality control system in the laboratory of Municipal consultative diagnostic center i 1 of St. Petersburg. Initially, on the basis of interpretations of biological variations of every analyte, the requirements to analytical quality are developed. Subsequently, the actually attainable reproducibility of measurements and their bias is examined. The real analytical characteristics of 27 biochemical analytes are presented. The aggregate laboratory ratings are quoted based on the results of involvement in three EQAS programs since 2005, concerning biochemistry, immunochemistry and hematology. The important quality of laboratory research on its analytical stage is maintained by the interaction between inter-laboratory and regular external control.
Collapse
|
42
|
Nilsson AF, Dahllöf J, Allerstrand G, Englund C, Pettersson G, Wettermark B. [Individual data about dispensed drug prescriptions--quality indicator for primary health care]. Lakartidningen 2011; 108:471-474. [PMID: 21744613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
43
|
Abstract
With the changing health care delivery, patients receive care at various settings, including acute care hospitals, skilled nursing facilities (SNFs), and ambulatory clinics, thus becoming exposed to pathogens. Various health care settings face unique challenges requiring individualized infection control programs. The programs in SNFs should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. In ambulatory clinics, the program should address triage and standard transmission-based precautions; cleaning, disinfection, and sterilization principles; surveillance in surgical clinics; safe injection practices; and bioterrorism and disaster planning.
Collapse
Affiliation(s)
- Elaine Flanagan
- Department of Infection Prevention and Hospital Epidemiology, Detroit Medical Center, Veterans Affairs Ann Arbor Healthcare System
| | - Teena Chopra
- Division of Infectious Diseases and Infection Control, Wayne State University, Veterans Affairs Ann Arbor Healthcare System
| | - Lona Mody
- University of Michigan Medical School, Division of Geriatric Medicine and Geriatrics Research, Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System
| |
Collapse
|
44
|
Boltin B, Berlinger N. Values engineering: the ethics of design in community health centers. Hastings Cent Rep 2011; 41:27-8. [PMID: 21329102 DOI: 10.1002/j.1552-146x.2011.tb00096.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
45
|
New York City Department for the Aging. Innovative senior centers. Care Manag J 2011; 12:50-3. [PMID: 21717846 DOI: 10.1891/1521-0987.12.2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Editor’s Note: The following article is adapted from New York City Department for the Aging. Reproduced with permission.
Collapse
|
46
|
Nteta TP, Mokgatle-Nthabu M, Oguntibeju OO. Utilization of the primary health care services in the Tshwane Region of Gauteng Province, South Africa. PLoS One 2010; 5:e13909. [PMID: 21085475 PMCID: PMC2976689 DOI: 10.1371/journal.pone.0013909] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 10/13/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In South Africa, the provision of primary health care is a basic service designed to be cost effective and bring healthcare as close as possible to the population, particularly to those people of low economic status. It is a service which is provided free of charge by the South African government and as part of the millennium health goals, it is intended that the service should be accessible to the populace and be effectively utilized. OBJECTIVE This study was designed to investigate the accessibility and utilization of the primary health care services in three community health care centres in the Tshwane of the Gauteng Province, South Africa. METHODOLOGY Data were obtained from participants attending three Community Health Care Centres in the Tshwane Region using self-administered structured questionnaires. A document review of the Community Health Care Centres records was conducted to investigate the utilization trends of the services provided and descriptive statistics were used to analyze the data obtained. RESULTS The results showed that the Community Health Care Centres in the Tshwane Region are accessible to most participants who lived within 5 km of such centres and who traveled 30 minutes or less to the clinic. Using a taxi or walking were found to be the most common means of transport used to gain access to such a clinic. The findings showed that generally, participants were satisfied with the services provided. CONCLUSION Participants of this study have access to the community health care centres in the Tshwane Region and there seems to be effective utilization by patients attending them.
Collapse
Affiliation(s)
- Thembi P. Nteta
- School of Public Health, MEDUNSA, University of Limpopo, Pretoria, South Africa
| | | | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, South Africa
| |
Collapse
|
47
|
Halldin J. [Limited value of the Care Choice follow up]. Lakartidningen 2010; 107:2253-2254. [PMID: 21043170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
48
|
Si D, Bailie R, Dowden M, Kennedy C, Cox R, O'Donoghue L, Liddle H, Kwedza R, Connors C, Thompson S, Burke H, Brown A, Weeramanthri T. Assessing quality of diabetes care and its variation in Aboriginal community health centres in Australia. Diabetes Metab Res Rev 2010; 26:464-73. [PMID: 20082409 DOI: 10.1002/dmrr.1062] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Examining variation in diabetes care across regions/organizations provides insight into underlying factors related to quality of care. The aims of this study were to assess quality of diabetes care and its variation among Aboriginal community health centres in Australia, and to estimate partitioning of variation attributable to health centre and individual patient characteristics. METHODS During 2005-2009, clinical medical audits were conducted in 62 Aboriginal community health centres from four states/territories. Main outcome measures include adherence to guidelines-scheduled processes of diabetes care, treatment and medication adjustment, and control of HbA(1c), blood pressure, total cholesterol and albumin/creatinine ratio (ACR). RESULTS Wide variation was observed across different categories of diabetes care measures and across centres: (1) overall adherence to delivery of services averaged 57% (range 22-83% across centres); (2) medication adjustment rates after elevated HbA(1c): 26% (0-72%); and (3) proportions of patients with HbA(1c) < 7%:27% (0-55%); with blood pressure < 130/80 mmHg: 36% (0-59%). Health centre level characteristics accounted for 36% of the total variation in adherence to process measures, and 3-11% of the total variation in patient intermediate outcomes; the remaining, substantial amount of variation in each measure was attributable to patient level characteristics. CONCLUSIONS Deficiencies in a range of quality of care measures provide multiple opportunities for improvement. The majority of variation in quality of diabetes care appears to be attributable to patient level characteristics. Further understanding of factors affecting variation in the care of individuals should assist clinicians, managers and policy makers to develop strategies to improve quality of diabetes care in Aboriginal communities.
Collapse
Affiliation(s)
- Damin Si
- Charles Darwin University, NT, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Rubinstein Z, Polakevitz Y, Ben Gershon B, Lubin G, Bar-Dayan Y. [The treatment of anxiety and acute stress reaction (ASR) in civilian casualties in community stress centers (CSC) in the 2nd Lebanon War]. Harefuah 2010; 149:427-481. [PMID: 21465755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The treatment of anxiety and acute stress reaction (ASR) in civilian casualties exposed to continuous missile attacks during Lebanon War II is described in this study. Casualties were treated in community stress centers (CSC) erected ad-hoc, as a result of cooperation between the Mental Health Section of the Home Front Command of the Israel Defense Forces (IDF), the Mental Health Services of the Ministry of Health (MOH) and the Emergency and Disaster Management Division of the MOH. RESULTS A total of 536 casualties were admitted to the centers. Eighteen were evacuated to the zone hospitals due to physical problems. The remaining casualties were released within 2-4 hours of intensive intervention according to the protocol. Symptoms of casualties ranged from anxiety (and ASR)--90%; fear (mainly agoraphobia)--7%; adaptation--2%; sleep disturbances--1%. Mental health intervention included counseling talk--80%; ventilation--9%; relaxation--3%; non-verbaL intervention--3%; fulfillment of basic needs--1% and evacuation to hospitals--3%. We discovered that anxiety and ASR were the most prevalent syndromes among those casualties as a result of the missile attacks on the civil population. RECOMMENDATIONS The CSCs succeeded in providing adequate response and treatment for the majority of the casualties, thus putting off the need to evacuate those casualties to the ERs. Thereby, evacuation resources were saved and the ER load was reduced. The authors recommend that preparedness of the population under missile attacks, as well as other disaster scenarios, which resulted in a high rate of mental casualties, will be focused in the activation of CSCs in the format which has been described in this article.
Collapse
Affiliation(s)
- Zohar Rubinstein
- School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University.
| | | | | | | | | |
Collapse
|
50
|
André M, Jaktlund E. [National database for research and quality development--a general medicine alternative to disease-specific quality registries]. Lakartidningen 2010; 107:922-923. [PMID: 20432869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|