Dissertations / Theses: '200302 Community health care'

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Holmes, Frances Ann. "The illuminative evaluation of a Project 2000 pre-registration nursing course." Thesis, University of Surrey, 1996. http://epubs.surrey.ac.uk/842730/.

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This study is about the progress of a cohort of students who commenced a Project 2000 pre-registration nurse education course in April 1991. The research was undertaken entirely within one setting - in a College of Healthcare which was one of the 13 Demonstration colleges in England - and was conducted over a period of three years and ten months. The aim of the study was to evaluate what was considered by the nursing profession, government officials and educationalists, to be a radically new and innovative nursing course. A case study research approach of illuminative evaluation was used, within which a three stage framework of observation, further enquiry and evaluation was followed. The emphasis of the research was on the illumination of the processes, perceptions and contingencies which resulted in particular outcomes for the participants. This has enabled a comprehensive understanding of the complex realities which surrounded this innovative course, and the effects that a number of contemporaneous events have had on the findings. A description of these events has been presented, as has a literature review, overviews of both the history which preceded the introduction of Project 2000 and the professional concerns regarding the rapidity with which it was implemented. Multiple data collection methods were used to obtain the required information from the April 1991 cohort, the teachers involved with these students, the practitioners from three health authorities and other members of the College staff. The analyses of the data and the progressive focusing on the findings, have resulted in the identification of numerous positive and negative aspects and outcomes, together with problem areas and particular issues associated with the rapidity of the implementation of the course and the management of change. The placing of the negative and positive findings in a broader explanatory context, demonstrates how they relate to each other and with the research literature, and how the resulting conclusions have been reached. The research demonstrated that there were some very positive aspects and desirable outcomes which arose from the P.2000 programme. However, the concerns are the detrimental effects which arose from the introduction of numerous innovations into a constantly changing environment. The nursing profession had placed great importance on the introduction of P.2000, but insufficient time had been allowed for the application of management of change theories which would have enabled a more successful implementation to take place.

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Sheridan, Ann Josephine. "An analysis of the activities of psychiatric nurses practicing in Ireland 1950 - 2000." Thesis, University of Birmingham, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275666.

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Zimba, Anthony Andile. "A descriptive analysis of how primary health care services have developed in the Cape Metropolitan Area from the period: pre-1994 to post-2000 elections." Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52632.

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Assignment (MPA)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: Primary Health Care (PHC) approach is currently receiving tremendous attention worldwide as a mechanism to ensure effective and efficient public health services. The concept has evolved from the Alma Ata conference (1978). Since then many countries began to reorient their health services to achieve the goals of availability, accessibility and affordability of health care for all citizens and a number of management issues came to the forefront. Therefore, the provision of comprehensive PHC services is the key aspect to improving health services. A district health system has been identified as an ideal model for comprehensive PHC services to all the citizens in South Africa. Public health services in the Cape Metropolitan Area are characterised by functional fragmentation. Two public authorities render Primary Health Care services, namely the: Provincial Administration of the Western Cape through CHSO, and the Municipal Health Department. The fragmented nature of the public health services, which result in poor coordination of service delivery between the two health authorities, compromises the quality of service delivery. Historically, PHC services in the Cape Metropolitan Area - and indeed in the whole South Africa - have developed in a skewed manner. This work is an attempt at conceptualising the implications and consequences of this skewed health development. South Africa is presently undergoing fundamental reform, which has brought the PHC into disarray of fundamental change. Since the South African health care system is a highly complex institution, attempts have been made to critically analyse those aspects and features of inequality, inaccessibility, and inequity. Among these is the historical and present development of Cape Metropolitan Area health care and the structural features it assumed with the passing of time, trends and characteristics. In order to examine the theory in practice, the evolvement of PHC in the Cape Metropolitan Area will be analysed. The analysis highlights how different political formations have affected the development of PHC services and points out obstacles and limitations throughout the process, which had to be dealt with. Transformation of the existing health services, based on the principles of PHC, requires the redressing the imbalances of the past. Therefore, the integration of the two health authorities into one entity would best achieve the principles of district health system and will ensure comprehensive PRe.
AFRIKAANSE OPSOMMING: Die Primêre Gesondheidsorg benadering geniet tans wereldwyd erkenning as 'n meganisme om doeltreffende openbare gesondheidsdienslewering te versker. Die konsep, wat ontwikkel en gegroei het uit die Alma Ata-konferensie van 1978, is reeds deur verskeie regerings ge-implementeer ten einde die doelwitte van beskikbaarheid, toeganklikheid en bekostigbaarheid van gesondheidsorg vir alle landsburgers te verseker. Die voorsiening van omvattende Primêre Gesondheidsorgdienste word erken as 'n noodsaaklike middelom gesondheidsorg te verbeter. Die Distrikgesondheid-stelsel is geidentifiseer as 'n ideale model vir die implementering van omvattende Primêre Gesondheidsorgdienste in Suid Afrika. Publieke Gesondheidsdienste in die Kaapse Metropolitaanse-gebied word gekenmerk deur die feit dat dit funksioneel gefragmenteer is. Twee publieke owerhede, te wete die Provinsiale Administrasie van die Wes Kaap en die Kaapse Stadsraad lewer Primêre Gesondheidsorgdienste, wat aanleiding gee tot swak koordinering met die gevolg dat dienslewering daaronder ly. Primêre Gesondheidsdienste in die Kaapse Metropolitaansegebied, soos in die res van Suid Afrika, het op 'n onlogiese, skewe manier ontwikkel Hierdie werk is 'n poging om die gevolge en implikasies van die onlogiese, skewe gesondheids-ontwikkeling te konseptualiseer. Daar is gepoog om die uiters gekompliseerde gesondheidsdiens-stelsel in Suid Afrika krities te analiseer met spesifieke verwysing na die kenmenrke van ongelykheid, ontoeganklikheid en onbillikheid. Dit sluit die historiese en huidige ontwikkeling van gesondheidsorg in die Kaapse Metropolitaanse gebied en die strukturele kenmerke in wat deur die loop van jare as gevolg van verskeie invloede en neigings sigbar geraak het. Die ontwikkeling van Primêre Gesondheidsorg in die Kaapse Metropolitaanse-gebied word ge-analiseer ten einde bogenoemde teorie in die praktyk te bevestig. Die analise beklemtoon die invloed van verskillende politieke rolspelers op ,die ontwikkeling van Primêre Gesondheidsorgdienste en bevestig die struikelblokke en beperkings wat deurentyd opgeduik het. Transformasie van gesondheidsdienste soos dit tans daaruit sien, gegrond op die beginsels van Primêre Gesondheidsorg, vereis dat die ongelykhede van die verlede aangespreek word. Die integrasie van die twee gesondheidsdiensowerhede sal die beginsels van die Gesondheidsdistrik-stelsel verwesenlik, wat daartoe sal aanleiding gee dat omvattende Primêre Gesondheidsorg 'n werklikheid word.

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Denver, Sara Jane. "Experiences of developing cancer and palliative care services in one community in North West England 1976-2000 : an oral history and documentary reconstruction." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5526/.

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The purpose of this study was to explore how cancer and palliative care services developed in one place and changed in the course of time. Research on how local cancer and palliative care services have developed is limited. A small number of researchers have provided accounts of hospice developments nationally, but they did not explore individual experiences and the micro context in detail. Other studies have examined accounts of developing local cancer support services, but not hospice developments. This research addresses the question - how were cancer and palliative care services developed in Lancaster 1976 ? 2000? Oral history and documentary sources were used to generate data, which was analysed using thematic analysis/constant comparison. Social constructionism offered a fruitful theoretical basis that increased understandings of oral history accounts. A snowball sample recruited a broad group of participants that had been involved with the local cancer and palliative care services in the relevant period. Thirty five interviews were conducted. The study revealed that services developed in the absence of national planning; participants worked to make them respectable, but there was tension at times. Progress was shaped by a combination of individual and social factors. Services evolved outside the National Health Service, yet alongside oncology and were therefore tripartite in character. Elsewhere developments were often fragmented. Many participants were involved in all the local services; they created networks and collaborated to form comprehensive facilities, which were available from diagnosis to the terminal stage of illness. The approaches complemented each other to reveal that at the macro level services were initially flexible. In time they became more structured, as social, historical, economic, professional and political mechanisms in the broader context impacted to shape them; this created some challenges. The study also uncovered aspects of the meaning of compassion. It revealed that compassionate practices challenged the rationality of conventional approaches and shared relativist perspectives because participants found different ways of providing care. All of these findings contributed to new knowledge about the development of local cancer and palliative care services. The study was limited by the historical period, perhaps by the place and because the reconstruction was one interpretation. It is possible there are others.

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Morosini, Márcia Valéria Guimarães Cardoso. "A política de formação dos Agentes Comunitários de Saúde: memória de uma formulação em disputa nos anos 2003-2005." Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=5288.

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Este estudo trata da formulação da política de formação do agente comunitário de saúde (ACS), buscando compreender as disputas que então se travaram, a partir dos processos políticos relativos à gestão da educação e do trabalho do ACS, implementados no período compreendido entre o início de 2003 e meados de 2005. Para tal fim, foram analisados os documentos debatidos nessa formulação, no intervalo de tempo compreendido entre março de 2003 e julho de 2004, o qual se revelou um período intenso de produção conceitual em torno dessa política. Nos documentos analisados, revelaram-se posições acerca do perfil social do ACS e do trabalho que este deve realizar, articuladas a concepções de ensino e formação em saúde, que disputaram o conteúdo e a forma que a política de formação desses trabalhadores deveria assumir. Tais disputas guardam relação também com o modo como esta função se instituiu no SUS e as contradições geradas desde então; ao mesmo tempo, as posições conflitantes apontam para distintos projetos de saúde, educação e trabalho. Esse processo resultou na publicação do Referencial Curricular para Curso Técnico de Agente Comunitário de Saúde, que consolidou a proposta de formação técnica, mas cuja implementação não tem se dado integralmente, configurando a prevalência de uma qualificação inicial, conforme determina a legislação que orienta o exercício da profissão de ACS. Entretanto, a dissertação indica que o processo não se esgotou, sendo a atual política de formação dos ACS objeto de disputas e demandas, tanto pela sua conservação, quanto pela sua transformação.
This study focuses on the community health agent (from now on, CHA) education policy formulation, aimed at understanding the disputes that occurred within the political processes relative to CHAs education and work management, implemented in the period between the beginning of 2003 and the middle of 2005. To that end, the documents debated in this formulation were analyzed in the time frame between March 2003 and July 2004, which revealed to be an intense conceptual production period about this policy. In the documents analyzed, positions about the CHAs social profile and the work that he/she has to do turned out to be articulated to teaching and health training conceptions, which disputed both the content and the format that the formation policy of these workers should assume. Such debates also bear relation to the way this function has been instituted in SUS (Brazilian Public Health System) and the contradictions generated ever since; at the same time, the conflicting positions point out to distinct health, education and work projects. This process resulted in the publication of the Curricular Referential for the Community Health Agent Technician Course, which consolidated the technical education proposal, but whose implementation has not been complete, figuring the prevalence of an initial qualification, as determined by the legislation on CHA profession. However, the dissertation indicates that the subject has not been exhausted, as the current CHA education policy is an object of dispute and demand for its conservation as well as for its transformation.

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McAree, D. P. "Women's health : community pharmacy care." Thesis, Queen's University Belfast, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391103.

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Songpaisan, Yupin. "Community oral health care projects in Thailand." Malmö, Sweden : Dept. of Cariology, Faculty of Odontology, Lund University, 1994. http://books.google.com/books?id=ZAxqAAAAMAAJ.

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Wilson, Stephen Francis. "New models of multidisciplinary community health care." University of Sydney, 2005. http://hdl.handle.net/2123/895.

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Doctor of Philosophy(PhD)
This thesis consists of a series of studies of new models of multidisciplinary community health care in four compartments. These compartments are acute, subacute, outpatient and maintenance care. The purpose of the individual studies is to demonstrate the benifits of munltidisciplinary community health care in delivering alternatives to current practice by replacing hospital care or improving traditional community care.

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Gooding, Lewis D. "Care, community and the mental health nurse." Thesis, University of East Anglia, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.399844.

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Meebunmak, Yaowaluck. "Community mental health care in Thailand: Care management in two primary care units." Thesis, Meebunmak, Yaowaluck (2009) Community mental health care in Thailand: Care management in two primary care units. PhD thesis, Murdoch University, 2009. https://researchrepository.murdoch.edu.au/id/eprint/6502/.

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Thailand faces increasing mental health problems, however mental health services are limited. In particular, mental health services provided in communities across the country are not clearly structured. Research in regard to community mental health care is rare. The purpose of this study was to explore mental health care management in two primary care units (PCUs) in Thailand in order to understand the ways they operate within Thai communities. The specific objectives were to identify mental health care practices and roles of health providers, models of care and influences on mental health care practices in the two PCUs as case studies. An ethnographic approach using participant observation, semi-structured interview, quantitative questionnaire and document analysis was used in gathering data. The participants were seven nurses and three public health workers practising in the PCUs. Findings enhanced understanding in the context of two PCUs located in communities of the Northern and Central Thailand. Both were local health centres providing a wide range of health services based on the principles of primary health care (PHC). The PCUs were operated without mental health specialists, however nurses were the main resource in providing mental health care in terms of primary and secondary prevention. Primary prevention was provided through counselling sessions, drug prevention activities and seniors clubs. In addition, the health providers conducted activities of mental health promotion towards particular risk groups after assessing risks. They also gave support to mental health and normal cases that had possible mental health problems. Secondary prevention was provided in home visits, primarily in giving injections. The health providers played four main roles as educator, consultant, agent and manager in primary and secondary prevention. There was no single model of mental health care practice provided in the PCUs. Information derived from the present study showed a variety of models underpinning care practices. The nursing process was clearly adopted, as well as integrated care, community participation, collaboration and consultation, and using standard guidelines. Personal knowledge and interest in mental health were mentioned as an important factor in practising mental health care. Environmental factors such as adhering to policy, being family-oriented, being mindful of economic factors, using Buddhist Principles to guide interactions, guarding against occupational risks, maintaining a teamwork approach and the lack of specialists appeared to be factors influencing mental health care. This study contributes to the body of knowledge of community mental health care management in Thailand. The findings suggest implications for practices, education, and policy making to improve quality of care.

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Singh, Dorian. "Accessing health care : barriers to care in a Romanian Roma community." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.669918.

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Welschhoff, Anja. "Community Participation and Primary Health Care in India." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-69547.

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Schemmer, Ruth Ann. "Survival of nonprofit community health clinics." Texas A&M University, 2003. http://hdl.handle.net/1969.1/3885.

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In the provision of public goods such as health care for the uninsured, nonprofit organizations serve important functions in society. Because they often rely on volunteer labor, and funding is frequently unstable, their survival depends on factors not present in either private enterprise or state agencies. This comparison case study examines three clinics, one surviving clinic and two that did not survive, to find patterns that characterize organizational success and survival. Theories about public goods, volunteering, and organizational coordination and communication provide insight into different aspects of the case study. Data was gathered from 19 in-depth interviews with individuals connected to the three clinics. The analysis employs OstromÂs characterization of eight principles of longstanding common-pool resource organizations, with slight adjustments for the public goods setting. As expected, the successful clinic reflects more of the characteristics, or possesses them to a greater degree, than the unsuccessful ones. Specifically, the successful clinic reflects a greater degree of congruence between organizational rules and local conditions (as evidenced by community support), and collective-choice arrangements (as indicated by the presence of an actively engaged board of directors). In addition, the successful clinic is loosely nested with other organizations, whereas the nonsurviving clinics were more tightly nested within local organizations; the looser nesting allows for greater autonomy in decision-making. Finally, an unexpected finding drawn from the interviews concerns the manner in which the clinics framed their message and mission. The successful clinic framed its mission in terms of serving the Âworking poor,Â whereas the nonsurviving clinics stated their mission as charity for the poor and needy. This variance may have contributed to greater community support for the successful clinic.

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Jewkes, Rachel Katherine. "Meanings of 'community' in community participation in health promotion." Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/meanings-of-community-in-community-participation-in-health-promotion(b6de367c-b093-4d06-a81b-42bb9746d344).html.

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Grainger, Roger. "Implicit religion and health care." Thesis, University of Cambridge, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316645.

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Maclean, John Ross. "Telemedicine in remote health care." Thesis, University of Aberdeen, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264331.

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This thesis offers a review of the historical development of telemedicine services in remote health care. It addresses the professional concerns in practising medicine in isolated conditions, and the advances in telecommunications technology since the telephone was invented. It also examines the application of telemedicine in remote environments across the world, such as in indigenous communities, remote industrial work sites and at scientific bases in Antarctica. At its most exotic, a review is offered of the health care for space crews. The literature review highlights a number of concerns about the state of the art knowledge on remote health care services. These concerns are the minimal training requirements of individuals who act as health care practitioners in the remote environment, the additional training requirement upon the advising medical practitioner, and the design of a system for the collection of clinical information from the patient. In response to the above a two year study was conducted. Quantitative and qualitative observation of remote health care consultations was undertaken. The environments studied were simulation cases occurring in the UK and Antarctica, and real cases presenting on oil installations in the North Sea. The study results answer the original concerns about the training levels, data collection and communications components of a remote health care service. In addition, they offer valuable input towards the design of a telemedicine model for remote health care. The telemedicine model is presented as a framework upon which future developments in the field of telemedicine may be approached.

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Anderson, Claire Wynn. "Health promotion by community pharmacists." Thesis, King's College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299776.

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Beecham, Jennifer Kate. "Community mental health services : resources and costs." Thesis, University of Kent, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.319222.

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Kama, Zukiswa Shirley. "An evaluation of access to health care : Gugulethu Community Health Clinic." Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2456.

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Thesis (MTech (Public Management))--Cape Peninsula University of Technology, 2017.
The purpose of this study was to examine the problem of access to health care centres in the Western Cape and to forward recommendations that will improve access to health care facilities in the Western Cape. The first objective of the study was to identify trends in primary health care looking at Nigeria, with the view of learning lessons of experience. Secondly, the study provided an overview of the South African health care system. The study further examined the problems around access to Gugulethu Community Health Clinic. The research objectives were directly linked to the composition of chapters. The study utilised a mixed-method approach of quantitative and qualitative approaches. This method is called multi-method approach. The purpose of combining the two approaches was to understand the research problem from a subjective and objective point of view, as well as to provide an in-depth understanding of a research topic, which led to more reliable research results. Data collection was acquired by utilising a structured questionnaire and personal observations. Two groups of respondents participated in the study inter alia: the patients and the staff of Gugulethu Community Health Clinic.

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Morgan, Natalie D. G. "The impact of health care reforms on community health nurses' attitudes /." St. John's, NF : [s.n.], 2002.

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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.

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Master of Public Health - MPH
Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

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Gamiet, Shamila. "Health professionals' perceptions of rehabilitation care workers." Thesis, University of the Western Cape, 2015. http://hdl.handle.net/11394/5246.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
People with disabilities (PWD) often come from disadvantaged communities and struggle to access health and rehabilitation, education and employment. This leads to poorer health outcomes, lower education achievements, and higher rate of unemployment in comparison to people without disabilities. Therefore there is a need to empower PWD to remove all barriers which prevent them from participating in all aspects of their communities. In South Africa, 5% of the population is disabled and in a worldwide review conducted on access to rehabilitation services, it was reported that South Africa provided 21% to 40% of the disabled population with rehabilitation services. In 2012 the Department of Health (DOH) trained a new cadre of community health worker (CHW) in the field of rehabilitation in order to improve PWDs‘ access to health services. As a result, health professionals in the Western Cape became concerned about the role of this new cadre of rehabilitation care worker in PHC and CBS. The aim of this study was therefore to explore health professionals‘ perceptions of the newly trained rehabilitation care workers (RCWs). Q methodology was selected as an appropriate research design to meet the objectives of this study as it can be used to analyse opinions, perceptions and attitudes. The study population consisted of all the health professionals who engaged with the RCWs in the clinical workplace during their clinical practice module. A convenient sample of sixteen health professionals participated in this study. Ethics approval was obtained to conduct this study and all participants gave written consent to participate in this study. The researcher gathered all the viewpoints of the health professionals regarding the new rehabilitation care workers (RCWs) by conducting focus group discussions and document analysis. Statements were then drawn up based on the health professionals' viewpoints. The participants then ranked these statements from strongly agree to strongly disagree on a Q data score grid, in a process called Q sorting. The completed Q data score grids, called Q sorts, were then entered into PQMethod software programme for statistical and factor analysis. From the results of this Q analysis, two factors emerged which were analysed and interpreted. A factor is representative of participants with similar opinions. The participants loading onto Factor one and Factor two shared similar opinions of the RCWs. The results indicated that the participants were of the opinion that RCWs‘ role would be to strengthen primary health care (PHC) and community-based rehabilitation (CBR) and promote the participation of PWD in society. The results suggested that the RCWs were capable of improving the quality of life of PWD by empowering PWD to become actively involved in all aspects of community life. The participants felt that the RCWs would be included in the health system by working at intermediate care centres (facility-based) and in the community (home-based). However, the participants agreed that the RCWs must work under the direct supervision of qualified health professionals. Participants loading onto Factor one and Factor two further agreed that RCWs worked well in the structured environment of intermediate care health facilities. They felt that it would be beneficial for RCWs to be employed at these health facilities as the RCWs reduced the workload of the health professionals. From the results, it was also found that health professionals were of the opinion that the RCWs displayed positive attitudes and good professional behaviour in the clinical environment. Health professionals however identified gaps in the knowledge of the RCWs and a lack of skills to perform certain tasks. However, health professionals agreed that the RCWs' skills will develop and improve with time and exposure. This study showed that health professionals had positive perceptions of the RCWs and this could indicate that RCWs will be well accepted by health professionals as part of the PHC team. This could lead to the effective utilisation of RCWs in community-based rehabilitation. Recommendations can be made to the developers and implementers of the RCW training curriculum to make adjustments to the curriculum so as to address the lack of knowledge and skills in certain aspects of health and disability. It can further be recommended that South Africa's National DOH capitalise on these positive perceptions and train more RCWs to extend rehabilitation and health services to more underserved communities. This will assist the South African Government in ensuring that more PWD receive rehabilitation and become included in all aspects of their communities as is envisaged in the 2020/2030 health plan.

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Friedman, Nicole Lisa. "Impactful Care: Addressing Social Determinants of Health Across Health Systems." PDXScholar, 2019. https://pdxscholar.library.pdx.edu/open_access_etds/5073.

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There is emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related social needs, such as food insecurity, inadequate or unstable housing, and lack of access to transportation may increase the risk of developing chronic conditions, reduce an individual's ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization. In response, work on social needs is happening across large health systems in the United States, but the pace of progress is slow and accountability is diffuse. The goal of this applied research project is to examine Kaiser Permanente Northwest's patient navigator program as a case study for how health systems can transform into organizations that bridge clinical, social and behavioral health and redefine what it means to be a prevention-oriented delivery system. Kaiser Permanente Northwest (KPNW) provides high quality, patient-centered care to over 550,000 medical members and 240,000 dental members in Oregon and Southwest Washington. In conjunction with the Care Management Institute, KPNW created a patient navigator administered, social needs screening tool called "Your Current Life Situation" (YCLS). This thesis focuses on the data collected from this screening tool with an emphasis on operations management, workflows, and the technical tools that have been supported to do this work. The analysis also uses semi-structured qualitative interviews from patient navigators, physicians, social workers, community organizations and members to better understand the experience of social needs screening in clinical practice and its impact on members and community partners as they receive referrals for services outside the health care delivery system. Through using anthropological theory and methods, I seek to help health systems think and act differently by elevating the voice and experience of the community and translating vulnerable populations' needs into a language that can be integrated into multiple systems of care.

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Wood, Lisa. "Green care in the community." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/14996/.

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There is a growing body of evidence to suggest that community based horticultural projects can be effective interventions for people experiencing mental health difficulties. Such programmes have been shown to provide a wide range of benefits, including increased confidence and self-esteem, improved mood, extended social networks as well as the development of new skills and a circadian rhythm. Whilst there is now considerable evidence demonstrating the beneficial outcomes of group gardening, there is a lack of understanding as to how psychological processes that contribute towards therapeutic outcomes might be affected by these interventions. This study explored experiences of community gardening programmes in order to better understand how attendance may affect the psychological health of people experiencing mental distress. In particular, it sought to understand the impact of nature on psychological experience during group attendance. Eleven people experiencing mental health difficulties were interviewed about their experiences of attending community gardening groups. The study adopted an ethnomethodological approach to constructionist grounded theory, in order to develop a framework within which participant experiences could be understood. Findings suggested that key processes of feeling safe, letting go, (re-)connecting and finding place provided mechanisms of positive psychological change. Fundamental to each process were changes in construal of, and relationships with, others, nature and importantly, the self, within the gardening group contexts. An increased sense of identification with other people and non-human nature, and the development of empathy and compassion, appeared to be key psychological processes which may account for the positive impact on participants’ mental health. Directions for future research and implications for future clinical interventions are suggested.

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Hunter, Duncan James Webb. "Assessing health care need for prostatectomy." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682257/.

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This thesis describes a study that estimated the health care need for prostatectomy in a typical district of 250,000, among men who have both the appropriate indications for treatment and who would choose treatment if offered. It established the appropriate indications for prostatectomy using a literature review and a nominal group type consensus panel consisting of 6 urologists and 3 general practitioners. These were expressed in terms of different combinations of type of retention, type and severity of symptoms, and level of comorbidity. A 2-stage community survey of 2000 men aged 55 and over randomly selected from 8 general practices, using postal questionnaires, was conducted in North West Thames health region. The surveys collected information about: (1) self-reported frequency and severity of lower urinary tract symptoms; (2) the impact of these symptoms on daily activities and on health status; (3) the advice-seeking behaviour of men with symptoms and consequent action of GPs and urologists; and (4) patient preference for treatment. These results were combined to estimate the number of prostatectomies required in a typical district. The overall response rate was 66% (initial survey=78%, follow-up survey=84%). 20% of men reported moderate or severe lower urinary tract symptoms. Of these, 28% found their symptoms to be a medium or big problem and that, depending on the activity, between 9% and 39% experienced interference with their daily activities. Health status, as measured by either the Nottingham Health Profile or the SF-36, worsened as symptom severity increased. Forty five per cent of men with symptoms had seen their general practitioner for their symptoms. Of these, 62% were referred on to a urologist, of which the majority (71 %) were offered, and accepted surgery. When presented with details and information on the risks and benefits of prostatectomy, a substantial proportion (22%) of men with lower urinary tract symptoms, reported that they would probably, or definitely, refuse treatment, while a 47% of men were unsure. The estimate of required number of prostatectomies in a district with a population of 250,000 ranged from 225 to 4329 depending on the level of appropriateness, symptom severity and preference adopted. The decision about which estimate to use in purchasing prostatectomy for lower urinary tract symptoms must be made by local authorities.

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Hungerford, Gabriela Marie MS. "Characterizing Community-Based Usual Mental Health Care for Infants." FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/2609.

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Infants who experience multiple risk factors, such as preterm birth, developmental delay, and low socioeconomic status, are at greater risk for mental health problems. Mental health interventions for infants typically target infants from high-risk groups, and there is strong evidence that some intervention programs for infants can prevent long-term negative outcomes and promote long-term positive outcomes. Despite emerging research and federal initiatives promoting early intervention, minimal research has examined community-based mental health services during infancy. Improving the effectiveness and efficiency of routine care requires close examination of current practices. The current study characterized current usual care practices in infant mental health through a survey of mental health providers. Provider, practice, and client characteristics, provider use of intervention strategies and intervention programs, and provider attitudes toward and knowledge of evidence-based practices are described. Study findings are discussed in the context of previous usual care research. Implications and directions for future research are discussed.

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Goodwin, Simon Christopher. "Community care : the reform of the mental health services?" Thesis, University of Sheffield, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387717.

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Eaton, Kenneth Anthony. "Factors affecting community oral health care needs and provision." Thesis, University College London (University of London), 2002. http://discovery.ucl.ac.uk/95208/.

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Buys, Lüet Schraader. "Bridging the divide between primary health care and community." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22998.

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South African cities have a complex social and physical post-Apartheid layering. The historical legacy, referring here specifically to the inadequate roll-out of public facilities in areas and uprooting as well as separating of communities, have resulted in under serviced environments that can lack social cohesion and often struggle with poverty. Public institutions play a catalytic role within a community. To this end, health care portrays the government in a legible 'provider' role and is, in some ways, an obvious way to make citizens feel valued in comparison with other public institutions. Health care institutions impact the community in a unique way due to the combination of specificity of service and the emotive way it is experienced by the individual. This dissertation aims to research, define (and ultimately) test a strategy that aims to stitch together the fissure between community and institutions, by rethinking the urban interface of generic primary health care facilities. This research is structured around themes of theory, policy, the continuum of care and physical environments; each in order to better understand what and how the 'gap' between health care institution and community is constructed. Programmatic and/or spatial ideas that inform the architectural design. This dissertation asserts that providing 'traditional' generic institutions sustains rather than improves the life of the community. The research suggests that existing health care facilities can be more effective as public spaces by introducing new programmes, disaggregating the formal interface, redefining and activating a new urban threshold and providing meaningful open space. The design ultimately aims to act as a new skin or threshold through which institutions relate to the community.

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Harvey, Jennel Arlean. "Community Social Capital and the Health Care Safety Net." Diss., The University of Arizona, 2006. http://hdl.handle.net/10150/195997.

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This dissertation offers an empirical examination of the relationship between community social capital and health care safety net capacity. The ability and willingness of federally qualified health centers (FQHCs) and private physicians to serve the uninsured is crucial to ensuring that all Americans have access to a basic level of health care. Among other factors, this ability and willingness has been found to be a consequence of unique community values and traditions. This dissertation examined the extent to which the level of community social capital (community rates of participation in club meetings, projects, volunteer and civic activities) was related to three health care provider outcomes; 1) the willingness of private physicians to deliver uncompensated care; 2) the financial capacity of FQHCs to provide uncompensated care; and 3) the amount of FQHC resources directed toward the provision of largely uncompensated community-oriented services.Community and health care provider data on 1,248 FQHCs across 183 U.S. counties and 12,406 private physicians across 1,029 U.S. counties were collected from multiple data sources. Comprehensive multivariate analyses including Canonical Correlation Analysis (CCA), Ordinary Least Square (OLS) and Hierarchical Linear Modeling (HLM), and a planned comparison was conducted on these data at the community ecological and individual provider levels of analysis.Based on a literature review and the theoretical components of social capital theory, I developed a conceptual framework that proposed a relationship among social context, institutional frameworks and organizational behavior. The dissertation research sought to determine the extent to which the social context in which the organization was embedded influenced organizational behavior.I found that the relationship between community social capital and health care safety net capacity was weak and the direction of the association mixed. Among the findings was a positive and significant relationship between civic participation and FQHC grant revenues. Unexpected findings included significant correlations between community social capital and Medicaid generosity, and social capital and uninsurance. Although the data analysis suggested that unmeasured factors were largely responsible for variation in safety net capacity, it raised interesting questions that provoke future study. Important implications for theory, policy and practice are discussed.

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Hariri, Shapour. "Multimedia health promotion in community pharmacy." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301212.

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Dudley, Nancy Elizabeth. "Factors Influencing the Uptake of Community-based Palliative Care." Thesis, University of California, San Francisco, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10133428.

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Over the past ten years, community-based palliative care (CBPC) has rapidly expanded as older adults are living in the community longer with advanced illness and high symptom burden. Yet there are no models of standardized care for this population. It has been suggested that primary and secondary palliative care be delivered in the primary care setting to address palliative care needs in the community. However, a description of older adults in primary care with advanced illness and symptom burden who would benefit from primary and secondary palliative care, and a description of the process to deliver care are lacking. The aim of this dissertation was to explore the facilitators and barriers to providing palliative care in primary care, and to describe the prevalence of advanced illness and symptoms of older adults in primary care to identify who would benefit from palliative care in primary care.

Using a grounded theory methodology, twenty semi-structured interviews were conducted with primary care and palliative care providers in academic and community settings. Four major themes emerged from the data that are facilitators and barriers in care coordination: (i) role clarity; (ii) feedback and communication; (iii) time constraint and workforce; (iv) education.

A secondary analysis was conducted using the National Ambulatory and Hospital Medical Care Surveys 2009-2011 to examine primary care visits. There were more visits by older adults to primary care for advanced illness and symptoms than to non-primary care. More visits were due to advanced COPD, CHF, dementia, pain, depression, anxiety, fatigue, and insomnia compared to non-primary care. This research contributes to our knowledge of the delivery of palliative care in the community and the patient population that could benefit from primary and specialty palliative care. I offer a conceptual model of the process of primary care and specialty palliative care in order to coordinate care for older adults with advanced illness and progressive symptomatology.

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Jenkins, Juliette Swanston. "Community Health Worker's Perceptions of Integration into the Behavioral Health Care System." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6908.

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Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl's five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs' integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.

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Jones, Roger Hugh. "Self care and primary care of dyspepsia." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241615.

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35

From, Ingrid. "Experiences of health and care, when being old and dependent on community care." Licentiate thesis, Karlstad University, Faculty of Social and Life Sciences, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-1307.

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36

Johnston, Corrine W. "Whither the community in community health centres?, the limits of primary care reform." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0005/NQ41181.pdf.

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37

Wangombe, Joseph Kibuchi. "Economic evaluation in primary health care : the case of the western Kenya community based health care project." Thesis, Swansea University, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.639341.

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38

Mukiapini, Shapi. "Baseline measures of Primary Health Care Team functioning and overall Primary Health Care performance at Du Noon Community Health Centre." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24504.

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Background: The importance of effective team work for improving quality of care has been demonstrated consistently in research. We conducted a baseline measure of team effectiveness and a baseline measure of primary health care performance. Aim: To improve Primary health care team effectiveness and ultimately the quality and user experience of primary care at Du Noon Community Health Centre. (CHC) Setting: Du Noon CHC in the southern/western substructure of the Cape Town Metro district services. Methods: A cross sectional study using a combination of Nominal Group Technique (NGT) method and a questionnaire survey to assess PHC team effectiveness and to obtain baseline measure for Primary Health Care (PHC) organization and performance. Results: Data from 20 providers from the primary health care team, showed that the PHC team members perceived their team as a well functioning team (70% agreement on the 7 items of the PHC team assessment tool, incorporated in the ZA PCAT. The NGT method reveals that communication and leadership are the main challenges to effective team functioning, The NGT also provides ideas on how to deal with these challenges. Data from 110 users and 12 providers using the ZA PCAT: 18.2% of users rated first contact-access as acceptable to good; 47,3% rated ongoing care as acceptable to good. The remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 65% of the users. 33% of the providers (doctors and clinical nurse practitioners) rated first contact-access as acceptable to good; 25% rated ongoing care as acceptable to good, the remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 50% of providers. First contact-access received the lowest acceptable to good score (18.2%) and comprehensiveness (service available) received the highest score (88.2%) from the users. For the providers the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team (100%). The total primary scores are good (above 60%) for both users and providers but moderately higher for the providers. Conclusions: How teams perceive their effectiveness can motivate them to generate ideas for improvement. There were discrepancies between ZA PCAT (PHC team functioning) results and the NGT method results. The ZA PCAT (8 pre-existing domains) baseline results show a contrast between providers' and users' perceptions of the PHC system at Du Noon consistent with the finding of the Western Cape ZA PCAT study. We encourage Du Noon CHC to use these results to improve the user experience of primary health care services there.

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Hannigan, Pamela Ann. "The psychological impact of a community care project on elderly care recipients and their care givers." Thesis, University of Ulster, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274102.

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Jackson, Anne Margaret. "Explaining hydrotherapy outcomes : quality in health care." Thesis, University of Surrey, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324076.

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Poulton, Brenda Christine. "Effective multidisciplinary teamwork in primary health care." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339905.

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42

Hamid, Mir Ajmal. "Regulation of private health care in Pakistan." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682255/.

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The private health sector in Pakistan has been expanding rapidly, largely unregulated and partly at the expense of the public sector. While there have been previous attempts at formulating policies for the regulation of this sector, these have not always been based on ground realities, with the result that they never reached the stage of implementation. The objectives of the thesis were: 1) to describe and evaluate the existing regulatory framework governing health care provision in general and private health care provision in particular both at federal & provincial levels; 2) to explore the views and perceptions of key stakeholders regarding existing regulations and the reasons for their effectiveness/non-effectiveness; 3) to identify whether and how regulatory mechanisms can be made to work effectively; and 4) to explore the views of stakeholders regarding the potential for alternative mechanisms for ensuring the quality of formal private medical services, including the role of information dissemination to service users/the public. The methods adopted to achieve the stated objective were mapping of the existing legislations and a stakeholder analysis. The results showed that the existing legislations on regulation of health care provision were scanty, weak and inadequate and required radical re-structuring. The stakeholder analysis demonstrated the conflicting interests of the state and the private providers, the role of the powerful medical community and the views of the service users, who were shown to be the ultimate victims. Avenues for alternative regulatory mechanisms, including one based on information dissemination were explored and their feasibility discussed. It is hoped that the information gained from this study, by reflecting the views of the various actors in this process, will contribute towards the formulation of a policy for regulation of private health care provision in Pakistan, which is realistic, feasible and sustainable.

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43

Atkin, Karl Michael. "The production of health and social care." Thesis, University of York, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297066.

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44

Dlatu, Ntandazo. "The integration of mental health care services into primary health care system at King Sabata Dalindyebo Municipality Clinics." Thesis, Walter Sisulu University, 2012. http://hdl.handle.net/11260/d1008290.

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Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.

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Bjorn, Agnes Marie. "Community health assessment and nursing care needs of the elderly." Thesis, University of Manchester, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.237239.

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Loader, Jill. "Management of hi-tech health care in the community setting." Thesis, University of Bath, 2001. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.392060.

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47

Bautista, Maria Cristina Ginson. "Markets in health care : an analysis of demand, supply and the market structure of health care in the Philippines." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1995. http://researchonline.lshtm.ac.uk/682284/.

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This study sought to examine the economic structure of the Philippine health care system, in the light of recent legislative initiatives in the country and global managed market reforms. In the context of a market-orientated system in the Philippines, the study modelled the interaction of health care agents in three markets: regulations, financing or insurance and health services. The bulk of the research examined the nature of exchange in the health services market, using neo-classical economics. Theories in industrial organization and public choice served as organizing frameworks for explaining other market elements. The study' s methodology used primary and secondary data analysis, as well as findings of other research, to bring together a coherent picture of the market structure of health care in the Philippines. The analysis of the regulatory market showed that the rent-seeking nature of Philippine social, political and medical institutions has weakened regulatory structures in health care. Compared to its Asian neighbours, the relative position of the country in the 60s in terms of major health indicators, has been eroded. Limited resources and allocative inefficiencies have affected the government's ability to fulfil its constitutional mandate to ensure minimum levels of care, especially for the poor. The performance of the market was examined in terms of health policy objectives of efficiency and equity in the financing of health care. Private sources, with households forming the bulk, comprised 64 percent of health care expenditures. The position of concentration curves drawn to illustrate the equity of household financing, showed inequities in health and health expenditures. The largely fee-for-service system operating in the health insurance market had caused risks to be borne largely by consumers and funders. Low coverage of the population and weak utilization rates, may have encouraged some providers to behave opportunistically. An examination of the prospects for an alternative system of compulsory health insurance, illustrated through a project with health maintenance organizations indicated the problems of contracting. Estimates of health service market conditions on the demand-side, from an outpatient provider choice model, showed low price and time cost elasticities, with the poor being more responsive than the rich. Simulations showed that the introduction of user fees in public services were likely to drive demand towards private care in urban areas, and out of the market in rural areas. The welfare effect estimates showed that if public hospitals were to charge one-half the price of private doctors, the welfare loss would be about 10 percent of household budget of the lowest income group. The amounts needed to compensate losers from the policy change can be transformed into contributions for risk -sharing schemes. From the supply-side, the distribution of facilities, productive resources and technology were shown to have wide variations across regions and types of facilities. The study cited research that showed that total cost structures in hospital firms were largely determined by the volume of services rendered. Moreover, variable costs were shown, by other research, to be neither influenced by scale nor by the scope of operations. The analysis of the market structure, based on a modified Hirschman-Herfindahl measure, showed that no hospital-firms had a dominant share of the market. Regression results, from the same research on total cost functions, showed that hospital outputs were unresponsive to actual competition. Price competition appeared to be swamped by nonprice competition. An examination of pricing behaviour showed widespread cost-price mark-ups, reflecting the 'market power' of providers. The co-existence of competitive and monopolistic tendencies in the health care market, combined with weak and/or distortive incentive structures, suggests that the tenets of contestability analysis were not fulfilled. The last chapter showed the limitations of the analysis in providing conclusive evidence on the behavioural underpinnings of the health care market in the Philippines. Conceptual and methodological difficulties, arising from data and measurement problems, imply that the results are at best exploratory; and that further work can use the issues raised as starting points. For health policy reforms in the Philippines, recent legislative initiatives could improve health sector performance from a three-pronged approach: enhancing access, agency and co-ordination.

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Fos, Elmer B. "Assessing Convergence of Community Benefit Programs and Community Health Needs among North Carolina's Tax-Exempt Hospitals." Thesis, The University of North Carolina at Charlotte, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10838721.

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The Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every three years, formulate implementation strategies, and report yearly to the IRS and the public the progress of their work. The IRS CHNA incentivizes hospitals to provide programs responsive to community health needs. The purpose of this study was to examine the relationship between community benefit programs and prioritized community health needs in the context of a national IRS reporting requirement through analysis of published community benefit reports among North Carolina’s (NC) tax-exempt hospitals.

This study employed quantitative research that analyzed longitudinal and cross-sectional data; qualitative research that reviewed published documents; and mixed-methods research that analyzed the integrated quantitative and qualitative results. The findings indicate that performing IRS-mandated CHNA did not substantially increase the alignment of community benefit programs with prioritized community health needs but did clearly highlight those needs. NC tax-exempt hospitals continue to focus on providing patient care financial assistance than population health, a strategy misaligned with community health needs. Although the hospitals are beginning to address population health and access to care concerns, their dollar expenditures in these areas paled in comparison to patient care financial assistance. If the IRS’ purpose in mandating CHNA was to spur a shift in community benefit priorities toward population health needs and away from the traditional patient care financial assistance, then, the evidence from 4 years after the requirement’s implementation, indicates it is currently failing in North Carolina. As elucidated in the articles, their ingrained patient-level intervention perspective and desire to recover high unreimbursed costs or lost revenues for providing care to Medicare, Medicaid, and poor patients likely influence the hospitals’ community benefit programming to favor individual welfare over population health. Nevertheless, policymakers should continue to direct community benefit programs toward population health because it is a step in the right direction. Organizational change takes time and the desired results of policy interventions are usually incremental. Thus, conducting CHNA must remain a legal obligation by non-profit hospitals for maintaining their privileged tax status to facilitate organizational paradigm shift in community benefit programming toward population health programs or community building activities and away from individual welfare.

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Young, Kate. "The organisation of the community health services in Norwich Health District : an evaluation of the community care group scheme." Thesis, University of East Anglia, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.303065.

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Jones, Andrew Peter. "Health service accessability and health outcomes." Thesis, University of East Anglia, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296338.

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Dissertations / Theses on the topic '200302 Community health care'

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