Dissertations / Theses: 'Community health care'

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

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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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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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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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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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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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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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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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Achmat, Asma. "Professional health care workers' experiences of care at two Community Day Clinics on the Cape Flats." University of the Western Cape, 2016. http://hdl.handle.net/11394/4896.

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Magister Artium (Social Work) - MA(SW)
Primary Health Care (PHC) is the cornerstone of health care globally, nationally and locally and, therefore, should be regarded as the foundation of health care provision. In South Africa, Community Day Clinics (CDCs) are part of the bouquet of services that is being offered at a PHC level. There are various factors that generate inconsistency in the provision of care to people accessing these CDCs. The purpose of this study was to identify and explore how these factors impact on the care practices that health care professional’s provide. Research suggests that the majority of health care workers are women, who play a double role as carers in their professional and private lives. Therefore, the political ethics of care, a feminist theoretical approach, was utilized to understand care practices in these health settings. The aim of the study was to develop an in-depth understanding of the care practices of health care workers at two CDC facilities on the Cape Flats. A qualitative research methodology was used to explore and identify the phenomenon under study. The research project followed an explorative and descriptive research design, as the researcher sought to understand the care practices of health care workers and how their values and ethics further influenced care practices at these two CDC settings. The data was gathered using semi-structured one-on-one interviews, and later analysed using qualitative thematic analysis. The research findings were grouped in terms of the values entrenched in the political ethics ofcare, which are attentiveness, responsibility, competence, responsiveness and trust. The research findings identified various aspects that, either negatively or positively, impact on these values. Finally, recommendations were made to management, as well as care workers. These recommendations were in terms of implementing care services that are attentive to service-users and care-workers; providing a service that takes into consideration the value of responsibility; the provision of competent services; and finally creating trusting relationships within the CDC.

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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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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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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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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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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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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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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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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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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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Cornoc, N. S. "Quality improvement cycle for cardiac failure in primary health care : Elsies River community health centre, Cape Town." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97226.

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Abstract Introduction The study aimed to assess and improve the quality of care for congestive cardiac failure in a public sector, primary health care setting, in Cape Town. There is currently no literature available on the quality of care for the management of congestive cardiac failure in primary health care in South Africa. Methods A disease register was constructed by identifying patients prescribed Furosemide and checking the medical records. Altogether 95 patients with CCF were identified. The study followed the usual steps for a quality improvement cycle: Formation of an audit team; agreeing on criteria based on current CCF guidelines; collection of data from medical records to measure the criteria; analysis and feedback of results to the staff; critical reflection, planning and implementing change; re-audit of the medical records. Results There was a mean age of 63.4 years, 21% were male and 75% were females. The results of the initial audit revealed suboptimal management of patients diagnosed with CCF: 53% had an aetiological diagnosis recorded in the clinical notes, 24% had a documented functional capacity, 12% of patients had documented precipitating/exacerbating factors, 58% had fluid status documented, and 37% had documentation of their cardiac rate and rhythm. The intervention consisted of feedback on the audit results and critical reflection with the relevant staff members. The doctors were provided with a printed protocol to refer to for the management of CCF. Clinicians were resistant to change and to taking on new tasks in relation to the management of patients with CCF and decided to only focus on improving the clinical assessment of patients. The results of the re-audit after 5-months in 40 patients demonstrated improvement in the clinical assessment criteria: 95% of the patients had an aetiological diagnosis recorded in the notes, 50% had a documented functional capacity, 42% had documented precipitating/exacerbating factors documented, 72% had their fluid status documented, and 85% of patients had their cardiac rate and rhythm documented. None of the five assessment criteria were met at baseline but post-intervention three of the five met the target set and all showed substantial improvement. There was no improvement noted in any of the other criteria, which were not specifically focused on in the plan to improve clinical practice. Conclusion The current quality of care for CCF in primary health care is poor and needs to be improved. The quality improvement cycle led to substantial improvement in the clinical assessment of patients with CCF. Recommendations are made regarding future criteria, which could be included in local audit tools.

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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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Donaldson, Cam. "Willingness to pay for publicly-provided health care." Thesis, University of Aberdeen, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296009.

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In economic theory, the utility which an individual consumer obtains from a good is valued by the maximum amount s/he would be willing to pay for that good. On the face of it, therefore, it would seem that a measure of the benefits of a commodity based on maximum willingness to pay (WTP) offers great potential for policy makers. It provides a single measure of value which is rooted in economic theory. This thesis is concerned with valuing the benefits of public sector health care using the WTP approach. The aim of the thesis is to contribute to the development of WTP as a measure of the value of the benefits of health care. Potentially, such a measure would be of use in specific economic evaluations of health care alternatives (i.e. close substitutes) and in eliciting the strength of preference of the public with regard to the broader issue of health care priority setting. The contributions of the thesis are to theory and to the design of such WTP studies, with greater emphasis on the latter. Each of these is discussed in the following sections before going on to list the main recommendations for the future conduct of WTP studies which arise from the work presented. Contributions to theory The main theoretical contributions involve, first, bringing together the concepts of WTP and the nature of the commodity health care, second, examining this relationship within the contexts of patients' and the citizens' utility functions and, third, the examination distributional issues within the context of WTP.

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Valtonen, Hannu Juhani. "Application of cost-benefit thinking in health care." Thesis, University of York, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316208.

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Nganda, Benjamin Musembi. "Structural reform of the Kenyan health care system." Thesis, University of York, 1994. http://etheses.whiterose.ac.uk/14168/.

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Sun, Xiao Ming. "Health access and health financing in rural China." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263121.

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Koo, Sun Tien-lun Catherine. "The impact of health care policies on the health status of the population of Hong Kong /." Hong Kong : University of Hong Kong, 1987. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14016989.

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Dissertations / Theses on the topic 'Community health care'

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