Dissertations / Theses on the topic 'Healthcare programmes'
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Evans, Amanda. "Interprofessional collaborative practice in healthcare : perceptions and experiences of healthcare students undertaking accelerated pre-registration programmes in the practice placement setting." Thesis, King's College London (University of London), 2012. https://kclpure.kcl.ac.uk/portal/en/theses/interprofessional-collaborative-practice-in-healthcare(a159fb2d-29bd-4364-b0e5-c7eb6ab7ed9d).html.
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This study investigates experiences of accelerated pre-registration healthcare students of collaborative interprofessional working and examines their perceptions of the factors which influence this, including the interprofessional education they have undertaken. It is set in context of current NHS policy, where professional collaboration is advocated as a means of addressing issues of quality, efficacy and efficiency in patient care. Design: Mixed Methods Study Method: Three studies were undertaken. 1. Longitudinal panel survey examining students’ attitudes to interprofessional learning, (questionnaire administered at three points during the course) 2. Survey study using critical incident technique to explore examples of ’good’ and ’poor’ collaborative practice 3. Interview study examining beliefs and attitudes in depth. Subjects: Total sample of 207 students, from two cohorts of accelerated learning students (nursing, physiotherapy and dietetics) attending one university. Analysis: Descriptive statistical analysis was performed to describe the population characteristics, the context of their practice and reported practice incidents. Thematic content analysis, employing triangulation between data sources, was applied to the qualitative data. Results: This accelerated group was similar to standard pre-registration students, entering university with a strong professional identity and openness to interprofessional learning, which attitudes declined over time. ’On the job’ learning was identified as the predominant way students learned about working collaboratively. Five factors were identified as key in influencing interprofessional activity of which Communication and Teamwork were the most important.
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Lehl, S. "Healthcare practitioners' and patients' perspectives of a weight management service and the place of psychological support within this." Thesis, University of Wolverhampton, 2016. http://hdl.handle.net/2436/617877.
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Both the NHS and Public Health are keen to identify how best to manage long term health condition’s as a result from obesity and vice-versa. There is evidence to support the efficacy of psychological support in weight management programmes. This study explored the perceived importance of psychological support within weight management services; perspectives of both client and healthcare practitioners, in view of considering the implications for the role of a counselling psychologist. There were nine interviews conducted with five healthcare practitioners and four clients. The professionals’ disciplines included: physiologist, dietician, health psychologist, programme manager, and a medical consultant. Of the four patients, two had accessed psychology services as part of their weight management programme and two had not. Data was analysed using thematic analysis. Five overarching themes were identified. Tension (pivotal central theme) this connected to: Lifestyle; Quality of Life (QoL); Service Delivery Model; and Professional and Personal beliefs and values. The findings highlighted that perceived importance of psychological support was influenced by an individuals’ background and experiences by both groups. The implications for the role of a counselling psychologist was to provide training to health professionals as well as raising clients’ awareness of the role of counselling and psychological support within such programmes. Further research is needed to understand better the potential of psychological support within weight management services to help contain UK obesity.
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Neves, Ana Margarida Lopes das. "Efeitos da formação na prevenção de lesões músculo-esqueléticas da coluna lombar nos profissionais de saúde : revisão sistemática." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/9708.
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RESUMO - A morbilidade associada às lesões músculo-esqueléticas da coluna lombar é estimada em 0,8 milhões de DALYS em todo o mundo, constituindo-se a maior causa de absentismo ao trabalho, o que induz uma enorme perda económica. Os profissionais de saúde são um grupo vulnerável a ocorrência de lesões-músculo-esqueléticas ligadas ao trabalho (LMELT), nomeadamente aqueles que mobilizam os doentes no seu dia-a-dia.
Perante a frequente perspetiva da imutabilidade da situação de trabalho, a pressão organizacional na prestação de cuidados e o reduzido número de recursos humanos, subsiste a implementação de programas centrados na formação dos profissionais de saúde sobre técnicas e mobilização de doentes, com o intuito de prevenir as LMELT inerentes a esta atividade.
O objetivo do estudo é analisar as principais intervenções descritas na bibliografia no que respeita ao impacto da formação dos profissionais de saúde sobre mobilização de doentes, nomeadamente enfermeiros, de modo a contribuir para a prevenção de LMELT ao nível da coluna vertebral.
Realizou-se uma revisão sistemática segundo a metodologia do Prisma Statement® nas bases de dados PubMed, Web of Science, B-On, JSTOR, Science, Nature, Scielo e IndeX, no período de 1998-2011, em Português, Inglês e Francês. Foram identificados 79 artigos. Após triagem e avaliação da qualidade dos estudos foram selecionados 11.
Verificou-se que não existe evidência científica que suporte o investimento em programas centrados na formação/informação dos profissionais de saúde acerca das técnicas de mobilização de doentes com o intuito de prevenir as lesões músculo-esqueléticas da coluna lombar. Constatou-se que os programas de intervenção multifatorial, apoiados na componente sistémica e integrada, permitem compreender as relações entre o trabalhador, o trabalho e os efeitos sobre a saúde, de forma a implementar medidas eficazes para a prevenção de LMELT.ABSTRACT - Morbidity from lumbar spine musculoskeletal disorders is estimated to be around 0.8 million DALYS worldwide and is the main cause of absenteeism from work, causing high economic and social losses. Healthcare professionals are one of the most vulnerable groups to work-related musculoskeletal disorders (WRMSD), namely those moving and handling patients everyday. Facing the frequent perspective of unchanging working conditions, organisational pressure on healthcare and the lack of human resources, programmes focused on training healthcare professionals in patient mobilisation techniques are implemented in order to prevent WRMSD associated with this activity. The aim of this study was to focus on the main interventions described in the bibliography concerning the impact of healthcare professional training on patient handling, more specifically nurses, with regard to helping to prevent WRMSD of the lumbar spine. A systematic review was conducted according to the Prisma Statement® method based on data from PubMed, Web of Science, B-On, JSTOR, Science, Nature, Scielo and IndeX, between 1998 and 2011, in Portuguese, English and French. 79 articles were found and after screening and assessing the quality of the studies, 11 were selected and analysed. There is no scientific evidence to warrant investment in programmes focused on healthcare professional training/information on patient mobilization techniques to prevent musculoskeletal disorders of the lumbar spine. Multifactorial intervention programmes based on systemic and integrative components allow us to understand the relationship between workers, their work and health-related issues and how to implement efficient WRMSD prevention measures.
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Arrighi, Yves. "Essays in the economics of health policies." Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM1094.
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Cette thèse contribue à l’analyse des relations entre santé, revenu et politiques de santé. Il m’a semblé nécessaire de mener cette recherche pour chaque direction de la relation. Ainsi, le 1er article étudie la solvabilité financière de différentes politiques de lutte contre le SIDA grâce à un modèle de microsimulation. La santé y est vue comme un facteur de production ; son amélioration génère des gains de productivité. Cette analyse montre que les programmes de traitement peuvent générer un surplus économique et ce net des coûts engendrés. Le 4ème article étudie la relation entre santé infantile et milieu social d’origine à partir d’une enquête internationale. Les analyses montrent que si un gradient socio-économique de santé s’impose à tous à travers le globe (les enfants issus de milieux pauvres sont en moins bonne santé), ce gradient varie selon le niveau de revenu et d’offre de soin du pays considéré. Les deux autres articles s’intéressent aux problèmes de mesures liés à la mise sous traitement des agents malades : le poids de ces derniers dans la population augmente. Au niveau macroéconomique, le PIB par habitant pourrait diminuer si les traitements ne permettent pas de maintenir un niveau de productivité suffisant. Les analyses dans le cadre du VIH montrent que cet effet pervers ne supplante pas les effets positifs. Cette problématique est élargie à la mesure du bien être dans le 3ème article de la thèse. En ne s’attachant qu’aux populations vivantes, les indicateurs traditionnels ne tiennent pas compte du fait que certains agents auraient pu être maintenus en vie (avec un bien être moindre). Les comparaisons inter-pays pourraient ainsi être fausséesThis dissertation aims at improving our understanding of the links between health and wealth, and between health programs and macroeconomic outcomes. Because the former might be bi-directional, it seemed sensible to tackle this issue for each direction of the causality. In the 1st paper, I examine using microsimulation the financial solvability of alternative policies against HIV. Health improvements at the individual level generate productivity gains which translate into an economic surplus that outweighs programs’ costs. In the 4th paper, I examine the relationship between child health and social background using an international survey. Analysis reveals a substantial gradient in health: across the globe, poorer children have worse health. Yet, the effect of wealth is moderated by country-level income and health-supply variables. The two other papers focus on rather methodological issues raised by the fact that curative programs save lives but increase the prevalence of the disease. One study highlights that average income could fall if treatments cannot guarantee a sufficient level of productivity among sick workers. Despite this adverse effect, the microsimulation model demonstrates that treatment policies can raise per capita income in the context of HIV. The 3rd paper of the thesis extends this message to welfare measurement. By restricting attention to the living population, standard indicators of welfare ignore the fact that individuals who would otherwise be dead can be kept alive through treatment, but with a lower than average welfare. Cross-country comparisons based on indicators that are made invariant to the population size may therefore be biased
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Patel, Deepak N. "Participation in a health promotion programme and healthcare costs : cross-sectional research of the Discovery Vitality programme." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/11687.
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Includes abstract.Includes bibliographical references (leaves 55-61).
To examine the association between 1) the levels of participation in an incentive based health promotion program (study1), 2) the level of engagement with the fitness related activities (Study2) and medical claims and hospital admission amongst adult members of a major health insurer.
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Bradley, Dominique K. F. "The 'Productive Community Services' programme : implementing change in a community healthcare organisation." Thesis, University of Essex, 2015. http://repository.essex.ac.uk/15475/.
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The Productive Community Services (PCS) is a change programme which aims to engage frontline healthcare staff in improving quality and productivity. PCS draws on tested improvement methodologies such as Lean, however there has been little research specifically carried out on PCS in practice. The aims of this study were to explore the perceptions of the healthcare staff that implemented the programme, to identify the enabling and constraining contexts of the programme’s mechanisms of change, and to examine the meaningfulness and reliability of quantitative data generated during a PCS implementation. It also sought to explore the implications of these findings for managers, implementation teams, and commissioners in healthcare. To achieve this, an implementation of PCS was investigated using methods of participant observation, analysis of qualitative and quantitative data, semi-structured interviews and a focus group. A mixed methods approach was taken using the principles of Realist Evaluation. The results indicate that perspectives of the implementation varied widely, and that pay-for-performance targets contributed towards staff perceiving that the programme was irrelevant. Stock value was reduced by over £42,500, the time taken to find patient information was reduced by 62%, and services spent on average 36% of their time with patients. However, these figures lacked reliability and meaningfulness as the data were not validated or were produced using apparently flawed experimental designs. Contexts that constrained or enabled the mechanisms of change included staff attitudes, available resources, the effectiveness of communication, and whether technology could be used to resolve problems identified. The findings indicate that managers in healthcare should challenge implementation teams if the purpose of an innovation is unclear, that implementation teams need to be equipped with knowledge about technological solutions to efficiency in healthcare, and Commissioners need to ensure that pay-for-performance targets promote continuous quality improvement rather than temporary solutions.
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Jaafaripooyan, Ebrahim. "Contextual approach to the performance analysis of Iran's national accreditation programme for healthcare organisations." Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/210549/.
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The importance of focusing on performance measurement systems (PMSs) in the public sector has increased following the introduction of new public management (NPM) initiatives, which placed a greater emphasis on organisational accountability and performance measurement. PMSs have always been a key player in ensuring accountability and improvement in the practices of public sector (e.g. healthcare) organisations. Critical features of the health sector have particularly warranted the application of various internal or external PMSs in this area as well as the regular assessment of their own performance. This is crucial in terms of both maintaining their alignment with the initially determined objectives and improving their merits and capabilities to continuously detect the deficiencies and malpractices in healthcare organisations (HCOs). Iran’s national accreditation programme for healthcare organizations (NAPH) has served as the sole element of macro control and regulation in the country’s health sector at national level. It has been set up to reflect, operationalise and guarantee the intentions of the government for promoting quality and safety in the local HCOs, mainly hospitals, across the country. Despite the NAPH’s importance and vital position in the country’s health system and its long-time implementation, the contextual effects of this evaluator mechanism on the individual hospitals have not been empirically researched in current organizational context; i.e. there is a lack of empirical evidence in the literature on how this macro PMS impacts in practice on the hospitals at local level. Accordingly, this study aims to render a contextual evaluation of the performance of this evaluatory system. A middle-range thinking (MRT) research approach has informed the study. Drawing on this approach, Broadbent and Laughlin’s theoretical framework was adopted to both guide the empirical work and help with the analysis and interpretation of the empirical data. The findings of the study showed that it was mainly the financial benefits rather than the quality improvement merits of the current hospital accreditation and evaluation programme that were apparently the main rationale behind the conformity of the hospitals. Both dysfunctional and beneficial consequences were associated with the NAPH by the hospitals’ members. In addition, the hospitals showed different reactions including rejection and gaming as well as absorption to achieve the beneficial gains of the programme. However, they also adopted some requirements of the NAPH exclusively in view of its perceived merits and some other contextual factors. Changes in the hospitals as a result of the programme occurred mostly in the early years following its introduction or modification. This study further provides both theoretical and practical research implications for policy and practice for the improvement of this evaluation mechanism
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Ma, Y. "The development and evaluation of a breastfeeding training programme for healthcare professionals in China." Thesis, Coventry University, 2015. http://curve.coventry.ac.uk/open/items/53d0027f-3864-4a21-9ef9-3a1e48879927/1.
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Breastfeeding is widely considered the healthiest way to feed an infant. Promoting breastfeeding and increasing breastfeeding rates has become a global strategy to improve children’s health. However the latest rate of exclusive breastfeeding at six months in 2014 in China was 30% in rural areas and 16% in urban areas. Support from skilled practitioners can positively influence breastfeeding initiation rates, duration and women’s breastfeeding experience. This research aims to develop and evaluate a new breastfeeding training programme for professionals to improve support for breastfeeding mothers in China. Mixed research methods were used in the research which included qualitative and quantitative studies. Two qualitative studies provided the evidence for the importance of training professionals in two essential skills of positioning and attachment (P & A) and hand expression (HE). This study further applied a 15-minute breastfeeding DVD training intervention to train Chinese professionals in P & A and HE. At the meantime, the research developed two valid breastfeeding assessment tools, including knowledge assessment tool and confidence assessment tool. Two quantitative studies of the pilot study and RCT study evaluated the effectiveness of DVD training intervention on improving professionals’ knowledge and confidence before and after DVD training by the two breastfeeding assessment tools. The findings in both studies indicated that the DVD training intervention significantly improve the professionals’ knowledge and confidence in P & A and HE with a big effect size. The semi-structured interviews conducted after the RCT study showed the feasibility and applicability of DVD training for professionals in China. This first evidence-based new training programme is likely to be widely implemented in China due to its effectiveness, convenience and ease of access. However, the long-term effectiveness of the DVD training at improving professionals’ knowledge, confidence and breastfeeding outcome needs to be further examined in the future.
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Onate, Öberg Bernard. "Jämförelse av bildkvalité mellan standardsskelettscintigrafi och programmet Evolution for Bone TM i GE-healthcare gammakamera." Thesis, Örebro universitet, Institutionen för hälsovetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-68429.
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Hale, Rachel. "An actor-network analysis of the healthcare worker influenza immunisation programme in Wales, 2009-2011." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33126/.
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Frontline healthcare workers (HCWs) in the UK have been prioritised for free occupational immunisation against seasonal influenza since 1999. During the 2009-10 influenza pandemic, they were identified as a priority group to receive the strain-specific vaccine. Nevertheless, take-up rates among HCWs have rarely exceeded 50%, even during the pandemic. Most attempts to change this situation have been predicated on the assumption that these low rates are the result of reluctance or resistance by individual HCWs, who must be persuaded or coerced to comply with employer directives. To gain a novel understanding of this immunisation programme, an actor-network theory approach is adopted to trace the journeys of vaccines through two Local Health Boards in Wales during the 2009-10 H1N1 influenza pandemic and in the following winter influenza season (i.e. during 2010-11). The research reported shows that low uptake is largely the result of complex social, organizational and cultural processes. Only when these have been changed will it be appropriate to frame the remaining problem as reluctance or resistance by individual HCWs. The study reveals that this immunisation programme is inherently unstable and subject to ambivalence from actors at all levels. Suggestions for practical improvement are given.
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Olsson, Jesper. "Factors for successful improvement of Swedish healthcare /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-391-4/.
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Meakin, Stephanie. "Exploring the potential of the pre-registration programme for developing student nurses as future clinical leaders within contemporary healthcare." Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/366261/.
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This thesis describes a project using a qualitative study approach. It explores the utilization of the pre-registration period as preparation for clinical nurse leadership relevant to work in contemporary health care. The empirical focus of this study was to fundamentally address only the perceptions of senior student nurses about to qualify, of their own leadership development during their programme. Using focus groups with a total of 35 third year pre-registration students about to qualify as nurses provided a rich and detailed description of what inhibited and enhanced the development of their leadership skills. Alongside this, the students' perceptions of qualities and competencies required specifically for contemporary nurse leader roles were identified. No substantive studies exist in the United Kingdom exploring the experiences and perceptions of student nurses regarding nurse leadership during their training. It is distinctive as it challenges the state of nurse leadership in healthcare and the expected developmental needs for it. Students recognised the need to be prepared for leadership during their pre-registration programme and questioned the use of the standard theoretical approach for its development. They asked instead for skills to deal with difficult conversations, unexpected power struggles, challenging and dealing with inappropriate behaviour and introducing evidence into practice in areas of resistance. The study makes an important contribution to education as the findings can inform leadership development throughout the pre-registration nursing programmes within England. It also raises the question as to whether nursing needs more leaders, or just for nurses to take the professional responsibility for their own practice.
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Lindsay, Claire Frances. "Lean in healthcare : an evaluation of Lean implementation in NHS Lothian." Thesis, Edinburgh Napier University, 2016. http://researchrepository.napier.ac.uk/Output/455610.
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The overarching aim of this thesis is to critically evaluate the implementation of Lean in NHS Lothian, a National Health Service (NHS) Health Board in Scotland. Against challenging financial times, Lean has been endorsed for adoption in the provision of healthcare by The Scottish Government and NHS Scotland and so the objectives are to understand how Lean is implemented in healthcare, the impact on the organisation and what role(s) are held by front-line staff including medical staff, in this implementation. This is an exploratory and descriptive interpretivist case study incorporating content analysis, observational and interview data which is based on a qualitative and inductive approach. The interpretative and inductive nature of the research is used to identify emergent themes and to afford greater insight into the implementation process, outcomes and the role of healthcare staff. The sociology of professions is used to evaluate the role of the medical professional within Lean from the emergent data, with the focus being on behaviours expected and demonstrated in Lean implementations. The findings provide a mapping of the process for implementing Lean. It is also demonstrated that although medical professionals are expected to hold a crucial role in Lean implementations, their identity as a professional with corresponding power and autonomy provides challenges for implementing Lean in hierarchical areas such as healthcare. This professional identity also impacts on project initiation and sustainability as other stakeholders recognise hierarchical constraints. However, evidence grounded in the data illustrates that Lean breaks down hierarchies and has resulted in improved working in services. The implementation of Lean has been programmatic in line with best-practice case examples and has been driven by strategy and target pressures faced by services. This research provides a contribution to knowledge in three key areas: firstly through mapping the approach to Lean implementation which is a contribution to Programme Theory. Secondly medical professionals are explored through the lens of professionalism which has received limited attention to date within Lean; and finally a set of propositions are generated as a framework for Lean implementation in healthcare.
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Wang, Chen. "Intercultural competence and short-term overseas study programs: An investigation with healthcare students." Thesis, Queensland University of Technology, 2019. https://eprints.qut.edu.au/134412/1/Chen_Wang_Thesis.pdf.
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The research used a mixed-methods and longitudinal approach to investigate the efficacy of short-term overseas study programs in promoting intercultural competence among Australian healthcare students. Results showed that overseas study experiences are one of the most significant factors affecting intercultural competence. Short-term overseas study programs can contribute to the development of cultural knowledge, but had limited effects on cultural awareness, attitude, or skills.
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Dolatabadi, Mjid Davari. "Does the Iranian health system need a health technology assessment programme to improve effectiveness, efficiency and equity of its healthcare services?" Thesis, University of Liverpool, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.501580.
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Health Technology Assessment (HTA) is increasingly being utilized on a global scale to Improve the clinical and cost-effectiveness of healthcare resource utilization. This thesis addresses the potential application and implications underlying the development of a structure of HTA specifically designed to fit in with the culture and healthcare system in Iran.
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Tucker, Faye Bronwyn. "An assessment of the Isoniazid preventative therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay, Eastern Cape Province." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15737.
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Introduction: Tuberculosis is the second leading cause of death from an infectious cause worldwide having claimed approximately 1.5 million lives in 2013. Estimates suggest that children account for about six percent of the total number of TB cases globally, however in South Africa this figure is much higher (15%). Young children are at particularly high risk of mortality and significant morbidity from TB. Despite clear evidence that Isoniazid preventative therapy (IPT) can reduce the risk of progression from TB infection to disease, IPT has been a poorly implemented component of national TB control programmes, especially in high TB-burden areas, including South Africa. This study aims to determine current practices regarding the identification and management of child contacts < 5 years in an area with an extremely high TB incidence rate where little background data exists on the topic. It will also assess the operational aspects of the TB control programme relating to the spread of TB to children. Methodology: A cross-sectional descriptive study was conducted using a retrospective review of clinic records from infectious index patients aged ≥15 years at West End clinic in the Nelson Mandela Bay health district in the Eastern Cape Province. A sample size of 246 child contacts (<5 years) was required to obtain a 95% confidence index with a 5% precision. This is based on 20% of eligible child contacts < 5years receiving IPT, as described by van Wyk, et al. (2010). 491 Index patient records were assessed in order to identify 261 child contacts < 5 years of age. Results: Contacts were generally well recorded with only 12.5% of index patient folders having no contacts documented although only 0.53 child contacts <5years were identified per index patient. A total of 261 child contacts < 5 years were identified and of these 184 (70.5%) were screened for TB. Two contacts were started on TB treatment and 108/184 (58.7%) were initiated on TB prevention therapy. For the remaining 74 (40.2%) children who were screened there was no documentation of further management. Adherence to IPT was extremely poor with only 4 (3.7%) children who started TB prevention completing the 24 week course. Female index patients were more likely to have contacts documented and to bring their contacts for screening. Contacts of index 16 patients who had previous TB were less likely to be screened and initiated on TB prevention therapy. The results of the assessment of programmatic factors relating to childhood TB control showed that patients were diagnosed and were rapidly initiated on treatment (median time of 5 days from sputum collection to commencement of treatment). It took a median of 4 days for children to be screened once the index patient had started treatment and a further 2 days (median) for child contacts < 5 years to be initiated on preventative therapy. Conclusion and recommendations: The results of this study are in keeping with those obtained in other settings with a high burden of TB. Although the documentation of contacts in this setting was relatively good, child contacts < 5 years were poorly identified and the fall-out of children at each step from identification to preventative treatment completion was still unacceptably high. Contacts of men and retreatment index patients are at particularly high risk of poor management. Recommendations are made for interventions at national and local level to improve contact management and the documentation thereof.
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Singh, Jitendra, and Tracy Eisenschenk. "A Thematic Analysis of the Attitudes and Perceptions of Faculty Towards Inclusion of Interprofessional Education in Healthcare Curriculum." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/ijhse/vol8/iss1/1.
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This qualitative study aimed to explore attitudes and perceptions of faculty towards inclusion of interprofessional education (IPE) in healthcare curriculum. Efforts were made to explore faculty members’ definition of IPE, significance of including IPE in content and curriculum and resources available to implement such initiatives in healthcare education programs. Further, challenges faced while including IPE in curriculum were also explored. Face to face semi structured interviews were conducted, and a six-step thematic analysis framework was utilized to analyze the collected data. Further, four dimension criteria was utilized to establish the rigor of the study. Eleven participants across undergraduate and graduate health profession programs participated in in-depth semi structured interviews. Findings suggest that faculty defined IPE through the framework of teamwork, the integration of clinical and non-clinical health-based disciplines, and as a means to foster experiential learning. Faculty identified organizational support, culture, the healthcare industry, administration, and accreditation as both resources and barriers to the successful implementation of IPE. Because there is paucity of research on IPE in clinical and non-clinical health disciplines, this research can provide practical tips to both academic administrators and faculty members.
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Gajaria, Asha. "Alignment of Patient and Provider Views in Health Care Intervention Programs: A Study of the Centre for Healthy Active Living at the Children’s Hospital of Eastern Ontario." Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30386.
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This research study focuses on examining the views of patients, their families, and staff member providers of the Centre for Healthy Active Living a clinical obesity management program for children and youth at the Children’s Hospital of Eastern Ontario, in Ottawa, Canada. Qualitative methodology was used and content analysis was conducted with data obtained from family questionnaires and a provider focus group. Analysis of obtained data was conducted to determine alignment of views between patient, family, and provider views, and the formal goals of the program. Emerging themes from the data indicated that patients and families place higher value on the formal goals of “improve quality of life; improve eating behaviours; improving fitness, increasing activity levels; and empower/strengthen families.” (Children’s Hospital of Eastern Ontario, 2012). Specific recommendations with regards to each component of these goals were provided. Instrumental, procedural, systemic, and conceptual recommendations of program components were also provided.
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Ensley, Tucker, KariLynn Dowling-McClay, Jeffrey Gray, Susie Crowe, and Katelyn Alexander. "Preceptor Perceptions of Contemporary Practice Skills Amongst New Graduates Amid Community Pharmacy Transformation." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/1.
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As community pharmacy transitions from a fee-for-service model to a focus on value-based care, the desired skills of pharmacist graduates in contemporary practice is an evolving paradigm. Meanwhile, most student pharmacists pursuing a career in community pharmacy upon graduation rely solely upon their pharmacy school training as preparation for entering practice. Community pharmacy preceptors are stakeholders in a unique position to compare the dichotomy of the current climate of community practice with the preparedness of graduating students to enter this field. Therefore, these preceptors’ perceptions of contemporary practice services and skills essential for new graduates may be useful in identifying methods of educating and assessing PharmD candidates in their preparation to enter the evolving landscape of community practice. The objective of this research was to identify essential skills for new graduates in contemporary community pharmacy as perceived by these current practitioners. To accomplish this, researchers developed an anonymous web-based survey using REDCap which was emailed to active Advanced Pharmacy Practice Experiences (APPE) community preceptors. The survey included 3 sections: (1) preceptor demographics; (2) perceptions of “contemporary” services and an evaluation of services offered at their sites; and (3) essential skills for graduates entering contemporary community practice. Following a 30-day window of the survey being open, 25% of preceptors responded (n = 42). Survey responses provided clarity in comparing the proportionality in services offered versus services viewed as contemporary. This information may be useful in identifying transformations that have already seen implementation in practice compared to emerging areas yet to be implemented. We also found broad consensus in the perceived importance of most skill areas offered in the survey with just a few showing broader discrepancies with a minority of respondents suggesting skills which held less importance. Monitoring fluctuations of these parameters over time may disclose trends in community pharmacy practice transformation, further delineating service areas that are trending toward adoption in contemporary practice. Therefore, continued use of preceptor surveys may offer insights on the incremental progression of community pharmacy curricula.
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Pougheon, Bertrand Dominique. "Partenariat patient dans une démarche d’amélioration de la qualite des soins : l’expérience du programme qualité en mucoviscidose." Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCD067/document.
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Contexte : Un programme d’amélioration de la qualité des soins est implémenté depuis2011 en France dans la filière mucoviscidose en adaptant la démarche qualité collaborativedéveloppée aux USA par la Cystic Fibrosis Foundation et le Dartmouth Institute pour lescentres spécialisés américains.Objectif : Evaluer l’apport de la participation des patients et parents d’enfants malades, auxcôtés des professionnels soignants, dans les équipes qualité des CRCM formés auprogramme qualitéMéthode : Design mixte de recherche associant un volet quantitatif sur l’évolution desindicateurs de santé des patients et un volet qualitatif selon une étude réaliste à travers uneenquête par questionnaire et focus group auprès des patients, parents et professionnelsimpliqués dans le programme qualité.Résultats : Les résultats témoignent des bonnes conditions créées par le programme pourla participation des patients et parents, de l’appropriation de cette démarche par lesprofessionnels et les patients/parents, de son utilité perçue pour améliorer la qualité dessoins et de l’évolution de la représentation de la place de l’usager dans l’amélioration del’organisation et des processus jusqu’à la considérer comme une évidence et un atout.Discussion : La démarche qualité développe la pratique collaborative interdisciplinaire etavec les patients/parents. Les progrès organisationnels observés sont concomitants dudéveloppement d’une culture de la qualité. L’implication des patients/parents dans unedémarche qualité au sein du microsystème clinique constitue une évolution majeure pourl’amélioration du système de soinBackground: A quality improvement program (QIP) has been implemented since 2011 inthe CF care network in France adapting the Learning and Leadership Collaborative programdeveloped in the US by the CF Foundation and the Dartmouth Institute for the American CFCentre network.Objective: Assess the contribution of patients and parents of children with CF engaged inthe CF center quality improvement teams, besides their care team, to improve care in theircenter.Method: Mixed design research including a quantitative study focusing on patient outcomesevolution and a qualitative study according to a realist approach using a questionnaire andfocus groups to patients, parents and professionals engaged in the QIP.Results: Participants attested of the good conditions implemented by the QIP to allowpatient and parent engagement, a consensus about the appropriation of the quality methodand tools, the usefulness of the program to improve the quality of care; in the end, patientand parent engagement in the QIP was found to be a given and an asset.Discussion: The QIP has developed collaborative practice in multidisciplinary teams andwith patients and parents. Organizational improvements were concurrent with a cultural shifttowards a culture of quality improvement. Patient and parent engagement in a QIP within theclinical microsystem is a major development for the improvement of the health care system
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Vilar, Bruno Siqueira Campos Mendonça 1982. "Context driven workflow adaptation applied to healthcare planning = Adaptação de workflows dirigida por contexto aplicada ao planejamento de saúde." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/275505.
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Orientadores: Claudia Maria Bauzer Medeiros, André SantanchèTese (doutorado) - Universidade Estadual de Campinas, Instituto de Computação
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Resumo: Sistemas de Gerenciamento de Workflows (WfMS -- em inglês) são usados para gerenciar a execução de processos, melhorando eficiência e eficácia de procedimentos em uso. As forças motrizes por trás da adoção e do desenvolvimento de um WfMS são aplicações científicas e de negócios. Esforços conjuntos de ambos resultaram em mecanismos consolidados, além de padrões e protocolos consensuais. Em particular, um WfMS científico (SWfMS -- \textit{Scientific WfMS}) auxilia cientistas a especificar e executar experimentos distribuídos. Ele fornece diferentes recursos que suportam atividades em um ambiente experimental, como prover flexibilidade para mudar o projeto de workflow, manter a proveniência e suportar reproducibilidade de experimentos. Por outro lado, apesar de poucas iniciativas de pesquisa, WfMSs não fornecem suporte apropriado à personalização dinâmica e baseada em contexto durante a execução; adaptações em tempo de execução normalmente requerem intervenção do usuário. Esta tese se concentra em superar essa deficiência, fornecendo a WfMSs um mecanismo de ciente do contexto para personalizar a execução de workflows. Como resultado, foi projetado e desenvolvido o DynFlow -- uma arquitetura de software que permite tal personalização aplicada a um domínio: planejamento de saúde. Este domínio foi escolhido por ser um ótimo exemplo de personalização sensível ao contexto. Procedimentos de saúde constantemente sofrem mudanças que podem ocorrer durante um tratamento, como a reação de um paciente a um medicamento. Para suprir a demanda, a pesquisa em planejamento de saúde desenvolveu técnicas semi-automáticas para suportar mudanças rápidas dos passos de fluxos de tratamento, de acordo com o estado e a evolução do paciente. Uma dessas técnicas é \textit{Computer-Interpretable Guidelines} (CIG), cujo membro mais proeminente é \textit{Task-Network Model} (TNM) -- uma abordagem baseada em regras capaz de construir um plano em tempo de execução. Nossa pesquisa nos levou a concluir que CIGs não suportam características necessárias por profissionais de saúde, como proveniência e extensibilidade, disponíveis em WfMSs. Em outras palavras, CIGs e WfMSs têm características complementares e são direcionadas à execução de atividades. Considerando os fatos citados, as principais contribuições desta tese são: (a) especificação e desenvolvimento do DynFlow, cujo modelo associa características de TNMs e WfMS; (b) caracterização das principais vantagens e desvantagens de modelos CIGs e WfMSs; (c) implementação de um protótipo, baseado em ontologias e aplicadas ao domínio da saúde e enfermagem
Abstract: Workflow Management Systems (WfMS) are used to manage the execution of processes, improving efficiency and efficacy of the procedure in use. The driving forces behind the adoption and development of WfMSs are business and scientific applications. Associated research efforts resulted in consolidated mechanisms, consensual protocols and standards. In particular, a scientific WfMS helps scientists to specify and run distributed experiments. It provides several features that support activities within an experimental environment, such as providing flexibility to change workflow design and keeping provenance (and thus reproducibility) of experiments. On the other hand, barring a few research initiatives, WfMSs do not provide appropriate support to dynamic, context-based customization during run-time; on-the-fly adaptations usually require user intervention. This thesis is concerned with mending this gap, providing WfMSs with a context-aware mechanism to dynamically customize workflow execution. As a result, we designed and developed DynFlow ¿ a software architecture that allows such a customization, applied to a specific domain: healthcare planning. This application domain was chosen because it is a very good example of context-sensitive customization. Indeed, healthcare procedures constantly undergo unexpected changes that may occur during a treatment, such as a patient¿s reaction to a medicine. To meet dynamic customization demands, healthcare planning research has developed semi-automated techniques to support fast changes of the careflow steps according to a patient¿s state and evolution. One such technique is Computer-Interpretable Guidelines (CIG), whose most prominent member is the Task-Network Model (TNM) -- a rule based approach able to build on the fly a plan according to the context. Our research led us to conclude that CIGs do not support features required by health professionals, such as distributed execution, provenance and extensibility, which are available from WfMSs. In other words, CIGs and WfMSs have complementary characteristics, and both are directed towards execution of activities. Given the above facts, the main contributions of the thesis are the following: (a) the design and development of DynFlow, whose underlying model blends TNM characteristics with WfMS; (b) the characterization of the main advantages and disadvantages of CIG models and workflow models; and (c) the implementation of a prototype, based on ontologies, applied to nursing care. Ontologies are used as a solution to enable interoperability across distinct SWfMS internal representations, as well as to support distinct healthcare vocabularies and procedures
Doutorado
Ciência da Computação
Doutor em Ciência da Computação
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Silva, João José Francisco da. "Obama's law : analysis of a breakthrough law on healthcare access and lessons for the Portuguese health system management." Master's thesis, Universidade Nova de Lisboa. Escola Nacional de Saúde Pública, 2012. http://hdl.handle.net/10362/9667.
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ABSTRACT - The Patient Protection and Affordable Care Act shook the foundations of the US health system, offering all Americans access to health care by changing the way the health insurance industry works. As President Obama signed the Act on 23 March 2010, he said that it stood for “the core principle that everybody should have some basic security when it comes to their health care”. Unlike the U.S., the Article 64 of the Portuguese Constitution provides, since 1976, the right to universal access to health care. However, facing a severe economic crisis, Portugal has, under the supervision of the Troika, a tight schedule to implement measures to improve the efficiency of the National Health Service. Both countries are therefore despite their different situation, in a conjuncture of reform and the use of new health management measures.
The present work, using a qualitative research methodology examines the Affordable Care Act in order to describe its principles and enforcement mechanisms. In order to describe the reality in Portugal, the Portuguese health system and the measures imposed by Troika are also analyzed.
The intention of this entire analysis is not only to disclose the innovative U.S. law, but to find some innovative measures that could serve health management in Portugal. Essentially we identified the Exchanges and Wellness Programs, described throughout this work, leaving also the idea of the possibility of using them in the Portuguese national health system.RESUMO - O Patient Protection and Affordable Care Act abalou recentemente as bases do sistema de saúde dos EUA, possibilitando a todos os cidadãos Americanos o acesso aos cuidados de saúde, alterando os mecanismos em que a indústria de seguros de saúde funcionava naquele país. Ao assinar a citada lei a 23 de Março de 2010, o Presidente Obama afirmou que defendia "o princípio fundamental de que todos devem ter alguma segurança básica quando se trata dos seus cuidados de saúde". Ao contrário dos EUA, o artigo 64 º da Constituição da República Portuguesa prevê desde 1976 o direito de acesso universal aos cuidados de saúde. No entanto, enfrentando uma forte crise económica, Portugal tem, sob a vigilância da Troika, um calendário apertado para implementar medidas que permitam melhorar a eficiência do Serviço Nacional de Saúde. Ambos os países se encontram, pois, apesar das situações serem diferentes, numa conjuntura de reforma e de utilização de novas medidas de gestão em saúde. O presente trabalho, utilizando uma metodologia (qualitativa) de pesquisa documental, analisa essencialmente o Affordable Care Act de forma a descrever os seus princípios e mecanismos de aplicação. O sistema de saúde português e as medidas a cumprir na área da saúde, ao abrigo do Memorandum da Troika são também analisadas no sentido de descrever a realidade portuguesa. O conjunto desta análise tem como finalidade, não só dar a conhecer a inovadora lei norte-americana, mas, sobretudo tentar encontrar algumas medidas inovadoras que pudessem servir a gestão da saúde em Portugal. Identificámos essencialmente as Exchanges e os Wellness Programs, as quais descrevemos no âmbito do trabalho, deixando a ideia de uma possível utilização das mesmas no sistema de saúde nacional.
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Roepke, William B., Charles A. Edwards, and Nicholas I. McIntire. "Combating the physician shortage in rural America by increasing early exposure to the medical field through the use of summer medical camps." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/190.
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INTRODUCTION: The United States is currently experiencing a shortage of physicians that is projected to worsen substantially over the next decade. Rural regions are most affected by this shortage, with some statistics estimating that the physician-to-patient ratios reach 1 to 2500 in certain areas. While some measures have been taken to help combat this shortage, such as increases in medical school enrollment and the development of more residency training programs, additional interventions are needed that target rural regions specifically. One of the most powerful methods to improve this rural maldistribution of physicians is to make changes in medical education so that it trains and deploys more individuals who wish to practice in rural areas. The Quillen College of Medicine (QCOM) places tremendous focus on training rural physicians, with around 25% of students selecting an alternate educational curriculum that provides them with specific training in rural communities. To further QCOM’s commitment to improving rural healthcare, we hosted a no-cost, week-long camp for high school students. We specifically recruited students from the surrounding rural regions, as studies have demonstrated that students with rural origins are more likely to train in primary care and return to practice in rural areas. We hypothesize that earlier exposure to the medical field through summer camps is an effective method to increase the number of students from rural communities who wish to pursue careers in medicine. METHODS: The 2018 camp was held the week of June 4-8 and hosted 20 students from surrounding high schools. Throughout the week, the students engaged in a variety of fun and engaging activities that taught them about many important aspects of medicine such as proper patient care, communication skills, physical exam techniques, and critical thinking skills. We utilized both the Medical Simulation Lab and Standardized Patient Center at the Quillen College of Medicine, which allowed the students to interview, diagnose, and treat patients with various conditions in a simulated environment. Our objective was not to have the students accurately diagnose and treat the conditions, but rather to utilize teamwork, employ critical thinking skills, and enjoy doing it. Our data was collected pre- and post-surveys which contained closed-ended questions, Likert scales, and free-response questions. The surveys assessed demographic information, previous exposure to the medical field, interest in the medical field, and perceived potential obstacles in pursuing a career in medicine. RESULTS: Student feedback was positive overall. 65% of students stated they were more knowledgeable about the steps they needed to take to become a physician. 55% of participants reported an increased desire to pursue a career in healthcare. 45% of students reported an increased desire to become a physician. CONCLUSIONS: We conclude that earlier medical exposure through summer camps is an effective method for increasing the number of students from rural East Tennessee who are interested in pursuing a career in medicine. We believe that similar opportunities should be offered to a greater degree in other areas to help combat the physician shortage affecting rural regions nationwide.
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Van, Dyk D. L., and H. Bezuidenhout. "Learning experiences of students during integrated management of childhood illness (IMCI) training." Journal for New Generation Sciences, Vol 11, Issue 2: Central University of Technology, Free State, Bloemfontein, 2013. http://hdl.handle.net/11462/641.
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Published ArticleThe aim of the study on which this article is based was to reflect on the learning experiences of students during integrated management of childhood illness (IMCI) training in an undergraduate programme. IMCI is a set of guidelines that was established by the World Health Organisation (WHO) for cost-effective quality care for children younger than five to prevent diseases and death (WHO, 2004). Skilled primary healthcare workers are required to provide quality care at first contact with these children. The IMCI package was presented as an integral part of the second-year module that focuses on primary healthcare. In order to improve the quality of health services and refocus the health system on primary health-care (South Africa Department of Health, 2010), students have to demonstrate that they have achieved competence. According to Killen (2000:188), competence is a holistic term and focuses on knowledge, skills and values instead of competencies, which refer to specific capabilities. Primary health-care workers who act competently will integrate foundational IMCI knowledge with skills and values as well as with the ability to verify their decisions (Killen, 2000:188). Aqualitative, exploratory and descriptive research design was used to investigate the IMCI learning experiences. Such experiences are one of the indications whether training has been successful and how it can be improved (Suski, 2004:222). Data was collected by means of nominal-group technique (NGT) interviews with second-year nursing students of the training school who complied with the criteria for inclusion. NGT interviews were used effectively to evaluate clinical interaction, education and training.The findings reflected the different emotions experienced during teaching and learning as having been positive, negative or neutral. The consideration of negative emotions will assist with the improvement of IMCI teaching and learning, but all these findings can be useful for other higher-education institutions that present or plan to present IMCI training.
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Silva, Cristiane Pavanello Rodrigues. "Proposta de avaliação de programas de controle de infecção hospitalar: validação das propriedades de medidas e diagnóstico parcial de conformidade em serviços de saúde do município de São Paulo." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-29042010-112347/.
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Estudo de desenvolvimento metodológico que teve por finalidade disponibilizar um sistema de avaliação de Programas de Prevenção e Controle de Infecção Hospitalar (PCIH), após validação das propriedades de medidas, que possibilite aplicação prática para diagnósticos situacionais, cujos resultados subsidiem tanto melhorias na área quanto informações concretas à sociedade sobre a qualidade desses PCIH em cada instituição de saúde. Para tal, previamente, foram construídos e realizada validação de conteúdo de quatro indicadores: 1- (PCET) Estrutura Técnico-operacional do PCIH; 2- (PCDO) Diretrizes Operacionais de Controle e Prevenção de IH; 3- (PCVE) Sistema de Vigilância Epidemiológica de IH; 4- (PCCP) Atividades de Controle e Prevenção de IH. Os objetivos específicos foram: realizar validação (construto e discriminante) e testar confiabilidade (consistência interna); realizar diagnóstico parcial de conformidade dos PCIH em serviços de saúde do Município de São Paulo. Os indicadores de PCIH foram aplicados em 50 instituições de saúde, que aceitaram voluntariamente participar do estudo. As características referentes ao perfil do hospital e os escores dos indicadores foram descritos por meio de estatística descritiva. A consistência interna foi analisada usando o coeficiente de Cronbach. A análise da validade discriminante foi realizada comparando-se os escores dos indicadores entre dois grupos de hospitais, (possuem algum tipo de certificação versus não possuem certificação em qualidade). E para a análise da validade de construto foi utilizada a Análise Fatorial Exploratória com matriz de correlação tetracórica. Os indicadores 1-PCET e 3-PCVE variaram pouco, com quase 100% de conformidade em toda a amostra, já os indicadores 2-PCDO e 4- PCCP apresentaram boa consistência interna com variação de 0,67 a 0,80. A validade discriminante desses indicadores indicou médias dos escores de conformidade superiores e com significância estatística no grupo de instituições com processos de qualificação ou acreditação em saúde. Na validação de construto foi possível diferenciar e identificar 2 dimensões para PCDO (fator 1- recomendações para prevenção de IH e fator 2 recomendações para padronização de procedimentos de profilaxia), com boa correlação dos itens que o compõe, o mesmo ocorrendo para PCCP (fator 1 interface com unidades de tratamento e fator 2 interface com unidades de apoio). N avaliação parcial de conformidade do PCIH todos os indicadores, com exceção do 4 PCCP, que variou de 9,5% a 100%, apresentaram escores > 90%,o que mostra que os hospitais participantes possuem um bom nível de qualidade dos PCIH instituídos, com médias superiores nas instituições com processos de qualificação da assistência. Com esse estudo foi possível validar as propriedades de medidas dos indicadores de PCIH e disponibilizar um instrumento factível como ferramenta de avaliação de PCIH de forma ética e científica para diagnóstico de qualidade na área.The objective of this study was to develop methodology that could ultimately be made available as a system for assessing Hospital Infection Control and Prevention Programs (HICPP), after validation of its measurement properties, which enable practical application in situational diagnoses, whose results provide both improvements in the area and reliable information about the quality of these HICPPs in each healthcare institution. To do so, the content of four indicators was constructed and validated beforehand: 1- (PCET) Technical-operational structure of the HICPP; 2- (PCDO) Operating Guidelines for Control and Prevention of HI; 3- (PCVE) Epidemiological Surveillance System for HI; 4- (PCCP) HI Prevention and Control Activities. The specific objectives were: fully validate (construct and discriminant) and test the reliability (internal consistency) of measurement properties; carry out a partial diagnosis of conformity of the HICPPs in São Paulo Municipal Healthcare Facilities. The HICPP indicators were applied in 50 healthcare institutions, which participated voluntarily in the study. The hospital profile characteristics and the scores of the indicators were described using descriptive statistics. Internal consistency was analyzed using the Cronbach coeficient; the analysis of discriminant validity was carried out by comparing the scores of the indicators between the two groups of hospitals, (those which had some type of quality certification versus those which did not) and exploratory factor analysis with a tetrachoric correlation matrix was used to analyze the validity of the construct. The indicators 1-PCET and 3-PCVE varied little, with almost 100% conformity throughout the sample, whereas the indicators 2-PCDO and 4- PCCP presented good internal consistency with a variation of 0.67 to 0.80; discriminant validity of these indicators showed higher average scores of conformity and were statistically significant in the group of institutions with certification or accreditation; in the validation of the construct it was possible to differentiate and determine 2 dimensions for PCDO (factor 1- recommendations for prevention of HI and factor 2 recommendations for the standardization of prophylaxis procedures), with good correlation of the units of analysis that composed it. The same occurred for PCCP (factor 1 interface with treatment units and factor 2 interface with support units). All of the indicators, with the exception of 4- PCCP, which ranged from 9.5% to 100%, presented scores of > 90%, which show that the HICPPs of participating hospitals have a good standard of quality, with higher average scores in the institutions with certification or accreditation. This study enabled the validation of the measurement properties of the HICPP indicators and produced a practicable HICPP assessment tool in an ethical and scientific manner for diagnosis of quality in this area.
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Staines, Anthony. "La relation "programme qualité" / "résultats cliniques" : du concept à sa mise en oeuvre dans trois systèmes hospitaliers : le Conseil de Comté de Jönköping (Suède), Intermountain Healthcare (Etats-Unis) et le groupe Reinier de Graaf (Pays-Bas)." Lyon 3, 2007. https://scd-resnum.univ-lyon3.fr/in/theses/2007_in_staines_a.pdf.
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Des méthodes de gestion de la qualité nombreuses et diverses ont été utilisées à l'hôpital. Si quelques projets spécifiques ont montré des résultats, l'efficacité des programmes institutionnels n'est en revanche pas démontrée dans le domaine clinique. Cette recherche s'intéresse à une catégorie particulière de programmes qualité : ceux reconnus par les experts comme de classe mondiale. Une étude de cas examine trois de ces programmes, explorant leur contenu, leur mise en oeuvre, leur perception et leurs résultats. L'étude montre que les programmes qualité peuvent aboutir à un impact sur les résultats cliniques. Elle documente pour chaque cas des améliorations mesurées sur des indicateurs de processus et dans 2 des cas une ou plusieurs améliorations de l'outcome. La recherche propose le concept de seuil de rentabilité qualitative, zone de bruit responsable du délai de carence à la mise en évidence de résultats, ainsi qu'un ensemble de facteurs accroissant ou réduisant l'efficacité des programmesQuality methods of many different types have been used in hospitals. Some specific projects have shown improved results, but there is no strong evidence of the effectiveness of institutionwide quality improvement (QI) programs. This research deals with a specific category of QI programs: those recognised by experts as world class. Three such programs are examined in a case study, investigating their content, implementation, perception and results. The study shows that QI programs can lead to improved clinical results. It documents improvements measured on process indicators for each of the cases and one or a few improved clinical outcomes in two of the cases. The concept of an investment threshold is proposed and explained, a zone of noise delaying evidence of improved results to show, as well as a set of factors increasing or decreasing the effectiveness of QI programs
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Nascimento, Fabiana Alves do. "A Vigilância Alimentar e Nutricional brasileira na produção científica e nos serviços de saúde." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6138/tde-21122016-104756/.
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Introdução: A Vigilância Alimentar e Nutricional (VAN) é um conjunto de estratégias de Vigilância em Saúde, incluindo o Sistema Nacional de Vigilância Alimentar e Nutricional (SISVAN), para monitorar e analisar continuamente as condições alimentares e nutricionais da população usuária do Sistema Único de Saúde (SUS), com o objetivo de subsidiar ações, programas e políticas. Objetivos: Descrever a produção científica brasileira recente sobre VAN e analisar em que medida a concepção presente nos trabalhos se aproxima do conceito estabelecido na Política Nacional de Alimentação e Nutrição (2012); e descrever as coberturas da avaliação do estado nutricional e do consumo alimentar da população usuária de serviços públicos de saúde registrada no SISVAN Web, entre 2008 e 2013. Métodos: O presente estudo está organizado em dois eixos metodológicos: uma revisão bibliográfica sobre o conceito de VAN presente na produção científica brasileira recente e dois estudos originais ecológicos com descrição das coberturas da avaliação do estado nutricional e do consumo alimentar a partir dos dados do SISVAN Web. Resultados: Na revisão bibliográfica, foram identificados artigos majoritariamente voltados para a análise de inquéritos populacionais, com menor contribuição sobre sistemas de informação em saúde e avaliação de serviços de saúde. Nos estudos originais, a cobertura total média do estado nutricional no Brasil variou de 9,78 por cento a 14,92 por cento ; e a do consumo alimentar variou de 0,13 por cento a 0,41 por cento . Ambas apresentaram tendência estatisticamente significativa de aumento e diferenças entre as unidades da federação e macrorregiões. Verificou-se a priorização da VAN voltada para o público materno-infantil, a proveniência dos dados de estado nutricional relacionada ao público prioritário do Programa Bolsa Família, e de consumo alimentar relacionada à presença de nutricionistas na Atenção Básica. Conclusão: Apresenta-se um panorama da produção científica recente sobre VAN e do acompanhamento do estado nutricional e do consumo alimentar nos serviços de saúde brasileiros, desvelando contextos em que recursos precisam ser mobilizados para melhoria da VAN.Introduction: The Food and Nutrition Surveillance (FNS) is a set of surveillance strategies within the Health Surveillance, which includes the National Food and Nutrition Surveillance System (Sistema Nacional de Vigilância Alimentar e Nutricional - SISVAN), that aims at continuously monitoring and analyzing the food and nutritional status of the population attended by the Brazilian National Health System (Sistema Único de Saúde - SUS) and supporting actions, programs and policies. Objectives: to describe the Brazilian scientific literature on FNS and analyze to what extent the studies approach is linked/associated to the concept of the National Food and Nutrition Policy (2012); to analyze the coverage of the assessment of the nutritional status and the food intake of the users of the public health services registered on the Web SISVAN between 2008 and 2013. Methods: This study is organized in two methodological axes: a literature review on the concept of FNS present in recent Brazilian scientific production and two original ecological studies describing the assessment of the coverage of the nutritional status and food intake from the Web SISVAN data. Results: In the literature review, we found that the papers were mainly focused on the analysis of population surveys with smaller contribution of studies on health information systems and evaluation of health services. In the original studies, the average full coverage in Brazil ranged from 9.78 per cent to 14.92 per cent for the nutritional status and from 0.13 per cent to 0.41 per cent for the food intake. Both showed statistically significant trends of increase and differences between the Brazilian Federal Units and macro-regions. The FNS was prioritized for mother-child pairs, priority public of the Bolsa Familia Program, in the case of nutrition status data, and related to the presence of nutritionists in the primary healthcare services, in the case of food intake data. Conclusion: We presented an overview of recent scientific literature on FNS and of the monitoring of nutritional status and food intake in the Brazilian health services, revealing contexts where resources need to be mobilized to improve the FNS.
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Adão, Izaltina. "Aplicação do instrumento worksite health scorecard para avaliar programas de promoção da saúde no ambiente de trabalho de indústrias catarinenses." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/24192.
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As doenças crônicas não transmissíveis são um problema crescente nos países. Os custos econômicos relacionados ao adoecimento e afastamentos do trabalho não param de aumentar. Empregadores estão implementando programas de promoção da saúde no local de trabalho para melhorar a saúde dos trabalhadores, a produtividade e reduzir os custos com os adoecimentos. Neste sentido, o objetivo principal deste Trabalho Aplicado foi avaliar os programas de promoção da saúde no ambiente de trabalho, oferecidos em uma amostra composta por 114 indústrias do Estado de Santa Catarina. Para isso, aplicou-se o instrumento Worksite Health ScoreCard (HSC) para avaliar o resultado dos programas de promoção da saúde. Foi possível identificar na revisão da literatura que a avaliação dos programas deve se concentrar em questões relevantes e úteis, promover um ciclo contínuo de melhorias de qualidade, eficiência e eficácia dos investimentos, além de identificar lacunas potenciais nas atuais ofertas. O resultado da pesquisa permitiu analisar que, a amostra de 114 indústrias atingiu 23,58% da pontuação máxima possível entre as estratégias e intervenções promotoras de saúde no ambiente de trabalho avaliadas com o HSC. Sobretudo, a pesquisa evidenciou que, os programas de saúde ofertados pelas indústrias participantes, em sua maioria, não correspondem aos conceitos de programas abrangentes, com estratégias e intervenções integradas às principais necessidades de saúde populacional. Notou-se que as estratégias e intervenções promotoras de saúde, aconteceram de forma isolada e não foram priorizadas de acordo com aquelas que são capazes de contribuir com melhores resultados organizacionais e nos comportamentos de saúde, e que refletem nas principais causas de adoecimentos e afastamentos do trabalho.
Chronic non-communicable diseases are a growing problem in many countries. Economic costs related to worker illness and absences continue to rise. Employers are implementing health promotion programs at the workplace to improve worker health, productivity and reduce costs related to illness. In this context, the main objective of this Applied Study was to evaluate health promotion programs at the workplace, offered in a sample composed of 114 industrial sectors in Santa Catarina state. To do so, the Worksite Health ScoreCard (HSC) was used to evaluate the results of health promotion programs. A review of the literature indicated that the evaluation of programs should be focused on relevant and useful issues, promote a continuous cycle of improvements in quality, efficiency and effectiveness of investments, and identify potential gaps in currently offered measures. The study revealed that the sample of 114 industrial sectors attained 23.58% of the maximum possible score for the strategies and interventions they use to promote health at the workplace that were evaluated with the HSC. Above all, the study revealed that most of the healthcare programs offered by participating companies do not correspond to the concepts found in broad programs with strategies and interventions that are integrated to the population’s main health needs. It was found that strategies and interventions that promote health are implemented in an isolated manner and were not given priority by those who are capable of contributing to better results at a company and in health-related behavior. This is reflected in the main causes of illness and work absence.
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Muller, Allison. "Bon usage des antibiotiques : résultats d'actions dans différents types d'établissements de santé." Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCE021/document.
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La résistance bactérienne aux antibiotiques est un problème de santé publique mondial principalement lié à un mésusage des antibiotiques (surconsommation et prescription inadéquate).Pour lutter contre cette menace, des recommandations diffusées par les sociétés savantes et des plans d’action ont été mis en place. Même si ils sont nécessaires, ils ne sont pas suffisants pour assurer une amélioration significative de l’usage des antibiotiques. Un fort taux de non-conformité de la prescription antibiotique au regard des recommandations est observé dans les établissements de santé (ES). La mise en place de programmes volontaristes de bon usage antibiotique au sein de chaque ES s’avère essentiel pour améliorer l’usage des antibiotiques : une action sur les comportements des prescripteurs est indispensable, par le biais de différentes stratégies. Qu’elles soient persuasives ou restrictives, celles-ci ont toutes montré leur efficacité, sans entraîner d’effets cliniques néfastes pour les patients (pas d’augmentation de la mortalité ni de la durée de séjour), tout en permettant une réduction des coûts liés aux anti-infectieux.Par le biais de nos travaux, nous avons cherché à étudier le bon usage antibiotique en milieu hospitalier, à l’échelle de différents types d’ES (hôpital local, centre hospitalier régional universitaire, cohorte de 259 ES), et en évaluant l’impact de recommandations nationales ou de programmes et de guides locaux. Ces travaux nous ont permis de constater que la diffusion de recommandations nationales pouvait permettre de réduire les consommations de carbapénèmes, et qu’un programme mené dans un hôpital local pouvait être très efficace pour réduire les consommations de fluoroquinolones, mais également la résistance bactérienne à plus long terme. Des audits ciblés sur la prescription des aminosides et l’antibioprophylaxie chirurgicale ont permis de mettre en évidence des non-conformités récurrentes orientant sur des actions d’amélioration ciblées à mener.En conclusion, ce travail souligne l’importance des programmes de bon usage antibiotique au sein de chaque ES, quel que soit le type et le nombre de lits. En effet, ces programmes venant en appui aux recommandations ont démontré leur efficacité pour réduire les consommations et améliorer la qualité des prescriptions antibiotiques, grâce à leur impact positif sur les comportements des prescripteursBacterial resistance to antibiotics is a worldwide public health issue which is mainly linked to antibiotic misuse (overconsumption and inappropriate prescription).To fight this threat, recommendations from learned societies and national action plans have been set up. Even if they are necessary, they are not sufficient to provide a significant improvement in the antibiotic use. A high rate of non-compliance with the recommendations is observed among healthcare facilities (HCFs). The setting up of proactive antimicrobial stewardship programs (ASP) among every HCF is essential to improve antibiotic use: an action on prescribers’ behavior is necessary, by using various strategies. These strategies, however persuasive or restrictive, have been shown to be effective, with no clinical negative effects for the patients (no increase in mortality and in length of stay), while reducing anti-infective costs.With this work, we aimed to study the appropriateness of antibiotic use in hospitals, at different HCFs levels (local hospital, university hospital, 259 French HCFs cohort), by assessing the impact of national recommendations or local ASP and guidelines. These studies showed that national recommendations could lead to a reduction in carbapenem consumptions, and that an ASP conducted in a local hospital could be very effective to reduce fluoroquinolones consumptions, and bacterial resistance at a longer term. Targeted audits on aminoglycosides prescription and on surgical antibioprophylaxis have permitted to highlight recurrent non-compliances, guiding improvement measures to set up.In conclusion, this work supports the weight of ASPs among each HCF, whatever type and size. Indeed, these ASPs, set up in support of the national recommendations, have demonstrated their effectiveness in reducing antibiotic consumptions and improving prescription appropriateness, by their positive impact on prescribers’ behaviors
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Panchalingam, Thadchaigeni. "Three Essays on the Economics of Food, Health, and Consumer Behavior." The Ohio State University, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=osu1618834416383345.
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Daldon, Maria Teresa Bruni. "Processo de trabalho dos profissionais de saúde em vigilância em saúde do trabalhador." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-18012013-104545/.
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Esta pesquisa, de enfoque qualitativo, buscou compreender o processo de trabalho dos profissionais que atuam em Vigilância em Saúde do Trabalhador (VST), lotados na Subgerência de Saúde do Trabalhador da Coordenação de Vigilância em Saúde (COVISA) e nos Centros de Referência em Saúde do Trabalhador (CRST) da Prefeitura Municipal de São Paulo. Procurou conhecer as estratégias, recursos e instrumentos utilizados por esses profissionais, além de identificar as ações reais e os significados atribuídos por eles a sua prática. Pretendeu, ainda, dar visibilidade a sua \"inteligência no trabalho\", acreditando que sua experiência e conhecimento podem colaborar para o aprimoramento e desenvolvimento das políticas públicas de saúde/trabalho e de suas próprias ações em (VST). Baseou-se nos referenciais teóricos da psicodinâmica do trabalho e da escola franco-belga da ergonomia. O método seguido foi o \"estudo de caso\". Foram consultados documentos governamentais, legislações e atas de conferências federais, estaduais e municipais, relativos à Saúde Pública no Sistema Único de Saúde e à área de Saúde do Trabalhador, em especial à VST. Foi feito um estudo da bibliografia pertinente à área, produzida entre 1980 e 2011. Esse material foi utilizado como fonte de dados simples e como informação para a compreensão dos referenciais teóricos, políticas e diretrizes que norteiam o trabalho dos profissionais em VST. A coleta de dados de campo partiu de um questionário, respondido pelos profissionais dos serviços em foco, a fim de caracterizar aquelas equipes multiprofissionais. Os dados permitiram fazer um diagnóstico do universo estudado e funcionaram como norteadores para a escolha, por critérios de representatividade, dos 13 profissionais que seriam convidados a participar de entrevistas semiestruturadas. Os dados das entrevistas realizadas foram tratados pelo método de \"análise de conteúdo\", com foco no processo de trabalho, na dinâmica do planejamento, desenvolvimento e avaliação das ações de VST, a partir da percepção dos profissionais que as realizam. Entre os resultados encontrados, verificamos que a VST não é um processo linear, está sujeita a tensões e conflitos de várias naturezas que deveriam ser considerados no estabelecimento dos critérios adotados para sua avaliação, na busca de avanços no alcance dessas ações. Insuficientes processos de reconhecimento e de troca de experiência e a aproximação da aposentadoria da maioria dos profissionais que atuam em VST no município evidenciam a possibilidade de que o \'saber-fazer\" construído se perca. A carência de recursos matérias, humanos e de processos de capacitação podem trazer prejuízos ao trabalho. A forma desordenada como vem sendo acolhida a demanda de acidentes de trabalho no município e o número insuficiente de autoridades sanitárias para atender à essa demanda podem estar comprometendo a qualidade e a capacidade efetiva das ações de VST. Concluímos que a ausência de clareza sobre o papel dos CRST e da área de Saúde do Trabalhador de COVISA, em tempos de Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST), e a defasagem entre trabalho prescrito e trabalho real, podem estar dificultando a construção de programas efetivos em VST. Com a precariedade de planejamento, avaliações e sistematização, as ações de VST podem estar se distanciando de seu objetivo de prevenção e promoção da saúde.This qualitative research is an attempt to understand working process of public healthcare providers who work in Surveillance of Workers\' Health of the Health Surveillance Coordination and of the Reference Center for Workers\' Health within the city of São Paulo. It has sought to understood the strategies, resources, and tools used by these professionals, in addition to identifying the real actions and the meanings assigned by them for their practice. It Intended to also give visibility to their \"intelligence at work\", believing that their experience and knowledge can contribute to the improvement and development of public health policies/work and their own actions in Surveillance of Workers\' Health. It was developed based on theoretical references of work psychodynamics and those of the French-Belgian school of ergonomics. The methodology used was the \"case study\". Government documents, laws and acts of federal, State and local conferences, relating to Public Health at the Brazilian Unified Healthcare System, and those in the area of Workers\' Health, in particular at the VST, were consulted. A study was made of the relevant bibliography to the area, produced between 1980 and 2011. This material was used as a simple data source, and how to information for the understanding of theoretical references, policies and guidelines that governs the work of professionals in Surveillance of Workers\' Health. The fieldwork started with a questionnaire answered by professionals of services in focus, in order to characterize those multi professional teams. The data allowed making a diagnosis of the universe studied and worked to orient to the choice, by representativeness criteria, of 13 professionals who would be invited to participate in semi-structured interviews. Data from the interviews were treated by the method of \"content analysis\", with focus on work process, in dynamics of planning, development and evaluation of the actions of Surveillance of Workers\' Health, from the perception of professionals that perform. Among the results, we see that the Surveillance of Workers\' Health is not a linear process, is subject to tensions and conflicts of various natures that should be considered in the establishment of the criteria adopted for its evaluation, in the pursuit of advances in reach of these actions. Considering the insufficient recognition processes and lack of exchange of experience, and adding to that, the approaching retirement of most professionals working in Surveillance of Workers\' Health in the municipality, highlighted the possibility that the \' know-how \' built up could be lost. The lack of human and material resources and of training processes can bring harm to work. The disorderly manner as has being accepted the demand of work-related accidents in the municipality and the insufficient number of health authorities to meet this demand may be compromising the quality and the effective capacity of Surveillance of Workers\' Health. We found that the lack of clarity about the actions of workers health developing by the Reference Center for Workers\' Health and by Health Surveillance Coordination, in times of National Network of Integral Attention to the Health of the Worker, and the lag between prescribed and real work, may be making it difficult to build up effective a Surveillance of Workers\' Health. With the precariousness of planning, evaluation and systematization, the \"Surveillance of Workers\' Health\" actions may be moving away from its goal of prevention and health promotion.
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Pinaire, Jessica. "Explorer les trajectoires de patients via les bases médico-économiques : application à l'infarctus du myocarde." Thesis, Montpellier, 2017. http://www.theses.fr/2017MONTS020/document.
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Avec environ 120 000 personnes atteintes chaque année, 12 000 décès suite à la première crise et 18 000 décès après une année, l'infarctus du myocarde est un enjeu majeur de santé publique. Cette pathologie nécessite une hospitalisation et une prise en charge dans une unité de soins intensifs de cardiologie. Pour étudier cette pathologie, nous nous sommes orientés vers les bases hospitalières du PMSI.La collecte des données hospitalières dans le cadre du PMSI génère sur le plan national des bases de données de l'ordre de 25 millions d'enregistrements par an.Ces données, qui sont initialement recueillies à des fins médico-économiques, contiennent des informations qui peuvent avoir d'autres finalités : amélioration de la prise en charge du patient, prédiction de l'évolution des soins, planification de leurs coûts, etc.Ainsi émerge un autre enjeu : celui de fournir des outils d'explorations des trajectoires hospitalières des patients à partir des données issues du PMSI. Par le biais de plusieurs objectifs, les travaux menés dans le cadre de cette thèse ont pour vocation de proposer des outils combinant des méthodes issues de trois disciplines : informatique médicale, fouille de données et biostatistique.Nous apportons quatre contributions.La première contribution concerne la constitution d'une base de données de qualité pour analyser les trajectoires de patients. La deuxième contribution est une méthode semi-automatique pour la revue systématique de la littérature. Cette partie des travaux délimite les contours du concept de trajectoire dans le domaine biomédical. La troisième contribution est l'identification des parcours à risque dans la prédiction du décès intra-hospitalier. Notre stratégie de recherche s'articule en deux phases : 1) Identification de trajectoires types de patients à l'aide d'outils issus de la fouille de données ; 2) Construction d'un modèle de prédiction à partir de ces trajectoires afin de prédire le décès. Enfin, la dernière contribution est la caractérisation des flux de patients à travers les différents évènements hospitaliers mais aussi en termes de délais d'occurrences et de coûts de ces évènements. Dans cette partie, nous proposons à nouveau une alliance entre une méthode de fouille de données et de classification de données longitudinalesWith approximately 120,000 people affected each year, 12,000 deaths from the first crisis and 18,000 deaths after one year, myocardial infarction is a major public health issue. This pathology requires hospitalization and management in an intensive care cardiology unit. We study this pathology using the French national Prospective Paiement System (PPS) databases.The collection of national hospital data within the framework of the PPS generates about 25 million records per year.These data, which are initially collected for medico-economic purposes, contain information that may have other purposes: improving patient care, predicting the evolution of care, planning their costs, etc.Another emerging issue is that of providing tools for exploring patients' hospital trajectories using data from the PPS. Through several objectives, this thesis aims to suggest tools combining methods from three disciplines: medical computing, data mining and biostatistics.We make four contributions.The first contribution concerns the constitution of a quality database to analyze patient trajectories. The second contribution is a semi-automatic method for the systematic review of the literature. This part of the work delineates the contours of the trajectory concept in the biomedical field. The third contribution is the identification of care trajectories in the prediction of intra-hospital death. Our research strategy is divided into two phases: 1) Identification of typical patient trajectories using data mining tools; 2) Construction of a prediction model from these trajectories to predict death. Finally, the last contribution is the characterization of patient flows through the various hospital events, also considering of delays and costs. In this contribution, we propose a combined-data mining and a longitudinal data clustering technique
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Bressan, Aparecida Isabel. "A disponibilidade de aceleradores lineares para o tratamento do câncer no Brasil e as teses de focalização e simplificação do SUS." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/2344.
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Previous issue date: 2010Esse trabalho analisa a disponibilidade de aceleradores lineares para o tratamento do câncer no Brasil na década de 2.000 a partir dos dados provenientes das pesquisas de Assistência Medição-Sanitária AMS/IBGE e do Cadastro Nacional de Estabelecimentos de Saúde CNES e da Comissão Nacional de Energia Nuclear CNEN. Descreve-se a localização geográfica dos equipamentos, especialmente nas grandes regiões, a disponibilidade ao SUS e aos planos privados de saúde e a natureza institucional dos estabelecimentos de saúde onde estão instalados e aplicados parâmetros oficiais de suficiência. As bases técnicas de sua utilização são descritas para mostrar a importância desses equipamentos de alta complexidade no controle do câncer,mostrado aqui como problema de saúde pública no Brasil. São também expostas as principais iniciativas públicas para a alocação de aceleradores lineares a partir dos anos de 1990: o Projeto REFORSUS, O Programa de Reequipamento da Rede Assistencial Privada do SUS e o Projeto Expande. São identificados os fundamentos e os elementos que nortearam a execução dessas iniciativas. Os achados são utilizados para analisar se a política pública de saúde brasileira, a partir dos anos de 1990 atendeu às teses de focalização e simplificação assistencial contidas nas propostas do Banco Mundial de 1993. Essas teses incluíam a focalização das ações de saúde nos grupos sociais mais necessitados, a simplificação da assistência, com base numa cesta básica de serviços,e a busca da promoção do setor privado por meio da expansão dos seguros de saúde, num contexto em que a dívida externa brasileira levaria o país a submeter-se a fórmulas de ajuste fiscal impostas por organismos internacionais.
The availability of linear accelerator for cancer treatment in Brazil and the focalization and simplification thesis for the public system (called SUS). (Dissertation). Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca - Fundação Oswaldo Cruz, 2010. This work analyze the availability of linear accelerator for cancer treatment in Brazil from 2000 decade considered date from brazilian date bureau survey AMS/IBGE, from Brazilian Ministry of Health survey - CNES and brazilian nuclear energy bureau - CNEN. The geographical location of the equipment is described, especially on the major regions, availability to SUS and private health plans and the institutional nature of health establishments where they are installed and applied official sufficiency parameters. The technical bases for their use are described to show the importance of such equipment high complexity in cancer control, shown here as a public health problem in Brazil. They are also exposed the major public initiatives for the allocation of linear accelerators from years 1990: the Health Sector Reform Project - REFORSUS, the program Reequipamento da Rede Assistencial Privada do SUS and the program Expande, identified their fundamental principles and the elements that have guided its implementation. The findings are used for analyzing whether the Brazilian health policy from the years 1990 attend the focalization and assistive simplification, contained in the proposals of the World Bank in 1993. These theses included the focus of health assistance in the poorest social groups, and simplification of assistance, on the basis of a "basic" basket of services, and promotion of the private sector through the expansion of health insurance, in a context in which the brazilian external debt would lead the country to fiscal adjustment formulas.
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Pathak, Amit. "Forecasting Models to Predict EQ-5D Model Indicators for Population Health Improvement." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1480959312370497.
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Santos, Manuel Taveira da Fonseca Ferreira dos. "Analysis, investment and innovation programme in imaging equipment to improve healthcare diagnosis." Master's thesis, 2021. https://hdl.handle.net/10216/134295.
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Santos, Manuel Taveira da Fonseca Ferreira dos. "Analysis, investment and innovation programme in imaging equipment to improve healthcare diagnosis." Dissertação, 2021. https://hdl.handle.net/10216/134295.
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Van, Wyk Heila. "Interprofessional education programme to develop teamwork among undergraduate healthcare students during community fieldwork." Diss., 2016. http://hdl.handle.net/2263/53052.
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Interprofessional education (IPE) has been identified as a strategy to overcome some challenges healthcare is facing throughout the world. Different professionals with a variety of skills are required for comprehensive and cost-effective healthcare.
An IPE programme was developed for and implemented with the undergraduate final-year occupational therapy students, speech therapy students and physiotherapy students in a care centre in a community. The purpose of the IPE programme was to teach these healthcare students how to function effectively within an interprofessional team.
The main aim of the study was to determine the influence of the exposure to the IPE programme on the development of the final-year healthcare students as interprofessional team members. The aim was reached as the study indicated that the students exposure to the IPE programme improved their ability to function as interprofessional team members. The aim of the study is more clearly described through the objectives of the study. The objectives were answered by generating qualitative data and collecting quantitative data. A multi-method research design was therefore used.
Qualitative data of the final-year healthcare students expectations before the implementation of the IPE programme and the students experiences after the implementation of the IPE programme were generated by means of reflective essays. A clinical supervisor was also invited to complete a reflective essay about her experiences of the students interprofessional teamwork. The essays were thematically analysed and themes emerged from the data. The findings of the study indicated three main themes. The first theme was the outcomes of IPE as experienced by the students. The second theme identified an optimal environment for the facilitation of teamwork and the third theme identified certain attributes that team members need for effective teamwork. The second and third theme were identified as the elements that led to the outcomes described in theme one. The clinical supervisor s reflective essay was used to support the themes that emerged and not used as primary data. Quantitative data of the healthcare students experiences of the quality of teamwork were collected before and after the implementation of the IPE programme with the use of a summarised Teamwork Quality (TWQ) Scale. The scale is used to measure the quality of teamwork and consists of ten categories, namely communication, co-ordination, contribution, mutual support, effort, cohesion, effectiveness, efficiency, work satisfaction and learning. The two sets of quantitative data collected were compared by using the related-samples Wilcoxan signed rank test of the Statistical Package for Social Sciences (SPSS) for Windows, Version 23.0 Chicago: SPSS Inc. The results indicated an improvement in all ten categories with significant improvement in eight of the categories namely co-ordination, contribution, mutual support, effort, cohesion, effectiveness, efficiency and work satisfaction.
The researcher kept a reflective journal during the entire research process to clearly state her position in the process as she developed and implemented the IPE programme.
The study indicated that the students experienced the IPE programme as a means to improve their ability to function as interprofessional team members. The limitations of the study are mentioned in the last chapter. The researcher also made recommendations for IPE developers as well as similar future IPE researchDissertation (MOccTher)--University of Pretoria, 2016.
Occupational Therapy
MOccTher
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Ibarra, Kimberley. "Exploring Ethicists' Perspectives of Healthcare Ethics Program Effectiveness." Thesis, 2013. http://hdl.handle.net/1807/42964.
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Proliferation of ethics programs in healthcare organizations has occurred without rigorous evaluation. This qualitative study explored what makes an ethics program effective from the
perspective of 15 practising ethicists across Canada. Objectives were to: describe how practising ethicists define ethics program effectiveness, identify evaluation strategies, and identify critical
success factors.
Ethicists defined effectiveness as: 1) meeting standards; 2) making a difference; and 3) delivering value for investment. To evaluate, ethicists assessed: ethics program activity data, qualitative feedback, relevant accreditation results, peer review, and pre- and post- results. Ethicist competencies and attributes, organizational understanding of, and support for, the ethics program, and a community of practice were critical success factors.
Effectiveness emerged as a multi-dimensional concept. Findings provide a preliminary outline of what an ethics program evaluation framework might include and inform practice standard development, ethicist training programs, and organizational oversight for ethics programs.
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Reilly, Siobhan, C. McCabe, N. Marchevsky, M. Green, L. Davies, N. Ives, H. Plappert, et al. "Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme." 2001. http://hdl.handle.net/10454/18576.
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YesThere is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant reference no. RP-PG-0611-20004). Professors Siobhan Reilly, Richard Byng and Max Birchwood are partially supported by the NIHR Applied Research Collaboration (ARC) for North West Coast, Care South West Peninsula and West Midlands, respectively.
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Reilly, Siobhan T., C. McCabe, N. Marchevsky, M. Green, L. Davies, N. Ives, H. Plappert, et al. "Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme." 2021. http://hdl.handle.net/10454/18576.
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YesThere is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (grant reference no. RP-PG-0611-20004). Professors Siobhan Reilly, Richard Byng and Max Birchwood are partially supported by the NIHR Applied Research Collaboration (ARC) for North West Coast, Care South West Peninsula and West Midlands, respectively.
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Williams, Adri. "The 2010 PMTCT programme as implemented at community healthcare centres in the Limpopo province: a nursing perspective." Thesis, 2016. http://hdl.handle.net/10539/23165.
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A dissertation submitted to the faculty of health sciences, University of Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of master of science in nursing
Johannesburg, 2016MT2017
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Sykes, Chris. "Being a student nurse: role duality issues for healthcare assistants undertaking a work-based learning pre-registration nursing programme." Thesis, 2019. https://arro.anglia.ac.uk/id/eprint/705287/1/Sykes_2019.pdf.
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Introduction and background: Nursing shortages have resulted in an increased interest in work-based learning programmes supporting employed healthcare assistants (HCAs) to train simultaneously as student nurses. This requires them to fulfil concurrent roles of both HCA and student. Successful transition generally results from exiting one role and accepting another, therefore these HCA/students risk remaining in a no-mans-land between the two roles. This study explored the practice experiences of one cohort of students and mentors in relation to the students’ dual roles.
Methodology: The research was carried out using an exploratory sequential mixed methods approach, with a thematic literature review, qualitative interviews and a quantitative pilot evaluation of one intervention arising from the qualitative phase.
Findings: The dual roles of HCA and student nurse created a potential barrier to students’ professional socialisation. Their ability to transition to the student nurse role was impacted by the primacy of the HCA role, lack of role clarity and the perceptions of other team members which resulted in them being perceived as ‘HCAs doing extra’ rather than as student nurses. However, visual reinforcement, through artefacts such as uniform and by avoiding placing the students in their employed areas, was perceived as beneficial. Mentors did not identify such role duality issues for themselves. The introduction of a booklet was intended to reinforce the student role when appropriately applied.
Conclusions: This exploratory sequential mixed methods research supported the development of new knowledge through identification of the experiences of this student cohort. New theory was derived from the development of a revised professional socialisation transition process for this group of students, but further research is needed to identify the generalisability of this theory. Whilst the pilot evaluation of the booklet was impeded by a poor response rate, service colleagues still believe this to be beneficial and have continued to use it in practice. Further work is needed to embed the booklet in practice and further explore its efficacy.
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Lawal, Afeez Folorunsho. "Between policy and reality: a study of a community based health insurance programme in Kwara State Nigeria." Thesis, 2020. http://hdl.handle.net/10500/27847.
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Bibliography: leaves 268-317The challenge of accessing affordable healthcare services in the developing countries prompted the promotion of community-based health insurance (CBHI) as an effective alternative. CBHI has been implemented in many countries of the South over the last three decades for the purpose of improving access and attaining universal health coverage. However, the sudden stoppage of a CBHI programme in rural Nigeria raised a lot of concerns about the suitability of the health financing scheme. Thus, this thesis examines the stoppage of the CBHI programme in rural Kwara, Nigeria. Premised on the health policy triangle as a conceptual framework, mixed methods approach was adopted for data collection. This involved 12 focus group discussions, 22 in-depth interviews, 32 key informant interviews and 1,583 questionaires. The study participants were community members, community leaders, healthcare providers, policymakers, international partner, health maintenance organisation officials and a researcher. Findings revealed that transnational actors relied on various resources (e.g. fund and ‘expertise’) and formed alliances with local actors to drive the introduction of the programme. As such, the design and implementation of the policy were dominated by international actors. Despite the sustainability challenges faced by the programme, the study found that it benefitted some of the enrolled community members. Though, even at the subsidised amount, enrolment premium was still a challenge for many. The main reasons for the stoppage of the programme are a paucity of fund and poor management. The stoppage of the programme, however, signified a point of reversal in the relative achievements recorded by the CBHI scheme because community members have deserted the healthcare facilities due to high costs of care. In view of these, the thesis notes that short-term policies often lead to temporary outcomes and suggests the need to repurpose the role of the state by introducing a long-term comprehensive healthcare policy – based on the reality of the nation – to provide equitable healthcare services for the citizenry irrespective of their capacity to pay.
Sociology
D. Phil. (Sociology)
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Sousa, Oloiva Maria Tavira da Silva e. "Impacto da implementação do sistema de gestão da qualidade em unidades de saúde – estudo de caso numa unidade de saúde." Master's thesis, 2018. http://hdl.handle.net/10348/9143.
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Dissertação de Mestrado em Gestão de Serviços de Saúde apresentada à Universidade de Trás-os-Montes e Alto DouroOs serviços de saúde e os profissionais de saúde, para melhorar e garantir a qualidade dos serviços, precisam de ferramentas de gestão para atingir resultados satisfatórios. Assim, o presente trabalho teve como finalidade estudar a Impacto da Implementação do Sistema de Gestão da Qualidade (SGQ) na Unidade Local de Saúde do Nordeste (ULSNE), EPE, unidades hospitalares de Mirandela, Macedo de Cavaleiros e Bragança. A razão da escolha destas unidades teve como base o SGQ e no modelo de acreditação, i.e., o Caspe Healthcare Knowledge Systems (CHKS), implementado nas unidades de Mirandela no ano de 2003 até 2015 e nas unidades de Bragança e Macedo de Cavaleiros do ano de 2006 até ao ano de 2015. Também se escolheu este tema por ser atual e muito importante para o crescimento das organizações e profissionais de saúde. O estudo foi feito através de uma pesquisa exploratória, recorrendo a uma revisão de literatura e à aplicação de questionários adaptado à estrutura organizacional da ULSNE, EPE. E para entender o Impacto da Implementação do SGQ na ULSNE, aplicou-se a metodologia quantitativa e o software Statistical Package for the Social Science (SPSS) para tratamento dos dados. O estudo teve uma amostra de 100 questionários respondidos, representando 7,98% do total de colaboradores da ULSNE, EPE, i.e., 1 252 colaboradores. A falta de disponibilidade dos colaboradores é indicada como motivo da reduzida amostra. A amostra reduzida e o longo tempo de resposta aos questionários (cinco meses), são apontadas como limitações do estudo. Como proposta aos próximos estudos, sugere-se: i) a continuação da pesquisa deste tema com uma amostra maior; ii) estudar o mesmo tema com questionários direcionados aos clientes e não aos colaboradores; iii) o uso da pesquisa mista como futuras investigações; e iv) uso do tema para complemento de outros trabalhos científicos. Este trabalho contribui para o corpo de conhecimento da Gestão de Serviços de Saúde porque mostra, através da investigação científica, como a atitude dos profissionais contribui para o impacto da implementação do SGQ baseado no modelo de acreditação CHKS e como, na perspetiva dos colaboradores, o SGQ contribui para o reconhecimento social e político da organização, para os trabalhos dos profissionais de saúde, para o melhor cuidado aos doentes e para a satisfação do doente/cliente. E como principais resultados destacamos os seguintes: i) O impacto da implementação do SGQ na unidade de saúde; ii) a perspetiva e atitude face à qualidade e acreditação por parte dos colaboradores é positiva; iii) relativamente à relação entre a idade dos participantes e a Perspetiva e atitude face à qualidade e acreditação, verificou-se uma correlação mais positiva e significativa (r= .296 ; p≤.05); e iv) quando comparados os colaboradores do sexo feminino e do sexo masculino, relativamente à perspetiva e atitude face à qualidade e acreditação, verifica-se que não existem diferenças significativas em função do sexo. Desta forma, podemos concluir que a implementação do SGQ na ULSNE, EPE, resultou numa atitude e perspetiva positiva dos profissionais de saúde que trabalham nas organizações estudadas.
Health services and health professionals, to improve and ensure the quality of services, need management tools to achieve satisfactory results. Thus, the present study aimed to study the Impact of the Implementation of the Quality Management System (QMS) at the Local Health Unit of the Northeast (ULSNE), EPE, hospitals of Mirandela, Macedo de Cavaleiros and Bragança. The reason for choosing these units was based on the QMS and the accreditation model, ie, Caspe Healthcare Knowledge Systems (CHKS), implemented in the units of Mirandela in the year 2003 to 2015 and in the units of Bragança and Macedo de Cavaleiros of the year from 2006 to the year 2015. We also chose this theme as it is current and very important for the growth of health organizations and professionals. The study was done through an exploratory research, using a literature review and the application of questionnaires adapted to the organizational structure of ULSNE, EPE. And to understand the Impact of QMS Implementation at ULSNE, we applied the quantitative methodology and the Statistical Package for Social Science (SPSS) software for data processing. The study had a sample of 100 questionnaires answered, representing 7.98% of the total employees of ULSNE, EPE, i.e., 1,252 employees. The lack of availability of employees is indicated as the reason for the reduced sample. The reduced sample and the long questionnaire response time (five months) are indicated as limitations of the study. As proposed to the next studies, it is suggested: i) the continuation of the research of this theme with a larger sample; ii) to study the same subject with questionnaires addressed to customers and not to employees; iii) the use of mixed research as future research; and iv) use of the theme to complement other scientific works. This work contributes to Health Service Management's body of knowledge because it shows through scientific research how the attitude of professionals contributes to the impact of the implementation of the QMS based on the CHKS accreditation model and how, from the perspective of employees, the SGQ contributes to the social and political recognition of the organization, to the work of health professionals, to better patient care and patient / client satisfaction. The main results are: i) The impact of the implementation of the QMS in the health unit; ii) the perspective and attitude towards quality and accreditation by employees is positive; iii) with respect to the relationship between the participants' age and the Perspective and attitude towards quality and accreditation, a more positive and significant correlation was verified (r = .296; p≤.05); and (iv) when female and male employees are compared, with regard to the attitude and attitude towards quality and accreditation, it is verified that there are no significant differences according to sex. In this way, we can conclude that the implementation of the QMS in ULSNE, EPE, resulted in a positive attitude and perspective of health professionals working in the organizations studied.
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Duquette, Julie R. "Évaluation de l’impact des services en téléobstétrique du RUIS McGill offerts à une population de femmes inuites avec grossesse à risque élevé habitant sur la côte de la baie d’Hudson au Nunavik." Thèse, 2016. http://hdl.handle.net/1866/16285.
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L’accessibilité à des soins de santé pour une population habitant une région éloignée au Québec représente un défi de taille pour le Ministère de la santé et des services sociaux. Des solutions, telles que la télésanté, ont été présentées afin de pallier ce problème. Le RUIS McGill a ainsi développé un programme de téléobstétrique afin de desservir une population de femmes inuites à grossesse à risque élevé (GARE) habitant le Nunavik. L’objectif de ce mémoire fut de comprendre l’impact du service de téléobstétrique du RUIS McGill sur la santé des femmes et de leur nouveau-né ainsi que sur les coûts de santé et l’utilisation des services suite à son implantation au Centre de santé et de services sociaux Inuulitsivik sur la côte de la baie d’Hudson. Les femmes inuites à grossesse à risque élevé et leurs enfants de la région de la baie d’Hudson du Nunavik, éloignés des services obstétriques spécialisés, sont visés. Le service de téléobstétrique permet un accès aux obstétriciens du RUIS McGill localisés à Montréal. Un devis quasi-expérimental est utilisé pour examiner trois hypothèses portant sur l’état de santé des mères et des enfants, sur l’utilisation des services de santé et sur leurs coûts. Le service de téléobstétrique est devenu fonctionnel en 2006, offrant la possibilité de constituer une étude avant-après à deux groupes de femmes, soit celles ayant accouché avant 2006 (prétest) et celle ayant accouché après 2012 (post-test). La collecte de donnée se fit, dans son intégralité, par l’entremise des dossiers médicaux papier des participantes permettant l’analyse de 47 dossiers pour le prétest et de 81 dossiers pour le post-test. L’exécution d’analyse de covariance, de régression logistique et du test non paramétrique de Mann-Witney permit de conclure que le prétest et le post-test ne différent que sur deux variables, soient le poids à la naissance, plus faible dans le post-test et la pression artérielle de la mère à la naissance, plus élevée dans le post-test. Pour l’ensemble des autres variables portant sur les trois hypothèses à l’étude, les résultats de ce mémoire ne démontrent aucune différence significative entre les deux groupes démontrant ainsi qu’une même qualité de soins a été conservée suite à l’implantation du programme de téléobstétrique. Sur la base des résultats, ce mémoire recommande de revoir et modifier les objectifs du programme; de partager les bornes de communication de télésanté avec d’autres spécialités; d’entreprendre une évaluation du programme axée sur les coûts; de suivre rigoureusement l’utilisation du programme pour en maximiser l’efficacité et le potentiel; d’établir un tableau de bord; et d’entreprendre une étude évaluative comparative dans un service de téléobstétrique comparable.Health care accessibility to the population located in a remote region of Quebec represents a challenge for the Ministère de la santé et des services sociaux. Solution such as telemedicine has been used to mitigate this issue. Therefore RUIS McGill has developed a teleobstetric program helping Inuit women in Nunavik with their risky pregnancy. This thesis’s objective is to understand the impact of the RUIS McGill teleobstetric program on the mother and her new born health plus the cost and utilization of health services following its implementation in the Inuulitsivik Health & and Social Services Centre located on Hudson Bay Shore. Inuit women at high risk pregnancy and their children in the region of Nunavik's Hudson Bay, who are far away from specialist in obstetric, are targeted. The teleobstetric program provides access to the RUIS McGill obstetricians located in Montreal. A quasi- experimental design was used to examine three hypotheses about the mothers and their children health, the use of health services and their costs. The teleobstetric program became operational in 2006, providing the ability to be a before-after study with two groups of women, those who delivered before 2012 (pre-test) and those who delivered after 2006 (post-test). The data collection took place, in its entirety, through paper medical records of the participants allowing the analysis of 47 cases for the pre-test and 81 cases for the post-test. Variance and covariance’s analysis, logistical regression and the non-parametric Mann-Witney test has allowed to conclude that the pre-test and post-test are different for only two variables which is the weight at birth, lower in the post-test and for the blood pressure of the mother at birth, higher in the post-test. For all other variables based on the three hypothesis of this thesis, results show no significate difference between pre-test and post-test, illustrating that the same level of quality has been conserved after the implementation of the teleobstetric program. Based on results, this thesis recommends reviewing and modifying the program’s objectives; sharing telehealth communication terminals with other specialties; undertaking an assessment of the cost-based program; strictly monitor the use of the program to maximize efficiency and potential; establishing a dashboard; and undertaking a comparative evaluation study in a comparable teleobstetric service.
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Pereira, Cláudia Raquel Prata. "A importância da intervenção precoce em oncologia oral." Master's thesis, 2017. http://hdl.handle.net/10284/6522.
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Os cancros da cavidade oral e orofaringe constituem o sexto cancro mais comum em todo o mundo, com uma alta taxa de incidência e mortalidade, principalmente em países cujas populações vivem com baixos rendimentos. Os Médicos Dentistas desempenham um papel importante na prevenção do Cancro Oral, quer pelo incentivo à mudança dos estilos de vida, quer pela identificação de lesões da mucosa oral através do exame completo da cavidade oral. Os rastreios a nível populacional não têm sido incentivados, mas sim os “rastreios oportunista”, onde os pacientes recebem um exame para sinais de Cancro Oral ou de Lesões Potencialmente Malignas, mesmo que não tenham procurado a consulta para esse fim. O objetivo desta revisão bibliográfica foi estudar as estratégias e os programas de intervenção precoce do cancro oral através da consulta de artigos publicados nos últimos 5 anos.Oral and oropharyngeal cancers are the sixth most common cancers in the world, with a high incidence and mortality rate, especially in countries where populations live on low incomes. Dentists play an important role in the prevention of oral cancer, either by the goal of changing lifestyles or by identifying lesions of the oral mucosa through a thorough examination of the oral cavity. Screening at the population level has not been encouraged, but rather the “opportunistic screening”, where patients receive an examination for signs of Oral Cancer or Potentially Malignant Injuries, even if they have not sought the consultation for this purpose. The aim of this bibliographic revision was to study the strategies and programs of early intervention of oral cancer through the consultation of articles published in the last 5 years.