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1
Iveson, Claire. "From primary care to mental health services:." Thesis, University of Liverpool, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490634.
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2
Filipe, Luís Alexandre Coelho. "Estimating demand for primary health care services." Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9543.
Testo completoAbstract (sommario):
A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics<br>Primary health services exist with the purpose of providing basic health care to every person at a cost they can afford. But is it fully available to everyone? The objective of this work project is to estimate the demand for primary health care services having into account that in some regions the citizens are not using as much health care as they would like due to supply side constraints. Using the number of consultations as proxy for demand, and applying an econometric tool called switching regression, the demand for primary health care services will be estimated.
3
Poulton, Brenda Christine. "Effective multidisciplinary teamwork in primary health care." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339905.
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4
Jones, Roger Hugh. "Self care and primary care of dyspepsia." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241615.
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5
Dunkley-Hickin, Catherine. "Effects of primary care reform in Quebec on access to primary health care services." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123121.
Testo completoAbstract (sommario):
Primary health care reform has become an area of priority in health policy with a strong importance placed on interdisciplinary teams of health care professionals. Quebec's model, the groupes de médicine de famille (GMFs), were introduced late in 2002 emphasizing team-centered approaches to service delivery and aiming to improve access to primary health care, especially to improve after-hours access and to increase the number of Quebecers with a family doctor.A decade after their implementation, I investigated the impact of GMFs on various measures of access to primary health care and perceived remaining barriers. I emphasize potential access – i.e. measures that capture whether an individual has the ability to access needed health care including having a regular medical doctor.I used data from seven waves of the Canadian Community Health Survey to capture reported access to primary care and barriers to access. GMFs emerged at different rates in different health regions across Quebec allowing the construction of a GMF 'participation' measure using the share of primary care physicians practicing in GMFs in each health region and year. I employed a modified difference-in-difference analysis design that uses multivariate regression analysis to control for time trends in the outcomes, time-invariant differences between regions and individual-level covariates in an attempt to estimate the causal impact of GMF implementation on access to primary health care.I verified that pre-policy differences in terms of population and socioeconomic characteristics between regions with ultimately high vs. low rates of GMF participation are reasonable and remain fixed over time, making comparisons of these regions appropriate. Results suggest that rates of reported access have increased over time in most Quebec health regions. However, these measures of access vary across regions and some always report lower rates of access. Controlling for time trends, fixed differences between regions, and individual characteristics, reported access does not change significantly as GMF participation increases. Improved access to primary health care was one of the principal objectives of Quebec's primary care reform a decade ago. My findings suggest that increased GMF participation has not improved several important measures of access, and that additional policy measures may be necessary to increase potential access to primary health care.<br>La réforme des soins de santé de première ligne occupe une place prioritaire parmi les réformes de santé, notamment avec une grande importance accordée à des équipes interdisciplinaires de professionnels de santé. Le modèle choisi par Québec, les groupes de médecine de famille (GMFs), a été mis en place à la fin de 2002. Ce modèle met l'emphase sur des équipes interprofessionnelles et vise à augmenter le nombre de Québécois avec un médecin de famille, ainsi qu'à offrir une plus grande accessibilité des services de la première ligne, notamment hors les heures normales de travail. Une décennie après leur implantation, j'ai étudié l'impact des GMFs sur diverses mesures d'accès aux soins de santé de première ligne. Je mets l'emphase sur l'accès potentiel – c'est-à-dire les mesures permettant de déterminer si un individu a la possibilité d'accéder aux soins de santé nécessaires, y compris d'avoir un médecin régulier.J'ai utilisé des données de sept cycles de l'Étude sur la santé dans les collectivités canadiennes pour capturer l'accès déclaré aux soins de première ligne et obstacles à cet accès. Il existe une variation régionale dans l'implantation des GMFs à travers les différentes régions sociosanitaires du Québec, ce qui me permet de construire une mesure de participation aux GMFs constituée de la proportion des médecins de première ligne pratiquant en GMF par région sociosanitaire et par année. J'ai employé une analyse qui consiste de modèles de différence-dans-les-différences modifiées qui utilise une analyse de régression multivariée pour contrôler les tendances temporelles, les différences constantes entre les régions, et les covariables au niveau individuel, le but étant d'estimer l'effet causal de la mise en œuvre des GMFs sur l'accès aux soins de santé de première ligne.J'ai vérifié que les différences de caractéristiques populationnelles et socio-économiques dans la période pré-politique entre les régions ayant un taux élevé par rapport à celles ayant un faible taux de participation aux GMFs sont raisonnables et fixes au cours des années de mon étude, rendant ainsi toute comparaison de ces régions appropriées. Les résultats suggèrent que les taux d'accès déclarés ont augmenté au fil du temps dans la plupart des régions sociosanitaires du Québec. Toutefois, ces mesures d'accès varient selon les régions et certains signalent toujours des taux inférieurs d'accès. Contrôlant pour les tendances temporelles, les différences fixes entre les régions, et les caractéristiques individuelles, l'accès déclaré ne change pas de manière significative avec l'augmentation de la participation aux GMFs.Un meilleur accès aux soins de santé de première ligne constituait l'un des principaux objectifs explicites de la réforme des soins de santé de première ligne de 2002. Mes résultats suggèrent que l'augmentation de la participation aux GMFs n'a pas amélioré plusieurs mesures importantes d'accès. En conséquence, des politiques supplémentaires pourraient être nécessaires pour accroître l'accès potentiel aux soins de santé de première ligne.
6
Feder, Gene. "Traveller gypsies and primary health care in East London." Thesis, King's College London (University of London), 1994. https://kclpure.kcl.ac.uk/portal/en/theses/traveller-gypsies-and-primary-health-care-in-east-london(f8d67b0e-b690-487d-b033-f9eebc6e678b).html.
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7
Giuffrida, Antonio. "Essays on the organisation of primary health care services." Thesis, University of York, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313956.
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Nickson, Patricia Jane. "The implementation of primary health care in North Eastern Zaire." Thesis, University of Liverpool, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.291717.
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Rahman, Shams-Ur. "Location-allocation modelling for primary health care provision in Bangladesh." Thesis, University of Exeter, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.280652.
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Boardman, Helen Fiona. "Headache in primary care : epidemiology, management, and use of health care services." Thesis, Keele University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275244.
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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.
Testo completoAbstract (sommario):
Master of Public Health - MPH<br>Community health workers (CHWs) are integral to improve Primary health care (PHC)
coverage, utilising their unique skills within the community to make services accessible and
equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision
of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South
Africa, has set priorities and requirements for the provision of funding to Non-profit
organisations (NPOs) for forming coalitions with the Health Department to deliver various
aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are
underscored by a strong sense of intersectoral collaboration to work together to attain sufficient
and sustainable progress. Collaboration between CHWs and PHC facilities is important in
aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring
UHC
12
Snyman, J. S. "Effectiveness of the basic antenatal care package in primary health care clinics." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.
Testo completoAbstract (sommario):
Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.
13
Arsov, Svetoslav A. "Primary Care and Behavioral Health Services in a Federally Qualified Health Center." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6966.
Testo completoAbstract (sommario):
Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.
14
Smith, Felicity Julia. "The contribution of community pharmacists to primary health care in London." Thesis, Queen Mary, University of London, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389618.
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Oluyole, Alexander Bolarinwa. "Community involvement and needs assessment in primary health care in Nigeria." Thesis, Keele University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261479.
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Bowerman, Robert Lorne. "Evaluating and improving the accessibility of primary health care services." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq22192.pdf.
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Mathews, J. R., J. H. Evans, Jodi Polaha, and R. J. Valleley. "A New Model for Behavioral Health Services in Primary Care." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6616.
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18
Mayes, Nicola. "Patient and health care professional views of re-designing services in primary care." Thesis, University of Bath, 2011. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.547864.
Testo completoAbstract (sommario):
Background: Increased pressure, rising demand and cost constraints have driven a need for radical service re-design in the NHS. To deliver re-design objectives it is necessary to understand how they are perceived by service users and providers. Aim: To investigate the views of patients and health care professionals (HCP) on aspects of health policy and service re-design affecting primary care. Setting: Patients and HCPs from one geographical area in England. Method: Themes from phase one qualitative interviews were explored quantitatively using a questionnaire in phase two and a discrete choice experiment (DCE) in phase three. Factor analysis was used to explore HCP responses in phase two. In phase three the DCE was administered to explore patients‟ relative priorities of a range of attributes. Results: HCPs had concerns that the Quality Outcomes Framework (QOF) detracted from the patient‟s agenda and did not improve health outcomes. GPs felt continuity of care was important Monday through Friday but were not keen on its provision out of hours. Neither did they feel nurses could run chronic disease management clinics without a GP present. Patients felt continuity could be provided by different HCPs for different conditionsPatients stated continuity of care and consultation duration were the most important attributes in a primary care service. However, in the DCE they prioritised both being seen on the day and by a GP over longer appointments. Patient preference to be seen by a GP may reflect the low uptake of non-medical prescribing in the area. Conclusion: Continuity of care, while remarked as being important to both HCPs and patients, appears less important when weighted against other primary care service attributes. HCPs appear to want longer consultations whereas patients saw time as encompassing both the time to wait for an appointment and consultation length. For patients, the quality of the time with a HCP may be more important than its duration, additionally patients appear to want choice but not necessarily to choose.
19
Roberts, Christopher. "Networked professional development : towards a model for primary care." Thesis, University of Sheffield, 2003. http://etheses.whiterose.ac.uk/14453/.
Testo completoAbstract (sommario):
Background. Although research has been carried out within higher education circles little is known about any educational benefits that may result from primary care professionals engaging in networked learning and what strategies may be used to overcome barriers to effective learning. Aim. This research was undertaken to identify specific educational strategies which may inform educators wishing to support continuing professional development for healthcare professionals within communication and information technology. Method. A model of networked learning was developed from the literature and using the experience of working models elsewhere. The model was implemented and evaluated over two case studies, and further refined in a third. The evaluation methodology used action research collecting data from surveys, interviews, observer participation, electronic text generated bye-mail discussions, and project documents. Results. Healthcare professionals were able to usefully communicate over a prolonged period with colleagues about clinical and professional matters, developing a number of process skills; using e-mail, web and on-line database searching. Compared to face -to-face small group learning, the added benefit of using e-mail discussions supported by web based learning resources was being able to use the method at a place, pace and time of their own choosing whilst still remaining committed to a shared educational experience. GPs were able to use the educational material to put to-wards a portfolio (personal learning plan) for accreditation for PGEA. Specific roles for an on-line facilitator in addition to small group learning skills were identified. However networked learning is acknowledged to have many obstacles, eg access, using software, lack of support which will need to be overcome. Managing a learning environment for CPO for healthcare professionals involves an integration of the teaching and learning strategy of the host organisation with a networked learning environment. Conclusion. A networked learning environment has the potential of supporting continuing professional development and its assessment with portfolios. For individual participants much depends on there own learning style, what they feel is relevant to learn at the time and their own preferences for a learning format. Much needs to be done to provide the necessary supporting infrastructure and integration of provision across traditional divides within healthcare education. This research describes a number of recommendations, which can inform action by educational stakeholders interested in healthcare education.
20
Mitchell, Penelope Fay. "Mental health care roles and capacities of non-medical primary health and social care services : an organisational systems analysis /." Connect to thesis, 2007. http://eprints.unimelb.edu.au/archive/00003854.
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Baker, Robin Lynn. "Primary Care and Mental Health Integration in Coordinated Care Organizations." PDXScholar, 2017. https://pdxscholar.library.pdx.edu/open_access_etds/3616.
Testo completoAbstract (sommario):
The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings.
The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health?
Using a case study approach, this study drew upon qualitative methods to examine and identify the factors throughout the system, organizational, professional, and clinic levels that support CCO efforts to facilitate the integration of primary care and mental health. Fourteen primary interviews were conducted with executive and senior staff. In addition, eleven secondary interviews from a NIDA funded project as well as twenty-four key CCO documents from three CCOs were also included in this study.
The RMIC was successful in differentiating extent of CCO integration of primary care and mental health. Findings demonstrate that normative and functional enablers of integration were most prevalent at the system and organization level for integrating mental health into primary care for these three CCOs. However, there was variation in CCO involvement in the development of functional and normative enablers of integration at the professional and clinic levels. Normative and functional enablers of integration were limited at all of the RMIC levels for integrating primary care into community mental health settings across all three CCOs.
The Patient-Centered Primary Care Home model provided CCOs with an opportunity to develop functional and normative enablers of integration for integrating mental health in primary care settings. The lack of a fully developed model for integrating primary care services in community mental health settings serves as a barrier for reverse integration. An additional barrier is the instability of community mental health as compared to primary care; contributing factors include historically low wages and increased administrative burden. System wide conversations about where people are best served (i.e., primary care or community mental health) has yet to occur; yet these conversations may be critical for facilitating cross-collaboration and referral processes. Finally, work is needed to create and validate measures of integration for both primary care and community mental health settings. Overall findings confirm that integrating primary care and mental health is complex but that organizations can play an important role by ensuring the development of normative and functional enablers of integration at all levels of the system.
22
Vaughan, David James. "Acceptability of primary care a study of one community in Montana /." Thesis, Montana State University, 2007. http://etd.lib.montana.edu/etd/2007/vaughan/VaughanD0507.pdf.
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Umunna, Zeluwa Ifeoma. "Exploring the factors that contribute to poor utilization of primary health care services: a study of two primary health care clinics in Nasarawa State, Nigeria." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4536.
Testo completoAbstract (sommario):
Magister Public Health - MPH<br>Introduction: Nigeria operates a three tiered health care delivery system with a large percentage of health care delivery vested at the primary care level. There has been over the years a continued effort by the government to decentralize health care service thereby increasing the range of services provided at the primary care level. Despite all these efforts there is still low utilization of primary health care services. This study therefore seeks to explore the factors that may be responsible for poor utilization of primary health service in Nasarawa State, Nigeria using two primary health clinics in Lafia local government area as case studies. Methodology: The study was carried out using the qualitative research methodology primarily using two data collection methods, the focus group discussions and individual interviews. A total of sixty participants were sampled, these consisted of ten members of staff, twenty non facility users and thirty facility users. Thirty individual interviews were conducted and four focus group
discussions held with staff and facility users at the two clinics. Facility users were randomly selected as they attended the clinic on the data collection days and were invited to participate in the study. Every second patient attending the clinic was selected for the focus group discussion and every third person for the interviews. The staff participants were randomly selected based on their availability while non-facility users were selected using snowballing. Data was analyzed using thematic analysis method. Findings: Two major themes emerged following data analysis; these were perception and experiences of facility users and barriers to utilization of health services. Users had a good perception of the services they received and are reasonably satisfied but certain deficiencies in the health care systems compromised the quality of service. Several factors were however hindering the utilization of these services and these include mainly institutional factors such as lack of infrastructure, equipment and staffing constraints; household factors such as cost of service and responsibility of decision making and other factors such as stigmatization and beliefs. Conclusion: Facility users of these clinics seem to have an overall good impression of services at the clinics; however there are certain fundamental deficiencies that need to be urgently addressed to improve the care provided at these clinics as these constitute barriers to utilization. These deficiencies such as the absence of electricity and water, lack of basic work equipment and inappropriate staff composition need to be addressed by the local government health department to ensure utilization and improved quality of service.
24
Steward, Jocelyn Louise. "Development and testing of the Primary Care Homeless Organizational Assessment Tool (PC-HOAT) to evaluate primary care services for the homeless." Thesis, The University of Alabama at Birmingham, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3634634.
Testo completoAbstract (sommario):
<p> The purpose of this dissertation is to develop and test an organizational assessment tool that can used to evaluate primary care services for the homeless. The research evaluates the importance, feasibility, reliability, and validity of organizational processes and structures of primary care services for the homeless. The final product is the validated <i>Primary Care Homeless Organizational Assessment Tool </i>(PC-HOAT). This tool provides stakeholders with information regarding the organizational structures and processes associated with greater quality of primary care for the homeless. This tool will help managers better understand their organization's strengths and weaknesses, guide discussions regarding operations, and provide information to inform future strategies. </p><p> The researcher conducted a mixed-method study of key informants and organizations receiving federal health care for the homeless funding. The study used eight key informants to refine the initial PC-HOAT. The researcher distributed the final instrument through a web-based survey to determine reliability and validity of the PC-HOAT. Data analysis included descriptive statistics, factor analysis, and regression analysis. </p><p> The study yielded a 7-factor scale, 34-item tool focused on evaluation and delivery of primary care services, organizational structures relevant to effective delivery of care, and patient and family centeredness. In particular, the scale describing access and quality of care provided a positive statistical association with the proportion of patients with controlled hypertension. The study yielded results that provide a better understanding of the vital organizational characteristics that contribute most appropriately to the design of health care for the homeless organization.</p><p> Keywords: homeless, primary care, organizational assessment, reliability, validity, factor analysis</p>
25
Zainy, Zainy M. Ali. "Primary care health centres : exploring the interface between patients' overall satisfaction with the primary health care environment, environmental factors, and non-environmental factors: case study Arriyadah City, Saudi Arabia." Thesis, University of Strathclyde, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287913.
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Hepburn, Robert Cameron. "Environmental epidemiology in primary care using a geographic information system." Thesis, University of Aberdeen, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268876.
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27
Sundquist, Kristina. "Individual health, neighborhood characteristics, and allocation of primary health care resources /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-595-6/.
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Johansson, Birgitta. "Intensified primary health care for cancer patients : Utilisation of medical services." Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2000. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-512.
Testo completoAbstract (sommario):
<p>The aim of the present thesis is to evaluate the effects of an Intensified Primary Health Care (IPHC) intervention on GPs' and home care nurses' possibilities to monitor and support cancer patients, and on cancer patients utilisation of medical services. A further aim is to identify determinants of cancer patients' utilisation of such services. A total of 485 patients newly diagnosed with breast, colorectal, gastric or prostate cancer were randomised to the intervention or to a control group. The follow-up period was 24 months for all patients.</p><p>Patients randomised to the IPHC were referred to the home care nurse. The home care nurse and the GP received copies of the medical record each time the patient was discharged from hospital after a period of in-patient care, or had visited a specialist out-patient clinic. In addition to this, recurrent education and supervision in cancer care were arranged.</p><p>The IPHC resulted in a marked increase of home care nurse follow-up contacts. The majority of control patients (74%) reported no such contacts, while 89% of IPHC patients reported this. High age (=80 yr) was the strongest predictor within the IPHC group for reporting a continuing home care nurse contact. Furthermore, the IPHC increased GPs' knowledge about patients' disease and treatments, and appeared to facilitate their possibilities to support the patients. The IPHC reduced the utilisation of specialist care among elderly cancer patients. The number of days of hospitalisation for older patients (=70 yr) randomised to the IPHC were 393 less than for older control patients during the 3 first months after inclusion. Regression analyses defined diagnosis, extensive treatment, comorbidity, low functional status, pain and socio-economic factors as predictors of a high utilisation of medical services.</p>
29
Bhakta, Padma. "Gujarati Hindu carers : their experiences with primary health care nursing services." Thesis, University of Leicester, 2005. http://hdl.handle.net/2381/29509.
Testo completoAbstract (sommario):
A pragmatic qualitative approach located within the research tradition of retrospective accounts was adopted and the perspectives of different types of carers, caring at home were obtained. The views of primary health care nurses were sought to examine their perspectives of caring for minority ethnic carers and the views of health service managers sought to examine their views about how primary health care nurses provide support for carers. A total of 43 in-depth interviews were conducted. A fieldwork diary was kept throughout the study and the data were analysed using a framework approach. The findings identified that despite policy intentions that health services should meet carers' needs and emphasis on the need for partnership, there was little evidence of this. Rather, Gujarati Hindu carers were not supported because primary health care nurses adopted a restricted model of the `patient-centred' approach to caring and failed to fully involve carers in holistic assessment. This subsequently affected their ability to access information, overcome communication difficulties and their need for emotional support. The interviews with primary health care nurses confirmed carers' claims of being unsupported. Primary health care nurses focused their attention on patients and viewed carers' needs as secondary. Health service managers also endorsed this view. An explanatory model is developed. It shows that socio-economic factors, carers' general material disadvantage, lack of awareness about service provision, coupled with primary health care nurses' lack of recognition of the need for support, compounded further by institutional racism and structural issues in the health services all served to disadvantage carers.
30
Idzerda, Leanne. "Effective coverage of primary health care services for the Roma in Serbia." Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28673.
Testo completoAbstract (sommario):
Research Question: This research will assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so.
Background: The Canadian International Development Agency (CIDA), in partnership with the Serbian government and the Canadian Society for international Health, has prioritized equitable access to healthcare services for vulnerable populations in Serbia. As part of this larger initiative, the factors that affect access to primary care services for the Roma population will be analyzed in an attempt to determine if and how services can be improved.
Methodology: Disaggregated data was collected from three population groups in Serbia; the general population, the poorest quintile (not including the Roma), and the Roma population. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness, was used to structure the analysis.
Results: This research found that the Roma are disadvantaged across a range of equity dimensions. The Roma are less likely to be able to afford health services, or physically access primary care centers, and are more likely to be discriminated against by health workers.
31
White, Connie Mae. "Diabetes education guide for primary care providers in Montana." Montana State University, 2005. http://etd.lib.montana.edu/etd/2005/white/WhiteC0505.pdf.
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32
Li, Jun. "The use of child health computing systems in primary preventive care : an evaluation." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274686.
Testo completo
33
Sturt, Jacqueline Alys. "Implementation of self-efficacy theory into health promotion practice in primary health care : an action research approach." Thesis, Bucks New University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251328.
Testo completo
34
Dlatu, Ntandazo. "The integration of mental health care services into primary health care system at King Sabata Dalindyebo Municipality Clinics." Thesis, Walter Sisulu University, 2012. http://hdl.handle.net/11260/d1008290.
Testo completoAbstract (sommario):
Introduction: Primary Health care refers to care which is based on the needs of population. Mental health care provided within general primary care services is the first level of care within the formal health system. There is no research in King Sabata Dalindyebo, carried out on issues around integration of mental health with primary health care. The present study is initiated to overcome this gap. Aim of the study: The aim of the study was to investigate the level of knowledge, implementation and barriers of integrating mental health care services into primary health care system at King Sabata Dalindyebo clinics, in Mthatha region. Methods: This descriptive cross-sectional study was conducted at King Sabata Dalindyebo Clinics, between January 2010 and December 2011. A 10% random sample of all health professionals from King Sabata Dalindyebo was interviewed concerning their demographic characteristics, education/ qualifications, general and further training in psychiatry, awareness about Mental Health Care Act 17 of 2002 and mental health care services characteristic related to the integration of mental health care services into primary health care system. For data analysis, the means of continuous variables across 2 groups were compared using Student-t test. The proportions (%) of the categorical variable across 2 groups were compared using Chi-square test. Results: A total of 52 health professionals (40.4% males, 59.6 females, 59.6 married, 3 doctors, 49 nurses, mean age 36.9± 8 years range 23 years-52 years), were surveyed. The participants were characterized by low level of qualification in specialization, further training in psychiatry, and by very low awareness about Mental Health Care Act 17 of 2002. Furthermore, there was no implication of expects (Regional psychiatrist, psychologist, social worker) and co-ordination of mental health care services. Working in remote and disadvantaged area, health workers with lower education qualification, absence of a coordinator for mental health care services and absence of workshop on Mental Health Care Act 17 of 2002 were determinants of lower awareness about Mental Health Care Act 17 of 2002. However, there was a good to excellent framework for potential implementation of mental health care services into primary health care system. The government support in infrastructures, drugs availability, transport and equipment was evident. Patients were helped within abroad based ethical, human rights and psycho-social framework. Conclusion: There is a lack of improving human capacity for mental health in terms of continuous training in mental health issues, policies, organisation and development. Globally, the integration of mental health care service in King Sabata Dalindyebo is non-optimal.
35
Billmeyer, Tina W. "Evaluation of a behavioral health integration program in a rural primary care facility." Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=755.
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36
Baker, Jonathan B. "Examining Spatial Patterns of Primary Health Care Utilization in Southern Honduras." University of Cincinnati / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1123088497.
Testo completo
37
Shafer, Joseph Aron. "Utilization and Intensity of Integrated Behavioral Health Services Within a Primary Care Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2381.
Testo completoAbstract (sommario):
Integrated behavioral health care within primary care has become a popular style of health care delivery within the United States. However, individuals with a behavioral health concern face several barriers in using these services. The purpose of this quantitative study was to identify key factors accounting for individuals' utilization and intensity of behavioral health services. Andersen's behavioral model of health care use and the integrated theory of health behavior change served as the theoretical framework. It was hypothesized that gender, age, race, ethnicity, family size, payer type, poverty level, and certain preexisting medical conditions (obesity, diabetes, hypertension, and tobacco use) would determine behavioral health care utilization and intensity. A secondary data analysis of 315 individuals who used behavioral health services within primary care was performed; the study setting was at the Center for Health, Education, Medicine, and Dentistry, located in Lakewood, New Jersey. Among the individual variables examined, only a preexisting condition of hypertension reached statistical significance, showing that those individuals were more likely to attend multiple sessions, Ï?2 (1) = 5.77, p = .02. Payer type was also found to be predictive of behavioral health care intensity. Medicare recipients were more likely to attend multiple behavioral health care sessions (74%) than were Medicaid recipients (59%) and those who were uninsured (25%). By providing insights about the barriers faced by individuals, study findings may help patient advocates and health care professionals to provide individuals with better health care. This study has implications for positive social change, as study findings may assist the United States health care system in its shift toward an integrated behavioral health care style of health care delivery.
38
Horrocks, Susan. "Evaluation of health services in primary care and the community (1995-2008)." Thesis, University of the West of England, Bristol, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.522545.
Testo completo
39
Nteta, Thembi Pauline. "Accessibility and utilization of the primary health care services in Tshwane Region." Thesis, University of Limpopo (Medunsa Campus), 2009. http://hdl.handle.net/10386/237.
Testo completoAbstract (sommario):
Thesis (MPH)--University of Limpopo, 2009.<br>Background
Primary Health Care is a basic mechanism that brings healthcare as close as possible to the people. In South Africa, it is seen as a cost effective means of improving the health of the population. It is provided free of charge by the government. This service should be accessible to the population so as to meet the millennium health goals.
Aims
The aims and objectives of the study were:
• To investigate whether Primary Health Care services were accessible to the communities of Tshwane Region.
• To determine the utilization of the health care services in the three Community Health Care centres of Tshwane Region.
Methodology
Data were collected at the three Community Health Care centres of Tshwane Region using self-administered questionnaires. A document review of the Community Health Care centres records was conducted to investigate the utilization trends of services. Descriptive statistics were used. The analysis was based on the information that was elicited from the questionnaires that the people who utilize the Community Health Care centres of Tshwane Region provided. The extracted data emanating from the records from the three centres were also used.
Results
The study demonstrated that in terms of distance, the Community Health Care centres of Tshwane Region are accessible as most participants lived within 5km. They traveled 30 minutes or less to the clinic. The taxi and walking was the most common form used to access the clinic. The services were utilized with the Tuberculosis clinic being the most visited. Generally, people were satisfied with the service and their health needs are met.
Conclusion
The Community Health Care centres of Tshwane Region are accessible and utilized effectively.
Key words: Primary Health Care, accessibility, utilization.
40
Algaman, Abrahim Hamad. "TQM implementation in a health care setting : a case study of a Saudi Arabia National Guard primary care setting." Thesis, Manchester Metropolitan University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311074.
Testo completo
41
Dale, Jeremy. "Primary care in accident and emergency departments : the cost effectiveness and applicability of a new model of care." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://researchonline.lshtm.ac.uk/682264/.
Testo completoAbstract (sommario):
The thesis describes the development, research and evaluation of the applicability of a new model of care that involves GPs being employed on a sessional basis in A&E departments to treat patients attending with primary care needs. The main aim of the study was to research its cost and clinical effectiveness. A multi-faceted approach was taken to include consideration of patients' needs and preferences, professional concerns, organisational and structural issues within the health service, and planning and policy issues. Clinical, sociological, epidemiological, and economic perspectives are drawn upon, reflecting the context of the service development and to provide a firm base for discussion about the generalisability and applicability of the findings. The first two chapters provide a detailed review of the epidemiological, sociological, clinical, and organisational literature relating to the primary care/A&E interface. The incentives and disincentives that may act to increase or reduce demand and supply are explored, in addition to issues relating to the 'appropriateness' of demand, the organisational culture of A&E departments, and strategies used to curtail or cope with demand. The demand for primary care at A&E departments appears to cross national boundaries and hence, literature from other countries (particularly the USA) is included and its applicability to the UK considered. Relevant literature relating to the quality of A&E care, patient satisfaction, and the costing of care is also discussed. The main study was a prospective controlled trial that was conducted at King's College Hospital. This compared process variables, clinical outcome and costs of 'primary care' consultations performed by senior house officers (SHOs), registrars, and general practitioners working three-hour sessions in A&E. A new system of nurse triage was implemented to allow the prospective identification of patients presenting with primary care needs. A total of 27 SHOs, three registrars and one senior registrar were included, and the patient sample comprised 1702 patients seen by GPs, 2382 by SHOs, and 557 by registrars or the senior registrar. GPs were found to practice considerably less interventionist care than A&E medical staff, and the resource implications were substantial. The findings are discussed critically, and their applicability is considered drawing on empirical data from recent evaluations of A&E Primary Care Service developments in other parts of London. The policy and service implications of the study are considered and further research needs identified.
42
Hanna, Elizabeth Gayle. "Environmental health and primary health care : towards a new workforce model /." Access full text, 2005. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20061110.152550/index.html.
Testo completoAbstract (sommario):
Thesis (Ph.D.) -- La Trobe University, 2005.<br>Research. "A Thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy [to the] School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria". Includes bibliographical references (leaves 255-293). Also available via the World Wide Web.
43
Rahman, Syed Azizur. "Utilisation of primary health care services in rural Bangladesh : the population and provider perspectives." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682288/.
Testo completoAbstract (sommario):
This thesis is about the Utilisation of Maternal and Child Health Care Services (MCH) in Rural Bangladesh. Investigations have been made to identify the underlying causes of low use of the MCH services provided through the public sector health care facilities, which is a major concern for the government of Bangladesh. This thesis focuses on the factors that are affecting the use of MCH services both from population and provider perspectives. Socio-economic condition of people, their knowledge and attitudes towards the public sector health care services are considered as population factors, while different aspects of quality of public health services, access to the service facilities and provider's behaviour are explored as the providers' factors. Aims: The aim of this research was to provide policy recommendations for improving utilisation of the public health services at the primary health care level by redesigning more accessible, acceptable and quality health care services, especially for rural women and children. Scope: Maternal health services: antenatal care; tetanus vaccination; place of child delivery; and postnatal care are considered in this study. While two major killer diseases: diarrhoea and acute respiratory infections, and immunisation of children under five years of age are included as child health care services. Methods: A combination of qualitative and quantitative methods are used to collect data /information from 360 mothers, 28 formal and informal community leaders, 44 various types of health care providers and 22 public sector facilities in a rural area of Bangladesh. The World Health Organisation (WHO) recommended 30 cluster sampling method was used in sample design. Household survey, in-depth interview, informal and formal discussion, participant observation and document analysis have been carried out to obtain necessary information/data. Data analyses: The quantitative data have been analysed by using STATA and SPSS statistical computer programme, performing descriptive, bivariate and logistic regression analysis. The qualitative information has been analysed in a descriptive way. Results: The results show that the use of government health facilities: THC, FWC and VHCP is generally very low with an exception of the use of VHCP for TT vaccination to women and child immunisation. The use of VHCP is encouraging for the government policy makers and planners. THC is partially meeting the health care need of rural people and mainly serving the interest of people of relatively high socio-economic condition. FWC is the most unused health care facility at the rural areas of Bangladesh. The majority of people (86%) received health care from non - qualified health care providers. Among the socio-economic factors - family education and income were found to be significant both individually and jointly with the variations of use of MCH services. The majority of the sample population does not have knowledge about the MCH service availability and possessed negative attitudes towards the public sector MCH services. These are attributable to the under utilisation problem. Nine gaps have been identified between peoples' `reasonable expectation' and the `existing' MCH service delivery system. Peoples' involvement in the health service organisation at the thana and union level was found almost nil. However their involvement in the operation of VHCP was encouraging. Low (2-3 minutes) consultation time, lack of privacy in treatment, unregulated involvement of public sector provider in private practice, lack of accountability, supervision and improper behaviour of providers deteriorating the quality of services hence decreases the use of public sector facilities. Unavailability of drug was found to be the single most important reason that deters people from using public facilities. Difficulties in access to quality services were found to be a major problem than access to the service facilities. Conclusions: This thesis suggests that giving priority to improving the service qualities of the existing facilities rather than construction/development of additional facilities at PHC level. It also suggests the initiation of behaviour change programmes for public sector health care providers. Secondly an effective mechanism needs to be developed to ensure peoples' involvement in the management and operation of public health care facilities to enhance accountability of public sector provider to the population and reduce the gap between them. Initiatives could be taken to improve the quality of non-qualified health care providers, as they are the main source of health care for the majority of population. Finally, increasing the education level of rural population particularly for women could increase the use of health services.
44
Mangula, Anna Shemu. "Enhancing the utilization of primary mental health care services in Dodoma, Tanzania." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/6930.
Testo completoAbstract (sommario):
Thesis (MCur (Nursing Science))--University of Stellenbosch, 2010.<br>ENGLISH ABSTRACT: This research study aims at enhancing the utilisation of primary mental health care services in Dodoma, Tanzania. Primary health care (PHC) according to the Alma Ata conference 1948 is an essential part of the health care system for bringing health care closer to where people live and work, is people-centred, affordable and achieves better health outcomes, and is considered to contribute to communities’ social and economical development. PHC facilities in Tanzania are health centres and dispensaries, which are within five kilometres from where people live. In the 1980s’ countries integrated mental health into PHC to improve the mental health status of their people. To facilitate delivery of Primary Mental Health Care (PMHC), Tanzania has formulated a mental health policy and trained PHC workers on mental health. Despite of these efforts, people still go to referral hospitals for mental health care services. However, authors commented that “when comprehensive primary health is implemented fully” it will bring about security, safety and hope to people and therefore, they will continue to fend for health for all.
The main aim was to explore and describe why people go to referral hospitals instead of utilising PMHC services closer to them. A qualitative descriptive clinical ethnographic research design was employed to examine the mental health care-giving within the context of this research. Purposive non-probability sampling was utilised. Sample size was determined by the saturation. Data collection methods were in two phases. Phase one was participative observation on mental health care-giving in the Primary Health Care (PHC) facilities for a period of at least four weeks, and phase two was by use of an in-depth interview with family members at referral hospitals who had passed Primary Health Care facilities.
Data analysis was an open thematic coding. Trustworthiness of the research was established through credibility, dependability, conformability, triangulation and a thick description.
The findings of this research suggested that there is inadequate service delivery at PHC facilities, disrespect of patients and lack of knowledge on available services and on referral systems, which led to not utilising the available Primary Mental Health Care services. In conclusion the researcher expresses the recommendations of this research in the form of strategies.<br>AFRIKAANSE OPSOMMING: Hierdie navorsing is daarop gemik om die gebruik van primêre geestesgesondheidsorg dienste in Dodoma, Tanzanië te bevorder. Volgens die Alma Ata verklaring van 1948 is primêre gesondheid sorg (PGS) ʼn noodsaaklike deel van die gesondheidsorg stelsel ten einde gesondheidsorg nader na mense werkplek en tuistes te neem. PGS is persoons-gesentreerd, bekostigbaar en het beter gesondheids resultate, dit word aanvaar dat PGS bydra tot die sosiale en ekonomoiese ontwikkeling van gemeenskappe. PGS fasiliteite in Tanzanië is hoofsaaklik gesondheidsentra en apteke, wat binne ʼn radius van vyf kilometere vanaf mense se woninigs is. Gedurende die 1980’s het lande geestesgesondheid integreer in die PGS stelsel in ’n poging om die geestesgesondheidstatus van mense te verbeter. Ten einde die lewering van primêre geestesgesondheid sorg (PGGS) te verbeter het Tanzanië ʼn geestesgesondheidsbeleid geformuleer en primêre gesondheidsorg werkers opgelei in geestesgesondheidsorg. As omvattende primêre gesondheidsorg ten volle implementeer is sal dit bydra tot sekuriteit, veiligheid en hoop en mense sal aanhou veg vir ”gesondheid vir almal”.
Die hoofdoel van hierdie navorsingstudie was ʼn ondersoek en beskrywing ten opsigte van die redes waarom mense eerder verwysings hospitale as PGS fasiliteite nader aan hulle besoek. Die navorser het gebruik gemaak van ʼn kwalitatiewe, beskrywende kliniese etnografiese studie ten einde geestesgesondheidsorglewering te ondersoek binne die konteks van hierdie studie. Die navorser het doelgerigte nie-waarskynlikheids steekproefneming gebruik en die versadigingsvlak is bereik deur middel van data-saturasie. Data is tydens twee fases ingesamel. Fase een was gekenmerk deur deelnemende observasie ten opsigte van geestesgesondheidsorg lewering in ʼn PGS fassiliteite. Tydens fase twee het die navorser in-diepte onderhoude gevoer met famililede van die persoon wat eerder die verwysings hospitaal as PGS fasiliteit besoek het.
Data analise is gedoen deur tematiese, kwalitatiewe kodering te gebruik. Betroubaarheid van die navorsing is verkry deur middel van vertrouenswaardigheid, eerbaarheid, triangulasie en in-diepte beskrywing. Die bevindings van hierdie navorsings studie suggereer die teenwoordigheid van ondoeltreffende diens lewering by PGS fasiliteite, onrespekvolle hantering van pasiënte en gebrekkige kennis rondom die beskikbare dienste en verwyssings stelsel in plek, derhalwe maak pasiënte eerder gebruik van die verwysings hospitale.
Gevolglik beveel die navorser aan dat strategieë gebasseer op die resultate van hierdie navorsings geïmplementeer word.
45
Lynn, Nancy Bridger. "Correlates of attitudes toward behavioral health services among older primary care patients." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002881.
Testo completo
46
Al-Ribdi, Mohamed Saleh. "The geography of health care in Saudi Arabia : provision and use of primary health facilities in Al-Qassim region." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.280833.
Testo completo
47
Janicke, David Michael. "Children's Primary Health Care Services: A Social-Cognitive Model of Sustained High Use." Diss., Virginia Tech, 2001. http://hdl.handle.net/10919/37659.
Testo completoAbstract (sommario):
This study tested portions of a social-cognitive
model that explained the mechanisms involved in
the parent decision-making process that ultimately
drive and maintain children's health care use.
Eighty-seven primary caretakers of children ages
4 to 9 years completed measures of child health
and behavior, parental stress and functioning,
and social cognitive measures related to parenting
and health care use. Primary care use data over
the two-years prior to recruitment were collected
from primary care providers. Regression analysis
showed that social cognitive measures were
significant predictors of pediatric primary care
services. Specifically, parental stress interacted
with general parenting self-efficacy; parents with
high stress and high parenting self-efficacy were
more likely to use pediatric primary care
services. Self-efficacy for accessing physician
assistance and parental outcome expectations for
pediatric physician visits were positively related
to pediatric primary care use. These social
cognitive variables accounted for more variance
than variables traditionally included in health
care use research (i.e., child behavior,
parental distress, and parent health care use).
Best Subsets analysis resulted in an overall best
predictive model that accounted for 29.8% of the
variance in pediatric primary care use. In this
model, the interaction between parental stress
and general parenting self-efficacy was the best
predictor of use, accounting for 11.5% of the
variance in physician use. High internalizing
behavior scores, higher self-efficacy for
accessing physician assistance, use of medication,
and more parent health care visits were
associated with higher pediatric primary care
use in this overall model. While acknowledging
the role of child health and behavior, this study
extends the literature by demonstrating the
importance of considering parental perceptions
of burden, confidence, and ability to help
themselves and their family. Implications for
health care professionals and directions for
future research are discussed in light of these
finding.<br>Ph. D.
48
Chimezie, Raymond Ogu. "A Case Study of Primary Healthcare Services in Isu, Nigeria." Thesis, Walden University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3558764.
Testo completoAbstract (sommario):
<p> Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included that (a) healthcare is focused on children and pregnant women; (b) healthcare is largely ineffective because of insufficient funding, misguided leadership, poor system infrastructure, and facility neglect; (c) residents lack knowledge of and confidence in available primary healthcare services; (d) residents regularly use traditional healers even though these healers are not recognized by local government administrators; and (e) residents can be valuable participants in community-based research. The potential for positive social change includes improved communication between local government, residents, and traditional healers, and improved access to healthcare for residents.</p>
49
Holmqvist, Marika. "Addressing Alcohol : Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services." Doctoral thesis, Linköpings universitet, Socialmedicin och folkhälsovetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-16815.
Testo completoAbstract (sommario):
Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol. This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey. Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient. OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories. Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy. MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.
50
Al, Magrabi Katibah Saad Aldean. "Geographical aspects of health and use of primary health care services in Jeddah, Saudi Arabia." Thesis, University of Strathclyde, 2001. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21426.
Testo completoAbstract (sommario):
This thesis examines the contribution that geographical analysis can make to the study of the variation in the patterns of human health and subsequently to the discussion on the type and level of use of the public health service in a rapidly developing country. The current study was conducted in Jeddah Governorate, Kingdom of Saudi Arabia during the period 1994 and 2000. One of the main aims was to examine the pattern of health services provided in Saudi Arabia and this aim was achieved by investigating the provision and use of the Public Healthcare services. An attempt was made to clarify the complex web of relations that existed between, on the one hand, the different socioeconomic and geographic factors and on the other, the distribution of common ailments together with the level of utilization of health services. Shortcomings in the nature of the official health statistics regarding socioeconomic conditions of the patients were remedied through the use of a questionnaire. A tot al of 1000 patients from the eight PHCCs were surveyed for their use of the public health service. Data was collected from the same patients on their socio-economic, education and habitation details. This sample was used to supplement the data collected from the official government health statistics. These two data sets permitted an evaluation of the occurrence of different ailments and the variations in geographic distribution among the eight selected PHCCs. Difficulties persisted in the availability of official 1992 census data until publication of census data became available in 1999. In contrast to the problems of the census data, the availability of accurate and up-to-date patient records compiled by Ministry of Health staff was of considerable benefit to this research project. Use was made of Geographic Information Systems software for the analysis of data collected at the level of the PHCC. This allowed visual identification of the spatial variation in the use of the different health services and also allowed the identification of gaps in healthcare provision. The study showed that a density of habitation index used as a prime indicator of socio-economic status could be used as an indicator of the occurrence level for a number of common diseases. A pattern of disease was observed that suggested that the number of visits to PHCCs was substantially higher in low socio-economic districts compared to medium and higher socio-economic districts. It can be shown that the most common ailment was Upper Respiratory Tract Infections followed by Dental and Gingival diseases. Persons aged between 15 and 44 years made most visits to PHCCs although children under 15 years made proportionately greater use of PHCC facilities. No difference could be found between Saudi and Non Saudi as regards the occurrence of the most common ailments and diseases. The lack of difference was probably due to the close integration of the two population groups and the sharing of the same local environment. This similarity occurred despite considerable differences in income levels and socio-economic status. The level of utilisation of health centers in the selected districts showed differences, being higher in those districts categorized as low socio-economic in the south of Jeddah when compared to higher socio-economic districts in the north of the city. It was evident that the difference in socio-economic factors had an impact on the occurrence of some frequently occurring diseases e.g. URI, Dental, Ophthalmic, musculoskeletal and skin diseases. Although not primarily concerned with private health care facilities, for completeness sake some information was collected on the use of private health care in conjunction with public health care facilities. The author was surprised to discover that greatest use of private facilities occurred among women and children patients from Al Nuzla al Yamaneyyah and Al Thaalebah, districts that were characterised by low socio-economic conditions. The use of traditional folk healing was also briefly studied as this form of treatment remains important for some patients. Results showed that there was no difference between the educational standards of patients and their use of traditional folk healers. Again, children and women constituted the majority (86.6%) of users of traditonal healing with Saudi users (18.9%) higher than non Saudi (11.4%). There remains the supposition that alternative medicine may be of far greater importance than the sparse official data suggests. The unquantified illegal immigrant population may be totally reliant on unofficially operating alternative medicine centres. The thesis concludes by recommending a number of improvements to the existing public health care system. Some changes in the policy and practice of PHCC services will inevitably require more financial resources. These include an extension of the opening times of PHCCs and an increase in the number of specialist facilities such as dental surgeries. Other changes may not require more finances. These include a strengthening of communication and co-operation between PHCCs and hospitals to improve the referral of patients. Expansion of the existing computer network connecting PHCCs with hospitals should be given high priority.