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1
Hanna, Elizabeth Gayle (Liz), i lizhanna@netc net au. "Environmental health and primary health care: towards a new workforce model". La Trobe University. School of Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20061110.152550.
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Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals.
The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure.
A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys.
The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure.
The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.
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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.
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Thesis (Ph.D.) -- La Trobe University, 2005.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.
3
Boucher, Duane Eric. "An information privacy model for primary health care facilities". Thesis, University of Fort Hare, 2013. http://hdl.handle.net/10353/d1007181.
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The revolutionary migration within the health care sector towards the digitisation of medical records for convenience or compliance touches on many concerns with respect to ensuring the security of patient personally identifiable information (PII). Foremost of these is that a patient’s right to privacy is not violated. To this end, it is necessary that health care practitioners have a clear understanding of the various constructs of privacy in order to ensure privacy compliance is maintained. This research project focuses on an investigation of privacy from a multidisciplinary philosophical perspective to highlight the constructs of information privacy. These constructs together with a discussion focused on the confidentiality and accessibility of medical records results in the development of an artefact represented in the format of a model. The formulation of the model is accomplished by making use of the Design Science research guidelines for artefact development. Part of the process required that the artefact be refined through the use of an Expert Review Process. This involved an iterative (three phase) process which required (seven) experts from the fields of privacy, information security, and health care to respond to semi-structured questions administered with an interview guide. The data analysis process utilised the ISO/IEC 29100:2011(E) standard on privacy as a means to assign thematic codes to the responses, which were then analysed. The proposed information privacy model was discussed in relation to the compliance requirements of the South African Protection of Personal Information (PoPI) Bill of 2009 and their application in a primary health care facility. The proposed information privacy model provides a holistic view of privacy management that can residually be used to increase awareness associated with the compliance requirements of using patient PII.
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Mathews, J. R., J. H. Evans, Jodi Polaha i 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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Polaha, Jodi, Tim Bishop i Leigh Johnson. "A Collaborative Practice Model for Behavioral Health in Primary Care". Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6668.
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Funderburk, J., i Jodi Polaha. "The Primary Care Behavioral Health Model: Current State of the Evidence". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6656.
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Polaha, Jodi. "The Primary Care Behavioral Health Model: Current Evidence and Future Directions". Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6649.
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Roberts, Christopher. "Networked professional development : towards a model for primary care". Thesis, University of Sheffield, 2003. http://etheses.whiterose.ac.uk/14453/.
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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.
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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.
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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.Ph. D.
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Nassali, Musoke Maria G. "Health information access and use in rural Uganda : an interaction-value model". Thesis, University of Sheffield, 2001. http://etheses.whiterose.ac.uk/14829/.
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The study investigated the accessibility and use of health information within the lower echelons of Primary Health Care service delivery. Hence, it focused on women and health workers' experiences with information in rural Uganda. Face-to-face interviews were conducted using an interview schedule that consisted of open questions and one relating to health information critical incidents. The qualitative interviews added depth, detail and meaning at a very personal level of experience. A holistic inductive paradigm was used in the study with a grounded theory analysis. This approach was adopted because of its ability to generate findings inductively from empirical data. An 'Interaction-value model' emerged from the study. The model was driven by the value and impact of information unlike previous information models which have been driven by information needs. This study has demonstrated that although an information need could trigger off an information activity, the subsequent information process could only be sustained by the value of information. Hence, access and use of information depends on the value and impact of information to overcome or reduce constraints. The value of information is therefore the core category, while the moderation of constraints and interaction with sources for latent or apparent needs are the two main categories that make up the model. The study has also shown that not all information users are active seekers. The main difference between the two groups of interviewees was that health workers' needs were generally apparent and led to active information seeking, whereas the women's needs were generally latent. Women mainly accessed information passively. Passivity, however, was generally limited to the act of accessing information. After passive information access, the subsequent user behaviour was active. Hence, women passively accessed information, but actively used it. Women's information behaviour was therefore dynamic. This was confirmed throughout the study when, for example, their information needs changed from latent to active and vice versa. The difference in the findings appears to stem from the fact that for women, the process of information access and use was dependant on the relationship and interaction between their social and information environment in everyday life; while for the health workers, professional matters added a further dimension to their information activities. The ways in which women and health workers accessed and used information as elaborated in this study have a number of implications for improving information provision, policies, training of health workers, and further research.
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Alexander, Kathy. "Promoting health at the local level : a management and planning model for primary health care services /". Title page, contents and introduction only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09pha376.pdf.
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Subramaniam, Natasha Marie. "Addressing Human Papillomavirus Vaccination in Primary Care Pediatrics". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7434.
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Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. Despite most common transmission, HPV immunization in adolescents remains below target rates of 80% as outlined by Healthy People 2020 Objectives. Nearly all individuals will contract HPV during their lifetime. The purpose of this project was to educate providers on successfully promoting HPV immunization in adolescents utilizing evidence-based methods. The health belief model (HBM) was the theoretical underpinning utilized to teach providers on discussions about 9vHPV immunization with parents of adolescents. The practice focused question explored whether an education program using concepts from the HBM would increase provider perception of preparedness on recommending Gardasil 9 immunization in adolescents. Convenience sampling was utilized to recruit participants. There were 9 out of 25 providers that attended the educational in service with 8 completing the continuing education evaluation tool. Participants included providers who are affiliated and hold privileges with the health care system. Survey Monkey was used to analyze the participant evaluations. All the participants found the educational information relevant to increasing their perception of preparedness on recommending Gardasil 9 immunization in adolescents. The findings suggest that providers would benefit from training on recommending HPV immunization in adolescents. Continued training would help enhance timely immunization rates that could decrease cancer rates and reduce associated healthcare cost, in turn promoting population health and positive social change.
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Carron, Rebecca C. "Development of a nursing model for the implementation of spiritual care in adult primary health care settings". Laramie, Wyo. : University of Wyoming, 2006. http://proquest.umi.com/pqdweb?did=1246570031&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Mntambo, Ishmael Mbuso. "Development of the Public Health model of Community participation in the Kwazulu - Natal primary health care system". University of the Western Cape, 2017. http://hdl.handle.net/11394/5978.
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Philosophiae Doctor - PhD (School of Public Health)The purpose of this study was to develop the public health model of community participation for the KwaZulu-Natal primary health care system. The model is intended to improve the understanding of community participation and to explore its potential value in strengthening the facilitation of health promotion in the health facilities.
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Shafer, Joseph Aron. "Utilization and Intensity of Integrated Behavioral Health Services Within a Primary Care Setting". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2381.
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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.
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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/.
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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.
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Arsov, Svetoslav A. "Primary Care and Behavioral Health Services in a Federally Qualified Health Center". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6966.
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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.
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Rogers, Philippa. "Explanatory models of illness amongst primary health care users in Mamre". Master's thesis, University of Cape Town, 1992. http://hdl.handle.net/11427/13498.
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Includes bibliographical references.This study explores the illness experiences of twenty one patients who presented for treatment at primary health care settings in Mamre, a small "coloured" community approximately 50km from Cape Town, with the aim of investigating the possible contribution of psychological factors to presentation for primary health care. It also attempts to investigate how, psychologically, we may understand the process of illness identification and help-seeking. Selected literature on psychological issues in primary health care is reviewed. A hermeneutically-oriented medical anthropological approach to the study of illness and health care is outlined. The participants for the study were selected from all patients presenting at general practitioners in Mamre and for O.P.D treatment at Wesfleur hospital over a period of one week. A semi-structured interview, consisting mainly of open-ended questions aild focussing on their illness explanations, experiences of treatment, and their understanding and/or experience of "nerves", was conducted within ten days, in their own homes. The analysis of the interview material drew on both quantitative and qualitative methodologies. The quantitative analysis provides indications of the frequency of types of illness and patient responses to treatment. The qualitative analysis draws on Kleinman's (1980) explanatory model/ framework with the aim of understanding the illness experience of each participant. The participants' understanding and/or experience of nerves is also described. This study provides additional insights in understanding the process of illness identification r and help-seeking and the contribution of psychological issues in the presentation for , primary health care.
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Foster, Christopher A. "Electronic Health Record Implementation Strategies for Decreasing Healthcare Costs". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6426.
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Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment.
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Al, Ahbabi Abdulhadi A. "The evaluation and development of a model for primary health care in the United Arab Emirates". Thesis, University of Aberdeen, 2003. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU173912.
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The results of the literature review and survey show that tremendous changes have taken place in the United Arab Emirates both in its economic as well as in the provision of health care, since its independence in 1971. The country has extensive primary health care services that are easily accessible. The range of services provided includes health promotion, preventive, curative and maternity and child health services. However, the philosophy of primary health care is not generally accepted and the emphasis remains on providing a curative service and the use of high technology medicine. There are many other difficulties with the current system including a shortage of manpower; poor co-ordination between primary care and hospital based services; rising cost of health care provision; inadequate provision of health education programmes; inadequately or inappropriately resourced primary health centres; and the lack of reliable and good quality data on primary health care. Several recommendations are made: 1. Creating a task force dedicated to primary health care and involving all stakeholders in order to identify gaps and deficiencies, make recommendations for improvement and ensure that the recommendations are being implemented. 2. Emphasising the importance of primary health care in the overall provision of health care. 3. Establishing a correct balance and a better co-ordination between primary, secondary and tertiary levels of care. This should include an improvement in the referral and feedback system between primary care and hospitals. 4. Ensuring the establishment of an effective health education programme aimed at emphasising the value of primary health care, simple low-cost technology, health promotion and prevention services so minimising the dependence on the use of hospitals and high technology medicine. This should take into account the different cultural, religious and social backgrounds of both the expatriate community as well as local inhabitants. 5. Improving the provision of maternal child health care, screening, health promotion, prevention services and the availability of equipment, facilities and resources to enable primary care health professionals to carry out the assessment and management of most common and treatable conditions. 6. Producing doctors, nurses and other health professionals who will promote health for all people and meet the needs of the society they serve. This will require a greater collaboration and partnership between medical schools and the Ministry of Health. 7. Developing a system of continuing professional development with staff training programmes for health professionals, to ensure the maintenance of their competence. 8. Forming a professional organisation, such as a College or Institute of general practice, in order to identify the professional needs of general practitioners, to represent the specialty on professional matters and on all relevant medical decision making bodies, and to promote professional development at both national and international levels.
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Jackson, Kevin Lee. "Health Care Reform and the Transition from Volume to Quality Payment Models: A Primary Care Focus". ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/445.
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The 2010 Patient Protection and Affordable Care Act (PPACA) resulted in providers and health care organizations conforming to new payment models that connect reimbursement to patient outcomes. Primary care providers (PCPs) are tasked to provide new quality provisions as chronic disease management is a key focus to improve outcomes. The purpose of this study was to understand the transition to new payment models and determine whether care is improved. The conceptual framework is grounded in health care access models geared towards the improvement of quality outcomes including the chronic care model (CCM). The research questions were designed to understand providers' perspectives on new metrics to improve quality and the implications on practice workflows and patient outcomes. This phenomenological study consisted of interviews with 9 PCPs directly impacted by health care reform and the implementation of new quality metrics designed to improve patient outcomes. The study analyzed PCPs' perspectives on health care reform and the transition to new quality focused payment models and determined if quality is improved. Collection of data was designed to understand PCPs' challenges in alignment of their medical practices to newly defined provisions of quality expectations. Respondents reported concern with new payment models focused on quality outcomes and reported overall patient care had not improved as a result of alignment of quality initiatives to payment. The implications of positive social change will be an improved understanding of new models of payment intended to maximize reimbursement and address potential challenges with the implementation of quality metrics in order to effectively improve patient outcomes.
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Stapleton, Greta Krahn. "Serving primary caregivers of persons with Alzheimer's disease : an integrated service delivery model". PDXScholar, 1986. https://pdxscholar.library.pdx.edu/open_access_etds/3687.
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Alzheimer's disease (AD) is the most common form of nontreatable dementia, a syndrome which reflects a progressive and global impairment of memory, intellect, and other cognitive abilities. This devastating condition directly touches the lives of as many as 10 million Americans, including not only persons suffering from the disease but their primary caregivers and other family members as well. At present the course of AD cannot be halted or reversed, and no cure is known. The problem, then, is how to most effectively respond to the psychosocial needs of primary caregivers in order to help them provide the best possible care for a loved one with AD.
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Ebeid, Yasser. "The acceptability of the Family Health Model, that replaces Primary Health Care, as currently implemented in Wardan Village, Giza, Egypt". University of the Western Cape, 2016. http://hdl.handle.net/11394/5489.
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Magister Public Health - MPHIntroduction: Health Sector Reform was initiated as a component of the Structural Adjustment Policies that were imposed on the developing countries by the international monetary organizations such as the International Monetary Fund and the World Bank during the 1980s and the 1990s. It included three main components, that is, financing reforms, decentralization and introducing competition to the health sector. Changes to the Egyptian health system were introduced in the 1980s through the cost recovery projects, while the Health Sector Reform Program was announced in 1997. This culminated in a change from a Primary Health Care model to a Family Health Model as regards the Primary Health Care sector of the Egyptian health system. Changes in the health systems have profound effects on people, so that it is essential to study the ongoing transformation of the Egyptian health system and its implications. Aim: The aim of the current study was to determine the acceptability of the Family Health Model, which replaces Primary Health Care, as currently implemented in Wardan Village, Giza, Egypt. Methodology: The study was a cross sectional survey utilizing a structured questionnaire that was used to determine the awareness and perception/satisfaction of the community members in an Egyptian rural area (Wardan village, Giza Governorate) towards the transformation from primary health care to family health model. 357 subjects participated in this study. Results: Awareness of the study participants towards the transformation process was 15.6%. The overall satisfaction with the family health unit by the participants was 80.5% compared with 35.7% for the old PHC one. Higher satisfaction was associated with older age (p=0.02), less education (p<0.001), being married in the past or present (p=0.02), working status (p=0.007), and more years of using the unit (p<0.001). Acceptability of the family health model among the participants of the current study was high at 88.3%. Higher score of acceptability were associated with less education (p<0.001), being or have been married (p=0.048), and with working status (p=0.005). 93.8% of the participants think that family health unit services are accessible and 79.9% of the participants think that the family health unit provides quality services. Conclusion: The Family Health Model has achieved successes when implemented but encountered some difficulties that have limited the gains and interfered with some of its aspects. The current study has shown that the Family Health Unit has gained a high score of satisfaction and acceptability by the study participants, although the awareness of the study participants about the transformation of the Primary Health Care Model to a Family Health Model was low.
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Hunter, Christopher L., Jennifer S. Funderburk, Jodi Polaha, David Bauman, Jeffrey L. Goodie i Christine M. Hunter. "Primary Care Behavioral Health Model (PCBH) Research: Current State of the Science and a Call to Action". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6739.
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The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.
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Mayo-Bruinsma, Liesha. "Family-centered Care Delivery: Comparing Models of Primary Care Service Delivery in Ontario". Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19952.
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Family-centered care (FCC) focuses on considering the family in planning/implementing care and is associated with increased patient satisfaction. Little is known about factors that influence FCC. Using linear mixed modeling and Generalized Estimating Equations to analyze data from a cross-sectional survey of primary care practices in Ontario, this study sought to determine whether models of primary care service delivery differ in their provision of FCC and to identify characteristics of primary care practices associated with FCC.
Patient-reported scores of FCC were high, but did not differ significantly among primary care models. After accounting for patient characteristics, practice characteristics were not significantly associated with patient-reported FCC. Provider-reported scores of FCC were significantly higher in Community Health Centres than in Family Health Networks. Higher numbers of nurse practitioners and clinical services on site were associated with higher FCC scores but scores decreased as the number of family physicians at a site increased.
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Laws, Rachel Angela Centre for Primary Health Care & Equity Faculty of Medicine UNSW. "Putting prevention into practice: developing a theoretical model to help understand the lifestyle risk factor management practices of primary health care clinicians". Awarded by:University of New South Wales. Centre for Primary Health Care & Equity, 2010. http://handle.unsw.edu.au/1959.4/44828.
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Despite the effectiveness of brief lifestyle interventions delivered in primary health care (PHC), implementation in routine practice remains suboptimal. Previous research suggests that there are many barriers to PHC clinicians addressing lifestyle risk factors, however few studies have identified the importance of various factors and how they shape practices. This thesis aimed to develop and describe a theoretical model to explain the lifestyle risk factor management practices of PHC clinicians and to identify critical leverage points for intervention. The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in NSW, Australia, involving 48 PHC providers working outside of general practice. Grounded theory principles were used to inductively develop a model, involving three main stages of analysis: 1) an initial model was developed based on quantitative analysis of clinician survey and audit data, and qualitative analysis of a purposeful sample of participant interviews (n=18) and journal notes; 2) the model was then refined through additional qualitative analysis of participant interviews (n=30) and journal notes; and 3) the usefulness of the model was examined through a mixed methods and case study analysis. The model suggests that implementation of lifestyle risk factor management reflects clinicians??? beliefs about commitment and capacity. Commitment represents the priority placed on risk factor management and reflects beliefs about role congruence, client receptiveness and the likely impact of intervening. Capacity beliefs reflect clinician views about self efficacy, role support and the fit between risk factor management and ways of working. The model suggests that clinicians formulate different intervention expectations based on these beliefs and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians??? appraisal of the overall benefits and costs of addressing lifestyle issues acts to positively reinforce or to diminish their commitment to implementing these practices. The model extends previous research by outlining a process by which clinicians??? perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.
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Polaha, Jodi, Karen E. Schetzina, Katie Baker i Diana Morelen. "Adoption and Reach of Behavioral Health Services for Behavior Problems in Pediatric Primary Care". Digital Commons @ East Tennessee State University, 2018. https://doi.org/10.1037/fsh0000380.
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Introduction: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. Method: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. Results: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. Discussion: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes.
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Tolliver, Sarah, Sara Reed, Robert Matthew Tolliver, Jodi Polaha Jones i Karen E. Schetzina. "Assessing For and Treating Postpartum Depression in a Pediatric Primary Care Setting Using a Stepped-Care Model: Is It Feasible?" Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/5073.
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Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.
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Herman, Patricia, Sally Dodds, Melanie Logue, Ivo Abraham, Rick Rehfeld, Amy Grizzle, Terry Urbine, Randy Horwitz, Robert Crocker i Victoria Maizes. "IMPACT - Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model". BioMed Central, 2014. http://hdl.handle.net/10150/610366.
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BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.
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Aluko, Joel Ojo. "Quality of service analysis towards development of a model for primary-level maternity care in Ibadan, Nigeria". University of the Western Cape, 2016. http://hdl.handle.net/11394/4990.
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Philosophiae Doctor - PhDThe unacceptable high rate of maternal and neonatal deaths in Nigeria has been persistently unabated. Therefore, the present quality of maternal care evident by the magnitude of severe maternal/neonatal morbidity and mortality in this region makes designing of a model that will serve as a framework for provision of quality maternity care to women and their new-born a worthwhile study. The global report of deaths related to pregnancy and childbirth documented 600,000 maternal deaths annually. Developing countries, including Nigeria, have the highest burden of maternal and neonatal deaths resulting from complications related to pregnancy and childbirth. There has been no improvement in Nigeria as far as maternal and neonatal deaths are concerned. In Nigeria, the maternal mortality ratio in 2008 was recorded as 545/100,000 live births, and 576/100,000 live births in 2013. Women and children from low socioeconomic background are the vulnerable groups. The peculiarity of their vulnerability predisposes them to finding quicker and cheaper avenues to seek health care. The Primary Health Care (PHC) maternity facilities are to serve this large population of women and their babies at grassroots level. Few studies have been done to measure quality of antenatal and delivery care separately at higher level of care with resultant subjective findings and conclusions. Each of these aspects of maternity is a part of the whole and not the whole. Currently, there is gross dearth of literature regarding quality of maternity services at the disposal of the vulnerable women, who are likely to utilize the PHC facilities. The measurement of the quality of the existing maternity services at primary level is imperative for designing a more effective model capable of improving quality of services at this level. This study sought to develop a quality service improvement model for primary level-based maternity following rigorous analysis of the quality of its structure, the process and the outcome as proposed by Donabedian. The specific objectives of the study were to describe the status of infrastructures, equipment, instruments, medications; investigate the degree to which the services rendered are timely, appropriate, satisfactory and consistent with current professional knowledge; investigate the degree to which services rendered in the facilities are satisfactory to the women and uphold their basic reproductive rights; measure clients’ return rates for maternity-related services in the facilities; and to develop a validated model to guide provision of quality maternity care in PHC facilities. Using a theory-generating approach, the study was conducted in two distinct phases. The first phase focused on analysis of the existing maternity services at PHC level, while the second phase concentrate on model development. The first phase, which is an embedded mixed-methods approach, utilized validated clients’ questionnaire, health workers’ questionnaire, observation checklist, focused group discussions, and in-depth interviews for data collection. A multistage sampling method was used for sample size selection. Five local government areas (LGAs) in Ibadan were selected purposively. Similarly, all the facilities that offer maternity care in each LGA were purposively selected. Postnatal women, health workers in each facility, medical officers of health (MOHs) and heads of facilities were the participants in the study. A total of 755 postnatal women who participated in the surveys were recruited from the sample frames (attendance registers) using systematic random sampling. A validated structured questionnaire was utilized to elicit information on their experiences with their chosen places of antenatal and childbirth care from pregnancy to puerperium. Similarly, the 130 health workers who participated in the surveys were recruited from the sample frames (duty rosters) using systematic random sampling. A validated structured questionnaire was utilized to elicit information on their competences, attitudes and the midwifery practice in their respective facilities. In addition to the quantitative surveys, focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted for some postnatal women and four MOHs/heads of group of facilities. The participants for the FGDs and the IDIs were conveniently and purposively selected, respectively. FGD guide and IDI guide were used to guide the interviewers. The study was approved by the Faculty Board Research and Ethics Committees, the Senate Research Committee of University of the Western Cape and Oyo State Research Ethical Review Committee in Nigeria. Informed consent was obtained from each study participant. Autonomy, anonymity, and confidentiality of information provided by the participants were ensured. Nobody was coerced to participate in the study. The data collected with the aid of observation checklist and questionnaire from the selected PHC, health workers and client (postnatal women) were analyzed using descriptive statistics (frequency/percentage distributions); while association between variables of interest and difference in mean values were done using chi-square and t-test statistics, respectively. The second phase of the study focused on model development, and was done in line with a theory- generating research process in the literature supported by McKenna & Slevin, (2008) and Chinn& Kramer (2014). The developed model was tested for its appropriateness, adequacy, accuracy and whether it represents reality, for it to be assumed effective in achieving the goal if applied in midwifery practice at primary level.Client-participants were between 15 and 44 years; their mean age ± standard deviation was 28 ±5.3. The health workers were between 20 and 58 years; mean age ± standard deviation being 41 ±10. Out of the 730 client-participants, 92.1 % were married. None of the women had access to preconception counselling in any health facility. A total of 92.6 % of the women received prenatal care under the existing traditional model of antenatal care (ANC), out of which 22.6 %registered for ANC in two different facilities for various reasons. Although there was gross shortage of manpower in all the facilities, the percentage of nurses/midwives was fewer than that of the community health extension workers (CHEWs) and health assistants (HAs), while only one medical doctor was employed to cover all the different types of facilities in each local government area . There was a questionable staff level of competence reported in the study. Evidence of training in life-saving skill (LSS), post-abortion care (PAC) and safe motherhood was rare among the health worker participants. Among health workers who had witnessed vaginal laceration and those who claimed to have performed episiotomy on women, 30.2% and 32.6 % would depend on other health workers for repair of the vaginal traumas, respectively. Partograph was not in use for management of progress of labour by any health worker in any of the facilities. Both quantitative and qualitative data analysis showed evidences of abuse of women’s rights to timely, quality and respectful maternity care and risky practices by the health workers. The conditions of the buildings used for PHC centres and the beds were not satisfactory. There was gross inadequacy of essential and basic items needed to provide standard and quality care across all the facilities, while significant proportion of the available equipment/instruments were obsolete, dirty, rusty and faulty. The infection prevention and control practices were sub- standard. Inadequate funding by respective local government authorities was implicated for the poor conditions of infrastructures, equipment/instruments, staff recruitments and consequent shortage of manpower. Low level of patients’ satisfaction, evidenced by verbal expression, percentage difference between antenatal registration and childbirth record, immunization clinic visits and childbirth record in each facility, was reported. Therefore, fixing the deplorable and/or non-commodious building infrastructures to meet the required standard, provision of facilities and items needed for quality care and infection prevention, recruitment of skilled qualified health professionals, establishing a new Primary Health Board in the state to provide efficient funding and effective monitoring systems were recommended, based on the findings of the study. Lastly, the implementation of the newly developed model is strongly recommended in order to improve women’s and new-born’s health.
Centre for Teaching and Learning Scholarship, School of Nursing, University of the Western Cape
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Wener, Pamela. "Collaborating in the context of co-location: An interprofessional collaborative relationship building model". Taylor & Francis, 2013. http://hdl.handle.net/1993/31989.
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Background: Primary care providers, family physicians and nurse practitioners provide most mental health services in Canada. However, primary care providers lack knowledge, skills, and time to provide these services. Access to onsite mental health consultation or collaborative mental health care, affords primary care providers support to offer patients increased access to mental health services. Researchers suggest that interprofessional collaborative relationships are foundational to the success of collaborative mental health care. However, there is little understanding of how to build these relationships.
Purpose: The purpose of this grounded theory study was to develop an understanding of how primary care and mental health care providers collaborate to deliver mental health care in primary care settings.
Methods: Counsellors, family physicians, psychiatrists, nurse practitioners, and program leaders were recruited (N=40). Data were collected using individual (19) and focus group (7) semi-structured interviews. Interviews were audio recorded, transcribed and open coded. After open coding the first seven interviews, memos were written on each participant and focus group. These memos were sorted, compared to previous memos and then used to create a coding table. This iterative process of open coding, memo writing and then adding emergent codes to the coding table was repeated for all transcripts. Similar codes were grouped then collapsed to create the preliminary categories. Preliminary categories were sent to the participants after the primary care provider interviews and again after the provider focus groups to create the final categories. The final categories were compared to examine their relationships to one another.
Findings: The main finding of this study is a theoretical rendering of the participants’ experiences and ascribed meaning of interprofessional collaboration to deliver mental health services in primary care. Specifically, a collaborative relationship building model with four developmental stages: 1) Primary Care Providers Need for Collaboration, 2) Initiating Co-location, 3) Fitting-in, and 4) Growing Reciprocity is offered.
Conclusions: The findings underscore that collaborative care requires an understood need for collaboration, organizational support, contextually effective modes of communication, and a perception that collaboration improves patient care. Further research may explore the applicability of this model to other health care contexts.February 2017
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Laws, Lorre Ann. "Engagement of Primary Stakeholders to Tailor a Comprehensive Transitional Care Model for Persons Who Have Experienced a Stroke and Their Caregivers". Thesis, The University of Arizona, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10932335.
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Background: Stroke is the leading cause of disability in the US, affecting approximately 795,000 persons annually. Stroke care is delivered across multiple settings from hyperacute care in a hospital through chronic stroke management in the community. Considerable advancements have been made in the delivery of hyperacute and acute stroke care. Science and practice gaps exist in providing stroke transitional care across multiple providers and settings once an individual is discharged from an in-patient care facility to home.
Purpose: Using a qualitative descriptive design, this study engaged and elicited descriptions from stroke survivors and caregivers affected by stroke to inform the refinement and tailoring of a stroke-specific model of transitional care.
Sample: A purposeful sample of 19 individuals affected by stroke and their caregivers was required to attain data saturation. Participants provided rich descriptions regarding the postacute stroke transition from an inpatient care facility to home.
Methods: The investigator conducted five focus group discussions using a semi-structured interview format to elicit participant descriptions of their stroke transitional care experience. Interviews were audio-recorded, transcribed, organized using Atlas.ti 8.1 software, and analyzed using the content analysis method.
Findings: Stroke transitional care is generally not provided, and a host of unmet survivor and caregiver needs persist. The findings of this study inform stroke-specific exemplars for essential transitional care components. Stroke-specific findings emerged from the data that could not be explained in the context of the transitional care model, such as self-determination and self-efficacy, transportation challenges, and neuropsychiatric management. There is considerable healthcare system passivity in delivering postacute and transitional stroke care, leaving stroke survivors and their caregivers feeling abandoned and marginalized. The findings from this dissertation study and the literature inform refined, stroke-specific components and a stroke transitional care model.
Conclusion: This dissertation study is the first of its kind to engage primary stakeholders in developing stroke-specific refinements to and exemplars of stroke transitional care components. Study findings describe an urgent need for active stroke transitional care delivery, discusses stroke-specific exemplars of core transitional care components, and identifies refinements for a stroke transitional care model. The findings of this study are innovative in describing a community stroke nurse-led transitional care model that “reaches back” to the hospital. The unique findings from this study can inform a community-centric, stroke-specific transitional care model that aligns with the American Heart Association/American Stroke Association’s guidelines for adult stroke rehabilitation and recovery, from which community stroke nurse-led interventions can be developed and examined.
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Guy, Anne. "Exploring psychotherapists' experience of medical model thinking in the settings of primary care and private practice : a small scale study". Thesis, University of Roehampton, 2013. https://pure.roehampton.ac.uk/portal/en/studentthesis/exploring-psychotherapists-experience-of-medical-model-thinking-in-the-settings-of-primary-care-and-private-practice-–-a-small-scale-study(5b0c4aff-1dc5-4134-a6da-272be330963f).html.
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This small scale research study explores psychotherapists’ experience of medical model thinking on their practice delivered in the two separate settings of GP surgeries and private practice. The study’s key philosophical theme is the difference between modern and postmodern perspectives and how they might manifest themselves in social practices (such as medical interviews), knowledge creation and the practice of psychotherapy. The researcher locates the concepts key to the research in existing literature in terms of theory, research studies and their historical development – this latter being in support of the use of a Foucauldian discourse analytic method which is selected as that which best supports a social constructionist, postmodern approach to research. Parker’s method of using the research interview as a text-in-progress is explained and implemented, with eight participants being interviewed twice by the researcher. A discourse analytic framework which draws on defined theoretical resources was applied. The findings from the two part study show that for those participants working in primary care the GP/patient relationship has at least four key impacts on psychotherapy delivered in that setting and that for those working in a private setting it is through their relationships with individual GPs and psychiatrists that participants’ have constructed the biggest impact of medical model discourse on their practice and perhaps more importantly on their clients. Links are made to the literature reviewed concerning notions of the power of doctors and ideas for future research focused on the prevalence of ‘splitting’ in the UK are discussed. The researcher concludes with some thoughts about the fact that whilst the medical models’ invisibility and taken-for-granted nature for participants working within a primary care setting was more severe than expected, it was discursively constructed as having less of a wide-ranging impact on the participants in private practice. The importance of remaining awake to the influence of the medical model is discussed particularly during a cultural moment dominated by modernist approaches to notions of research and increasingly, practice.
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Brown, Rachel. "Organisational prerequisites to fund, implement and sustain Maori health promotion in a primary care setting". AUT University, 2010. http://hdl.handle.net/10292/938.
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Māori are the indigenous people of New Zealand. As a population group Māori have on average the poorest health status of any ethnic group in New Zealand (Ministry of Health, 2007). Much of this disproportionate ill-health is linked to manageable and/or preventable conditions. Given this, there is much scope for effective Māori health promotion in particular, as the Māori population is relatively young. The primary objective of the case study research was to determine the organisational pre-requisites necessary to fund, implement and sustain Māori health promotion within a primary care setting. Secondary aims were to; identify how health promotion is perceived within a ‘Māori’ primary health care setting, identify existing health promotion practice, and test the feasibility of implementing a current Māori health promotion framework. The case study research was informed by 19 key informant interviews and two focus group sessions. A literature review including an organisational document review was also undertaken. Findings indicated that many of the pre-requisites necessary for effective Māori health promotion implementation sat outside the scope of the organisation and needed to come from a variety of sources including the Ministry of Health, District Health Board’s (DHB’s), community organisations and health providers, whānau (family), hapū (sub tribe) and iwi (tribe), including support from other sectors. The research also found a number of underlying issues that impacted greatly on the health of the Māori population within the PHO. These issues need to be addressed at a number of levels and given high New Zealand priority. In testing the feasibility of a current Māori health promotion model (Kia Uruuru Mai a Hauora) it was considered by participants to fit well with the goals, principles and values of the case study site and within primary health care in general, complementing critical health care service delivery components that already exist. The study’s conclusion found that there was much scope for Māori health promotion that was fully supported, recognised, and adequately and appropriately resourced by the New Zealand Government, Ministry of Health and DHB’s in order to provide long term cost effective and sustainable health benefits.
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Anjara, Sabrina Gabrielle. "A study of two models of primary mental health care provisions in Yogyakarta, Indonesia". Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/289729.
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Background The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Despite its importance, mental health provisions are often limited. In 2015, Indonesia had only 773 psychiatrists for 250 million residents. This shortage of specialist mental health professionals is shared by most Low- and Middle-Income Countries (LMICs) and is reflected in the Treatment Gaps in this region indicating the very small proportion of people who receive adequate mental health care for their needs. While the median worldwide Treatment Gap for psychosis is 32.2% (Kohn et al., 2004), in Indonesia it is more than 90%. Experts suggested integrating mental health care into primary care, to help bridge this gap (Mendenhall et al., 2014). The systematic introduction of the World Health Organization Mental Health Gap Action Programme into primary care clinics across Indonesia and the presence of a 15-year-old co-location of Clinical Psychologists in Yogyakarta province's primary care clinics presented an opportunity to assess the clinical and cost-effectiveness of both frameworks. Methods This research ("the trial") set out to develop an approach, and then implement it, to compare the adapted WHO mhGAP framework with the existing specialist framework within primary mental health services in Yogyakarta, Indonesia, through a pragmatic, two-arm cluster randomised controlled non-inferiority trial. This design enabled an examination of patients derived from whole populations in a 'real world' setting. The trial involved two phases: a pilot study in June 2016 with the objectives to refine data collection procedures and to serve as a practice run for clinicians involved in the trial; as well as a substantive trial beginning in December 2016. The 12-item General Health Questionnaire (GHQ-12) was established as a 'fairly accurate' screening tool using a Receiver Operating Curve study. Using the GHQ scoring method of 0-0-1-1, a threshold of 1/2 was identified for use in clinical setting, i.e. the context of the trial. The primary outcome was the health and social functioning of participants as measured by the Health of the Nation Outcome Scale (HoNOS) and secondary outcomes were disability as measured by WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality of life as measured by European Quality of Life Scale (EQ‐5D-3L), and cost of intervention evaluated from a health services perspective, which aimed to determine the clinical effectiveness and cost-effectiveness of both frameworks at six months. Results During the recruitment period, 4944 adult primary care patients attended 27 participating primary care centres. Following screening (n=1484) and in-depth psychiatric interviews (n=394), 174 WHO mhGAP arm and 151 Specialist arm participants received a formal diagnosis and were recruited into the trial. The number of required participants per treatment arm, to provide statistical power of 0.80 and statistical bilateral significance value of 0.05 was estimated to be 96. A total of 153 participants of the WHO mhGAP arm and 141 of the Specialist arm were followed-up at six months, representing 90.8% of all participants diagnosed. At follow-up, 82% (n=126) participants of the WHO mhGAP arm indicated they had attended at least one treatment session during the trial, significantly more than in the Specialist Arm (69%; n=97), 2 = 7.364, p=0.007. The WHO mhGAP arm was proven to be statistically not inferior to the Specialist arm in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Cost-effectiveness analyses show that the Specialist arm was dominant for a unit of improvement in patient outcomes at six months. While the framework is more expensive for the Health System, participants in the Specialist arm were found to have larger improvements. Conclusion Given that both frameworks yielded positive patient outcomes, there is no immediate need to increase the absolute number of specialist mental health professionals in community psychiatry (i.e. replicate the specialist framework outside Yogyakarta). As most psychologists and psychiatrists in Indonesia reside in large cities, the current systematic roll-out of the adapted WHO mhGAP framework might address the need to strengthen non-stigmatising mental health care within community contexts, reflecting the preferences of primary care patients. In districts or provinces which could afford the additional cost, however, the Specialist framework was shown to be better at improving patient outcomes than the adapted WHO mhGAP framework. Existing resources for specialist care can be arranged in a hub-and-spoke (step-up care) model where higher-level interventions are provided for those with greater needs. The proposed model would free-up resources for advanced clinical training of the specialist workforce in key areas of need while keeping specialist services accessible. Trial Registration This trial has been registered with clinicaltrials.gov since 25 February 2016, NCT02700490. Ehical Standards Full ethics approval from the University of Cambridge, UK was received on 15 December 2015 (PRE.2015.108) and from Universitas Gadjah Mada, Indonesia on 14 April 2016 (1237/SD/PL.03.07/IV/2016). A condition of ethics approval from the University of Cambridge is that the investigator is covered by indemnity insurance and that participants are insured for the period of their participation. This was provided by the University of Cambridge Trial Insurance Office (609/M/C/1510). Ethics approval from all the clusters was not required as each cluster (Puskesmas) is a local GP surgery which does not have its own ethics committee. Instead, approval to conduct research at the province of Yogyakarta including all five districts: Kota Yogyakarta, Sleman, Gunung Kidul, Kulon Progo, Bantul Districts was obtained from the Provincial Government Office (070/REG/V/625/5/2016) following ethics approvals. Written consent to participate was obtained from clinicians taking part as well as all patient-participants.
36
Parekh, Nina Navita. "Towards a multi-view model of quality in primary health care : user involvement in the North West region of England". Thesis, University of Central Lancashire, 2005. http://clok.uclan.ac.uk/21993/.
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Issues about quality are paramount in the NHS. Part of this, is the Government's declaration of partnership at all levels with user involvement at its centre. Clinical Governance has been introduced as the mechanism to deliver quality, by encouraging professional accountability through one strategic direction. However some argue that this emphasis on clinical quality has been at the expense of users. In a management context, Garvin (1988) developed a model that consists of four views of quality. A strength of Garvin's model is that the user view is equally as important as other views. The first part of the study (M-Phil stage 1996-1999) aimed to investigate the context of the user view of quality by studying the user elements within each of Garvin's views. A taxonomy was developed using Garvin's four views of quality in order to classify the many different quality approaches and techniques in the literature. By classifying the literature in this manner, individual frameworks of quality were devised that could be used to assess approaches and techniques in any new quality models. In addition the taxonomy represented a new way of reviewing literature in this area. This coincided with the introduction of Clinical Governance within the National Health Service in 1997. The frameworks were used to assess to what extent this new development represented the four views of quality. The conclusion from this exploration was that the user view of quality remained under-represented despite the introduction of Clinical Governance. The empirical stage (PhD stage 1999-2003) aimed to investigate whether user involvement is under-represented in PCGs in the North West region of England. The major finding is that the level of user involvement is dynamic. Board members are willing to involve users in discussions and evaluation stages to a large extent compared to lower levels of involvement during priority setting and strategy formulation (key decision-making stages). The results therefore indicate that PCG Board members' interpretation of user involvement is markedly different to that of the Government. This research has contributed to the operational i sation of user involvement by providina: * The first investigation of the degree of development of user involvement agendas within the embryonic PCGs in the North West region of England; * An exploration of the extent that user involvement agendas coincide with other PCG agendas, particularly Clinical Governance; * An exploration of the views about user involvement of different professional groups represented on the PCG Boards. * The development of policy recommendations.
37
Moerane, Rebone. "The impact of training using a structured primary animal health care model on the skills of rural small scale farmers". Diss., University of Pretoria, 2013. http://hdl.handle.net/2263/40697.
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Primary animal health care (PAHC) programs are aimed at the provision of basic animal health
services at local level. No single approach has emerged as the one of choice. The aim of this
study was to evaluate the impact of training using the PAHC model developed by Afrivet
Training Service, on the skills of small scale rural farmers.
Seventy nine farmers were selected randomly from Makapanstad, Ratjiepane and Mnisi area
using a statistical software EpiCalc 2000 v1.02. The selected farmers were assessed for
knowledge and skills with background information collected prior to a 5 day training session.
Data was captured using Microsoft Excel and analysed using Stata 12.1. Means were
compared using participant’s t-test or ANOVA while the proportions were compared using
Fisher’s exact test. The statistical significance was assessed at p < 0.05.
The findings prior to training indicated that complete data was available for 77 participants, of
which the majority were adult males with age of mean±SD of 49±18.2 years. The average herd
size was 12±14.1 cattle. There was a significant involvement of youth and females at 31% and
32% respectively. The unemployment rate amongst participants was 91%. Farmers perceived
clinical services as being unaffordable. Most of the participants (79%) preferred to treat a sick
animal themselves or seek advice from the neighbouring farmers as compared to 21% who
approached a veterinary professional for assistance. Lack of knowledge, poor access to
products and poor communication between farmers and veterinary officials was identified. Post-training assessment indicated that farmers gained skills to observe, examine and treat;
implement preventative measures independently. There was a better understanding of the
farmers’ role in the provision of animal health care. There was no significant difference in overall
skill level between the various age groups, level of education and farming experience. There
were differences between the genders in the acquisition of specific skills during the training,
with females performing better in data recording while males were more skilled at determining
temperature using a thermometer.
The conclusion is that the training model used had a positive impact on the ability of the
participants to provide first-line animal health care and keep records. A modified, standardised
method to evaluate knowledge before and after training is proposed for future studies. Further
studies are also required to evaluate the impact of the training on animal health and production,
food security and socio-economic impact.Dissertation (MSc)--University of Pretoria, 2013.
gm2014
Production Animal Studies
unrestricted
38
Dominguez, Jr Arthur. "Decreasing Primary-Care-Related Emergency Department Visits in the Hispanic Population Using Patient Navigators". ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4616.
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Primary-care-related emergency department (PCR-ED) visits by Hispanic patients enrolled in a not-for-profit Medi-Cal and Medicare health plan resulted in longer wait times in the emergency department (ED) at a regional medical center in Southern California. This congestion decreased access for those with true emergencies, created capacity issues, increased ED length of stay, and resulted in potential safety risks. This project focused on decreasing PCR-ED visits in the Hispanic population using patient navigators in Southern California. Applying the health belief model and Lippitt's theory of change, this doctoral project involved the creation and implementation of a culturally appropriate, population-specific patient navigator model for the Hispanic population. Evaluation of outcomes was accomplished using electronic health record (EHR) results, which demonstrated a reduction of PCR-ED visits and revisits. The project exceeded the goal of 10% reduction in PCR-ED visits and revisits in the target population and resulted in a 14.31% reduction of PCR-ED visits and revisits within 1 month of implementation. Emergency Severity Index levels, wait time associated with each Emergency Severity Index level, and visits of the targeted Hispanic population enrolled in the health plan were analyzed to evaluate the success of the program. This project may lead to improvements in nursing practice and positive social change by supporting population health management and continuum of care to a primary care physician through safe and efficient patient navigation to treatment and care.
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Nwachuku, Ada Nwachuku. "Type 2 Diabetes Prevention and Management in a Primary Care Clinic Setting". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3314.
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Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.
40
Lloyd, Bridget. "Stakeholder perceptions of human resource requirements for health services based on primary health care and implemented through a national health insurance scheme". Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7813_1363786823.
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In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the
human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR
odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and
proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas)
researchers
academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo
s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category
has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical
health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.
41
Petersen, Rochelle Louisa. "Perceptions and expectations of patients regarding a new rehabilitation model to encompass the vision of the new health plan 2030". University of the Western Cape, 2017. http://hdl.handle.net/11394/6366.
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Masters of Science - Msc (Physiotherapy)People with disabilities face many challenges. Some are made to feel inferior by others because of their physical or mental disabilities. Primary healthcare described by the Alma Ata Declaration as "health for all", is a process of care which encompasses a comprehensive approach to meet the basic healthcare needs of all, including people with disabilities. The main focus of the primary healthcare approach is to put people at the centre of healthcare. Primary healthcare utilises rehabilitation as a service. Rehabilitation services worldwide are set to improve the standard that the United Nations Convention of the Rights of People with Disabilities and National Committee of Rights People with Disabilities aims to achieve. There are however, gaps in the delivery of healthcare services at a primary level, as identified by the Western Cape Department of Health in South Africa. The 2030 healthcare plan was developed to fill the gaps at this level of service. The plan builds on the comprehensive service plan of healthcare 2010 which aimed to strengthen community-based services, primary healthcare and district hospitals. The plan also looks at how the Department of Health will operate using this platform. The framework was established to focus on changes inclusive of threats in the environment such as technological advances and the availability of resources, building on lessons learned in the Comprehensive Service Plan 2010 as well as a reimagined future to improve healthcare services for all. Key stakeholders in the Western Cape aim to improve these health services by providing patientcentred care, moving towards a goal orientated outcome, improving services at a district health level, improvement of equity, affordable health services and establishing premeditated partnerships.
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Boyd, H. Glenn. "A model program for primary health care delivery in Ghana, West Africa, for the African Christian Hospitals Foundation (Churches of Christ)". Theological Research Exchange Network (TREN), 1988. http://www.tren.com.
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Chitnis, Ketan S. "Communication for Empowerment and Participatory Development: A Social Model of Health in Jamkhed, India". Ohio : Ohio University, 2005. http://www.ohiolink.edu/etd/view.cgi?ohiou1127144625.
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Mohammed, Ashraf. "Epidemiological study of Tuberculosis in Macassar camp". University of the Western Cape, 1995. http://hdl.handle.net/11394/8436.
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Magister Scientiae (Medical Bioscience) - MSc(MBS)The aim of this study was to determine and evaluate the prevalence of TB infection, active TB cases and the risk factors associated with TB infection in Macassar Camp in Macassar (about 40 km from Cape Town on the False Bay coast, with a population of 369). The study design of this epidemiological study was a cross sectional study with a descriptive and an analytic component A comparison between the Mantoux, TB ELISA and X-ray screening tests was performed first. A description of the origin, discovery, characteristics and pathology associated with Mycobacterium tuberculosis as well as the development of the TB epidemic on a global, national and local level, is given. TB was first described to give a South African perspective of the TB epidemic and both the "Virgin Soil" and "Non-Virgin Soil" theory of TB was reviewed. Secondly, ~he TB infection rate in Macassar Camp and the risk factors as well as the determinants of TB infection with regards to overcrowding, ventilation, primary food subsistence level rating (PFSL), social class and employment status were evaluated The third aspect of the study compares prevalence/incidence rates of TB to clinical diagnosis with regards to the symptomatology, radiographs, sputum microscopy, bacteriology and Mantoux test. Lastly the Mantoux test was compared with the TB ELISA test with regards to diagnosis of infection, in new and past confirmed TB cases. The first part of the survey involved the measurement of openable window area and the floor area of each Camp dwelling (to determine if ventilation was within required limits), during the administration of a household questionnaire which was designed to determine the number of occupants, rooms, income, food expenditure per household in the Camp. A personal questionnaire was administered to all Macassar Camp residents to elicit information on demography, knowledge and attitudes to TB, history of past TB, TB contacts, alcohol intake and smoking habits, occupation and BCG status. The Mantoux test were performed on consenting Camp residents in addition to the collection of 5 ml of blood for the TB ELISA tests. The Camp residents heights and weights were recorded prior to the miniature mass chest radiographs being taken. The 'TB suspects' sputa were collected for the microscopy and bacteriological examination. A review of the clinical records of TB patients in the Macassar/Stellenbosch area was also undertaken. The response rate to the household questionnaire was 60 from 63 (95,2%) dwelling units. Whereas the response rate to the personal questionnaire was 296 (80,2%). As for the Mantoux and TB ELISA tests the response rate was 209 (56,6%). Of the 60 dwelling units, 43 (71,7%) were calculated (according to . Batsons Index) to be crowded and 16 (26,7%) dwelling units had an overall ventilation of less than 5% (below the required regulation). There were significantly (p<0,005) more male than female smokers and only 78 (34,2%) of the residents regarded themselves as non-smokers. A similar trend was noted with regards to the alcohol intake of the residents, where only 86 (37,7%) regarded themselves as teetotallers, with significantly more (p=0,003) male than female alcohol consumers. Females sc6red significantly (p=0,002) better than the males with regards to TB knowledge and awareness. Only 199 (67,2%), residents indicated that they had had BeG vaccination. Of the 296 residents responding to the survey, there were 83 children aged 14 years or less. And only 74 of these children were confirmed to have been vaccinated with BeG, resulting in a 89,2% BeG coverage. Two (4,7%) of the 43 children aged 14 years or less were determined to be malnourished on the basis of Z-scores (below -2SD) taking into account height for age as well as weight for height.
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Michael, Le. "The Effects of Provincial Policies on Early Career Family Physicians’ Career Choices". Thesis, Université d'Ottawa / University of Ottawa, 2021. http://hdl.handle.net/10393/41861.
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Over the past decade, the healthcare landscape has shifted for Ontario’s family physicians as government policies changed the availability of practice and compensation models. The most impacted population are early career family physicians. Given this changing healthcare environment, the factors that drive early career family physicians practice choices are unclear and not well-studied. Therefore, this thesis sought to answer the following research questions:
1. What factors shape family physician choice of practice and compensation models in Ontario?
a. How do early career family physicians perceive the availability of practice and compensation models in Ontario?
2. From the perspective of Ontario family medicine residency administrators, how does residency influence family physician practice choices?
This study was a part of a broader, cross-provincial study examining family medicine resident and early career family physician practice patterns in British Columbia, Nova Scotia, and Ontario. Nineteen early career physicians and 7 family medicine residency administrators were interviewed for their perceptions and understanding of the factors and policies affecting their (or in the case of administrators, residents’) career choices.
In this thesis, I used thematic analysis as described by Braun and Clarke to answer the research questions. Patton and McMahon’s Systems Theory Framework (STF) provided a systems perspective that was used to model and assess the interactions between emergent themes.
The factors that shaped family physician choice of practice and compensation models were divided into micro- and macro-level factors as described by the STF. Micro-level factors were ‘gender’, ‘health’, ‘interests’, and ‘world of work knowledge.’ Macro-level factors included ‘educational institutions’, ‘geographical location’, ‘historical trends’, ‘peers’, ‘family’, ‘community groups’, ‘workplace’, and ‘employment market.’ Finally, two additional factors were found: ‘flexibility’, and ‘financial considerations.’ The interaction between these factors was complex, where many linked themes gave rise to career decisions made by family physicians. A second perspective in the form of residency administrators helped develop a holistic description of these factors. Furthermore, a gap between physician training and practice opportunities after graduation was identified.
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Assefa, Akinaw Solomon. "Exploring the implementation of the ‘model families’ approach as a strategy for diffusing desirable health practices in the community: the case of Yelmana-Denssa district, Ethiopia". University of Western Cape, 2013. http://hdl.handle.net/11394/3925.
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Magister Public Health - MPHEthiopia‟s health extension programme (HEP), which aims to improve access to and extend the coverage of health services in the country, makes use of the „model families‟ approach as a strategy for diffusing desirable health practices in the community. The approach, which emphasises prevention and health promotion, assumes that through training and accreditation „model families‟ will be able to set an example and encourage communities to embrace healthy lifestyles. However, the programme‟s implementation is not progressing at the pace originally envisaged. In addition, factors influencing the implementation of the „model families‟ approach have not, to date, been explored adequately. Thus, the aim of this study is to investigate the factors hindering or enabling the implementation of the „model families‟ approach as a strategy for improving primary health care (PHC) services in Yelmana-Denssa District (YDD).
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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation". eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/710.
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Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population.
In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands.
We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable.
We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models.
In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group.
In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).
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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation". eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/710.
Pełny tekst źródłaStreszczenie:
Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population.
In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands.
We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable.
We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models.
In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group.
In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).
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Jacob, Kuruthukulangara Sebastian. "A randomized controlled trial of the effect of patient education on explanatory models and common mental disorders in primary care". Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312815.
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Santos, Jacinta Maria Silva. "Alteração do paradigma da gestão dos cuidados à pessoa com infecção VIH : um modelo centrado nos cuidados de saúde primários". Master's thesis, Escola Nacional de Saúde Pública. Universidade Nova de Lisboa, 2011. http://hdl.handle.net/10362/6138.
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RESUMO - A infecção por VIH é reconhecida mundialmente como um problema de saúde
pública, apesar de todos os esforços e recursos despendidos e dos avanços científicos
conseguidos nos últimos anos.
Portugal, apesar do registo da diminuição de novos casos de infecção VIH,
encontra-se no 4.º lugar (dos países da União Europeia) em termos de incidência de
infecção por VIH (dados de 2008).
Esta situação, juntamente com a crescente constatação dos custos elevados
para o tratamento desta infecção, da variabilidade de práticas e a fragmentação dos
cuidados, motivou a reflexão sobre modelos alternativos de organização de cuidados,
inspirados em modelos de gestão da doença e idealmente centrados nos cuidados de
saúde primários.
O presente trabalho teve como objectivos analisar os modelos de organização de
cuidados prestados à pessoa com VIH, nos países desenvolvidos, a nível dos cuidados
de saúde primários e compreender o nível de adequação dos resultados encontrados,
para a realidade portuguesa.
Para os alcançar foi realizada uma revisão da literatura e a realização de
entrevistas a profissionais de saúde.
Nos artigos analisados na revisão da literatura, verificou-se consenso em torno
de um modelo baseado em cuidados partilhados, entre os prestadores primários e os
diferenciados. Foram ainda referenciados múltiplos factores e condições que terão de
ser assegurados para uma possível implementação do modelo.
Quanto aos entrevistados verificou-se uma opinião favorável em relação ao
modelo de cuidados partilhados, mostrando-se expectantes e despertos para a
necessidade de mudança, perspectivando uma maior integração do actual estado de
organização dos cuidados para a pessoa com VIH. Estes indícios reflectem a relevância
de maior investigação sobre o modelo de cuidados partilhados.ABSTRACT - HIV infection is recognized worldwide as a public health problem, despite all efforts and resources spent and scientific advances achieved in recent years. Portugal, despite the decrease in HIV new cases occurrences, is found in fourth place (on the EU countries) in terms of incidence of HIV infection (2008 data). This situation, combined with the growing knowledge of the high costs to treat the infection, and the variability of practices and fragmentation of care, led to the consideration of alternative models of care organization, inspired on disease management models and ideally focused on primary health care. The present work aims to analyse organizational models of care for HIV patients in developed countries, related with primary health care and understand the adequacy of the results for the Portuguese reality. To accomplish these goals, a literature review was performed as well as interviews to health professionals. In the articles review, the authors were consensual on a model based on shared care, between primary and specialized health care providers. It was referenced multiple factors and conditions that must be ensured for the model implementation. For the interviewed there was a favorable opinion towards the model of shared care, showing their expectation and awareness to the need for change, to a further integration of the current state of health care organization, for the person with HIV. These indications reflect the importance of additional research on the shared care model.