Retrenchment and Reform: The Politics of Medicare Under Labor, 1984–1996

Still Piecing It Together: Women's Primary Care

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

Health Policy In Two Nations: What A British Analyst Might Say

Food and nutrition education initiatives have been identified as a pivotal component of Primary Health Care (PHC) in addressing the escalating prevalence of non-communicable diseases (NCDs). The present integrative review sought to identify and analyse food and nutrition education activities that have been developed in the context of Brazilian PHC. The literature search was conducted in the BVS and SciELO databases using the following search terms: “Food and nutrition education” AND “Primary care” OR “Primary health care” OR “Basic care” OR “Basic health care”. The results revealed that most activities were focused on promoting healthy lifestyles through individual and group counseling, the development of educational groups grounded in theory and practice, and professional training initiatives. The vast majority of studies referred to actions taken in the city of Belo Horizonte, under the responsibility of students or teachers of the Federal University of Minas Gerais. This review highlights the critical role of health professional training in consolidating food and nutrition education efforts, as well as the importance of interdisciplinary teams in achieving effective outcomes. Moreover, the integration of graduate students into these actions has been identified as a valuable component, contributing both to the success of the initiatives and to the students’ professional development. These findings reinforce the relevance of structured and collaborative food and nutrition education strategies in the PHC setting and point to the need for their continued expansion and institutional support.

The Philippines' primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities' access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. Examining individual-, interpersonal-, institutional-, community-, and policy-level determinants that affect BHCs can inform community-based health promotion interventions for the country's underserved communities. Given the multidimensional barriers identified, a comprehensive program must be developed and implemented in collaboration with health care providers, community leaders, local and regional health care department representatives, and policy makers.

Improving access to basic health care is the linchpin in The Robert Wood Johnson Foundation’s (RWJF’s) grant-making strategy for the 1990s. This goal of assuring access to care for all Americans is one of three new program goals set forth last year by the f o u n d atio n’ s p r e s id en t, Steven A. Schroeder. To address the problem, the foundation has decided to zero in on what it sees as the three barriers to access: financing, supply and distribution, and organizational/ sociocultural factors. Schroeder’s objectives for the foundation regarding access are ambitious. “The first thing I’d like to see accomplished is that [access] become a major policy issue,” he said. To do so, he said, necessary ingredients are accurate data and well-focused programs. “More fundamentally, we have to try to help the nation come to grips [with the fact] that this is a problem that we can do something about,” he explained in an interview at his Princeton, New Jersey, office. The foundation’s leadership role is important, Schroeder believes. RWJF plans to focus on the uninsured, the underinsured, and the inadequacies of the public and private health insurance system. He wants RWJF to look at such national trends as how well Americans are achieving access to basic health care. RWJF Vice-President Ruby Heam, who has been on staff for sixteen years, chairs the foundation’s Access Goal Development Work Group. She said that this internal panel helps with program strategy and development and defined the main barriers to access that the foundation is addressing.

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

To Reach the Future, NPs Must Eliminate Obsolete Acute Care Rules

2005 APA Gold Award: Improving Treatment Engagement and Integrated Care of Veterans

There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced. Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration. Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care. Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health. Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care. Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.

UK aid—security, scrutiny, and the challenge of Afghanistan

The health and mental health systems in Quebec have recently been substantially transformed. At the heart of this restructuring, reforms aimed to strengthen primary care and to better integrate services, which are central trends internationally. This article summarizes Quebec's primary health and mental health reforms. It also presents the key role of general practitioners in the treatment of mental health disorders and their coordination strategies with the mental health care resources in the province. Numerous documents on the Quebec health and mental health reforms and the international literature on primary mental health care were consulted for this study. Information on general practitioner roles in mental health were based on administrative data from the Régie de l'assurance maladie du Québec (RAMQ) for all medical procedures performed in 2006. The data was compared with the results of a survey realized in the same year with 398 general practitioners in Quebec. Complementary qualitative data was collected through one hour interviews on a subsample of 60 of those general practitioners. The central aim of the Quebec healthcare reform was to improve services integration by implementing local healthcare networks. A population health approach and a hierarchical service provision were promoted. For a better access and continuity of care, family medicine groups and network clinics were also developed. The mental health reform (Action Plan in Mental Health, 2005-2010) was launched in this general context. It prioritized the consolidation of primary care and shared-care (i.e. increased networking between general practitioners and psychosocial workers and psychiatrists) by reinforcing the role of general practitioners in mental health, developing mental health interdisciplinary teams in primary care and adding a psychiatrist-respondent function in each Quebec local healthcare network. In mental health, general practitioners played a central role as the primary source of care and networking to other resources either primary or specialized health care services. Between 20-25% of visits to general practitioners are related to mental health problems. Nearly all general practitioners manage common mental disorders and believed themselves competent to do so; however, the reverse is true for the management of serious mental disorders. Mainly general practitioners practiced in silo without much relation with the mental health care resources. Numerous factors were found to influence the management of mental health problems: patients' profiles (e.g. the complexity of mental health problems, concomitant disorders), individual characteristics of the general practitioners (e.g. informal network, training); professional culture (e.g. formal clinical mechanisms), the institutional setting (e.g. multidisciplinary or not) and organizations of services (e.g. policies). Unfortunately, the Quebec health and mental health care reforms have not been fully implemented yet. Family medicine groups and networks clinics, primary mental health teams and psychiatrists-respondent are not optimally operational and therefore, are not having a significant outcome. Support mechanisms to help implement the reforms were not prioritized. Hindering factors should be identified and minimized to increase positive changes in the health and mental health systems. This article concludes on the importance of implementing continuums of care, especially local healthcare networks and best practices in mental health. Furthermore, strong strategies to support the implementation of changes should always accompany sweeping reforms.

This article analyzes the concepts of primary health care, basic health care, and family health care as used in official documents by the Brazilian Ministry of Health, final reports of the National Conferences on Health and Human Resources, the Basic Operational Ruling on Human Resources, and texts accessed on-line by BIREME. The data analysis, through double-entry matrices, showed a lack of these references in Brazilian health policy formulation and implementation. Basic Operational Ruling 96 (NOB/96) plays a distinct role in this regard; the national conference reports show an important gap in this debate, and most of the published articles present the concepts of primary care and basic care with the meaning of health unit or local service. Articles on the Family Health Program refer to it more as a program than a strategy, and the articles analyzing such concepts show the influence of rationalities underlying the different strategies for organization of health services in the Brazilian scenario, namely Health Surveillance and Programmatic Actions in Health and in Defense of Life.

To determine (a) which patients seek primary care services with a complaint of headache, (b) the percentages of the various types of headache in this population, and (c) the impact of the care provided to these patients on the basic health care network. Headache is one of the most frequent symptoms reported in medical practice, resulting in significant medical services costs and loss of patient productivity, as well as reduced quality of life. A prospective study was conducted in two towns (Ribeirão Preto and São Carlos) in the State of São Paulo, Brazil. The participants in the study consisted of 6006 patients (52.4% women) with highly varied acute symptoms. The patients ranged in age from 14 to 98 years. Headache as the main complaint was reported by 561 (9.3%) of the patients considered, with 312 (55.6%) of those patients presenting with primary headache, 221 (39.4%) with headaches secondary to systemic disorders, and 28 (5.0%) with headaches secondary to neurological disorders. Migraine, the most prevalent primary headache, accounted for 45.1% of patients reporting headache as the single symptom. The most frequent etiologies of headaches secondary to systemic disorders were fever, acute hypertension, and sinusitis. The most frequent headaches secondary to neurological disorders were posttraumatic headaches, headaches secondary to cervical disease, and expansive intracranial processes. Of the 26 cases of drug abuse, 20 were secondary to alcohol (hangover). Headaches secondary to systemic disorders were more frequent in the extreme age ranges. Headache is a very frequent symptom among patients seen at primary health care units and should be considered a public health problem. The dissemination of the diagnostic criteria of the International Headache Society among primary health care physicians is urgently needed in order to avoid the repeated return of patients or their referral to more differentiated emergency units, which overburden an already insufficient health care network.

Health Care Reform