Basic Care Services Research Articles

Job Characteristics and Consequences of Service Manger Engagement at Basic Care Services for Older Adults Living Alone

Job Characteristics and Consequences of Service Manger Engagement at Basic Care Services for Older Adults Living Alone

A Study of Specialized Personnel System for long-term Care Insurance in Korea

Korea is expected to have a steady increase in the number of elderly people who are in need of care and special care such as dementia and stroke, as the number of aging population is increased. Therefore, to stabilize supply and demand of long-term care professionals and to improve the quality of long-term care services, it is imperative that measures are taken to train long-term care professionals and diversify the care personnel system. The purpose of this study is to propose a new qualification system for securing the expertise of long-term care professionals and young long-term care professionals in Korea. This study examines both Korean and German case studies on long-term care professionals, including related literatures, regulations and statistical data. It examines the situation of long-term care professionals and their education system in Korea, and also explores the system of long-term care worker and their training system in Germany. For the training of professional care personnel, it is necessary to classify long-term care worker into care worker manager as professional workforce and care worker. Care worker manager get national certifications when they successfully complete a care curriculum at college or university where professional education is available. For this purpose, long-term care-related curriculum for social worker, health and nurse care is opened. Their main tasks include the provisions of basic long-term care services as well as care service guidance for care worker, case managements and counseling support. The introduction of a professional care worker training system enables the provision of high-quality services through the acquisition of long-term care professionalism. They are required for the increasingly diverse and complex long-term care. Also, the divisions of long-term care tasks can help relieve the burden of long-term care workers and improve their treatment of labor. This specialization of the long-term care services can also contribute solving the current aging problem of the care workers by expanding the participation opportunity of the young people, and improving their negative images and treatments.

Brazilian National Registry of Healthcare Establishments as a tool for the analysis of decentralization of tuberculosis treatment to basic care services

This study aimed to validate a method for classification of healthcare services in Brazil (basic care vs. other levels) and describe the decentralization of tuberculosis (TB) care to basic services (2002 to 2016). The healthcare services that reported and followed TB cases were classified as either "basic care" or "other levels" based on the type of establishment registered in the Brazilian National Registry of Healthcare Establishments (CNES, in Portuguese). The study estimated the agreement between this classification with a previous classification performed in 2013 by Brazil's state and local tuberculosis programs. Using the CNES registry, the authors then calculated the percentage of TB patients treated in basic care from 2002 to 2016. Agreement was 94.4%, and overall kappa index was 0.86. There was a relative increment of 31.2% in TB care provided by basic services (from 50.9% in 2002 to 66.8% in 2016). All regions of Brazil showed an increase in this percentage, except the South. The classification based on the CNES registry allowed analyzing the trend in decentralization of TB treatment to basic healthcare services in Brazil.

Commonweal of the medical and health services in China: a multi-perspective review

Through analyzing documents of healthcare departments, this paper explored the public benefit nature of the medical and health sector from such aspects as culture, philosophy, management, ethics, economy, politics and society. Furthermore, it analyzed the commonweal in the healthcare reform documents, including the commonweal in public health and medical services, basic medical care and health services, public hospitals and medical and health services. Public hospitals were cited as examples for an in-depth review of the profound connotation of commonweal in the medical and healthcare sector. Key words: Medical and health service; Commonweal; Multi-perspective; Connotation; Review

Cognitive Function and Related Factors of the Elderly in Urban Area: With Focus on Those Who Receive Basic Care Services for the Elderly

본 연구는 일부 도시 지역 재가노인의 인지기능에 영향을 미치는 요인을 관련변수인 식습관, 일상생활수행능력, 음주를 중심으로 확인하기 위한 서술적 조사 연구이다. 연구 대상자는 D지역의 노인돌봄기본서비스를 받고 있는 재가노인 165명이다. 자료수집 기간은 2017년 3월 2일부터 2017년 5월 8일까지였다. 변수간의 관계는 Pearson s 상관계수(Pearson s correlation coefficient)를 이용하여 분석하였으며, 인지기능에 영향을 미치는 요인은 연령, 학력, 관련변수인 식습관, 일상생활수행능력, 음주를 독립변수로 하여 단계적 다중회귀분석(stepwise multiple regression)으로 분석하였다. 연구 결과 대상자의 인지기능은 평균 24.23점(30점 만점)으로 높았으며, 84.5%가 정상범위였다. 대상자의 인지기능과 일상생활수행능력 간에는 양의 관계가 있었고, 인지기능과 음주는 음의관계가 있었다. 인지기능을 예측할 수 있는 변인은 연령, 학력 및 일상생활수행능력 이었고, 이들 변인은 인지기능의 31.5%를 설명하였다. 따라서 도시지역 노인의 인지기능을 유지하고 향상시키기 위해서 인지기능에 대한 주기적 평가와 관리가 요구된다. 또한 지역사회보건의료기관인 보건소, 복지관 중심으로 인지기능향상 활동에 일상생활수행능력을 포함시켜야 한다.This study aims to identify the relationship among eating habits, ADL, CAGE and cognitive function of elderly people in an urban area. 165 people over 65 years in D area were interviewed from March 2nd to May 8th, 2017. The outcomes were measured by the Korean version mini mental state examination instrument (MMSE-K), activity of daily living (ADL), and cut down, annoyed, guilty, eye-opener (CAGE). Data were analyzed using Pearson correlation coefficients and stepwise multiple regression. Cognitive function score of the subjects was 24.23, and 84.5% of them were within normal range. There was a positive correlation between cognitive function and ADL, but a negative correlation between cognitive function and CAGE. Age, education level, and ADL were identified as the predictors of cognitive function, which explained 31.5% of the total variance of cognitive function. For the preparation of intervention programs for elderly people in urban areas, Age, educational level, and ADL. should be considered. Furthermore, the programs for health improvement activities should be developed to maintain and increase current cognitive function.

An Analysis of the Moderating Effect of Hope on the Relationship between Social Support and Psychological Well-being Among Older Adults Living Alone with Basic Care Services

An Analysis of the Moderating Effect of Hope on the Relationship between Social Support and Psychological Well-being Among Older Adults Living Alone with Basic Care Services

Perceptions of Health Care and Access to Preventive Services Among Young Adults.

The enactment of the Affordable Care Act increased the emphasis on health promotion and disease prevention by making preventive care accessible for many Americans, especially young adults, who could remain on their parents or legal guardians' health insurance until the age of 26. Yet, many Americans receive only half of the recommended preventive care services, which highlight the need for the improvement of health promotion and prevention services. The aim of this study was to assess the relationship among access to health care insurance, perceptions about health insurance, and use of preventive care services among young adults. Nine hundred and forty-six participants ages 19-34 completed a 40 question web-based survey. Data analysis suggested that while the majority of participants had health insurance, there were significant differences in opinions about the ACA, health insurance, and use of preventive services by gender, education level, and health insurance status. Overall, participants with health insurance were more likely to have received at least three of the basic preventive care services; however, most of them were not getting the preventive care as recommended. Results reaffirm the need for further studies on the impact of health insurance among young adults and the need for the emphasis on health promotion to educate young adults about the importance of disease prevention and preventive services.

A decade of progress providing safe abortion services in Ethiopia: results of national assessments in 2008 and 2014

BackgroundEthiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia.MethodsThis paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis.ResultsThere has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased.ConclusionTen years after the change in abortion law, service availability and quality has increased, but access to lifesaving comprehensive care still falls short of recommended levels.

A cluster randomized trial of a primary palliative care intervention (CONNECT) for patients with advanced cancer: Protocol and key design considerations

BackgroundThe addition of specialty palliative care to standard oncology care improves outcomes for patients with advanced cancer and their caregivers, but many lack access to specialty care services. Primary palliative care—meaning basic palliative care services provided by clinicians who are not palliative care specialists—is an alternative approach that has not been rigorously evaluated. MethodsA cluster randomized, controlled trial of the CONNECT (Care management by Oncology Nurses to address supportive care needs) intervention, an oncology nurse-led care management approach to providing primary palliative care for patients with advanced cancer and their family caregivers, is currently underway at 16 oncology practices in Western Pennsylvania. Existing oncology nurses are trained to provide symptom management and emotional support, engage patients and families in advance care planning, and coordinate appropriate care using evidence-based care management strategies. The trial will assess the impact of CONNECT versus standard oncology care on patient quality of life (primary outcome), symptom burden, and mood; caregiver burden and mood; and healthcare resource use. DiscussionThis trial addresses the need for more accessible models of palliative care by evaluating an intervention led by oncology nurses that can be widely disseminated in community oncology settings. The design confronts potential biases in palliative care research by randomizing at the practice level to avoid contamination, enrolling patients prior to informing them of group allocation, and conducting blinded outcome assessments. By collecting patient, caregiver, and healthcare utilization outcomes, the trial will enable understanding of the full range of a primary palliative care intervention's impact.

Determinants of Malaria Prevention and Treatment Seeking Behaviours of Pregnant Undergraduates Resident in University Hostels, South-East Nigeria.

This cross-sectional descriptive survey investigated determinants of malaria prevention and treatment seeking behaviours of pregnant undergraduates resident in university hostels, South-East Nigeria. Purposive sampling was used to enrol 121 accessible and consenting undergraduates with self-revealed and noticeable pregnancy residing in twenty-three female hostels of four university campuses in Enugu State, Nigeria. Structured interview guide developed based on reviewed literature and WHO-recommended malaria prevention and treatment measures was used to collect students' self-report data on malaria preventive health behaviours, sick role behaviours, and clinic use using mixed methods. The WHO-recommended malaria prevention measures were sparingly used. Some believed that pregnancy does not play any role in a woman's reaction to malaria infection. Only 41 (50.6%) visited a hospital for screening and treatment. Thirty-four (28.1%) used antimalaria medicine bought from chemist shop or over-the-counter medicines, while 33 (27.3%) used untreated net. The students were more likely to complete their antimalaria medicine when they were sick with malaria infection than for prevention (p = 0.0186). Knowledge, academic schedule, cultural influence on perception and decision-making, and accessibility of health facility were key determinants of the women's preventive and treatment seeking behaviours. Health education on malaria prevention and dangers of drug abuse should form part of orientation lectures for all freshmen. University health centres should be upgraded to provide basic antenatal care services.

Assessing facility readiness to offer basic emergency obstetrics and neonatal care (BEmONC) services in health care facilities of west Pokot county, Kenya

Assessing facility readiness to offer basic emergency obstetrics and neonatal care (BEmONC) services in health care facilities of west Pokot county, Kenya

Children's Health in Brazil: orienting basic network to Primary Health Care.

This is an integrative literature review that analyzed the scientific knowledge produced on the orientation of Brazilian basic care services to primary health care focusing on child health. Searches were carried out in SciELO, Lilacs and Medline databases using descriptors "primary health care", "family health program", "child health" and "evaluation of health services". Studies published in Portuguese, English and Spanish between 2000 and 2013 were selected. A total of 32 studies were chosen and characterized in relation to the features of primary health care, region of the country, type of study and authors' practice area. A thematic review of studies was conducted and resulted in two categories: child care in the context of Brazilian primary health care and primary health care features: limitations to child care. It can be understood that Brazilian primary health care services are heterogeneous regarding the presence and scope of essential child care characteristics. There is a lack of structural and process changes in the services to substantially plan child care actions in basic care.

Analysis of Basic Emergency Obstetric and Neonatal Care (PONED) Services in Baso Public Health Center, Indonesia: Recommendations from Qualitative Interviews

One of the main indicators of the health status of a country is the Maternal Mortality Rate (MMR). In order to improve the MMR in Indonesia, the government has made a number of primary health centers (PHC) capable of providing basic obstetric and neonatal emergency care (PONED) services. The aim of this research is to learn how well PONED services have been implemented at the Baso PHC in Agam Regency as of 2015. We used a qualitative approach, with in-depth interviews and observations from June-August 2015. Ten respondents participated in the in-depth interviews, and observations were made about the infrastructure. The validity of the data is based on the standard of credibility, transferability, dependability, and confirmability of the content of the interviews. The analysis shows that there are still some obstacles in PONED PHC implementation, including the lack of human resources at the PHC and insufficient facilities, funding, and oversight, which causes many cases that should be handled by a PONED team to be referred to the hospital. Suggestions are provided to help improve policies and ultimately patient care.

Early Integration of Palliative Care in the Care of Women with Advanced Epithelial Ovarian Cancer: The Time Is Now

Early Integration of Palliative Care in the Care of Women with Advanced Epithelial Ovarian Cancer: The Time Is Now

Vision Impairment and Ocular Morbidity in a Refugee Population in Malawi.

To provide screening services and obtain information on the eye health status and distribution of visual impairments in a refugee population of the sole refugee camp in Malawi. A general eye screening at Dzaleka refugee settlement camp was organized in November 2012. Final-year optometry students conducted detailed optometry examinations, including visual acuity (VA) assessment for near and distance, retinoscopy, and subjective refraction in cases with distance VA less than 6/12 or near VA less than N8, anterior and posterior segment evaluation. Their findings were then verified by an optometrist. The World Health Organization definition of vision impairment was followed, and the cause of vision impairment was determined at the end of each examination. Where possible, participants requiring refractive correction were provided spectacles free of cost. Of a total 635 participants examined, around one-half were male with 61% in the 16 to 49 years age group. The overall prevalence of presenting blindness, severe vision impairment, and vision impairment were 1.3% (95% confidence interval [95% CI], 0.5 to 2.4), 0.5% (95% CI, 0.0 to 1.1), and 3.6% (95% CI, 2.3 to 5.2), respectively. Overall vision impairment (VA <6/18) was present in 5.4% (95% CI, 3.6 to 7.1) of the participants. The principal causes of blindness, severe vision impairment, and vision impairment were cataracts, refractive errors, and corneal opacities, respectively; and more than 90% of the overall vision impairment was avoidable. Refractive errors and presbyopia were the most common morbidity, present in more than two-thirds of the participants examined. Only 5% of all the participants ever had a previous eye examination. The prevalence and causes of blindness and vision impairment in a refugee population are comparable with those of the general population. Lack of basic eye care services in the health center for refugees is a major concern. The health care facility in the settlement camp needs to be upgraded to provide comprehensive eye care including refractive care services.

Scope of neonatal care services in major Nigerian hospitals

Background: Neonatal survival bespeaks the quality of neonatal care services available and accessible to the population. Intensive care improves outcome of high-risk infants with serious illness. The tiered level of care is yet to be applied to newborn care in Nigeria. Classification of care is key to improving neonatal survival with enhanced referral of high-risk patients to higher-level centres.Objective: To ascertain the scope and classify available newborn services offered at major Nigerian hospitals.Methodology: A semi-structured validated questionnaire was administered to attendees during 2015 Pediatric Association of Nigeria conference. The information derived was used to categorize neonatal care services.Results: The respondents consisted of doctors 201 (84.8%) and nurses 36 (15.2%) in 54 health facilities from all geopolitical regions of Nigeria. Of the 54 facilities, 34 (63%) were located in state capitals and 47 (87%) in public hospitals. Half of the evaluated units belonged to Class I, 22 (40.7%) Class II, and 5 (9.3%) Class III levels of neonatal care. Majority (81.6%) of the doctors have been trained on neonatal resuscitation; with senior residents being the highest 49 (89%) and Medical officers (MO) the least 4 (40%) trained. Doctors with training in mechanical ventilation (MV) were 39.2%; Consultants (51.2%), MO’s the least 1(11.2%) trained (p=0.025). Monitoring is usually by pulse oximeters 54 (100%), multi parameter monitors 23 (42.6%) and rarely ABGs 6 (11%).Conclusion: Neonatal care in Nigeria is still developing. Most centres provide basic neonatal care services. Regionalization of care may be the solution to higher level neonatal care.Kewords: Neonatal Care; Scope

Essential basic and emergency obstetric and newborn care: From education and training to service delivery and quality of care

Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego’s programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings.

Knowledge and practice of primary eye care among primary healthcare workers in northern Nigeria.

To assess knowledge and practice of primary eye care among primary healthcare workers known as community health extension workers in Funtua district of Nigeria. Cross-sectional mixed method study among health workers employed in government-owned primary healthcare facilities. Quantitative data were obtained using self-administered questionnaires and checklists, while qualitative data by modified Delphi technique, role plays and observation. A score of 1 was given for each correct answer, while a total score of ≥60% was considered 'good'. Eighty three of 88 health workers participated (94%) in the questionnaire survey; while 16 of them were selected for the qualitative survey. Good scores regarding the knowledge of common eye diseases were obtained by 68.7%, but only 26.4% of them could identify their most important features. Participants could undertake 3 of 5 steps in visual acuity testing. Skills in recognising common eye diseases and their management were weak; while practice was often not according to the guidelines. Community health extension workers displayed good knowledge of common eye diseases. Areas of weakness are recognition and interpretation of eye signs, and practice rarely follows the guidelines. Preventive medicine was neglected; community health extension workers require practical retraining and supervision to achieve integration of primary eye care into primary healthcare services.

Profile of Anganwadi workers and their knowledge regarding maternal and child health services in an urban area

Background: An Anganwadi worker (AWW), a lady selected from the local community, is a community-based frontline honorary worker of the Integrated Child Development Services program. Their understanding, communication skills, and approach are needed to implement the grand projects of the state and central governments, making them the most vital link in delivering the “health for all” mission. Objectives: The study aims to know about current level of knowledge among AWW regarding essential grassroot level health services provided in Anganwadi with the objectives to assess the level of knowledge among AWWs regarding basic maternal care services as well as basic child care services at Anganwadi level. Material and Methods: This study was a community-based cross-sectional observational study conducted in urban area. Data collection was carried out by preformed, prestructured, and pretested questionnaire by interview method individually. All 344 AWWs were interviewed for knowledge testing. Each AWW was contacted through monthly meetings. Scoring system was used for knowledge testing. The data was analyzed statistically using percentages and 2-test. Results: Maximum AWWs (43.31%) found to have average knowledge score. Significant association was found between educational status of AWWs and knowledge scores, between years of experience and knowledge scores, and between age of AWWs and knowledge scores. Conclusion: Continuous education in the form of refresher training (in-service) should be on regular basis for updating the knowledge of AWWs.

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

BackgroundThere is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services.MethodsThis is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs.ResultsThe unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies.ConclusionsThe unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting.