Provision Of Comprehensive Health Care Research Articles

General practitioner perspectives on a shared-care model for paediatric patients post-intensive care: A cross-sectional survey

IntroductionWhile paediatric critical illness mortality rates in Australia are declining, the growing cohort of paediatric intensive care unit (PICU) survivors means an increasing number of children facing substantial health challenges after their discharge from intensive care. General practitioners (GPs) play a key role in provision of comprehensive health care to children and families and are ideally positioned to provide developmental surveillance and support the care of both the child and family following critical illness. MethodsAn anonymous, cross-sectional survey of 60 GPs, reached via private invitation (19% response) or via social media weblink, was conducted where the GPs were asked about their current confidence and knowledge in managing children post PICU. This included awareness of short- and long-term problems, of paediatric intensive care syndrome in paediatrics (PICS-p), and of educational materials. Lastly, a parent-completed screening questionnaire and shared-care pathway were proposed to GPs for their feedback on perceived benefit and willingness to participate. Data were analysed using frequency distributions and chi-square statistics. ResultsNinety-three percent of GPs had some level of confidence in caring for a child post PICU admission and low confidence in their knowledge of potential short- and long-term complications. Eighty percent of GPs had not heard of PICS-p, and 93% were unaware of educational materials available on this topic. Ninety-five percent of GPs perceived that the proposed patient-screening tool and shared-care pathways would be beneficial, and 70% predicted that they would definitely use educational materials if accessible through GP central repositories. ConclusionTo reduce ongoing health problems for children recovering from critical illness, the family GP plays a pivotal role in providing community-level developmental care, particularly in Australia. Increasing GP confidence and knowledge through education is essential, and using a parent-completed screening questionnaire and shared-care pathway to improve care may be beneficial. GPs must also be involved in the implementation stages of future shared-care models.

SARS-CoV-2: Pregnancy, Delivery and Postpartum. A short review.

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the ninth documented coronavirus to infect humans and it is highly transmissible; has caused a global pandemic and dramatic loss of human life worldwide. Isolated in Wuhan, China in late 2019, it struck nations with significant economic and public health consequences. The International Committee on Taxonomy of Viruses (ICTV) named the virus as SARS-CoV-2 and the disease as COVID-19. However, few studies have been published on the effects that this virus can have during pregnancy, childbirth and postpartum, so the objective of this review is to alert about the possible problems that women can present during their pregnancy, and provide adequate and specialized. It has been described that SARSCoV-2 virus has a predilection for the angiotensin converting enzyme (ACE) II receptor present in pneumocytes, enterocytes and at the placental level. Placental involvement could lead to hypoperfusion and thrombosis, resulting in fetal intrauterine growth restriction and preterm delivery. Careful monitoring of pregnant patients who test positive for SARS-CoV-2 is recommended because of the potential complications that could occur in the mother and fetus. The recommendations include offering vaccines against SARS-CoV-2 to pregnant and breastfeeding women, the provision of comprehensive health care to the mother-child pair; for example, maternal support networks and establishment of successful breastfeeding, which involves the development of the maternal-neonatal bond.

General practice access in regional and remote Australia for ageing populations

AbstractIdentifying and removing access barriers to the timely provision of comprehensive health care is increasingly important for the wellbeing of Australia's rapidly ageing and frail populations, particularly those in non‐metropolitan settings. This study has examined if current general practice (GP) locations in non‐metropolitan South Australia (SA) and Western Australia (WA) are geographically accessible to the rapidly growing frail and prefrail populations known to have a high level of health service use and reduced mobility. Geospatial analysis linking 60‐kilometre GP service catchments, 2016 population counts, and 2027 population projections has estimated that the size of the frail and prefrail population that live outside these GP service catchments will double, reaching 7,800 people by 2027. The maldistribution of GP locations was most evident in WA. As regional and remote populations continue to age, the challenge of health service provision, including geographic access to care, must be resolved to ensure that populations in these areas have the best opportunity to age well. Geospatial methods linking service and demographic information, such as the approach used in this analysis, can aid in planning the equitable provision of health care for older Australians.

Regionalized networks and guarantee of specialized health care: the experience of Ceará, Brazil.

This paper analyzes policies and management tools aimed at the regional organization of specialized care in Ceará. A case study was developed in a health region based on 18 interviews with regional and municipal managers and health professionals and visits to services. Several factors enabled advances in the organization of specialized care: the preponderant role of the State Health Secretariat in the regional health coordination of actions and services, providing infrastructure, financing with redistribution of resources and technical support to municipalities; implantation of regional Polyclinic and Specialized Dental Care Centers through the Public Health Consortium; and logistics support of transport system. The institutional framework of Municipal Health Secretaries Council and the participatory functioning of the Regional Interagency Committee provided adequate space for the regional governance. Challenges remain for the integration of the network, qualification of care regulation, and provision of hospital care in the region. The results reinforce the importance of public and universal arrangements for the provision of comprehensive health care that can reduce inequities.

Specialized care in health regions: challenges to ensure comprehensive health care in Brazil

To analyze aspects of specialized health care provision in the context of incipient regional integration, as well as barriers to offering comprehensive health care. Case studies in tree municipal seats of health regions in the state of Bahia, Brazil. 31 semi-structured interviews were conducted with health managers and surveys were applied to 201 physicians and nurses of family health care teams and 1 590 users. The participants agreed on the lack of the specialized health care, considering limitations in regional planning due to low public funding and difficulties to attract specialized physicians. A significant percentage of users seek specialized health care directly in private services. The provision of comprehensive health care faces not only the challenge of strengthening the essential characteristics of primary health care (PHC), but also the lack of specialists, the fragmentation between different points of the network and communicational disarticulation between levels of the health system.

Speech-language therapy to elderly patients in a health care network in Florianópolis: a health surveillance initiative.

To investigate aspects of health care provided to the elderly, as a way to undertake health surveillance initiatives. Cross-sectional quantitative study with elderly people who participate in health promotion groups in health centers at Florianópolis, Santa Catarina, Brazil. Surveys were conducted on aspects relative to comprehensive health care provision, namely, records of the Family Health Strategy, diagnosis, awareness of initiatives to treat non-communicable diseases, as well as awareness of related risks and complications. A descriptive statistical analysis was performed of the profile and perception of elderly patients about comprehensive health care. Were interviewed 58 elderly patients; 94.83% of them reported having Arterial Hypertension (AH); 44.83%, Diabetes Mellitus (DM) and 39.66% reported having both comorbidities. Only a small part of the participants was aware of initiatives promoted by health centers for treatment of AH and DM; thus, there is little participation of the elderly in such initiatives. It was found that these patients still have limited awareness of the risks of not treating chronic Non-Communicable Diseases (NCDs). The population's lack of awareness of primary health care initiatives and low adherence must be addressed by primary health care policies. Importantly, awareness-raising proposals that seek to integrate health promotion and disease prevention may bring comprehensive health care provision to the elderly, thus strengthening health surveillance initiatives.

Patterns of behaviour in families of critically ill patients in the emergency room: a focused ethnography.

The aim of this study was to understand the patterns of behaviour from relatives of critically ill patients admitted to the emergency room. Admission of a critically ill family member to an accident and emergency department is often a sudden and unexpected experience for the family. This stressful event often creates feelings of instability and intense suffering in relatives. Understanding the experiences of these families is essential for the provision of comprehensive health care in the emergency room. A focused ethnography design was applied to the study. Peripheral participant observation and informal conversations were conducted in an emergency room in southern Brazil during January 2015. Analysis of data was based on Leininger. Suffering was recurrent among family members of critically ill patients admitted to the emergency room. The environment, which was conditioned by the patient's life-threatening situation and professionals' attitudes, resulted in relatives experiencing a range of feelings from suffering to calm. A distant approach and poor communication of professionals made relatives confused and silent. Factors that seemed to foster feelings of calm in families were the establishment of a continuous and close communication with professionals and the possibility to remain with the patient outside the established visiting hours. The findings of this study challenge emergency department providers and managers to promote comprehensive care in the emergency room by inviting family members to be with the patient and by engaging in family-centred care.

The Oral Health Care Manager in a Patient-Centered Health Facility

The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Background and purposeAlthough dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. MethodsBased on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. ConclusionA health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care.

Committee Opinion No. 547

Military service is associated with unique risks to women's reproductive health. As increasing numbers of women are serving in the military, and a greater proportion of United States Veterans are women, it is essential that obstetrician-gynecologists are aware of and well prepared to address the unique health care needs of this demographic group. Obstetrician-gynecologists should ask about women's military service, know the Veteran status of their patients, and be aware of high prevalence problems (eg, posttraumatic stress disorder, intimate partner violence, and military sexual trauma) that can threaten the health and well-being of these women. Additional research examining the effect of military and Veteran status on reproductive health is needed to guide the care for this population. Moreover, partnerships between academic departments of obstetrics and gynecology and local branches of the Veterans Health Administration are encouraged as a means of optimizing the provision of comprehensive health care to this unique group of women.

Can a Sector‐Wide Approach Underpin and Advance Universal Health Coverage?

Fragmented management approach makes the provision of comprehensive health care for achieving universal health coverage very unlikely. This article aims to explore the potential contribution of a systemic approach—the sector‐wide approach (SWAp)—to achieving universal health coverage (UHC), using the Mongolian context as an example. The paper describes UHC and factors that hinder its achievement in developing countries, based on the Mongolian experience. The analysis focuses on the root factors hindering the achievement of UHC and examines how these affect system and local capacity critical for achieving UHC. Two principally different approaches, a sector‐wide (holistic) approach and a standalone project (fragmented) approach are compared in terms of their contribution to the main indicators of achieving UHC. The current stage of the Mongolian health SWAp is identified and early rewards of a SWAp are presented. The paper proposes a SWAp as a potential approach to tackle these root factors to help in achieving UHC, because it is a promising instrument that promotes a systems‐strengthening and capacity‐building approach to enable effective coordination of standalone projects in alignment with the national priorities.

Conceito e avaliação de habilidades e competência na educação médica: percepções atuais dos especialistas

As Diretrizes Curriculares Nacionais (DCN) para cursos de Medicina orientam mudanças nos currículos e processos de ensino-aprendizagem-avaliação para desenvolvimento de competências e habilidades profissionais. O presente trabalho, iniciativa da Associação Brasileira de Educação Médica (Abem), investiga os significados e a apropriação da noção de competência por estudiosos da avaliação educacional na medicina. Foram realizadas dez entrevistas mediante roteiro com questões abertas e respondentes selecionados a partir de sua produção acadêmica sobre o assunto. Suas narrativas foram submetidas a análise de conteúdo mediante análise temática. Os resultados enfocam o significado da competência, o papel dos sujeitos e do contexto na construção da competência e a relação entre avaliação de competência e construção da integralidade em saúde. Observa-se que, embora de modos heterogêneos, o conceito de competência tem sido apropriado de modo fértil pelos especialistas brasileiros. No entanto, o estudo sugere que a consolidação de uma "cultura de avaliação" nas escolas médicas demandará investimentos em núcleos de estudo e pesquisa para aprofundamento de conceitos, objetivos, seleção de conteúdos, pactuação de critérios, elaboração de instrumentos e treinamento de avaliadores nas instituições brasileiras.

Psychosocial Problems among Patients in Neighborhood Health Centers: Perspectives from Health Care Providers

Little is known about how health care professionals perceive and understand the psychosocial problems of individuals receiving services in neighborhood health centers (NHCs). We conducted interviews with health care professionals in NHCs in New York City. The respondents identified seven problems, including a lack of financial resources, unsafe housing, and emotional distress/depression as affecting large portions of their patient populations. Respondents reported that they are presently meeting many of the psychosocial needs of their clients, but they were pessimistic about their ability to continue to do so due to a lack of funding streams to support their provision of comprehensive health care that includes psychosocial services. The findings suggest that while NHCs may be "holding their own" in providing quality services to their clients, this will be harder to sustain in the future if the numbers of the uninsured served continues to increase, and the revenues generated continue to decrease.

Achieving excellence in veterans healthcare--a balanced scorecard approach.

This article provides healthcare administrators and managers with a framework and model for developing a balanced scorecard and demonstrates the remarkable success of this process, which brings focus to leadership decisions about the allocation of resources. This scorecard was developed as a top management tool designed to structure multiple priorities of a large, complex, integrated healthcare system and to establish benchmarks to measure success in achieving targets for performance in identified areas. Significant benefits and positive results were derived from the implementation of the balanced scorecard, based upon benchmarks considered to be critical success factors. The network's chief executive officer and top leadership team set and articulated the network's primary operating principles: quality and efficiency in the provision of comprehensive healthcare and support services. Under the weighted benchmarks of the balanced scorecard, the facilities in the network were mandated to adhere to one non-negotiable tenet: providing care that is second to none. The balanced scorecard approach to leadership continuously ensures that this is the primary goal and focal point for all activity within the network. To that end, systems are always in place to ensure that the network is fully successful on all performance measures relating to quality.

Who Is Indoctrinating Whom?

Who Is Indoctrinating Whom?

Pharmacists in the future

Over the next few years, over 40 000 pharmacists in the US will have to make themselves more valuable as the processes of automation and centralisation occur. Otherwise, many pharmacists face the bleak prospect of being replaced by automated technology. The future of pharmacy in the changing healthcare environment may depend on the ability of the discipline to prove the value of pharmaceutical care in the provision of comprehensive healthcare. The future role of the profession was discussed at the 10th Annual Meeting of the National Managed Health Care Congress [Atlanta, US; April 1998].

Does comprehensive care make a difference? Pediatric utilization in the Kaiser Health Plan of Oregon.

These data are from the Health Services Research Center of the Kaiser Health Plan of Oregon and pertain only to the Oregon Kaiser Health Plan experience, but may serve as a basis for interesting and useful comparisons. The Kaiser Health Plan of Oregon has been in existence since 1942 and during this time has been concerned with the provision of comprehensive health care utilizing a prepaid insurance scheme. Information contained in this report is derived from the following data systems: (1) a random sample of 5% of the Health Plan population which was begun in October 1966. This 5% sample provides complete utilization data including presenting symptoms, primary and associated morbidity diagnoses, and contacts with the system, such as telephone calls and prescription refill requests. (2) A 100% sampling of the outpatient utilization experience of the medically indigent cared for under a contract with the Dept of Health, Education, and

Health Needs of the Nation

NATIONAL HEALTH is nothing more nor less than the health of every State, every community, and every individual. All of us share the responsibility for solving three major health problems. The first is the changing pattern of disease 'in our growing population. The past two decades have witnessed the virtual conquest of bacterial diseases. In that period, chronic diseases have continually risen in prominence as causes of death and even more so as causes of prolonged disability. This problem is closely associated with the medical needs of the aged, since cardiovascular disease, cancer, and metabolic diseases strike most severely in the later years of life. But chronic conditions also inflict the highest disability rates in all age groups, from early infancy through the most productive years of adulthood. The second problem is a corollary of the first; namely, the provision of comprehensive health care for 180 million people. The core of this problem is our lack of facilities and personnel and of effective organizations for the application of medical science to human needs. We need more efficient systems of financing medical care for age,d and dependent groups. Modern medicine has a vast array of preventive, curative, and restorative techniques, and if these were readily available to all segments of the population in all communities, we could anticipate a substantial reduction in costly long-term disability. The third problem is the emergence of new environmental threats to life and health. These include ionizing radiations, chemical wastes in the atmosphere and water resources, and the use of new chemicals in foods and domestic products. Both rural and urban populations are confronted with increased exposures to these hazards. Our hopes for ultimate success in solvinig the-se major problems depend upon one commoll factor: continued progress in the health sciences. During the past 15 years, our national health policy ha,s given highest priority to the expansion of medical research. The result has been greater advances in scientific medicine thani in any prior period. We can anticipate further medica.l advanlces under that policy. But many problems in the life sciences remain unsolved; many re.se,arch areas affecting human health are little explored. Notable among these areas are the environmental sciences, the behavioral sciences., and administrative research. Also of critical concern is the fact that the health professions in many parts of our country lack the essential support of strong research programs.