Health Professionals In Centers Research Articles

Pintar y aprender a vivir sano

The objective of this study arises in the health center from the need to improve the emotional environment, going from a sad, dull and inexpressive waiting room to a welcoming, friendly and educational one. We understand that the waiting room must be part of the global care of the children and their family. We looked for a physical improvement of the the pediatric area in the health center. Painting the walls of the health center may not humanize the space but it makes it friendlier, trying to create a place where art not only brings beauty but is also a health education strategy. During the wait, there won´t be only an attractive and pleasant environment, but also healthy lifestyle habits in a creative way through drawings that will develop stories with teachings about food, hygiene, friendship, etc. Children, teachers, the Zaragoza city council, health center professionals and especially the architect of the work, Leticia García Longás, have been involved in the different phases of the project.

“We bleed for our community:” A qualitative exploration of the implementation of a pragmatic weight gain prevention trial from the perspectives of community health center professionals

BackgroundClinical trial implementation continues to shift toward pragmatic design, with the goal of increasing future adoption in clinical practice. Yet, few pragmatic trials within clinical settings have qualitatively assessed stakeholder input, especially from those most impacted by research implementation and outcomes, i.e., providers and staff. Within this context, we conducted a qualitative study of the implementation of a pragmatic digital health obesity trial with employees at a Federally qualified health center (FQHC) network in central North Carolina.MethodsParticipant recruitment was conducted through purposive sampling of FQHC employees from a variety of backgrounds. Two researchers conducted semi-structured qualitative interviews and collected demographic data. Interviews were digitally recorded, professionally transcribed and double-coded by two independent researchers using NVivo 12. Coding discrepancies were reviewed by a third researcher until intercoder consensus was reached. Responses were compared within and across participants to elucidate emergent themes.ResultsEighteen qualitative interviews were conducted, of whom 39% provided direct medical care to patients and 44% worked at the FQHC for at least seven years. Results illuminated the challenges and successes of a pragmatically designed obesity treatment intervention within the community that serves medically vulnerable patients. Although limited time and staffing shortages may have challenged recruitment processes, respondents described early buy-in from leadership; an alignment of organizational and research goals; and consideration of patient needs as facilitators to implementation. Respondents also described the need for personnel power to sustain novel research interventions and considerations of health center resource constraints.ConclusionsResults from this study contribute to the limited literature on pragmatic trials utilizing qualitative methods, particularly in community-based obesity treatment. To continue to merge the gaps between research implementation and clinical care, qualitative assessments that solicit stakeholder input are needed within pragmatic trial design. For maximum impact, researchers may wish to solicit input from a variety of professionals at trial onset and ensure that shared common goals and open collaboration between all partners is maintained throughout the trial.Trial RegistrationThis trial was registered with ClinicalTrials.gov (NCT03003403) on December 28, 2016.

Offer of complementary therapies by Extended Family Health Center professionals: reaffirming holistic and integral care

RESUMO O estudo analisa a implantação e implementação das práticas integrativas e complementares (PIC), bem como limites e potencialidades desse processo, nos serviços de Atenção Primária à Saúde (APS) de uma região de saúde do estado de São Paulo, na perspectiva de profissionais dos Núcleos Ampliados de Saúde da Família (NASF). Trata-se de estudo de abordagem quanti-qualitativa cujos dados foram coletados por meio de questionário e entrevista semiestruturada on-line e analisados com uso de estatística descritiva e análise de conteúdo modalidade temática. Do conjunto de dados emergiram três unidades temáticas: (des)estrutura para compra de materiais para as PIC; PIC enquanto cuidado ampliado, resolutivo e integral; e (Des)estrutura na alocação de profissionais para oferta de PIC. Em um contexto marcado por políticas de desmonte do NASF e do Sistema Único de Saúde (SUS), a continuidade do cuidado com a oferta de PIC por profissionais do NASF emerge como prática de resistência que reafirma a vida e reitera a longitudinalidade, o acolhimento e a integralidade, essenciais à APS e ao SUS.

"My Patients Asked Me If I Owned a Fruit Stand in Town or Something." Barriers and Facilitators of Personalized Dietary Advice Implemented in a Primary Care Setting.

Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle intervention in primary care, as perceived by health center professionals and program participants. Thirteen focus groups were conducted with 49 professionals and 47 participants. Audio recordings were transcribed. Professional group text was coded using the Consolidated Framework for Implementation Research (CFIR). Participant group text was coded via an inductive approach with thematic analysis. Across most CFIR domains, both barriers and facilitators were equally present, except for ‘characteristics of individuals’, which were primarily facilitators. Intervention characteristics was the most important domain, with barriers in design and packaging (e.g., the ICT tool) and complexity. Facilitators included high evidence strength and quality, adaptability, and relative advantage. Participants described the importance of more personalized advice, the value of follow-up with feedback, and the need to see outcomes. Both professionals and patients stated that primary care was the place for personalized dietary advice intervention, but that lack of time, workload, and training were barriers to effective implementation. Implementation strategies targeting these modifiable barriers could potentially increase intervention adoption and intervention effectiveness.

Prevalence of lifetime nonmedical opioid use among U.S. Health Center Patients aged 45 years and older with psychiatric disorders

Objective Despite recent concerns over the increase in opioid misuse among aging adults, little is known about the prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older patients with psychiatric disorders. This study aims to determine the lifetime prevalence of nonmedical opioid use among underserved, vulnerable U.S. adults aged ≥45 years with psychiatric disorders. Method A nationally representative sample (n = 3,294) was obtained from the 2014 Health Center Patient Survey which collects data on psychiatric disorders, opioid use, and other health information from underserved, vulnerable U.S. primary care populations. Predictor variables included self-reported panic disorder, generalized anxiety disorder, schizophrenia, or bipolar disorder. The outcome variable was self-reported lifetime nonmedical opioid use. Frequencies, counts, and unadjusted and adjusted logistic regression models were conducted with the cross-sectional survey dataset. Results Patients with bipolar disorder had the highest lifetime nonmedical opioid use rate (20.8%), followed by schizophrenia (19.3%), panic disorder (16.5%), and generalized anxiety disorder (14.5%). Nonmedical opioid use was significantly associated with bipolar disorder (OR 3.46, 95% CI [1.33, 8.99]) and generalized anxiety disorder (OR 2.03 95% CI [1.08, 3.83]). Conclusion Our findings demonstrate a high prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older health center patients with psychiatric disorders. Given the prevalence, health center professionals should monitor, prevent, and treat new or reoccurring signs and symptoms of nonmedical opioid use in this high-risk group of aging patients with psychiatric disorders.

Organizational Savvy: Critical to Career Development in Academic Medicine.

Organizational savvy is critical to career development, but is rarely discussed as a learnable skill. Drawing on >45 years of working closely with Academic Health Center professionals, the author offers an introduction to navigating organizational dynamics that will be especially valuable to women, as they tend to be less effectively mentored than men; mentors may also find this guide of use in coaching these skills. Common misconceptions that interfere with acquiring organizational savvy include assuming that academic medicine is a meritocracy, that hard work will assure success, and that disagreements are personal. People who learn to navigate competitive hierarchies are continuously expanding their understanding of significant events, of how their unit fits within the larger system, and of which constraints they can influence. Strategies suggested for developing a political compass focus on building relationships, learning from surprises and disappointments, facilitating dialogue with open-ended questions, and handling sensitive topics as they arise. The author opens with a case illustrating common new faculty dilemmas and closes with examples applying the mentioned recommendations. Becoming more organizationally savvy helps professionals advance not only their own careers but also improvements in their institutions.

International Collaborative Donor Project

The International Donor Collaborative Project (PCID) research group was created in 1996 in Spain with the aim of promoting research in the field of organ donation and transplantation, led by Spanish surgeons. During this period they have developed the questionnaires of the PCID, both the attitude towards cadaver and live donation, which are the most used questionnaires in publications in indexed journals. They have been the driving group of stratified studies representative of the populations under study, and of the performance of multivariate statistical analyses in the field of psycho-social research in organ donation and transplantation. The main contributions of the group focus on the analysis of health center professionals and emerging migrant groups. In recent years, studies have been extended to the United States, Latin America (mainly Mexico) and Europe.

Proyecto colaborativo internacional donante

The International Donor Collaborative Project (PCID) research group was created in 1996 in Spain with the aim of promoting research in the field of organ donation and transplantation, led by Spanish surgeons. During this period they have developed the questionnaires of the PCID, both the attitude towards cadaver and live donation, which are the most used questionnaires in publications in indexed journals. They have been the driving group of stratified studies representative of the populations under study, and of the performance of multivariate statistical analyzes in the field of psycho-social research in organ donation and transplantation. The main contributions of the group focus on the analysis of health center professionals and emerging migrant groups. In recent years, studies have been extended to the United States, Latin America (mainly Mexico) and Europe.

Factors Associated with Unintentional Injury among University Students in 26 Countries.

The aim of this study was to determine estimates of the incidence and social correlates of nonfatal injury among university students in 26 low-, middle-, and high-income countries. Using anonymous questionnaires, data were collected in a cross-sectional survey of 19,111 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa, and the Americas. Questionnaire on health risk behaviors, psychological distress, personality, social variables, and injury requiring medical treatment or missing at least one day of usual activities. The percentage of university students reporting one or more serious injuries within the past 12 months was 25.2% for all countries, in men 28.8% and women 21.1%. In multivariate logistic regression among men, socio-demographic variables, health risk behaviors, posttraumatic stress (PTSD) symptoms, lack of personal control and lack of social support, and among women, residing on campus, health risk behaviors, PTSD symptoms, lack of personal control, and lack of social support were associated with injury incidence. Several risk factors were identified which will increase the understanding of public health nurses of injuries in university communities to design programs for injury prevention programs specifically targeting university students, staff, and university health center professionals.

Atención a la Demanda Indemorable en Atención Primaria. Descripción y detección de posibles áreas de mejora

ObjectiveTo identify the main areas of improvements in the care process of undelayable consultations in Primary Care Health Centre of Miralbueno (Zaragoza). DesignCross-sectional study using a telephone questionnaire. Location/settingUrban Health Centre with a rural annexe. ParticipantsA representative sample of 238 users was selected from the total undelayable consultations made (6884 visits) during 2009. The response rate was 35%, with 83 surveys finally being made. MeasurementsTelephone surveys based on a valid questionnaire called SERVQUAL. The user responses were assessed by professional using improvement cards. ResultsThe user's survey gave mean satisfaction scores above 3.50 out of 5. The best rated items were: the treatment by medical staff, information received and the degree of problem solving. Improvement proposals made by professionals were related to telephone access, and the paediatric opening hours for continuous treatment and the waiting time to be seen. ConclusionsThe user survey detected a high level of overall satisfaction. But valued aspects were: the difficulty in telephone access, the lack of paediatric visits availability and the waiting times. The Health Centre professionals offered suggestions to improve the areas rated worst by users.

Views of Persons With Schizophrenia on Their Own Disorder: An Italian Participatory Study

This study explored the views of 241 patients with schizophrenia about their own disorder. Patients' knowledge of their diagnosis, confidence that they will be well again, and perception of limitations in their own life as a result of the disorder were explored in relation to patients' opinions about the social consequences of schizophrenia. Study results were presented to participants, and suggestions were collected regarding how these study results should be used. Seventy-two respondents (30%) reported that a psychiatrist told them that they have schizophrenia. Respondents who were confident that they would be well again had a lower duration of contact with psychiatric services and a less pronounced perception of affective and social difficulties related to schizophrenia. Respondents who did not feel limited in their life by the disorder reported less social distance and more optimism about the usefulness of treatments. Participatory studies may provide ideas for a more constructive interaction between patients and professionals.

Actividad clínica en la consulta médica a demanda de un Centro Penitenciario frente a la de un Centro de Salud

To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likely differences from a community Health Care Centre. To identify possible training needs when transferring health care staff from one system to another in the light of probable integration of Prison Health Care into the Public Health System. A transversal descriptive study was used for three Primary Health Care teams: an urban health centre with a high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison). Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmed by the health professional and administrative consultancy was excluded, while efforts were made to locate troubled consultations. Comparisons were made by contrasting differences in proportions. The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drug abuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is a therapeutic priority). In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics. In the prison environment there is significantly higher troubled consultation. In a future context of integration of prison health care services into the Public Health Service, training in mental health care (especially addictive disorders) and in HIV-HCV infection management may be necessary for community health centre professionals wishing to transfer to prison health care units. The prison health care professional who wants to work in a public health centre may need training in Internal Medicine (especially Geriatrics). The statistically significant results for health care in prison, Primary Health Care and troubled consultation suggest that the GP plays a more active role in prison than in the community health centre. This should also be borne in mind when the intended integration of Prison Health Care into the Public Health Service takes place.

Prevención del VIH/sida en el medio penitenciario: una experiencia de planificación participativa

To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program. Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates) in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center's male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center's health professionals and management as well as to health promotion experts. Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those directed at the prisoners themselves: increasing preventive mesures in material used in injection and in sexual relationships; b) those directed at the prison management: increased distribution of condoms, safety razors and bleach and the introduction of sterile injection material. In the personal interviews, agreement on a future prevention program was high among the female inmates and the other key informants. Preferred measures were the acquisition of information on the mechanisms of HIV transmission and prevention and on the differences between HIV carriers and those suffering from AIDS and the acquisition of skills for disinfecting material used for drug injection and in negotiating the use of condoms with partners. The preferred methodology was based on groups that would allow for an interchange of experience and would deal with the difficulties of putting preventive measures into practice. The participation of the prison's inmates and staff supplied information that facilitated the design (choice of aims, measures, methods and resources) of an HIV prevention program adapted to the needs and preferences of all the interested parties.

Profesionales y gestores ante la formación

To analyse ongoing education within primary care teams from managers' perspective. Cross-sectional descriptive study. The Mother-Infant Health Programme of Andalusia in primary care. The views of health centre professionals were obtained through 8 groups. The type of health district and the number of years in operation were used as criteria for division. The views of the area managers were collected through a self-filled questionnaire from all the managers in the autonomous community. Professionals believed it necessary to keep up to date and train in new technology. They thought that training activities should focus on questions such as evaluation of programmes, focus of risk, counselling and communication, and certain techniques such as IUD insertion. Both managers and professionals coincided in recognising the effect of training on the development of mother-child services. There was consensus among professionals in affirming that training increases the quality of care delivered. Access to training was the main incentive element used by most area managers and one of those most highly valued by professionals. The professionals affirmed that in recent years there had been obstacles to their education by attending scientific events outside their areas. Many professionals stated that the economic assistance of the pharmaceutical industry for courses caused inequalities between doctors and nurses in access to training. Professionals were very critical of training combined with specialist training. Professionals think they have sufficient training for mother-child health care. It is generally recognised that family doctors are better trained for working on health programmes than other professionals at the centres. Ongoing training was rated very highly by both professionals and directors, as it was seen as a motivating element and thought to be an activity almost solely carried out at health centres.

The process and methods of health counseling by primary health care personnel in Finland: a national survey

A stratified random sample of 53 Finnish health centers was selected, and representative samples of their physicians, nurses and physiotherapists were surveyed by questionnaire on the frequency of their use of health education methods in health counseling and their perception of the ease vs. difficulty of implementing the stages of the process of lifestyle counseling. Overall, the assessment of the enabling and reinforcing factors in client health behavior (social relationships and physical environment), the translation of these factors into a behavior change program and the evaluation of such programs were seen as difficult by all three categories of health care professionals. The implementation stage of lifestyle counseling was, however, generally rated as easy, although quite a limited selection of education methods and self-evident motivational prompts were used. The physiotherapists regarded the process of lifestyle counseling in their specialty, exercise counseling, as easier to conduct and they used a more varied selection of methods than the other health care personnel groups. The findings indicate a need for further in-service education for Finnish health center professionals on health education methods as well a need for the restructuring of the care system to allow better opportunities for the full realization of the process of health counseling.

La perspectiva profesional en la reforma de la atención primaria de salud: una aproximación cualitativa

The objective of this study was to find out opinions and experiences of primary health centre professionals on the process of implementation and development of the New Model of Primary Health Care in the Valencian Community. Nin semi-structured group interviews with professionals were carried out, directed by two researchers who proposed the topics for discussion by means of open questions and took notes on the interventions. Some others aspects of health centres' situation were also assessed by observation. The majority of the professionals thought high prevalence disease programmes should be elaborated by the Health Administration that community participation was an important dimension but difficult to develop, that the population perceived an improvement in health care with the new model, and that relationships with Health Area Managers were good, even though they were not thought to have a real management role. The greatest differences in opinions and experiences among primary health care teams concerned the development of some dimensions of the new model, especially comprehensive care, continuous care and team work.

Community Health and Medical Practitioners Scheme: providers evaluate a pilot program of integration of services.

To set up and evaluate a pilot scheme integrating salaried community health centre staff and fee-for-service medical practitioner services (CHAMPS). Preliminary interviews with both groups established the aims, logistics and financial arrangements of the project. The community health centre provided staff and the general practitioners provided premises and administrative services. Follow-up interviews evaluated the scheme and made recommendations. A New South Wales country town, population 24,000, with 25 general practitioners and 23 community health centre professionals. Six general practitioners and 23 community health professionals determined the aims to be: improved access for patients to community health services; improved liaison between the two groups of providers; and a broadening of services offered at general practice locations. Two dietitians and three mental health workers were rostered for half a day per week in four general practices for six months. The dietitians continued after the project finished, but the mental health workers did not. The five community health staff, five of the general practitioners originally interviewed and six other general practitioner participants cited the major benefits as increased communication between providers and improved access for patients, and the major difficulties as lack of appropriate equipment and organisational logistics. The providers believe that the project succeeded in improving access to community health services and liaison between professionals. For future projects they recommended better communication, firmer role delineation and better planning for space and equipment.

Professional autonomy and managed care in Dutch health centres: Stakeholders' perceptions of a strategic option

The on-going reforms of the Dutch health care systems call for the introduction of managed care elements. Health centres in the Netherlands already bear some resemblance to health maintenance organizations in the USA. However, managed care challenges provider autonomy, and the strategic development of managed care plans may be hampered by providers' perceptions. We draw a distinction between managed care within an insurance arrangement and managed care as a package of methods. Both options are evaluated as suitable for Dutch health centres, though with differences in terms of strategic logic and cultural fit. Lastly, some general conditions are formulated that should be considered before care management processes can be implemented. These include: specify clear objectives for introduction of managed care; strengthen corporate culture; develop internal motivation for change; develop a practice criterion with health centre professionals; reduce workloads in order to provide development time; and, promote better cooperation between general practitioners and specialists.

Feeding the child with diarrhea: A strategy for testing a health education message within the primary health care system in Egypt

Egypt has successfully implemented a nationwide program of oral rehydration therapy (ORT) for acute diarrheal disease which should make a substantial impact on diarrhea-specific mortality. However, ORT alone cannot alleviate or prevent the malnutrition which commonly accompanies diarrhea. Traditional practices in Egypt result in food being withheld from children who have diarrhea, thus contributing to the vicious circle of diarrhea and malnutrition. Early and continued feeding of children with diarrhea has been shown to be effective when practiced; however, it requires specific efforts to educate mothers appropriately. This study was designed to address the operational problem of promoting the nutritional repletion of children with diarrhea. Specifically, the tasks were to design an appropriate and practical message for the education of mothers, to test its delivery through the existing primary health care (PHC) system, and to incorporate it into the nationwide program of diarrheal disease control. A baseline survey of knowledge, attitudes, and practice (KAP) of mothers and health center professionals was carried out in July 1985 in three areas of Egypt. A simple educational message was developed based on knowledge of existing practices, consistency with existing mass media messages, and the addition of a component specific to this project. The message was delivered through the PHC system for three months. No special infrastructure or training was developed; the directors of several programs in three governorates simply incorporated the message into their existing systems of information flow and training. A second KAP survey was conducted in the same centers in December 1985. The followup survey indicated several significant findings. Of mothers who had attended any PHC center in the previous three months, 78% reported that a staff member had talked to them about feeding their child during and after diarrhea. Behavioral differences were also reported. There was a statistically significant increase in the proportion who continued to give breast milk during diarrhea and a significant increase in ORT use. Health care providers in the follow-up survey reported giving more, and more appropriate, dietary advice. In conclusion, the PHC system, with no additional infrastructure, was able to successfully incorporate this educational component. The message has now been adopted by the mass media and other health education channels.

Opinions concerning criminality among mental patients

Estimations of the arrest rates for various offense categories of civilly admitted male mental patients were made by mental health center professionals, state hospital professionals and aides, law enforcement officers, college students, legislators, and community residents. Mental health personnel and legislators tended to judge patients as having lower arrest rates than was actually the case. Community residents overestimated patient arrest rates for rape and “other sexual offenses”, while police overestimated the patient rate for “other sexual offenses”.