Main Care Providers Research Articles

Moderately overweight and obese patients in general practice: a population based survey

BackgroundObesity is a main threat to public health in the Western world and is associated with diseases such as diabetes mellitus and coronary heart diseases. Up to now a minority of research studied the relation between obesity and the use of primary health care. In the Netherlands the general practitioner (GP) is the main primary health care provider. The objective of this article is to evaluate GP consultation and prescription of drugs in moderate and severely overweight (obese) persons in the Netherlands.MethodsData were used from a representative survey of morbidity in Dutch general practice in 2001. Our study sample consisted of 8,944 adult respondents (18+ years) who participated in an extensive health interview. Interview data were linked to morbidity and prescription registration data from 95 general practices where respondents were listed. Body mass index (BMI) was calculated using self-reported height and weight. Analyses were controlled for clustering within practices as well as for socio-demographic and life style characteristics.ResultsObesity (BMI ≥ 30 kg/m2) was observed in 8.9% of men and 12.4% of women; for moderate overweight (BMI 25-<30 kg/m2) these percentages were 42.2% and 30.4% respectively. Obese men and women were more likely to consult their GP than persons without overweight. This especially holds for diseases of the endocrine system, the cardiovascular system, the musculoskeletal system, the gastro-intestinal system, and skin problems. Related to this, obese men and women were more likely to receive drugs for the cardiovascular system, the musculoskeletal system, alimentary tract and metabolism (including, for example, antidiabetics), and dermatologicals, but also antibiotics and drugs for the respiratory system. For moderately overweight men and women (BMI 25-<30 kg/m2) smaller but significant differences were found for diseases of the endocrine system, the cardiovascular system, and the musculoskeletal system.ConclusionObesity increases the workload of Dutch general practitioners and the use of prescribed medication. The current increase in the prevalence of obesity will further increase the use of health care and related costs. Since a large majority of Dutch persons visit their GP over the course of one year, GPs' potential role in effective prevention strategies cannot be denied.

The economic impact of visceral leishmaniasis on households in Bangladesh

To explore current patterns of diagnosis and treatment, quantify household economic impact and identify household strategies to cover the costs of visceral leishmaniasis (VL) care in rural Bangladesh. Structured interviews with 113 VL patients from 87 households documenting all provider visits and expenditures for health care for VL, and the ways in which the expenditures were covered. Patients paid a median of 7 visits to six different providers before beginning VL treatment. All visited the subdistrict government hospital at least once. While health care, including antileishmanial drug therapy, is officially available free of charge at government facilities, 79% of patients reported making informal payments for provider access, diagnostics and drug administration; only 14% of patients received their full drug course from this source. For the 58% of patients who purchased the full treatment course, drug cost constituted 34% of direct expenditure. Median direct expenditure for one VL patient was US$87 and median income lost was $40; median total expenditure was 1.2 times annual per capita income of our study population. Households employed multiple coping strategies to cover expenditures, most commonly sale or rental of assets (62%) and taking out loans (64%). Visceral leishmaniasis treatment causes a major economic burden in affected families. Control strategies for VL should facilitate timely, affordable diagnosis and treatment of patients to decrease the infection reservoir and to alleviate the economic burden of VL on households.

An Education Intervention for Families of People with Schizophrenia in China: Development and Evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.

District nursing support for patients with cancer requiring palliative care

Patients with cancer spend the majority of the last year of life at home, with district nurses (DNs) as the main care coordinators and providers. However, there is a relative lack of empirical work on the DN role in this area. This study used qualitative, case-study methods to explore the role of district nurses caring for patients with cancer who require palliative care. The study focused on three patient cases and the researcher visited each patient with the DN on several occasions. The sample was three DNs and the principal data collection methods were episodes of participant observation (n=11) and in-depth interviews (n=12). The findings suggest that DN role was as linchpin or coordinator of palliative care at home. They were the main providers of physical and emotional support for the patients and families in this study. The supportive role of the DN involved referral to other agencies. Patient and carer preferences impacted on decision-making and care planning and reaching a compromise was often necessary.

Mental health care in Madrid

Aim. To describe principles and characteristics of mental health care in Madrid. Method. Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported. Results. In Madrid, mental health services are organized into 11 zones/areas, divided into 36 districts, where there is a mental healthoutpatient service with a multi-disciplinary team. Home treatment and psychosocial rehabilitation services have been developed. Specialist programmes exist for vulnerable client groups, including Children and Adolescents, Addiction/Alcohol and Older People. The Madrid Mental Health Plan (2003–2008) is regarded as the key driver in implementing service improvement and increased mental health and well-being in Madrid. It has a meant global budget increase of more than 10% for mental health services. Results of the first 2 years are: an increase in mental health staff employed (17%), four new hospitalization units, 50% increase in places for children and adolescents Day Hospitals, 62 new beds in long care residential units, development of specific programmes for the homeless and gender-based violence, a significant investment in information systems (450 new computers) and development of best practice and operational guidelines. Mental health system was put to the test with Madrid's March 11th terrorist attack. A Special Mental Health Plan for Affected people was developed. Discussion. Unlike some European countries, public mental health service is the main heath care provider. There are no voluntary agenciescollaborating with mental health care. Continuity of care and coordination between all mental health resources is essential in service delivery. Increased demand of care for minor psychiatric disorders, children and adolescent mental health care, and implementation of rehabilitation and residential facilities for chronic patients are outstanding challenges similar to those in other European capitals. Overall, the mental health system had successfully coped with last year's increased care demand after March 11th terrorist attack in Madrid.

Should the Emergency Department be Society's Health Safety Net?

In the US health care system, a core safety net provider has two defining characteristics: (1) either by legal mandate or explicitly adopted mission, they maintain an "open door," offering patients services regardless of their ability to pay; and (2) a substantial portion of their patients are uninsured, on Medicaid, and/or otherwise vulnerable. The hospital Emergency Department (ED), by all accounts, falls within the definition of a core safety net provider. Yet many would argue that this is a primary health care role for which the ED was not originally intended or equipped. Should the ED be society's health-care safety net? Should it be the main provider of care for the indigent? Is this placing an unbearable strain on the ED? Should it be providing primary health-care? If not, what are the alternatives?

Community Health Workers and Professional Nurses: Defining the Roles and Understanding the Relationships

The use of community health workers (CHWs) has been advocated in both developed and developing countries for many years. This article reports the findings of a descriptive research study that explored the relationship between CHWs and nurses working in resource-poor settings in South Africa. The findings of the study highlight dimensions of complex interactions occurring between these two main providers of care at the district level. Understanding the primary interaction of CHWs with nurses offers further understanding of the broader role of CHWs within the district health system. It is evident that CHWs are ideally suited to play a pivotal role in supporting the public health services. However, their role and functions are not formalized and the effectiveness of programs is often not rigorously evaluated. This article discusses some of the issues related to this cadre of health worker and their role in public health care structures.

Knowing the diagnosis and counselling the relatives of a person with dementia: the perspective of home nurses and home care workers in Belgium

Relatives are the main providers of care for people with dementia who live at home and it is district nurses/home nurses and care workers overseen by social services who often are an important source of carer support. This Belgium study asked whether knowing that a patient has dementia informs how home nurses and home care workers provide care, what they recognise as symptoms of dementia and how they assess if someone has dementia. The authors surveyed 1,546 nurses and care workers and achieved a response rate of 54 per cent. All the respondents confirmed that knowing the patient’s diagnosis was important in influencing how care was planned and provided and in communication with relatives. Only a few thought there could be negative consequences because relatives might not want to discuss the diagnosis.

Maternal health care utilisation in Teso District

This paper sets to establish the level of awareness of antenatal care, the timing of antenatal clinic visits, the level of utilisation of maternal health care, to identify the main service providers, and existing barriers to the utilisation of maternal health care in Teso District. Data and information collected in Teso District between the year 2000 and 2001 is used. Descriptive statistics are the main tools of data analysis. The results obtained indicate that most respondents in the study area are aware of the importance of antenatal care, the majority seek antenatal care but late in pregnancy and make very few antenatal visits, and that most of the childbirths take place at home mainly because of lack of access to institutionalised care; quick means of transport, inability to meet user charges and associated costs, the availability of cheap and more accessible alternative care providers such as traditional birth attendants (TBAs), and the poor quality of services offered at the local health facilities. The traditional birth attendants and nurse /midwives are the main providers of maternal health care. The obstacles to utilisation of maternal health care are manifold. The major constraints are unavailability and inaccessibility of health facilities, poverty, exorbitant user charges and associated costs, and poor services offered at the local health facilities. Reducing or removing these obstacles would result in increased utilisation of maternal health care in the study area.

Managing Newborn Unit Without Nurses: A Tragedy Of Our Time

A retrospective analysis of records of neonates admitted into Wesley Guild Hospital, Ilesa during a four month period of industrial dispute affecting all hospital workers except the doctors in the teaching hospitals and research institutions in Nigeria was carried out. The main objective was to determine effect of absence of on outcome and the possible value and risks in using the mothers as the main nursing care providers. Only very ill newborns were admitted. Mothers were trained and used as natural nurses for their babies care. Neonatal mortality rate (NMR) was 250/1000, almost twice the NMR for the unit. The main reasons and respective case fatality rates were: birth asphyxia (60.0%), tetanus (57.1%), low birth weight (28%). Main causes of death were similar to what were previously documented in the unit. Majority of the deaths were preventable. Though the mortality rate was much higher than what was previously recorded in the unit, the effort saved many babies who would have died if they had not been admitted. Better management of industrial dispute would forestall this avoidable tragedy with increase in NMR. A retrospective analysis of records of neonates admitted into Wesley Guild Hospital, Ilesa during a four month period of industrial dispute affecting all hospital workers except the doctors in the teaching hospitals and research institutions in Nigeria was carried out. The main objective was to determine effect of absence of on outcome and the possible value and risks in using the mothers as the main nursing care providers. Only very ill newborns were admitted. Mothers were trained and used as natural nurses for their babies care. Neonatal mortality rate (NMR) was 250/1000, almost twice the NMR for the unit. The main reasons and respective case fatality rates were: birth asphyxia (60.0%), tetanus (57.1%), low birth weight (28%). Main causes of death were similar to what were previously documented in the unit. Majority of the deaths were preventable. Though the mortality rate was much higher than what was previously recorded in the unit, the effort saved many babies who would have died if they had not been admitted. Better management of industrial dispute would forestall this avoidable tragedy with increase in NMR.

Urgences gériatriques

There are several types of geriatric emergencies with specific care. The first emergency type is constituted by emergencies identical to that of the young adult, but with a different semiological presentation that makes the diagnosis more difficult and induces a delay in the treatment. Some non specific symptoms (agitation, digestive disorders) can be the only clinical signs of serious pathologies. Other symptoms such as fever or pain can be missing in infectious or surgical presentations. In addition, some non serious diseases of the young adult can have severe consequences in the elderly and must be treated urgently. The second emergency type is more specific of the elderly because of its particular frequency in an old population, and its functional consequences. Falls and loss of autonomy are rarely taken into account, or wrongly attributed to age whereas they require an adapted treatment to avoid complications. The third type of emergency is a failure in the assistance system implemented for a frail elderly subject (for example a medical or social problem with the main care provider). Urgent management of the patient is then mandatory.

Patient safety initiatives in Brazil: a nursing perspective

The science development and technology application improvement in all areas of knowledge, including health care, represent an advance in patient care. The health care providers face challenges to accomplish complex procedures and treatments, which demand infrastructure, defined framework, constant process establishment and redesign of nursing care, based on a continuous outcomes evaluation. Therefore, this development requires nurses with advanced knowledge and skills. As the main health care provider in Brazilian hospitals, the nursing staff perform and control the majority of direct patient care procedures, and as such, nursing professionals can be responsible for triggering adverse events that can compromise patient safety. Research conducted in Brazil showed that the quality of health care delivery system and the results of care have significant variation nationwide. Health care professionals should be valued as the one who can promote patient safety, providing high quality care within cost-effective services. Technology is a key element to support and enhance the professional’s performance. However, it is also important to promote and facilitate its implementation and development to retain a creative, engaged, skilled, satisfied, competent, and accountable professional capable of identifying and using technology resources in order to assure the quality of care for the population.

El impacto de cuidar en la salud y la calidad de vida de las mujeres

Background: Informal care currently lies at the heart of the debate on welfare policies since demands for such care are increasing and the future availability of informal caregivers is uncertain. Objective: To analyze the distribution of the burden of informal care between men and women and its consequences on health and quality of life. Methods: Data from Spain and other neighboring countries obtained from several bibliographic databases, publications, and official reports were gathered. In addition, the results of a home survey conducted by the authors on 1.000 male and female informal caregivers in Andalusia (Spain) were used. Results: The studies reviewed demonstrate that women are the main providers of informal care in Spain. Most informal carers are women with a low educational level, without employment and from a low social class. The negative impact of caregiving was noted by a large proportion of carers, especially financial consequences and loss of employment and time. Informal caregiving also has a considerable impact on health, especially on psychological health, and is associated with high levels of burden. Conclusions: The present study demonstrates the need to reorganize health and social policies and to provide sufficient resources to meet the increasing need for informal care and to mitigate the impact and costs of caregiving on diverse aspects of women’s lives.

Impact of caregiving on women's health and quality of life

Informal care currently lies at the heart of the debate on welfare policies since demands for such care are increasing and the future availability of informal caregivers is uncertain. To analyze the distribution of the burden of informal care between men and women and its consequences on health and quality of life. Data from Spain and other neighboring countries obtained from several bibliographic databases, publications, and official reports were gathered. In addition, the results of a home survey conducted by the authors on 1.000 male and female informal caregivers in Andalusia (Spain) were used. The studies reviewed demonstrate that women are the main providers of informal care in Spain. Most informal carers are women with a low educational level, without employment and from a low social class. The negative impact of caregiving was noted by a large proportion of carers, especially financial consequences and loss of employment and time. Informal caregiving also has a considerable impact on health, especially on psychological health, and is associated with high levels of burden. The present study demonstrates the need to reorganize health and social policies and to provide sufficient resources to meet the increasing need for informal care and to mitigate the impact and costs of caregiving on diverse aspects of women's lives.

Designations of Medicines

With the proliferation of medicines vying for recognition in modern health care systems, we are in some cases faced with the problem of what to call them. One has only to consider the terms ‘complementary’ and ‘alternative’, which appear in the title of this journal, to gain a sense of the problem. The two terms are virtually synonymous in their referents. Nevertheless, they differ markedly in their connotations, since they imply different roles in their relationship with the medicine that has come to dominate health care over the planet. What is more, they are considered by some as inappropriate designations for traditional medicines such as Chinese, Arabic and Ayurvedic medicine on the grounds that these cannot be defined in terms of an alien medical system of much more recent vintage. Many other terms used to designate medicines are also the subject of disagreement. Hence, clarification of their connotations may help to contribute to their understanding and thereby promote the development of a rational nomenclature. Before embarking on an investigation of terms used to refer to complementary and alternative medicines, it is as well to consider the confusing welter of terms that have arisen to denote the medicine with respect to which they are considered complementary or alternative. Modern Western Biomedicine The medicine that is taught in medical colleges was, until recently, the absolutely dominant medicine in the West and beyond. Hence it was simply referred to as ‘medicine’. The word ‘medicine’ has been used to refer to numerous different forms of healing that have existed over the centuries. It derives from the Latin medicina, which is related to medico, ‘to heal’ or ‘cure’. The word ‘medicine’ thus essentially means the art of healing. It is only over recent centuries that ‘medicine’ has come to denote specifically the medicine that is based on a wide gamut of natural sciences with biology at its core, since biology explains the workings not only of the human body, but also the microorganisms that account for a large portion of human suffering. This medicine, by its seemingly incomparable achievements, has attained dominance not only its in Western homeland, but also beyond. Even though it is not necessarily the main provider of health care in every country, Western medicine is the arbiter of health matters for the government of virtually every nation of the world. Because of this, its right to be simply called ‘medicine’ was, for the greater part of the 20th century at least, almost uncontested. It was only in the final decades of the last century that dissatisfaction with this medicine caused certain sectors of the Western population to turn to alternative forms of medicine, giving rise to the need for a term by which to distinguish the dominant medicine from the alternatives. Unfortunately, not one, but many, terms denoting this body of medical knowledge have come into use. ‘Western medicine’ labels the medicine it denotes by its origin. It is commonly used particularly in contexts in which non-Western medicines such Chinese, Arabic and Ayurvedic medicine are discussed. Some consider ‘Western medicine’ inappropriate because this medicine is now used across the globe and because it has major contributors outside the West. ‘Modern medicine’ is arguably a good term since it denotes a body of medicine that although it has roots in antiquity, is most precisely definable by its scientific stringency, which is of comparatively recent origin. It is a term commonly used in contexts where an ancient medicine (e.g. Chinese medicine or Indian medicine) is also discussed. In , there is a strong schol

Objective assessment of self-care and non-professional care: a proposal.

Nursing care today, both in theory and practice, consists not only of professional care rendered by nurse but, to a significant degree, involves also self-care and non-professional care. This tendency is also reflected in the philosophical premises of Polish Nursing. The interest in self-care and non-professional care in Poland, and, consequently, in the D. Orem's self-care deficit theory of nursing, as well as attempts at their implementation in nursing practice inspired the present attempt to develop a tool for objective assessment of these two types of care. The proposed Scale of Patient's and Care Provider's Agency (SPCPA) allows for the objective assessment of self-care as patient's self-care agency, and of non-professional care as the main care provider's agency measured in points. The aim of this study is to describe the tool and to assess its two psychometric properties: reliability and validity. The results of the statistical testing of the SPCPA show that the tool is capable of assessing precisely both the patient's self care agency and of the main provider's caring agency.

The USA approach to maternity care

This article provides an account of maternity services in a university hospital in the USA, covering pregnancy, labour and delivery and follow-up care. Obstetricians are the main care providers, although midwifery care is also available. Obstetric nurses give labour and postnatal support. Although this is not an account of the differences between the UK and the described USA system, the most obvious differences are highlighted, these being the variety of practice and the numbers of personnel involved at the delivery. Resources available to both staff and users of the service are substantial, and if midwives are contemplating gaining experience overseas the author highly recommends working within the USA health system.

Center of Excellence for Headache Care: Group Model at Kaiser Permanente

To evaluate the effectiveness of a disease management model for primary headache by: (1) assessing improvement in patients' quality of life, (2) decreasing headache-related visits to primary care and emergency departments, and (3) maintaining high levels of patient and physician satisfaction. Patients with headache regularly seek health care but, in general, are dissatisfied with the care they receive. Patients with primary headaches utilize resources and cost health plans more than patients with other chronic diseases. Primary care visits are time restricted, prohibiting adequate headache evaluation and management. Practice guidelines are inconsistently followed, and access to headache specialists is limited. This headache management program implemented an alternative means of delivering care to manage large volumes of patients with headache. A multidisciplinary team approach coordinated by a neurologist, utilizing education and a nurse practitioner as the main provider of care, was the central process of the program. This was a pilot study involving a prospective cohort with defined outcome measures. Inclusion criteria were adult patients with primary headaches. Patients initially attended an educational session instructed by a neurologist and a nurse practitioner. The patient was subsequently evaluated by the nurse practitioner who developed and coordinated a comprehensive individual treatment plan. The Migraine-Specific Quality of Life and the Medical Outcomes Study 36-Item Short Form Questionnaires were completed at baseline, at follow-up visits, and 6 months after completion of the program. Subjective patient assessment of improvement in their headaches, chart review for tabulation of headache-related visits, and primary care physician satisfaction surveys were measured. Both the Migraine-Specific questionnaire and the Short Form-36 measurements demonstrated a statistically significant improvement at 8 weeks, and this was maintained for 6 months after completing the program. At completion of the program, 92% of patients reported subjective improvement. Patient visits for headaches to primary care and emergency departments showed a significant decrease. High levels of satisfaction for primary care physicians were achieved. A disease management model using a multidisciplinary team improved individualized patient care. This model increased patient/provider rapport and communication through an educational class. It empowered the patient to take control of their health care by utilizing shared decision making. Patient satisfaction improved and overall health care utilization was reduced.

Primary health care provision for adults with a learning disability.

During the last decade, primary care has been designated as the main provider of health care to people with learning disabilities. Practice nurses based in primary care teams are increasingly the first points of contact with health services. They make an important contribution to promoting good health, with health screening and illness prevention work being a significant part of their role. However, little is known about their views or involvement regarding the provision of primary care for people with learning disabilities. There is therefore a need to explore the nursing perspective, from within primary care, on the current provision of care for people with a learning disability. To inform the learning disability service of the role of primary care in current service provision for people with learning disabilities. A survey of all practice nurses currently employed by Grampian Health Board in Aberdeen was conducted in June 2001. An initial pilot study was conducted in primary care and learning disability services. Data collection took place during June and July 2001. All practice nurses working in the geographical region of Grampian were invited to participate. Communication barriers exist, preventing access to health screening and treatment for some people with learning disabilities. Independent living skills, for example dietary management and budgeting, require additional community support. These conditions pose complex problems for practice nurses and other members of the primary care team. This study indicates a need for closer support and partnership with the learning disability service. The factors necessary for providing health care to people with learning disabilities extend beyond the domain of primary care teams. The findings of this survey have important implications for education and support to enable carers and professionals to provide a high standard of care.

Análisis de la percepción de capacitación y formación de los profesionales del ámbito sociosanitario en la atención a los cuidadores de personas mayores dependientes

IntroductionPrimary care practitioners and social workers are the main providers of health and social care to frail elderly individuals and their families. The rapid increase in this population requires a series of adjustments to be made to the health and social services system. ObjectiveTo analyze the degree to which these professionals consider their training to be sufficient to appropriately meet the needs and demands of caregivers. ProcedureThe Needs assessment questionnaire for caregivers of frail elderly people was mailed to all the Social Services Centers of the Community of Madrid and to a random sample of practitioners working in the XI Health Area of Madrid. The response rate was 12.5% (74 out of 590). ResultsWhile 3 out of 4 health providers considered themselves as competent to attend caregivers’ requests regarding everyday care tasks, only 5.5 out of 10 considered themselves competent to give advice and counseling on problematic behavior and difficult care-related situations. Furthermore, only 3 out of 10 considered themselves qualified to guide caregivers on the consequences of caregiving. Social workers reported they felt very underqualified to give advice on everyday tasks, scarcely qualified to give advice on the management of difficult situations and moderately competent to guide caregivers on the consequences of caregiving. Both professional groups perceived a strong need for specific training in this field (only 1 out of 4 had received specific training). ConclusionTo optimize health care and social services for caregivers, health professionals should be given specific training.