Network Of Health Services Research Articles

Investigation on community health service utilizing in discharged patients after operation

Objective To investigate the status of community health service utilizing in discharged patients after operation and provide basis for building community health service network.Methods Using cluster stratified sampling,to follow up 328 patients underwent surgery in Top three hospitals by telephone 1 week after discharge and investigate the status of communitv health service utilizing.Results 43.6%patients didn't ask the community health service institutions for help.The main reasons were distrust of community health service(39.0%),lack of knowledge about the community health service(29.3%),lack of required services(9.8%).People who got higher educational level,had the experiences of community health service utilization,were would to build the community health service network were more likely to utilize the community health service(P<0.05).Conclusions The utilization ratio of community health is lower,it is significant and important to develop community health service and enrich it in forms and content for patients'rehabilitation and health. Key words: Discharged patients after operation; Community nursing; Utilizing; Investigation

Registered Nurses’ smoking behaviours and their attitudes to personal cessation

The aim of the study was to assess smoking behaviour of nurses including; (1) smoking prevalence and nicotine dependence; (2) demographic characteristics according to smoking status and (3) attitudes to cessation amongst current smokers. Smoking amongst nurses is a barrier to the delivery of patient smoking cessation interventions. Studies on the smoking behaviour of nurses have lagged behind government surveys on smoking prevalence in the general population. A descriptive, comparative study using a self-administered questionnaire was distributed to 3200 nurses over July and August of 2007 across one major metropolitan health service network in Victoria, Australia. The questionnaire was completed by 1029 nurses, a response rate of 32%. Eleven per cent of nurses (n=113) were current smokers. Nurses who smoked were more likely to be divorced/separated and report smoking amongst family and friends. Smoking was more common amongst nurses who work in psychiatry and the emergency departments. Amongst the nurses who smoked, 45% desired to stop smoking and while 89% had experienced previous quit attempts, only half had ever received help or advice about smoking cessation. The most common factors preventing smoking cessation included fear of withdrawal symptoms including stress, weight gain and anxiety. Smoking rates amongst nurses in this sample have declined below smoking rates amongst the general population. Considering the low uptake of smoking cessation support reported in this study, targeted strategies must be developed sensitive to the potential intrapersonal-professional struggle related to personal smoking which is at odds with nurses' health promotion role.

A reflection on the continuity of the three-tier healthcare network in rural China

Through the analysis of the problems of health service delivery system in rural areas and the causes of the abnormal operation of the three-tier rural health service network, this article probed into the continuity of health service in rural China. These issues are observed from the aspects of continuity of disciplines, institutions, relationship and health information. Policy recommendations include remolding the institutional relations in the three-tier rural health service network, constructing reasonable supporting environment and improving the health delivery quality. Key words: Rural area; Health service; Continuity; Three-tier rural health service network

Equidade no acesso ao transplante de rim com doador falecido no estado do Rio de Janeiro

In Brazil, the transplant is a right of society, however the shortage of organs from deceased donors has been reflected in increased demand for transplantation. In this context, this paper aims to analyze access to kidney transplantation in the State of Rio de Janeiro from the perspective of fairness. We sought to identify through the charts and analysis from the non-transplanted qualified for kidney transplantation in 2008 the factors that hinder access, from the steps required for the potential recipient to undergo transplantation. Based on the consensus that equity is a constitutional principle and the Health System and the conceptual options influence the choice of distributive criteria, the indicators used to assess the degree of equity and interpretation of results for the effectiveness of interventions. Among the results, we highlight the "serum loser" as the main obstacle is not classified among the transplant, followed by "not informed", "Contact Phone", "Without clinical conditions"; "Contra-indication for transplantation teams"; "without examination" and "Other". It was noted that the current selection criteria for kidney transplantation has many limits to implement fairly, especially concerning the organization of the network and consumption of health services. The national policy on transplantation still presents a disjointed network that is unable to ensure access to the actions and health services, thus not allowing all health needs of the user population of transplant services in the State of Rio de Janeiro.

Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study

The worldwide Health Promoting Hospital and Health Services (HPH) network was initiated by the World Health Organizations in the late 1980s. The goal of the network is to change the focus of health services from curing patients to also embrace disease prevention and health promotion. In Sweden the network started in 1996, and involves mainly hospitals and primary care. The network members collaborate in task forces, one of which is working on the tobacco issue. There is limited evidence on the value of working within an HPH organization. The aim of this study was to investigate the experiences of members of the Swedish HPH network tobacco task force. Focus group interviews with task force members were analyzed using implementation theory. Three themes, overall experiences of working with tobacco issues, experiences of working with “free from tobacco in connection with surgery”, and experiences of work in the HPH tobacco task force, emerged from the interviews. The results show that working with the tobacco issue in the context of health-promoting hospitals and health services met with difficulties involving the following important factors: evidence, context, facilitation and adopter characteristics. Leadership, one contextual factor, at national and local level, seems to be crucial if the work is going to succeed. The tobacco task force of the HPH network is an important facilitator supporting the task.

Acesso à assistência oncológica: mapeamento dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama

This study analyzes the flow of patients with breast cancer treated in Brazil's Unified National Health System (SUS) by type of treatment (surgery, radiotherapy, and chemotherapy). Hospital and outpatient services networks were identified based on data from the National Information System for Inpatient Care (SIH), and the National Information System for Outpatient Cancer Care, for 2005-2006, using TabWin and TerraView. Health services networks reach most of the country, and few municipalities are not connected to a network. However, treatment is highly concentrated in the largest cities, and even the latter show evidence of service shortages. Furthermore, a large proportion of patients live more than 150 km from the respective service. Network identification is important for planning and improving services distribution, since geographic access is a relevant issue for treatment outcome. Reduction of morbidity and mortality requires early identification, and appropriate and prompt treatment can reduce the impacts of the disease.

O desenvolvimento de competências em atenção básica à saúde: a experiência no projeto Huka-Katu

This article explores the possibility of integration in the learning process in health services network of the Native People Health Sub-system, an integrant part of the Brazilian Unified Health System. This leading role is present in several instances and stimulates changes in the health professional education. It also emphasizes that the pedagogical conception and the methodologies of the teaching-learning process are important themes for the development of competencies of new health professionals. The aim of this article is to present by means of a descriptive analysis, the context in which the preparatory process is developed for the optative stage "Huka-Katu project--FORP-USP in the Xingu" highlighting the development of cognitive aspects presented in the proposition of actions directed to the primary care. The required competencies for the practice of the surgeon dentist in the primary health care is the base for the construction of SUS, while these competencies should answer the needs for the articulation of practice and education in a perspective of health care.

Organização de serviços de emergência hospitalar: uma revisão integrativa de pesquisas

doi: 10.5216/ree.v12i4.6585 A organização de serviços de urgência/emergência propicia elementos para assistência qualificada integral e contínua aos usuários. Trata-se de revisão integrativa de literatura com objetivo de sintetizar produção científica latino americana sobre organização dos serviços de urgência/emergência hospitalar no período de 1988 a março de 2010. Os dados foram coletados em base eletrônica (LILACS) e registrados em instrumento específico. A amostra totalizou 41 publicações. Os artigos foram agrupados por similaridade de conteúdo: aspectos estruturais do sistema de saúde, 12 artigos (29,3%), aspectos estruturais hospitalares, 10 artigos (24,4%) e qualidade da assistência, 19 artigos (46,3%). O crescimento do número de acidentes, violência urbana e insuficiente estruturação da rede de serviços de saúde são fatores que têm contribuído decisivamente para a sobrecarga dos serviços de urgência/emergência. O conhecimento desta realidade é de importância fundamental, no sentido de valorizar as necessidades de reestruturação do atual sistema de saúde, na perspectiva de consolidação dos princípios do SUS. Descritores: Serviços Médicos de Emergência; Organização e Administração; Enfermagem.

Support to Primary Health Care in Transitional Situations: Lessons Learned from the Field

In a war context, a transition period begins when the guns fall silent following a ceasefire or a peace agreement is signed. In a natural disaster context, it starts as soon as the search and rescue activities are over. Progression from the emergency to the transition phase is often a tedious process, involving a complex emergency context, unforeseen additional and emerging needs and the presence/withdrawal of stakeholders. Humanitarian aid commonly described in most emergencies often persists during the transition phase. It requires them to make a complete shift in its approach, planning, financing, performance monitoring and evaluation. In transition situations, the key is to develop national and international partnership in respect to primary health centres, with a clearly-defined, realistic and participative public health methodology. This paper, a review of some key humanitarian guidelines and peer reviewed studies, is presented with a methodological approach with a succession of practical questions, answers, and documented case examples and targets central, provincial and district health facilities and national and international public health workers facing the challenges of a fragmented and fragile post-emergency health service network.

One step forward, one step back: Quebec's 2003–04 health and social services regionalization policy

This article focuses on Quebec's most recent reform in the regionalization of health care to understand why the government chose to transform the regional boards into agencies. This case study used interviews and documentary analysis. Rooted in a political science perspective, the conceptual framework is inspired by the work of John Kingdon (1995) and draws on the four variables that influence the choice of policy: ideas, interests, institutions and events. Results of the case study suggest that Quebec's Commission of Study for Health and Social Services (the Clair Commission) in 2000 and the 2002 pre-electoral environment put the issue on the agenda. In 2003, the newly elected Liberal government passed Bill 25 – An Act Respecting Local Health and Social Services Network Development Agencies, which represented a political compromise: originally slated for eradication, the regional tier survived but in a new form. The element that sparked reform was the change in government following the elections. Different inquiry reports spread the reform's ideas, while interest groups articulated contrasting visions on the transformation. Above all, regional institutions showed great resilience in the face of change. From a historical perspective, this regionalization policy is a step backward: the regional tier is now stronger from a managerial and technocratic point of view, but it is politically and democratically weakened. This suggests a government intention, at that time, to maintain the regional level as a means of retaining centralized control over Quebec's health-care system.

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

To review the literature concerning the role and the inclusion of emergency psychiatric services in mental health networks. We performed a search in online databases (PubMed and SciELO) of empirical articles and reviews about emergency psychiatric services and networks of mental health services. Emergency psychiatric services are a core unit for a proper functioning of mental health networks, by both the management of emergencies itself, and the regulation of the network where it belongs. The emergency psychiatric services relate to all inpatient and outpatient services, allowing the organization of the flow of admissions and avoiding the overload of the network of mental health.The functions of emergency psychiatric services are broad and go beyond the simple referral for hospitalization, since clinical stabilization and psychosocial support can be reached in well structured emergency psychiatric services. In Brazil, these functions were expanded after the mental health reform and the burden of mental health network caused by difficulties and limitations of inpatient and outpatient services. Emergency psychiatric services should be recovered and expanded; especially those located in general hospitals. It is suggested that investment in psychiatric emergencies should be a priority of the Brazilian public health policies for improving the mental health care.

Modelo geoespacial automatizado para la regionalización operativa en planeación de redes de servicios de salud

To develop an automated model for the operational regionalization needed in the planning of the health service networks proposed by the new Mexican health care model (Modelo Integrador de Servicios de Salud MIDAS). Using available data for México during 2005 and 2007, a geospatial model was developed to estimate potential catchment areas around health facilities based on access travel time. The results were compared with an operational regionalization (ERO) study manually carried out in Oaxaca with 2005 data. The ERO assigned 48% of villages to health care centers further away than those assigned by the geospatial model, and 23% of these health centers referred patients to more distant hospitals. The model calculated by this study generated a more efficient regionalization than the ERO model, minimizing travel time to access health services. This model has been adopted by the General Department of Health Planning and Development of the Mexican Ministry of Health for the implementation of the Health Sector Infrastructure Master Plan.

Service provision by township hospitals in Beijing

Objective To probe into the current services and outcomes of township hospitals following their transformation, and their future positioning of functionality. Methods Pinpointing townships A, B and C as samples from a district in Beijing, in which field surveys were made in the township hospitals to learn their services, service provision methods and outcomes. Results Among the current services provided by these three hospitals, those of public health and primary healthcare nature in hospital A account for 50% each; those in hospital B account for 70% and 30% respectively; those in hospital C account for 60% and 40% respectively. Recommendable services provided in these hospitals include universal coverage of medical files, management of infectious diseases, public health emergency management, and immunization. Conclusion Township hospitals as the center of the 3-tier rural health service network, deserve a repositioning of their functionality to fit the health needs of residents at large. Key words: Township hospital; Transformation; Service provision; Functionality positioning

Mental health care network: the interaction importance between the primary

Introduction: The effectiveness of the mental health care network is necessary to the implementation of actions that provide the formation of the web links that promotes psychosocial and quality of life of individuals who have mental disorders. Objective: To develop a theoretical essay on the Brazilian Psychiatric Reform, legislation on mental health in Brazil and the services regulated by this as well as the importance of structuring the network of mental health care, emphasizing the interplay between the specialized services of mental health care and the role of primary health care in building this network. Materials and Methods: We searched the literature published in the last 10 years, written in Portuguese, as well as specific mental health descriptors. Results: The theoretical research pointed to the need of an expanded mental health view, including mental suffering, sheltering the User and promoting their best conveyance, recognizing the role that its territory has in the process, guiding an important and strategic relationship in the health care network articulation. Conclusion: Thus, it is necessary to promote the integration and interaction between the sectors and stakeholders in the mental health care network and primary care, involving health services, management and social participation, both in achieving the care and the mental health care, as in the production and regulation of the health services network.

Redes de atenção à saúde: contextualizando o debate

The proposal of organization in health services networks has been included in the broad field of integrated health care, a general denomination which includes a wide range of interventions varying in objectives and scope, which have in common the pursuit of integration strategies and tools. Among the main experiences in the field are the American integrated delivery systems and the traditional regionalized networks of the national health systems, especially after the introduction of new cooperation strategies. However, while strategies and organizational arrangements might be similar, context is central to debate. Not considering differences concerning health systems nature may turn it difficult to grasp main distinctions in policy making which are responsible for possibilities and limitations of adopting integration strategies and tools. This article aims to look for references in the literature and international experience that might contribute to the debate on health networks building in the Brazilian Unified Health System (SUS). It discusses context regarding the creation of integrated health services networks in two cases, the British National Health Service and the American Health System, focusing specifically on the health services organization component.

Previniendo el maltrato infantil: descripción psicosocial de usuarios de programas de intervención breve en Chile

El estudio describe características y factores de riesgo para el maltrato y negligencia infantil, en 591 niños y adolescentes, sus figuras parentales y familias atendidas por ocho programas de intervención breve (PIB) “Viviendo en Familia”, subvencionados por el Servicio Nacional de Menores (SENAME) y ejecutados por la Protectora de la Infancia en Chile. Los resultados revelan la existencia de problemáticas de mediana complejidad en el entorno, competencias parentales, interacciones familiares, seguridad familiar y bienestar del niño. Aproximadamente tres de cada cuatro cuidadores muestran indicadores de alto riesgo para el maltrato infantil y/o negligencia, especialmente en su salud mental, lo que debe ser considerado por los equipos para la planificación de un trabajo coordinado con la red local de salud.

Enfoque comunicativo del Planeamiento Estratégico Situacional en el nivel local: salud y equidad en Venezuela

The article discusses the results of operationalizing Situational Strategic Planning adapted to the local level in health, considering the communicative approach and equity in a parish in Venezuela. Two innovative criteria were used: estimated health needs and analysis of the actors' potential for participation. The problems identified were compared to the corresponding article on rights in the Venezuelan Constitution. The study measured inequalities using health indicators associated with the selected problems; equity criteria were incorporated into the action proposals and communicative elements. Priority was assigned to the problem of "low case-resolving capacity in the health services network", and five critical points were selected for the action plan, which finally consisted of 6 operations and 21 actions. The article concludes that the combination of epidemiology and planning expands the situational explanation. Incorporation of the communicative approach and the equity dimension into Situational Strategic Planning allows empowering health management and helps decrease the gaps from inequality.

Reflections on professional abilities for working in the Nuclei of Support to Family Health

The Nuclei of Support to Family Health (NASF), recently implanted in Brazil, aim at supporting family health teams in implementingthe network of health services and broaden the public and the target of Basic Assistance actions. Its implantation reflects theincreasing effort for integrality in assistance and interdisciplinarity of health actions, aiming at the consolidation of the Family HealthStrategy. This article presents some reflections concerning the tools used in NASF daily activities and the required professional abilities.An inconsistence between initial training and the concrete reality of services was perceived which challenges us to answer to the socialnecessities in the health field. A training grounded in the four pillars of education proposed by Delors may contribute to educatingprofessionals with knowledge, abilities and attitudes necessary for working in NASF.

Education in health and the Family Health program: nursing work in the prevention of complications in hypertensive patients

The Nuclei of Support to Family Health (NASF), recently implanted in Brazil, aim at supporting family health teams in implementingthe network of health services and broaden the public and the target of Basic Assistance actions. Its implantation reflects theincreasing effort for integrality in assistance and interdisciplinarity of health actions, aiming at the consolidation of the Family HealthStrategy. This article presents some reflections concerning the tools used in NASF daily activities and the required professional abilities.An inconsistence between initial training and the concrete reality of services was perceived which challenges us to answer to the socialnecessities in the health field. A training grounded in the four pillars of education proposed by Delors may contribute to educatingprofessionals with knowledge, abilities and attitudes necessary for working in NASF.

The epidemic tendency of dental caries prevalence of school students from 1991 to 2005 in China

The epidemic tendency of dental caries of school students over the past 15 years in China was analyzed in order to provide bases for prevention of dental caries. Data sets of boys and girls at the age of 7, 9, 12 years (deciduous caries) and 7, 9, 12, 14, 17 years (permanent caries) were collected from the series of Chinese National Surveillance on Students' Constitution and Health (CNSSCH) between 1991 to 2005, a survey that covers 30 provinces of and autonomous regions of China, with Tibet Autonomous Region and Taiwan Province excluded owing to unavailability of related data. According to their socioeconomic status, three urban regions and three rural regions (province capital must be included) were selected in each province, where its socioeconomic status and sports exercise can represent the general level of the locality. All subjects were Han students. Prevalence of deciduous and permanent caries was measured. In 2005, the prevalence of deciduous caries at 7, 9, 12 years was 52.87%, 52.04% and 9.80% in urban boys, 59.37%, 58.68% and 12.18% in rural boys, and that of permanent caries in boys at 7, 9, 12, 14, and 17 years was 2.35%, 5.63%, 13.94%, 19.05% and 21.29% in urban boys, 3.42%, 7.26%, 13.35%, 16.16%, 18.55% in rural boys, while in girls at the same age groups, the prevalence of deciduous caries was 53.53%, 49.48%, 7.92% in urban girls, 59.95%, 56.13%, 8.85% in rural girls; the prevalence of permanent caries was 3.61%, 8.99%, 19.32%, 24.75%, 28.62% in urban girls, and 3.47%, 10.65%, 17.66%, 22.52%, 24.27% in rural girls. The epidemic manifested a gradient distribution in age groups, which was closely related to region of the study population. A dramatic decreasing trend was witnessed among all sex-age subgroups in the rural groups between 1990 and 2005, and such a trend was stronger in deciduous caries than in permanent caries, however, this kind of decreasing trend was not steady, because there was bounce during some year. Although the morbidity of dental caries in China is lower than the standard set by the World Health Organization, and the prevalence of dental caries decreased from 1991 to 2005, the prospect of epidemic dental caries in China is in no way optimistic. The total population with dental caries is still very large and the prevalence decreased unstably. Therefore, financial support on school oral health care should be increased, and a national school oral health service network should be set up.