Private Health Services Research Articles

Experiences of care by Australians with a diagnosis of borderline personality disorder.

Accessible summary Borderline personality disorder (BPD) is a complex and challenging mental health condition for the person and service providers who support them.This paper reports on the results of a survey of 153 people with a diagnosis of BPD about their experiences of attempting to receive support in managing this mental health condition. It provides their perceptions of a range of experiences not reported in the existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types.People with a diagnosis of BPD continue to experience significant discrimination when attempting to get their needs met within both public and private health services. Further education for nurses and other health professionals is indicated to address pervasive negative attitudes towards people with a diagnosis of BPD. There is limited understanding of the experience of seeking and receiving treatment and care by people with a diagnosis of borderline personality disorder (BPD), their perceptions of barriers to care and the quality of services they receive. This study aimed to explore these experiences from the perspective of Australians with this diagnosis. An invitation to participate in an online survey was distributed across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 153 people with a diagnosis of BPD showed that they experience significant challenges and discrimination when attempting to get their needs met within both public and private health services, including general practice. Seeking help from hospital emergency departments during crises was particularly challenging. Metropolitan and rural differences, and gender differences, were also apparent. Community supports were perceived as inadequate to meet their needs. This study provides data on a range of experiences not reported in existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types. Its findings can help inform better training for health professionals and better care for this population.

Strategies to improve tuberculosis case finding in children.

Strategies to improve tuberculosis case finding in children.

Organising health services through modularity

Purpose– The purpose of this paper is to analyse the way in which the factors influencing a transformation towards or away from modularity, according to general modular systems theory, appear in the context of health services, and the extent to which the special characteristics of health services might support or prevent its application.Design/methodology/approach– The arguments constructed in the study are based on the theme of modularity, reflected against the special characteristics of health services identified in the context of health economics.Findings– The results include 11 proposition pairs that direct health services both towards and away from modularity.Research limitations/implications– Health services are highly heterogeneous in nature and the authors illustrate this with a wide range of examples from elderly care as the authors discuss the application of modularity in this context. Nevertheless, the authors recognise that modularity might suit some health services better than others. The findings provide potentially important information to health service managers and providers, enabling them to understand how modularity would benefit health service provision and where contradictions are to be expected.Originality/value– This study contributes to the discourse on service modularity in general, and complements the literature on modularity with reference to both public and private health services.

LEKSIKON ETNOMEDISIN DALAM PENGOBATAN TRADISIONAL MINANGKABAU

System of traditional medicine to this day is still alive, although the practices of modern medicine is growing rapidly with the emergence of centers of government and private health services. The phenomenon Back to Nature (back to nature) are increasingly intensified by the developed countries have a positive impact on the flourishing of the traditional medical systems. The method used to analyze the data are unified method. Unified method used is equivalent translational methods and methods of unified referential. In this study lexicon Minangkabau traditional medicine can be classified into three groups: the types of diseases, types of herbs and treatment process.

Barriers to Case Management Implementation: Differences Between Mental Health Teams in Portugal

1. Introduction Case management is defined as an evidence-based practice used to help patients in the recovery process. The experiences of several countries show that progress towards case management implementation is slow and complex, depending not only from the degree of effectiveness or the complexity of the practice, but also from regional and local barriers to implementation. 2. Objectives To study the differences in the case management barriers to implementation, between Portuguese specialised mental health teams. 3. Methods Data was collected in 26 public and private mental health services of mainland Portugal. Barriers were assessed using the BaFAI - Barriers and Facilitators Assessment Instrument (Peters, 2001). Services profiles were made using a specific questionnaire. 4. Results Significant differences between mental health teams were found in the following barriers to implementation: 1. Resistance to use treatment protocols was higher in teams that routinely don’t use clinical guidelines (p=0,028). This barrier was also higher in services without research activity (p=0,034); 2. Barriers linked with space availability to implement the practice were higher in teams without liaison with the primary health care (p=0,045). 3. Barriers associated with professional’s difficulty to change were found in less specialised mental health teams (p=0,006). 5. Conclusion Special attention is needed to regional and local barriers to implementation in the process of mental health services quality improvement and innovation. Implementation protocols should include prior barriers assessment so that implementation plans can incorporate the strategies to tackle differences between mental health teams.

Variation of Mental Health Case Management Fidelity in a Geographically Small Country

1. Introduction Strategies to implement evidence-based practices are critical to improve services. There are many barriers to their implementation, despite all available knowledge. Even geographically small countries like Portugal (92.152 km 2) can have substantial regional variations in evidence-based practices implementation. 2. Objectives Evaluate the regional variation of mental health case management fidelity during a systematic implementation process, according to the measurement of techniques and resources used by mental health professionals. 3. Methods The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a case management course, in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009). 4. Results Mental health professional’s assessment in 26 mental health public and private services (n=71) showed that there are significant differences in the proportion of case management adequate implementation between country regions (North = 35,7% / Centre = 57,5 / Lisbon and Tagus Valley = 65,3%, Alentejo 72,7% and Algarve = 50%). 5. Conclusion The results show that even in a geographically small country there are big differences in the quality and degree of effective practices implementation. This happens despite the fact that the implementation process was developed nationwide by the same training and implementation team, working with regional groups. Locally and regionally designed implementation programs are needed to balance the unevenness of evidence based practices fidelity and quality.

Personal Health Systems Technologies: Critical Issues in Service Innovation and Diffusion

Personal health system (PHS) technologies can enhance public and private health service delivery and provide new business opportunities in Europe and around the world. Although much PHS technology has already been developed and could potentially provide virtually everyone with access to personalized healthcare, research driven primarily by a technology push may fail, because it fails to situate PHS within the wider health and social care service systems. In this article, we explore the scattered PHS research and innovation landscape, as well its relevant markets, using several types of analyses: bibliometrics, patent analysis, social network analysis, stakeholder workshops, and interviews. Our analyses aim to identify critical issues in the development and implementation of service systems around PHS technologies. If I could time travel into the future, my first port of call would be the point where medical technology is at its best. Because, like most people on this planet, I have this aversion to dying.

Blind spot: how neoliberalism infiltrated global health

List of Illustrations Foreword Paul Farmer Preface Acknowledgments 1. Introduction: A World Transformed Part I. The Beginning of the Encounter: The Soviet World Meets Its Global Counterparts 2. Health in the Time of the USSR: A Window into the Communist Moral World 3. Seeking Help at the End of Empire: A Transnational Lifeline for Badakhshan Part II. Life at the End of Empire: The Crisis and the Response 4. The Health Crisis in Badakhshan: Sickness and Misery at the End of Empire 5. Minding the Gap? The Revolving Drug Fund Part III. Transplanting Ideology: Village Health Meets the Global Economy 6. Bretton Woods to Bamako: How Free-Market Orthodoxy Infiltrated the International Aid Movement 7. From Bamako to Badakhshan: Neoliberalism's Transplanting Mechanism Part IV. The Aftermath: Neoliberal Success, Global Health Failure 8. Privatizing Health Services: Reforming the Old World 9. Revealing the Blind Spot: Outcomes That Matter 10. Epilogue: Reframing the Moral Dimensions of Engagement Notes Bibliography Index

Idiopathic toe walking may impact on quality of life

Methods This research was a cross-sectional online survey. Parents of children aged 5-17 and people above 8 years, who previously or currently have an ITW gait, were recruited. Recruitment was through public and private health services and online parenting forums. Questions about known diagnoses, birth and developmental history were used for screening to reduce the chance of the toe walking being related to a medical condition. Data collected included PedsQL 4.0 Generic Core Scale via either parent proxy or child/adult report, the parent proxy PedsQL Family Impact module, past treatments of ITW and any current localised musculoskeletal pain. The results of the PedsQL 4.0 were compared to healthy population, cerebral palsy and Attention and Hyperactivity Disorder (ADHD) data for the parent proxy and child reports only.

Quality Assessment in the Service Area of Expertise in an Institution of Public Health Sector

In Mexico over time, economic crisis has worsened the health sector, where those most affected are the lower class, so that people with disease do not have access to private health services, given the high cost that this represents, just as people who are not beneficiaries of the Mexican Institute of Social Security by its Spanish initials IMSS, Institute of Security and Social Services for State Workers by its Spanish initials ISSSTE and other insured agencies providing public health services have no options to solve their health problems.

Commentary: Reproductive health and rights in Brazil 20 years post-International Conference on Population and Development

Commentary: Reproductive health and rights in Brazil 20 years post-International Conference on Population and Development

Commentary: Accelerating the quest for integrated and comprehensive sexual and reproductive health services in Nigeria

By centralising sexual and reproductive health (SRH) and rights, gender equality and adolescent empowerment within sustainable development, the 1994 International Conference on Population and Devel...

Barbara's story: a thematic analysis of a relative's reflection of being in the intensive care unit.

The aim of this reflective account is to provide a view of the intensive care unit (ICU) relative's experiences of supporting and being supported in the ICU. Understanding the relatives' experiences of ICU is important especially because a recent work has identified the potential for this group to develop post-traumatic stress disorder, a condition that is normally equated with the ICU survivor. A thematic analysis was used in identifying emerging themes that would be significant in an ICU nursing context. The incident took place in two 8-bedded ICUs (Private and National Health Service) in October. Two emergent themes were identified from the reflective story - fear of the technological environment and feeling hopeless and helpless. The use of relative stories as an insight into the live experiences of ICU relatives may give a deeper understanding of their life-world. The loneliness, anguish and pain of the ICU relative extends beyond the walls of the ICU, and this is often negated as the focus of the ICU team is the patient. Developing strategies to support relatives might include the use of relative diaries used concurrently with patient diaries to support this groups recovery or at the very least a gaining a sense of understanding for their ICU experience. Relative follow-up clinics designed specifically to meet their needs where support and advice can be given by the ICU team, in addition to making timely and appropriate referrals to counselling services and perhaps involving spiritual leaders where appropriate.

Healthcare experiences of lesbian and bisexual women in Cape Town, South Africa

Understanding the health needs and experiences of South African lesbian and bisexual women is imperative for implementing effective and inclusive public health strategies. Such understanding, however, is limited due to the exclusion of these women from most existing research on healthcare access in the region. This paper bridges that gap by investigating the healthcare experiences of lesbian and bisexual women in Cape Town. Data were gathered from 22 interviews with self-identified lesbian and bisexual community members and university students in the Cape Town area. Interviews explored obstacles women face in accessing affirming services, different experiences with public and private healthcare, fear of stigma/discrimination, availability of relevant sexual health information and suggestions to improve existing programmes. Findings suggest that South African lesbians and bisexual women may have a range of both positive and negative experiences in public and private health services, that they use protective strategies when ‘coming out’ and that they find that sexual health information pertinent to them is largely unavailable. These discussions contribute to a more inclusive understanding of the experiences of lesbian and bisexual women accessing healthcare and other services and help to inform providers, thereby enabling them to deliver more meaningful care to lesbian, gay, bisexual and transgender persons in South Africa.

Ethical challenges for doctors working in immigration detention.

The health of asylum seekers in Australia’s immigration detention centres has been the subject of a doctors’ letter of concern and two recent reports.1-3 Here, we present an analysis of the ethical dilemmas faced by health practitioners working in these centres1 and seek to promote a strong and considered policy discussion. Australia’s Department of Immigration and Border Protection (DIBP) contracts a private health service provider, International Health and Medical Services (IHMS), to provide health care to immigration centre detainees at an Australian standard.4 However, media and other reports from Christmas Island,1 Manus Island2 and Nauru3 have raised serious concerns about the quality of care provided and whether health care professionals have been able to fulfil their professional and ethical obligations to patients in these facilities.1-3

Study of musculoskeletal disorders in physical therapists: correlation with routine work.

Introduction: Work-Related Musculoskeletal Disorders (MSDs) affect health professionals by frequent exposure to physical and mental overloads during the workday. Physiotherapy aims to promote functional health of the individual, however ergonomic conditions in their workplace are often precarious and that along with the activities and repetitive movements resisted overload the musculoskeletal system inducing damage to your physical condition. Objective: Identify the occurrence of Musculoskeletal Disorders (DMEs) in physical therapists working in public and private health services in Recife-Pernambuco, recording determinants and establishing relationship with clinical practice and the workload of the tests. Method: Observational study of physiotherapists of both genders. Peres administered questionnaire collected personal information, professional performance and DMEs Results: 41 physiotherapists; 85.4% reported DMEs, females (80.5%); 41.4% between 24-30 years; places of work, hospitals (70.7%) and clinical (63.4%); predominance of lesions in the spine and upper limbs; 65.7% changed work habits due to the occurrence of DMEs. Significant correlation between age and gender prevalence in females; since the occurrence of DMEs was not significantly correlated with time of practice, with workload, with the number of daily visits nor to rest at work. Conclusion: The volunteers showed high percentage of involvement by DMEs, especially in the spine, which seems to be related to the age and gender of the therapist. The study indicates that physical therapists are an exposed to risk for developing occupational musculoskeletal disorders profession, requiring awareness of students and professionals about proper use of the body itself, the risks of the profession in order to prevent future physical limitations.

NATIONAL NURSING RESEARCH STRATEGY FOR SOUTH AFRICA

FUNDISA has been actively promoting nursing research since its inception, but more rigorously over the last five years as the nursing profession moves into Higher Education Institutions (HEIs) where research is a priority. A National Nursing Research Advisory Committee (NNRAC) was elected to draft the National Research Strategy for South Africa for the relevant stakeholders involved: Universities, Nursing Schools, Public and Private Nursing Colleges, Health Services and Professional Societies. The aim of this research strategy is to enhance collaborative rigorous scientific enquiry that builds a significant body of knowledge in order to improve the health of the people of South Africa. The objective of this strategy will be achieved by building a research culture in nursing, building nursing research capacity and building research programmes across the country. It is envisaged that the research strategy will contribute significantly to directing future nursing research development in South Africa.

Biological drugs for the treatment of psoriasis in a public health system.

OBJECTIVE To analyze the access and utilization profile of biological medications for psoriasis provided by the judicial system in Brazil.METHODSThis is a cross-sectional study. We interviewed a total of 203 patients with psoriasis who were on biological medications obtained by the judicial system of the State of Sao Paulo, from 2004 to 2010. Sociodemographics, medical, and political-administrative characteristics were complemented with data obtained from dispensation orders that included biological medications to treat psoriasis and the legal actions involved. The data was analyzed using an electronic data base and shown as simple variable frequencies. The prescriptions contained in the lawsuits were analyzed according to legal provisions.RESULTS A total of 190 lawsuits requesting several biological drugs (adalimumab, efalizumab, etanercept, and infliximab) were analyzed. Patients obtained these medications as a result of injunctions (59.5%) or without having ever demanded biological medication from any health institution (86.2%), i.e., public or private health services. They used the prerogative of free legal aid (72.6%), even though they were represented by private lawyers (91.1%) and treated in private facilities (69.5%). Most of the patients used a biological medication for more than 13 months (66.0%), and some patients were undergoing treatment with this medication when interviewed (44.9%). Approximately one third of the patients discontinued treatment due to worsening of their illness (26.6%), adverse drug reactions (20.5%), lack of efficacy, or because the doctor discontinued this medication (13.8%). None of the analyzed medical prescriptions matched the legal prescribing requirements. Clinical monitoring results showed that 70.3% of the patients had not undergone laboratory examinations (blood work, liver and kidney function tests) for treatment control purposes.CONCLUSIONS The plaintiffs resorted to legal action to get access to biological medications because they were either unaware or had difficulty in accessing them through institutional public health system procedures. Access by means of legal action facilitated long-term use of this type of medication through irregular prescriptions and led to a high rate of adverse drug reactions as well as inappropriate clinical monitoring.

Victorian Audit of Surgical Mortality is associated with improved clinical outcomes.

Improved outcomes are desirable results of clinical audit. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM) and the Victorian Admitted Episodes Dataset (VAED) to highlight specific areas of clinical improvement and reduction in mortality over the duration of the audit process. This study used retrospective, observational data from VASM and VAED. VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Aggregated VAED data were supplied by the Victorian Department of Health. Assessment of outcomes was performed using chi-squared trend analysis over successive annual audit periods. Because initial collection of data was incomplete in the recruitment phase, statistical analysis was confined to the last 3-year period, 2010-2013. A 20% reduction in surgical mortality over the past 5 years has been identified from the VAED data. Progressive increase in both surgeon and hospital participation, significant reduction in both errors in management as perceived by assessors and increased direct consultant involvement in cases returned to theatre have been documented. The benefits of VASM are reflected in the association with a reduction of mortality and adverse clinical outcomes, which have clinical and financial benefits. It is a purely educational exercise and continued participation in this audit will ensure the highest standards of surgical care in Australia. This also highlights the valuable collaboration between the Victorian Department of Health and the RACS.

Adult orthodontics part 1: special considerations in treatment

Adult orthodontic demand in the UK has increased significantly in both private and National Health Service sectors, the reason being improvement in the availability of orthodontic services and an increased patient awareness towards orthodontics; in particular the desire for adults to have an aesthetic smile. There is also the role of orthodontics as an adjunct to restorative, periodontal and orthognathic treatment. Clinical Relevance: Successful orthodontic treatment of adults depends on an understanding of the biological, mechanical, psychological and aesthetic needs of adult patients.