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Clinical relationships and ethical problems in primary care, Sao Paulo, SP, Brazil

ZOBOLI, Elma Lourdes Campos Pavone
Fonte: EDICIONES DOYMA S A Publicador: EDICIONES DOYMA S A
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
66.07%
Objectives: Main Objective: to identify ethical problems in primary care according to nurses` and doctors` perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design: Synthesis to integrate and reinterpret primary results of qualitative studies. Setting: Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context: Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods: Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results: Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation...

"Avaliação dos serviços de atenção primária à saúde no município de Uberaba: acessibilidade, utilização e longitudinalidade da atenção" ; "Evaluation on Primary Care Services in the municipality of Uberaba: acessibility, utilization and longitudinaly."

Martins, Gisele Paula
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 04/09/2006 PT
Relevância na Pesquisa
66.07%
A atenção primária é recomendada como um princípio organizador para os sistemas de saúde, preconizando, dentre outros aspectos, a acessibilidade, a utilização e longitudinalidade nos serviços de atenção primária, que este trabalho buscou conhecer no município de Uberaba. Para tanto, foram avaliadas: a acessibilidade dos serviços de atenção primária; a utilização do serviço de referência de atenção primária pela população adstrita; a capacidade de a população adstrita identificar qual é o serviço de referência de atenção primária da área onde mora; a opinião do usuário sobre a capacidade dos profissionais de saúde em identificar a população adstrita à área de atuação de seu serviço de saúde; a percepção do usuário sobre a existência de laços interpessoais (vínculo) entre os usuários dos serviços de saúde e os profissionais da equipe. Propôs-se a avaliar, ainda, se a estratégia adotada para o processo assistencial nos serviços de atenção primária estudados, influenciou na acessibilidade, utilização e longitudinalidade da atenção ofertada. Este é um estudo do tipo quantitativo, descritivo e transversal realizado por meio da aplicação de um questionário em domicílios selecionados aleatoriamente no Distrito Sanitário II (DSII)...

Análise da percepção e registro das medidas de prevenção de doenças por profissionais da atenção primária; Analysis of the Perception among and Documentation of Disease Prevention Measures by Healthcare Workers in Primary Care.

Santos, Luciane Loures dos
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 26/11/2010 PT
Relevância na Pesquisa
66.07%
A aplicação das medidas preventivas, principalmente das doenças crônicas não transmissíveis (DCNT), tem sido debatida mundialmente, já que poucos fatores de risco respondem pela maioria das mortes por DCNT, como o tabagismo, alcoolismo, obesidade e dislipidemias. A sistematização das medidas de promoção de saúde e prevenção de doenças (PSPD) pode contribuir para o trabalho das equipes de Saúde da Família, potencializando as suas ações e fortalecendo a Atenção Primária à Saúde (APS). Face ao baixo registro das medidas de prevenção das DCNTs no Brasil e à ausência de parâmetros na literatura nacional, comparamos a percepção dos profissionais e o registro das medidas de PSPD dos centros de saúde brasileiros com os serviços espanhóis, considerados referência no assunto. Realizamos um estudo descritivo e quantitativo, por meio da aplicação de um questionário aos profissionais e da análise dos prontuários dos serviços de APS de municípios de pequeno, médio e grande porte do Brasil e da Espanha. Entrevistamos 82 profissionais entre médicos (50%) e enfermeiros (50%), com elevado grau de especialização (77,5%). A maioria dos espanhóis tinha mais de 10 anos de formado (73%), e 54% atuavam na APS há mais de 10 anos...

Resolutividade do cuidado à saúde das crianças menores de cinco anos hospitalizadas por causas sensíveis a atenção básica; Resolution of the health care of children under five years hospitalized for sensitive causes to primary care

Toso, Beatriz Rosâna Gonçalves de Oliveira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 04/07/2011 PT
Relevância na Pesquisa
66.09%
A resolutividade da atenção básica à saúde deve se refletir na diminuição das hospitalizações por um grupo de causas específicas. As hospitalizações por causas sensíveis a atenção básica são um indicador indireto da efetividade do sistema de saúde, nessa instância de atenção, pressupondo que as internações decorrentes destas doenças não receberam atenção efetiva em momento oportuno, resultando em agravamento da condição clínica que exigiu a hospitalização. Objetivo: Apreender os atributos da atenção básica em saúde a partir do indicador de internação por condições sensíveis à atenção ambulatorial, mediante análise do caminho percorrido nos serviços de saúde por famílias de crianças menores de cinco anos hospitalizadas com doenças respiratórias. Método: Estudo qualitativo cujas bases conceituais estão centradas no cuidado em saúde, na vulnerabilidade e na hermenêutica. O material empírico foi produzido a partir de entrevistas com acompanhantes de crianças hospitalizadas, incluindo o mapa falante e com profissionais de saúde, na observação do processo de trabalho nos serviços de saúde e na análise documental dos prontuários de atendimento das crianças. A compreensão dos dados por meio da hermenêutica norteou a discussão do material empírico organizado em três unidades: perfil de morbidade hospitalar das crianças menores de cinco anos...

Produção do cuidado de enfermeiros em atenção primária à saúde no atendimento em situações de urgência; Production of primary care in the work process of nurses in demand emergency situations; Producción de cuidado primario en salud en el proceso laboral de los enfermeros y para atención en condición de urgencia

Pelegrini, Alisia Helena Weis
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Tese de Doutorado Formato: application/pdf
POR
Relevância na Pesquisa
66.09%
Este estudo teve como objetivo analisar a produção de cuidado primário em saúde no processo de trabalho dos enfermeiros com base na presença e na extensão dos atributos da atenção primária à saúde (APS) e no atendimento de usuários em situação de urgência. Foi utilizada a estratégia metodológica híbrida de combinação das abordagens qualitativas e quantitativas. A pesquisa foi desenvolvida com enfermeiros dos serviços de APS, unidades básicas de saúde (UBS) e unidades de saúde da família (USF) do Distrito Assistencial Glória/Cruzeiro/Cristal e do Distrito Assistencial Sul/Centro Sul do município de Porto Alegre. Na primeira etapa da pesquisa foram coletados dados qualitativos por meio de entrevista semiestruturada com 18 enfermeiros. Na segunda etapa foram coletados dados quantitativos através do instrumento Primary Care Assessment Tool – PCATool-Brasil, versão profissionais, com 52 enfermeiros. Os dados qualitativos foram tratados pela técnica de análise de conteúdo temática. Foi utilizado o software NVivo6 para operacionalização da análise qualitativa. Para organização dos dados quantitativos e realização das análises estatísticas foi utilizado o Programa Statistical Package for the Social Sciences (SPSS). A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Secretaria Municipal de Saúde de Porto Alegre. Conforme as respostas dos enfermeiros ao instrumento PCATool-versão profissionais...

Saúde mental na atenção básica : compreendendo uma história; Mental health in primary care attention : comprising a story

Luiza Oliveira Machado
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 13/02/2015 PT
Relevância na Pesquisa
66.05%
Ao longo das últimas décadas, tanto a Atenção Básica quanto a Saúde Mental vem buscando traçar seu percurso e amadurecer através de experiências nas práticas cotidianas e das diretrizes e questões legais. A Saúde Mental passou por diversas transformações que culminaram na Reforma Psiquiátrica brasileira. Nos últimos anos vem avançando, principalmente no que diz respeito à atenção aos transtornos mentais graves, no âmbito da atenção especializada. Por outro lado, no contexto da Atenção Básica, ainda é frágil, suscita dúvidas e angústias nos profissionais envolvidos. Este estudo visou conhecer os dilemas atuais apontados por artigos científicos entre os anos de 2011 e 2013. A partir do destaque desses desafios, buscou compreender as propostas ministeriais relativas à inserção da Saúde Mental na Atenção Básica do ponto de vista histórico. Trata-se de uma pesquisa qualitativa, que se utilizou da revisão narrativa da literatura e da análise documental como técnicas de coleta de dados; e que se baseou na hermenêutica como referencial teórico. A partir da leitura dos artigos foram identificadas cinco categorias de análise: Rede de Saúde Mental, Ações de Saúde Mental desenvolvidas por profissionais da Atenção Básica...

The study design and rationale of the randomized controlled trial: translating COPD guidelines into primary care practice

Parker, Donna R; Eaton, Charles B; Ahern, David Kevin; Roberts, Mary B; Rafferty, Caitlin; Goldman, Roberta E; McCool, F Dennis; Wroblewski, Joseph
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.04%
Background: Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease associated with significant clinical burden and is estimated to affect 15 million individuals in the US. Although a large number of individuals are diagnosed with COPD, many individuals still remain undiagnosed due to the slow progression of the disorder and lack of recognition of early symptoms. Not only is there under-diagnosis but there is also evidence of sub-optimal evidence-based treatment of those who have COPD. Despite the development of international COPD guidelines, many primary care physicians who care for the majority of patients with COPD are not translating this evidence into effective clinical practice. Method/Design This paper describes the design and rationale for a randomized, cluster design trial (RCT) aimed at translating the COPD evidence-based guidelines into clinical care in primary care practices. During Phase 1, a needs assessment evaluated barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from focus groups, three tools were developed. These include a computerized patient activation tool (an interactive iPad with wireless data transfer to the spirometer); a web-based COPD guideline tool to be used by primary care providers as a decision support tool; and a COPD patient education toolkit to be used by the practice team. During phase II...

Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI)

Vasan, Ashwin; Ellner, Andrew; Lawn, Stephen D; Gove, Sandy; Anatole, Manzi; Gupta, Neil; Drobac, Peter; Nicholson, Tom; Seung, Kwonjune; Mabey, David C; Farmer, Paul E
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.11%
Background: More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of ‘health for all’, high-quality primary care services remain undelivered to the great majority of the world’s poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization’s Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. Discussion Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI...

The impact of direct provision accommodation for asylum seekers on organisation and delivery of local primary care and social care services: a case study

Pieper, Hans-Olaf; Clerkin, Pauline; MacFarlane, Anne
Fonte: BioMed Central Publicador: BioMed Central
Tipo: info:eu-repo/semantics/article; all_ul_research; ul_published_reviewed
ENG
Relevância na Pesquisa
86.08%
peer-reviewed; Background: Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. Methods: In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. Results: There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. Conclusions: Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency...

South Australian Divisions of General Practice supporting diabetes care: insights from reporting data

Moretti, C.; Kalucy, E.; Hordacre, A.; Howard, S.
Fonte: Australian Journal Primary Health, Australian Institute Primary Care & School Public Health Publicador: Australian Journal Primary Health, Australian Institute Primary Care & School Public Health
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
75.97%
The study used public reporting data supplied by the South Australian Divisions of General Practice to examine their role and significance in supporting diabetes care in general practice. Data sources included the Annual Survey of Divisions 2002–07, and Divisions 12-month reports against National Performance Indicators for 2006–07. Results showed that Divisions combine collaboration, practice support and GP education approaches to support optimal diabetes care within general practice. Divisions commonly described their collaborative achievements in terms of connecting general practice with other diabetes providers, services, information and resources. Practice support and educational activities, which were highly interrelated, often focussed on strengthening use of chronic disease Medical Benefit Schedule items, practice nurse roles and computer and information management systems. In this way, Divisions strengthened primary care team functioning to achieve good communication and consistent standards of care between team members. Divisions detailed a range of strategies that worked well in delivering these practice-level outcomes, with implications for wider Network learning and development. These publicly available data sources provide scope for decision makers and researchers to explore other aspects of Divisions’ roles and performance.; Cecilia Moretti...

Study of a primary care depression relapse prevention program: "keeping the blues away".

Howell, Cate Adele
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2010
Relevância na Pesquisa
66.11%
Depression is a serious and often relapsing problem, and the primary care relapse rate is reported to be 37-44.5%. The majority of patients with depression will present to their general practitioner (GP), who will often continue to play a central management role. It is therefore important that GPs are able to access to effective long-term management programs aiming to prevent relapse. However, practical well-researched models for delivering long-term care in the primary care setting are limited. The desire to develop an evidence-based depression relapse prevention program (RPP) stemmed from caring for individuals with depression in primary care settings. A scholarship provided the opportunity to go overseas in the year 2000 to investigate the management of depression, and to speak with a number of leaders in the primary care mental health field. There was consensus that depression relapse was an important area to research. This combination of thesis and publications is the summation of eight years of work, related to the conceptualisation, development, and study of a primary care depression RPP called ‘Keeping the Blues Away’ (KBA). The overall aim of this research was to develop and implement a primary care depression RPP and to evaluate its acceptability and effectiveness. An action research approach involving enquiry...

Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study.

Carrington, M.J.; Jennings, G.L.; Harris, M.; Nelson, M.; Schlaich, M.; Stocks, N.P.; Burrell, L.M.; Amerena, J.; de Looze, F.J.; Swemmer, C.H.; Kurstjens, N.P.; Stewart, S.
Fonte: SAGE Publications Publicador: SAGE Publications
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
Relevância na Pesquisa
66.05%
BACKGROUND: Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain. AIMS: To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels. METHODS: We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%); practice nurse-mediated usual care (n=156, 10.5%); standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared. RESULTS: Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%)...

Screening for sickle cell and thalassaemia in primary care: A cost-effectiveness study

Bryan, S.; Dormandy, E.; Roberts, T.; Ades, A.; Barton, P.; Juarez-Garcia, A.; Andronis, L.; Karnon, J.; Marteau, T.
Fonte: Royal Coll General Practitioners Publicador: Royal Coll General Practitioners
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
66.07%
Background: Haemoglobinopathies, including sickle cell disease and thalassaemia (SCT), are inherited disorders of haemoglobin. Antenatal screening for SCT rarely occurs before 10 weeks of pregnancy. Aim: To explore the cost-effectiveness of offering SCT screening in a primary care setting, during the pregnancy confirmation visit. Design and setting: A model-based cost-effectiveness analysis of inner-city areas with a high proportion of residents from ethnic minority groups. Method: Comparison was made of three SCT screening approaches: `primary care parallel' (primary care screening with test offered to mother and father together); `primary care sequential (primary care screening with test offered to the mother and then the father only if the mother is a carrier); and `midwife care' (sequential screening at the first midwife consultation). The model was populated with data from the SHIFT (Screening for Haemoglobinopathies In First Trimester) trial and other sources. Results: Compared to midwife care, primary care sequential had a higher NHS cost of £34 000 per 10 000 pregnancies (95% confidence interval [CI] = £15 000 to £51 000) and an increase of 2623 women screened (95% CI: 1359 to 4495), giving a cost per additional woman screened by 10 weeks of £13. Primary care parallel was dominated by primary care sequential...

Primary care and youth mental health in Ireland:qualitative study in deprived urban areas

Leahy, Dorothy; Schaffalitzky, Elisabeth; Armstrong, Claire; Bury, Gerard; Cussen-Murphy, Paula; Davis, Rachel; Dooley, Barbara; Gavin, Blanaid; Keane, Rory; Keenan, Eamon; Latham, Linda; Meagher, David; McGorry, Pat; McNicholas, Fiona; O'Connor, Ray; O'D
Fonte: BioMed Central Publicador: BioMed Central
Tipo: info:eu-repo/semantics/article; all_ul_research; ul_published_reviewed
ENG
Relevância na Pesquisa
66.06%
peer-reviewed; Background: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15–24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people’s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals’ experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16–25 years) in primary care in deprived urban settings in Ireland. Methods: The chosen method for this qualitative study was inductive thematic analysis which involved semistructured interviews with 37 healthcare professionals from primary care...

Understanding Nursing and Organizational Contributions to Chronic Disease Management within Primary Care

Lukewich, JULIA
Fonte: Quens University Publicador: Quens University
Tipo: Tese de Doutorado
EN; EN
Relevância na Pesquisa
66.08%
Background: Innovative strategies have been implemented within primary care across Canada to improve the quality of care that is delivered. One such strategy has been the utilization of interprofessional teams, of which nurses are an integral component. The overall purpose of this thesis was to understand nursing contributions within primary care, specifically related to chronic disease management. Objectives: (1) To determine the roles of nurses in chronic disease management and the extent to which chronic disease management strategies have been implemented within primary care in Ontario, (2) to identify data collection tools that describe/measure primary care organizational attributes, (3) to determine the distribution and nature of organizational attributes across primary care practices in eastern Ontario, and (4) to explore relationships between the presence of nurses within Family Health Teams in south eastern Ontario and Type 2 diabetes health outcomes. Methods: Four studies were performed to address the stated objectives. A provincial nursing survey was conducted to obtain information about the roles of nurses working in primary care in Ontario and the extent to which chronic disease management strategies have been implemented in practices in which nurses work. A systematic search and review was completed to identify data collection tools that collect a broader range of organizational attribute data within primary care. Using the ‘Measuring Organizational Attributes of Primary Health Care Survey’ organizational-level data from practices in eastern Ontario were collected and then linked to diabetic patient outcomes. Results: The nursing survey and organizational attribute survey identified that nurses engaged in a broad range of chronic disease management activities and that chronic disease management strategy implementation was not uniform across practices. Registered nurses were identified as the most prominent non-physician healthcare provider within practices...

The influence of primary care clinic characteristics on the quality of care for depression in patients with different comorbidity profiles

Menear, Matthew
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
EN
Relevância na Pesquisa
66.11%
Dans les services de première ligne, la majorité des personnes atteintes de dépression souffrent également d’autres maladies chroniques comorbides. Offrir des soins de haute qualité à ces patients représente un défi important pour les intervenants en première ligne ainsi que pour le système de santé. Il y a des raisons de croire que les contextes organisationnels dans lesquels les intervenants pratiquent ont une influence importante sur les soins. Cependant, peu d’études ont examiné directement la façon dont les caractéristiques des cliniques facilitent ou entravent les soins offerts aux patients atteints de dépression et de différents types de maladies chroniques comorbides. L’objectif général de ce projet de recherche était donc de mieux comprendre comment différentes caractéristiques des cliniques de première ligne influencent la qualité des soins pour la dépression chez des patients ayant différents profils de comorbidité. La thèse comporte deux études. Tout d'abord, nous avons effectué une revue systématique examinant les relations entre la comorbidité physique chronique et la qualité des soins pour la dépression dans les services de première ligne afin de clarifier la nature de ces relations et d’identifier les facteurs qui pourraient influer sur ces relations. Ensuite...

Effecting change in primary care management of respiratory conditions : a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative

McDonnel, Juliet; Williams, Sian; Chavannes, Niels H.; Sousa, Jaime Correira de; Fardy, H. John; Fletcher, Monica; Stout, James; Tomlins, Ron; Yusuf, Osman M.; Pinnock, Hilary
Fonte: Primary Care Respiratory Society Publicador: Primary Care Respiratory Society
Tipo: Artigo de Revista Científica
Publicado em //2012 ENG
Relevância na Pesquisa
85.98%
This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health professionals in their learning...

The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers

Lyratzopoulos, Georgios; Saunders, C. L.; Abel, G. A.; McPhail, S.; Neal, R. D.; Wardle, J.; Rubin, G. P.
Fonte: NPG Publicador: NPG
Tipo: Article; published version
EN
Relevância na Pesquisa
66.06%
This is the final published version. It first appeared at http://www.nature.com/bjc/journal/v112/n1s/full/bjc201540a.html.; BACKGROUND: Appreciating variation in the length of pre- or post-presentation diagnostic intervals can help prioritise early diagnosis interventions with either a community or a primary care focus. METHODS: We analysed data from the first English National Audit of Cancer Diagnosis in Primary Care on 10?953 patients with any of 28 cancers. We calculated summary statistics for the length of the patient and the primary care interval and their ratio, by cancer site. RESULTS: Interval lengths varied greatly by cancer. Laryngeal and oropharyngeal cancers had the longest median patient intervals, whereas renal and bladder cancer had the shortest (34.5 and 30 compared with 3 and 2 days, respectively). Multiple myeloma and gallbladder cancer had the longest median primary care intervals, and melanoma and breast cancer had the shortest (20.5 and 20 compared with 0 and 0 days, respectively). Mean patient intervals were longer than primary care intervals for most (18 of 28) cancers, and notably so (two- to five-fold greater) for 10 cancers (breast, melanoma, testicular, vulval, cervical, endometrial, oropharyngeal, laryngeal...

Implementing stratified primary care management for low back pain: cost utility analysis alongside a prospective, population-based, sequential comparison study

Whitehurst, David G. T.; Bryan, Stirling; Lewis, Martyn; May, Elaine M.; Mullis, Ricky; Foster, Nadine
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Article; published version
EN
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66.06%
This is the final published version. It first appeared at http://journals.lww.com/spinejournal/Fulltext/2015/03150/Implementing_Stratified_Primary_Care_Management.14.aspx.; STUDY DESIGN: Within-study cost-utility analysis. OBJECTIVE:To explore the cost-utility of implementing stratified care for low back pain (LBP) in general practice, compared with usual care, within risk-defined patient subgroups (that is, patients at low, medium, and high risk of persistent disabling pain). SUMMARY OF BACKGROUND DATA: Individual-level data collected alongside a prospective, sequential comparison of separate patient cohorts with 6-month follow-up. METHODS: Adopting a cost-utility framework, the base case analysis estimated the incremental LBP-related health care cost per additional quality-adjusted life year (QALY) by risk subgroup. QALYs were constructed from responses to the 3-level EQ-5D, a preference-based health-related quality of life instrument. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses examined alternative methodological approaches, including a complete case analysis, the incorporation of non-back pain-related health care use and estimation of societal costs relating to work absence. RESULTS: Stratified care was a dominant treatment strategy compared with usual care for patients at high risk...

Integrating mental health into primary care: an integrative collaborative primary care model - the Jamaican experience

Abel,WD; Richards-Henry,M; Wright,EG; Eldemire-Shearer,D
Fonte: West Indian Medical Journal Publicador: West Indian Medical Journal
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2011 EN
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Many low-income countries face enormous constraints which limit the development of mental health services. The World Health Organization (WHO) made ten recommendations to facilitate the development of mental health services; among these is the integration of mental health into primary care. Jamaica developed an integrated collaborative system of mental health care through the adoption of a primary care model which is central to the delivery of mental health care. This model emphasized the integration of mental health into primary care and, in expanding the role of the mental health team, made it more collaborative. Mental health services were mainstreamed into primary care and several strategies facilitated this process. These included the training of staff in primary care, the availability of psychotropic medication in primary care facilities and the provision of mental health beds at the community level. Furthermore, focus was placed on human development and the involvement of consumers in the policy development and service delivery. This has resulted in a reduction in the population of the mental health hospital and expansion in the community mental health services.