Dissertations / Theses: 'Medical clinic –primary healthcare'

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Deedat, Raees. "Lessons learnt from a private sector business pilot targeting the primary healthcare needs of poor South Africans : the case of RTT Unjani Clinics." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/95693.

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Thesis (MBA)--Stellenbosch University, 2012.
Railit Total Transportation (RTT) is a multinational corporation whose core business is to be a logistics and distribution partner to other multinational corporations. Many of RTT’s key clientele are in the healthcare and pharmaceutical industry, with various key relationships and networks being developed over many years of operation. RTT set the trend by becoming one of the first large South African companies to participate in and profit from the rest of the African continent at a time when it was not popular to do so. On a similar motivation, the current CEO of the RTT Group, Dr Iain Barton, believes that it is a strategic imperative to participate in the Base of the economic Pyramid (BoP), both for economic and developmental reasons. The BoP is not a new market, but recent interest in its potential profitability has being sparked in the business community by the works of management gurus such as the late C.K. Prahalad and the current sustainability champion Stuart Hart. This dissertation presents a case study that will analyse the phenomenon of developing a business model that targets the primary healthcare (PHC) needs of poor South Africans. This study will also extract lessons learnt from the case study in the context of existing BoP theory, primary healthcare in South Africa, and a similar initiative implemented in Kenya in the form of the Child and Family Wellness Clinics (CFW). The case study presents the reader with the pilot phase of RTT’s Unjani Clinic project, and contrasts the findings and lessons learnt from the two main pilot sites in Johannesburg’s Etwatwa and Wattville peri-urban BoP communities. This study also explores a smaller business model concept among Cape Town’s informal traders, also known as spaza shops. The data collection for the case study was undertaken in the qualitative research methodological format with a comprehensive set of interviews that aimed to triangulate the views of management, operational staff, community participants and patient participants. The strength of the case study findings is enhanced by the inclusion of comprehensive case study data, which includes verbatim transcripts of all interview participants and focus group participants. The database can be found at the end of this research report. Many lessons emerged that were both expected and unexpected, with three major themes coming to the fore: • The strategic funding of Unjani, within the dichotomy of profit and non-profit hybrid models • Challenges in achieving operational scale and efficiencies within the BoP • Marketing the value proposition to the BoP. RTT’s management has already begun to implement many of the lessons that have emerged. This includes the marketing mix that requires greater appreciation at a detailed ethnographic level of the dynamics of non-traditional BoP markets. The research report also provides other recommendations to stimulate demand in BoP markets as well as suggestions for the ideal funding and business partners to move this project forward. This research is unique in exploring the challenges of business model development specifically to service the healthcare needs of poor South Africans, and to contribute a small but significant part in the broader understanding of doing business in the South African BoP.

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Luttig, Jana. "Evaluation and management of diabetic patients in a primary healthcare clinic / Jana Luttig." Thesis, North-West University, 2007. http://hdl.handle.net/10394/1834.

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In many African countries, including South Africa, much attention has been centred on the management of HIV/AIDS and tuberculosis epidemics. However, there is growing awareness in South Africa that life-style related non-communicable conditions, such as diabetes and obesity, represent an important health priority (Pirie, 2005:42). The general objective of this study was to evaluate the treatment of diabetic patients in clinics on primary healthcare level and to determine what contributions can be made in the prevention of diabetic complications. The research method consisted out of the selection of the study population, data collection (questionnaire) and the data analysis. There was no structural way of deciding which patients would be selected to be interviewed. As the patients arrived for their appointments the interviewer was informed. No patient was forced to participate in this study and after they agreed to the interview, they signed a consent form that releases the University of any liability that may occur and to give their permission for the interview. The questionnaire was compiled which covered all the aspects of diabetes. This included diagnostic data, life-style, well-being, compliance and monitoring. The researcher completed the questionnaires whilst interviewing the patients. The data obtained from the questionnaires were statistically analysed by using the Statistical Analysis System, SAS 9.1. Effect size, which was given by the Phi coefficient, was used as a descriptive statistic. In this particular study population, the majority of patients were classified as type 2 diabetics. This can be viewed in table 4.8 where 62.14% of the total study population was classified as group B, which means that these patients use oral glucose lowering drugs to control their disease. A further 33.98% of the population was classified as group C diabetics, which means that these patients need oral glucose lowering drugs as well as exogenous insulin to maintain a healthy life. The latter group obviously consists of patients whose diabetic status was not under control in the past, thus the need for the insulin. This clearly shows that these patients have not been informed about how they can manage the disease by dietary modification and lifestyle interventions. Lifestyle, socio-economic and education played a major role in the development of this disease in these patients. The weight status of the study population was determined and can be viewed in table 4.15. Only 20.39% of them were of normal weight with a body mass index (BMI) ranging between 18.5 - 24.9 kg/m2. 39.81% of them were overweight with their BMI ranging between 25 - 29.9 kg/m2 and the remaining 39.81% of the study population were classified as obese with their BMI's above 30 kg/m2. The majority (an estimated 80%) of the study population were above optimal weight. This may cause the development of chronic complications, such as retinopathy, neuropathy and nephropathy. The socio-economic status of the study population was relatively poor because of unemployment. Although 90.07% of them said they had no difficulty to follow their diet (table 4.56) almost half of the patients said they had some difficulty to get the correct food for their specific needs (table 4.53). The first may be because they are still eating they way they used to with no modifications and the latter may be because of their financial status. Not being able to find work has a major effect on their lives. They cannot afford to buy foods suitable for their needs. As previously stated, patient education is fundamental in the managing and controlling diabetes. When these patients were asked whether they know what diabetes is, and what the complications of the disease might hold, most of them answered that it means they have 'sugar', and cannot eat sugary foods any more. This clearly indicates that they did not have a complete knowledge of their disease. After having explained to them in uncomplicated terms what the disease implicates, many of them said it had not been not explained to them previously and that they now understood it better. It was concluded that the majority of the studied population were under a false impression of what diabetes implied. This is partly due to the lack of time the clinic staffs have to spend with each patient, educating them about the disease. One aspect that was most obvious during this study was the fact that an estimated 20% of all patients studied had their own blood glucose monitor (table 4.80). This is somewhat concerning because to have optimal control over one's blood glucose levels, one needs to has a blood glucose monitor for regular monitoring. An estimated 70% of the studied population measures their blood glucose only once a month when they attend the clinic for their monthly visit (table 4.81). This is not nearly enough to ensure optimal control. The average blood glucose levels were calculated and described in section 4.7. Even with the minimal measurement, about 50% of these patients' blood glucose levels were fairly under control with an average of 6-9mmol/L (table 4.88). But the other estimated 50% of the population were not controlled with averages of either below 5mmol/L or above 9mmol/L. This is concerning because the possibility that these uncontrolled cases may develop chronic complications, might be unavoidable unless they start taking control of their lives. And for this to happen, these patients need all the possible education from qualified health care providers and the support of their families. Certain recommendations and restrictions were formulated and discussed.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

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Bender, Kelly L. "Choosing a healthcare facility a survey of women's views in a local healthcare setting /." Online version, 2008. http://www.uwstout.edu/lib/thesis/2008/2008benderk.pdf.

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Wilsey, Katherine Lambos. "Why Patients Miss Appointments at an Integrated Primary Care Clinic." Antioch University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1595879483897791.

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Barker, McKayla, Angela Chrisman, Mason Johnson, Matthew Gouge, and Emily K. Flores. "I.M.P.A.C.T. of Interprofessional Student Teams at a Remote Area Medical Clinic in Rural Appalachia." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/26.

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Introduction: Remote Area Medical (RAM), a non-profit organization serving underserved populations, partnered with East Tennessee State University to provide a unique learning opportunity for student volunteers at a clinic in rural Appalachia. Interprofessional student teams were established with undergraduate and graduate students in multiple professions. This study examined the impact on attitudes of students who participated and the impact of student teams on the event, hypothesizing that a positive impact would be seen on both. COVID-19 adjustments made were also evaluated. Methods: Surveys of student participants were conducted electronically utilizing REDCap before and after participation in the event. Surveys included demographic questions, validated surveys, and open-ended questions. Demographic questions gauged personal background, level of education, and history of interprofessional education or events. The previously validated surveys utilized were the Interprofessional Collaborative Competency Attainment Scale-Revised (ICAAS-R) and the Student Perceptions of Interprofessional Clinical Education-Revised Instrument Version 2 (SPICE-R2). Quantitative data was analyzed with SPSS version 25. Qualitative data was analyzed with deductive coding. Interventions were tallied by student teams during the event. Results: Eighty-nine students participated logging 1,213 interventions and 84 completed portions of the survey (94% response rate). ICAAS-R (n=79) displayed mean increases from 4.19 out of 5 in the pre-survey to 4.58 in the post-survey (p Conclusion: Statistically significant quantitative findings and qualitative themes supported the hypothesis that working in interprofessional teams at a RAM event would positively impact student attitudes towards interprofessional practice, and that student teams would have a positive impact on the event. COVID-19 adjustments made were well perceived. Findings can be summarized with the I.M.P.A.C.T. neumonic.

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Stephenson, Melanie K. "Safety-Net Medical Clinic Behavioral Health Integration." Wright State University Professional Psychology Program / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wsupsych152767560332411.

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Chimezie, Raymond Ogu. "A Case Study of Primary Healthcare Services in Isu, Nigeria." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1057.

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Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included that (a) healthcare is focused on children and pregnant women; (b) healthcare is largely ineffective because of insufficient funding, misguided leadership, poor system infrastructure, and facility neglect; (c) residents lack knowledge of and confidence in available primary healthcare services; (d) residents regularly use traditional healers even though these healers are not recognized by local government administrators; and (e) residents can be valuable participants in community-based research. The potential for positive social change includes improved communication between local government, residents, and traditional healers, and improved access to healthcare for residents.

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Campbell, Kami S. "Enhancing Interest and Knowledge of How to Start a Nurse Practitioner-Led Clinic." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1461151661.

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Allen, Susan. "Creating an integrated nursing team within primary healthcare : an action enquiry approach." Thesis, University of Leicester, 2005. http://hdl.handle.net/2381/27841.

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This thesis is based on a journey towards developing team working within a primary healthcare setting which enabled the NHS agenda for primary care service delivery to keep pace with the government modernisation agenda. (Department of Health, 1997). Initially the focus was on the development of an integrated nursing team which enabled all disciplines of nurses to work towards a patient focussed healthcare service, but it soon became evident that all staff involved in delivering the primary healthcare service were essential to the process and developments of the enquiry if the objective was to be achieved. An action enquiry approach based on collaborative and participative action research (Carr and Kemmis, 1986; Lincoln and Guba, 1989; Cayer, 1997) was discussed and was the prime method of enabling changes to occur in the healthcare practice. This is represented by the interrelated four main cycles of enquiry that have emerged from the data, and discussed in this thesis. Key to the success of the developments was an understanding of team working and leadership as it applied within a healthcare setting and also the underlying dynamics, which are evident when different professional groups from different traditions and knowledge base work together. (Schon, 1983) This was explored within the context of a systems approach to organisational development and through reflective dialogue along the principles advocated for creating a learning organisation. (Senge, 1990) This thesis will demonstrate how confidence developed in myself and the practitioners, especially those from marginalised groups, and how the wider healthcare system made an impact on the developments within the practice. The area of leadership will be discussed from multiple perspectives and recognition that as a concept all stakeholders had a poor understanding of leadership. The key finding from this study identifies the need for a holistic approach to manage and sustain change, and indeed everyday productive working relationships. This especially identifies the importance of giving attention to the preparation of future healthcare workers, the appropriateness of organisational structures in which services are delivered and support structures available to those in team leadership positions.

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Nwachuku, Ada Nwachuku. "Type 2 Diabetes Prevention and Management in a Primary Care Clinic Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3314.

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Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.

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Foster, Christopher A. "Electronic Health Record Implementation Strategies for Decreasing Healthcare Costs." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6426.

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Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment.

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Ghareeb, Alia. "Examining the Impact of Accreditation on a Primary Healthcare Organization in Qatar." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1997.

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Although a modest body of literature exists on accreditation, little research was conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study assessed the changes resulting from the integration of Accreditation Canada International's accreditation program in a primary healthcare organization in the State of Qatar. The study also investigated how accreditation helped introduce organizational changes through promoting organizational learning as well as quality improvement initiatives. Pomey's Dimension of Change framework and questionnaire was used to measure the effect of Accreditation Canada International standards on the perceived quality performance and the progress towards organizational learning. The study explored the quality improvement initiatives resulting from the introduction of Accreditation Canada International accreditation program at the institutional level. It also aimed to identify the organizational learning resulting from application of accreditation standards across the various levels in the organization. Applying a quantitative design, a structured questionnaire was used to collect data from 500 staff. The study used T-test, Spearman's correlation coefficient, ANOVA to analyze the collected survey data. The results of this study provided much-needed insights on the possible changes that organizations might go through concerning quality improvement and organizational learning. The results would potentially support a smooth accreditation preparation process and ultimately contribute to positive social changes at the level of the safety and wellbeing of the people accessing the health services in the community.

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Turnberg, Wayne L. "Respiratory infection control practices among healthcare workers in primary care and emergency department settings /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/8475.

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Herman, Patricia, Sally Dodds, Melanie Logue, Ivo Abraham, Rick Rehfeld, Amy Grizzle, Terry Urbine, Randy Horwitz, Robert Crocker, and Victoria Maizes. "IMPACT - Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model." BioMed Central, 2014. http://hdl.handle.net/10150/610366.

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BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

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Holland, Amy Wharton. "INTERPRETER SERVICES FOR PATIENTS WITH LIMITED ENGLISH PROFICIENCY IN PRIMARY CARE: A PREREQUISITE FOR PROVIDING ETHICAL HEALTHCARE." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/497682.

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Urban Bioethics
M.A.
This paper highlights the importance of the provision of interpreter services for patients of limited English proficiency (LEP) in primary care settings in the United States. In the United States today, over 8% of the population is of LEP, and yet no formal funding structure exists to ensure that these patients have access to interpreter services when they see their primary care provider. Research shows that without appropriate interpreter services, LEP patients not only endorse poorer subjective experiences of healthcare, but that these patients also experience objectively worse healthcare, such as less frequent visits to primary care providers, poorer management of chronic illness such as diabetes and hypertension, and higher rates of expensive testing in emergency departments, to list a few examples. This paper was inspired by firsthand experiences of a medical student learner at an urban health center witnessing frequent improper utilization of interpreter services by physicians in primary care settings. The paper traces the federal legal history addressing communication services in healthcare in the United States, reviews papers that juxtapose patient and provider opinions of interpreter services, and concludes with a discussion of potential steps forward for improving interpreter services offered to the large percentage of the US population that is currently receiving subpar care due to unsurmounted barriers to communication.
Temple University--Theses

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Leutz, Kenneth, Cody Elmer, and Sarah Elmer. "Access to Primary Medical Care among Patients with and without Mental Illness in a Rural Setting." The University of Arizona, 2017. http://hdl.handle.net/10150/624172.

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Class of 2017 Abstract
Objectives: To assess access to and quality of primary health care services by individuals receiving meals at a food bank in a rural location using the Primary Care Assessment Tool- Short Form (PCAT-S). Also, to investigate whether individuals with a mental health condition at a rural community food bank receive different care compared to those without a mental health condition. Methods: The PCAT-S, a survey developed by John Hopkins University, was administered to evaluate care at first contact, ongoing care, coordination of care, and comprehensiveness of care. Demographics data (age, gender, health conditions, insurance status, etc.) was also collected. Results: The majority of our participants surveyed lived within an urban zip code (84.8%), had government insurance (81.4%), were male (61.9%), or were Native American (45%). The groups with the highest mean PCAT-S scores were participants with diabetes (mean score= 96.8), participants with no insurance (94.63), and participants who were female (91). The patient populations with the lowest scores were those with less than a high school education (63.11) with serious mental illness (64), or who had bipolar disorder (69). Groups with higher mean PCAT-S scores indicated more involvement with a primary care provider or overall better care within that section of the PCAT-S. Conclusions: Participants with a mental health condition may be receiving less healthcare than those without a mental health condition, especially in the coordination of care between healthcare services, as indicated by lower mean PCAT-S scores. Those living in a rural community, among our population, do not appear to be receiving less healthcare than those in an urban setting.

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Tucker, Faye Bronwyn. "An assessment of the Isoniazid preventative therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay, Eastern Cape Province." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15737.

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Introduction: Tuberculosis is the second leading cause of death from an infectious cause worldwide having claimed approximately 1.5 million lives in 2013. Estimates suggest that children account for about six percent of the total number of TB cases globally, however in South Africa this figure is much higher (15%). Young children are at particularly high risk of mortality and significant morbidity from TB. Despite clear evidence that Isoniazid preventative therapy (IPT) can reduce the risk of progression from TB infection to disease, IPT has been a poorly implemented component of national TB control programmes, especially in high TB-burden areas, including South Africa. This study aims to determine current practices regarding the identification and management of child contacts < 5 years in an area with an extremely high TB incidence rate where little background data exists on the topic. It will also assess the operational aspects of the TB control programme relating to the spread of TB to children. Methodology: A cross-sectional descriptive study was conducted using a retrospective review of clinic records from infectious index patients aged ≥15 years at West End clinic in the Nelson Mandela Bay health district in the Eastern Cape Province. A sample size of 246 child contacts (<5 years) was required to obtain a 95% confidence index with a 5% precision. This is based on 20% of eligible child contacts < 5years receiving IPT, as described by van Wyk, et al. (2010). 491 Index patient records were assessed in order to identify 261 child contacts < 5 years of age. Results: Contacts were generally well recorded with only 12.5% of index patient folders having no contacts documented although only 0.53 child contacts <5years were identified per index patient. A total of 261 child contacts < 5 years were identified and of these 184 (70.5%) were screened for TB. Two contacts were started on TB treatment and 108/184 (58.7%) were initiated on TB prevention therapy. For the remaining 74 (40.2%) children who were screened there was no documentation of further management. Adherence to IPT was extremely poor with only 4 (3.7%) children who started TB prevention completing the 24 week course. Female index patients were more likely to have contacts documented and to bring their contacts for screening. Contacts of index 16 patients who had previous TB were less likely to be screened and initiated on TB prevention therapy. The results of the assessment of programmatic factors relating to childhood TB control showed that patients were diagnosed and were rapidly initiated on treatment (median time of 5 days from sputum collection to commencement of treatment). It took a median of 4 days for children to be screened once the index patient had started treatment and a further 2 days (median) for child contacts < 5 years to be initiated on preventative therapy. Conclusion and recommendations: The results of this study are in keeping with those obtained in other settings with a high burden of TB. Although the documentation of contacts in this setting was relatively good, child contacts < 5 years were poorly identified and the fall-out of children at each step from identification to preventative treatment completion was still unacceptably high. Contacts of men and retreatment index patients are at particularly high risk of poor management. Recommendations are made for interventions at national and local level to improve contact management and the documentation thereof.

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Tokosi, Oluwatoyin Iyabode Abiola. "An assessment of current practice patterns of TB/HIV at primary healthcare clinics in the Western Cape and a needs assessment for clinic-based training among final year Pharmacy students." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_6836_1378888818.

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Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual
TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death
amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload
due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may
not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy.
Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored.

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Mahal, Dawn. "Resistance to change in primary care : an exploration of the role of professional identity." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27608.

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This thesis contributes to the academic knowledge in the field of professional identity and organisational change. This thesis also has a practical implication as the findings helped to shape an organisational change within the co-funders organisation. The research was guided by the wish to explore the extent to which professional identity affects the willingness of those within Primary healthcare Units to accept fundamental changes in their working practices. Specifically, the aim was to establish the relationship of professional identity to processes of change. As the owners of small businesses who contract their services to the Health Board, the opinions of General Practitioners (GPs) were deemed to be of particular interest. The study was undertaken using a mixed method design, based upon a Constructivist grounded theory methodology. This was chosen as the ideal vehicle to examine the complex nature of identity within healthcare professionals and how they viewed organisational changes. Research started with unstructured interviews (n-14) and the analysis of the data obtained was fed into a questionnaire (n-97). The questionnaire offered validation of the initial findings. The findings of the research showed that professional identity has a bearing on the willingness of professionals to accept changes to their working environment. The resistance demonstrated by Healthcare staff, and specifically, GPs, to organisational change could be linked to feeling a perceived threat to their professional identity. Therefore, to undertake a successful organisational change, change managers must recognise that identity is vitally important and can affect the success or failure of an organisational change. Consideration of how any change may be perceived by professionals, within an identity context, must be built into the organisational change programme and revisited regularly during the change programme.

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Coovadia, Mohamed Yusuf. "Identification and evaluation of patient satisfaction determinants in medical service delivery systems within the South African private healthcare industry." Diss., University of Pretoria, 2008. http://hdl.handle.net/2263/23094.

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The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. Copyright
Dissertation (MBA)--University of Pretoria, 2010.
Gordon Institute of Business Science (GIBS)
unrestricted

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Kirkpatrick, Tara. "Just what the doctor ordered: reformation of the U.S. healthcare system through a dose of preventative and primary care." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/TKirkpatrick2008.pdf.

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Cruz, Inez Isabel. "The lived experience of insulin-dependent diabetes among adult Latinos in a primary care clinic in San Antonio." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1444.

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Latinos are the fastest growing minority group in the Unites States (Fry, 2008). One in eight adult Latinos living in the United States has diabetes (CDC, 2011), and by the year 2020 diabetes is expected to increase by 107% in the Latino population (Caballero & Tenzer, 2007). Within the general diabetic population approximately 26% of the diabetic population requires the use of insulin in the management of their diabetes (DHHS: NDIC, 2011), making insulin-dependent diabetes a prevalent experience. The literature on how diabetes is experienced is divided. Clinical assessment literature strives to measure how people are coping with the illness and how one's experience with the disease impacts self-care. Literature on the diabetes experience is limited; however, the overall image that emerges is the negative expectation associated with having diabetes such as loss and suffering. Little is known about insulin-dependent diabetes as a lived experience, particularly among Latinos. The purpose of this research is to understand the experience of having insulin-dependent diabetes among adult Latinos, because focusing on this experience clarifies how daily nuances of living with the illness gives meaning to insulin-dependent diabetes. Increased understanding of how people interpret their illness can improve diabetes management, specifically within patient and social work interactions, and promote competent social work practice. The guiding research question for this research is, "what is the lived experience of insulin-dependent diabetes among Adult Latinos in a Primary Care Clinic in San Antonio?" This study uses van Manen's (1990) hermeneutic phenomenological approach to guide the research in capturing the nature of the phenomenon in order to gain a deeper understanding of the meaning Latinos attribute to daily experiences of having insulin-dependent diabetes. Utilizing a phenomenologically designed interview guide, this study includes interviews with 10 participants from a predominantly Latino, safety-net clinic in Texas with a 60% diabetes diagnosis rate. Five essential themes arose in exploring the lived experience of insulin-dependent diabetes among adult Latinos in a primary clinic in San Antonio. The themes include 1. diabetes goes against the natural state of the human body; 2. diabetes rules everything 3. insulin is the fast track to deterioration; 4. the relationships don't end, but they're not the same; and 5. managing diabetes with a broken system. The theme "diabetes goes against the natural state of the human body" is considered a core theme because it represents the other themes. Of those themes identified three support the current literature found on living with diabetes. The three themes insulin is the fast track to deterioration, managing diabetes with a broken system, and the subtheme love hate relationship with food are emerging themes identified by the study

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Nord, Johan, and Stefan Lindskog. "Hygiene Routines in the Students Clinic - Compliance, Attitude and the Student's View on Knowledge at Malmö University of Dentistry." Thesis, Malmö högskola, Odontologiska fakulteten (OD), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19792.

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SAMMANFATTNINGInledning: Vårdrelaterade infektioner har under den senaste tiden fått stor uppmärksamhet inom vård och omsorg. Dessa infektioner kostar samhället miljontals kronor varje år och dessutom ökar användningen av antibiotika tillsammans med utvecklingen av antibiotikaresistens. Det bästa sättet att motverka resistensutveckling och vårdrelaterade infektioner är att vara noga med basala hygienrutiner och handdesinficering. Syfte: Undersöka följsamhet, attityd och studenternas syn på deras egen kunskap för hygienrutinerna vid Tandvårdshögskolan i Malmö.Material och Metod: Vi har undersökt, genom punktprevalensmätning, hur tandläkarstudenterna vid Tandvårdshögskolan i Malmö följer de riktlinjer som Socialstyrelsen har utformat vid patientnära arbete. Synen på kunskap och attityd har utvärderats genom en webbaserad enkät som skickats ut till samtliga studenter som går i kurs 3 till och med kurs 10.Resultat: Tandläkarstudenterna följer riktlinjerna som Socialstyrelsen utformat väl på alla punkter utom handdesinficering och användandet av plastförkläde. Genom webbenkäten kan man se att studenterna medvetet struntar i att använda plastförkläde p.g.a. att det blir för varmt. Studenterna anser sig ha god kunskap och anser sig följa rutinerna för handdesinficering fullt ut men observerad följsamhet säger det motsatta. 60-80% av studenterna struntar i eller glömmer handdesinfektion under patientbehandling. Konklusion: Studenterna brister i följsamhet för handdesinfektion och användning av plastförkläde. Studenterna ser kurskamrater bryta mot hygienrutiner men säger inte till. Studenterna övervärderar sin egen följsamhet jämfört med vad som observerats.
ABSTRACTIntroduction: Hospital-acquired infections are a burden to society with an annual cost of millions of SEK. The use of antibiotics and the development of antibiotic resistance are on the increase. The most efficient way to counteract development of antibiotic resistance and hospital-acquired infections is to be immaculate with the basic hygiene routines and to disinfect the hand before and after every patient encounter.Aim: Evaluate student compliance, view on knowledge and attitude regarding basic hygiene routines set by the National Board of Sweden at Malmö University of Dentistry.Materials and methods: In this study, a point prevalence measurement has been carried out at the student’s clinic at Malmö University of Dentistry. Furthermore, knowledge and attitude towards the routines have been evaluated with a web-based survey sent out to students at the faculty.Results: Results of this study show that the students follow the National guidelines well, except for the use of apron and the disinfection of their hands during treatment sessions. In contrast to the aprons, the students consider themselves correctly following the routines of disinfection and also have knowledge about how it should be carried out and when. Analysis of the point prevalence measurement shows that 60-80 % of the students fail to follow the routines of hand disinfection. Conclusion: The students lack in compliance regarding to hand disinfection and the use of apron. They see their classmates violate the guidelines but do not inform them of the violation. The students overestimate their own compliance compared to what have been observed.

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Roberts-Andersen, Janet Patricia Hawkins Peggy L. Morin Patricia J. Erhlich Donna. "The perceived role of physician office health coaches in delivering chronic care to patients in a primary care clinic group in the midwest a phenomenological qualitative study /." Click here for access, 2009. http://www.csm.edu/Academics/Library/Institutional_Repository.

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Thesis (Ed. D)--College of Saint Mary -- Omaha, 2009.
A dissertation submitted by Janet Patricia Roberts-Andersen to College of Saint Mary in partial fulfillment of the requirement for the degree of Doctor of Education with an emphasis on Health Professions Education. This dissertation has been accepted by the faculty of Saint Mary by: Peggy L. Hawkins, PhD, RN, BC, CNE, Professor, Health Professions ; Pat Morin, PhD, RN ; Donna Erhlich, PhD. Includes bibliographical references.

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Jones, Cathy. "Creation of a Diabetic Health Literacy Program for Staff Of a Rural Federally Qualified Healthcare Center." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5633.

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Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase in nonadherence to treatment plans, decreased health stature, increased comorbidities, and an increase in utilization of emergency room and acute care resources. A prior study of 140 randomized adult diabetic patients was the basis for the need of this project. Designed as a staff development in-service to educate nursing and the care provider team, this program integrated health literacy and therapeutic communication techniques into diabetic care. Using the health literate care model universal precautions approach, the project began as a pilot at one of the FQHC's clinical sites by assessing all patients for health literacy using the Newest Vital Sign screening tool. Staff were instructed on the validity of using health literate therapeutic communications as a bridge to adherence to diabetic treatment regimens. The project has potential to improve the overall health and promote positive social change in the rural community.

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McDonald, Jacqueline. "Managing Diabetic A1C at a Primary Care Center: A Nurse Practitioner Perspective." NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/53.

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Background: At a primary care center in Brooklyn, New York, approximately 27% of diabetic patients with abnormal Hgb A1C fail to return for follow-up appointments, as recommended by the Centers for Disease Control and Prevention (CDC). According to electronic medical records (EMR), healthcare providers demonstrated inconsistency in ordering and monitoring Hgb A1C and clinic follow-up appointments for patients. Purpose: The purpose of this quality improvement project was to determine retrospectively the healthcare providers’ ordering, monitoring, and follow-up appointments for adult diabetic patients with abnormal Hgb A1Cs; to develop and implement astandardized process for healthcare providers to monitor and follow these patients, especially those with possible nonclinic follow-up compliance and abnormal Hgb A1C; to determine prospectively healthcare providers’ ordering, monitoring, and follow-up appointments; and to evaluate the prospective charts to determine if Hgb AIC results changed from abnormal to normal or elevation over time until the next follow-up appointment.

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Okoro, Chris U. "Perspectives of Primary Care Physicians on Adopting Electronic Medical Records in the Atlanta, Georgia Area." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5923.

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Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in their healthcare practice. Lewin's change management model of health services served as the framework for the study. Data was collected during face-to-face interviews with 19 primary care physicians at Grady's Ponce de Leon Clinic and Grady's East Point Clinic in Atlanta, Georgia. Participants were physicians or residents and not those in authority to make decisions about the EMR at the two clinics. NVivo 10 and automatic coding was used for data analysis to develop themes from the interviews. The findings revealed that the adoption of EMR has enabled primary care physicians to spend more time with their patients, but the barriers such as a lack of interoperability and lack of training, has fostered a feeling of disinterestedness towards EMR adoption. This study supports positive social change that EMR adoption aids in improving patient safety and outcome.

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Van, Dyk D. L., and H. Bezuidenhout. "Learning experiences of students during integrated management of childhood illness (IMCI) training." Journal for New Generation Sciences, Vol 11, Issue 2: Central University of Technology, Free State, Bloemfontein, 2013. http://hdl.handle.net/11462/641.

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Published Article
The aim of the study on which this article is based was to reflect on the learning experiences of students during integrated management of childhood illness (IMCI) training in an undergraduate programme. IMCI is a set of guidelines that was established by the World Health Organisation (WHO) for cost-effective quality care for children younger than five to prevent diseases and death (WHO, 2004). Skilled primary healthcare workers are required to provide quality care at first contact with these children. The IMCI package was presented as an integral part of the second-year module that focuses on primary healthcare. In order to improve the quality of health services and refocus the health system on primary health-care (South Africa Department of Health, 2010), students have to demonstrate that they have achieved competence. According to Killen (2000:188), competence is a holistic term and focuses on knowledge, skills and values instead of competencies, which refer to specific capabilities. Primary health-care workers who act competently will integrate foundational IMCI knowledge with skills and values as well as with the ability to verify their decisions (Killen, 2000:188). Aqualitative, exploratory and descriptive research design was used to investigate the IMCI learning experiences. Such experiences are one of the indications whether training has been successful and how it can be improved (Suski, 2004:222). Data was collected by means of nominal-group technique (NGT) interviews with second-year nursing students of the training school who complied with the criteria for inclusion. NGT interviews were used effectively to evaluate clinical interaction, education and training.The findings reflected the different emotions experienced during teaching and learning as having been positive, negative or neutral. The consideration of negative emotions will assist with the improvement of IMCI teaching and learning, but all these findings can be useful for other higher-education institutions that present or plan to present IMCI training.

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Chakare, Rejoice Sesedzai. "Attitudes towards adolescent friendly health service provision among health workers at a primary health care clinic in Windhoek, Namibia." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79966.

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Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Health statistics on adolescents in Namibia indaicate high incidences of teenage unwanted pregnancies, unsafe abortions, baby dumping, maternal ill health, early marriages and STIs including HIV. These are indicators of underutilisation of adolescent friendly health services (AFHS) by adolescents as education on these problems are covered in it. Although Government has made some strides to esure implementation starts, there is a recognisable lack of its adoption by health workers. The aim of this study was to establish the reasons for the slow adoption of AFHS practices by health workers at Katutura Health Centre. A quantitative non-experimental cross-sectional descriprive research approach was used in this study. Evidence using both primary data collected in the field through self-administered semi-structured questionnaires (with both open and closed questions) and secondary data collected in the literature review was employed . A census of the entire population of health workers was prefered over sampling. A total of 56 health workers accepted to participate in the study and the questionnaire, 46 of which returned it within a stipulated three weeks data collection period. Descriptive statistics was utilised together with frequencies, mean and basic collection. Eighty two percent of the sample participated in the study of which 67% respondents were female and 33% were male. The majority of the respondents (78.3%) had tertiary education. The results indicated: AFHS were not known to the majority of health workers; there is slow adoption of AFHS; and the programme introduction could have been done better. Factors significantly associated with adoption of AFHS are knowledge of such services, sex, level of education, job position, work experience and effective implementation of the programme. A probability value of p<0.05 was adopted. The programme is well appreciated despite concerns of lack of training and proper implementation. Key recommendations were on staff recruitment, retention and training of health workers; creation of space for implementing AFHS and marketing the programme. The system is in place, what is left is to tighten some loose ends and programme is up and running.
AFRIKAANSE OPSOMMING: Gesondheid statistieke oor die jeug in Namibië verwys na hoë voorkoms van ongewenste tiener swangerskappe en onveilige aborsies, weg gooi van babas, swak moederlike gesondheid, vroeë huwelike en seksueel oordraagbare siektes, insluitend MIV. Dit is aanwysers van die onderbenutting van jeug vriendelike gesondheidsdienste (AFHS) deur die jeug, as die onderwys op hierdie probleme gedek word. Hoewel die regering 'n paar implementerings begin het, is daar 'n beduidende gebrek van aanneming deur gesondheidswerkers. Die doel van hierdie studie was om die redes vas te stel vir die stadige aanvaarding van AFHS praktyke deur gesondheidswerkers by Katutura Gesondheids Sentrum. 'n Kwantitatiewe, nie-eksperimentele navorsingsbenadering is gebruik in hierdie studie. Bewyse uit beide primêre data wat ingesamel is in die veld deur middel van self-geadministreerde semi-gestruktureerde vraelyste (met beide oop en geslote vrae) en sekondêre data wat ingesamel is in die literatuuroorsig was gebruik. 'n Sensus van die hele bevolking van gesondheidswerkers is verkies in plaas van steekproefneming. 'n Totaal van 56 gesondheidswerkers het aanvaar om deel te neem aan die studie en die vraelys, waarvan 46 teruggedien is binne die vasgestelde tydperk van drie weke se data-invorderingstermyn. Beskrywende statistiek is gebruik saam met frekwensies, gemiddelde en basiese versameling. Tagtig en twee persent van die steekproef het deelgeneem aan die studie, waarvan 67% respondente vroulik en 33% manlik was. Die meerderheid van die respondente (78,3%) het tersiêre opleiding. Die resultate het aangedui: AFHS is nie bekend aan die meeste van gesondheidswerkers nie, en daar is stadige aanneming van AFHS; en die program inleiding kon beter gedoen gewees het. Faktore wat beduidend verband hou met die aanneming van AFHS is kennis van sodanige dienste, geslag, vlak van onderwys, werk posisie, werkervaring en doeltreffende implementering van die program. 'n Waarskynlikheid waarde van p <0,05 is aangeneem. Die program is goed waardeer ten spyte van kommer aan 'n gebrek van opleiding en behoorlike implementering. Belangrikste aanbevelings was op die personeel werwing, behoud en die opleiding van gesondheidswerkers; skepping van ruimte vir die implementering van AFHS en bemarking van die program. Die stelsel is in plek, wat oorbly om gedoen te word, is om 'n paar los punte te versterk en die program is aan die gang.

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Philip, Ajith John. "An assessment of equity in geographical allocation of resources relative to need, in public primary healthcare services in the Northern Cape in South Africa." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

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This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.

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Alzubaidi, Abdulhakeem. "The attitudes and beliefs of primary health care physicians toward electronic medical records : the impact of using electronic medical records on the care of patients seen in a diabetes mini-clinic in the United Arab Emirates." Thesis, University of Aberdeen, 2006. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU494611.

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Many studies have been conducted in the USA and Europe to explore the attitudes and beliefs of physicians toward the use of Electronic Medical Record (EMR) systems and to examine the impact of using EMR in the management of diabetes mellitus. However, no such study has been conducted in the United Arab Emirates (UAE). This study was designed to fill this gap. The study consists of two parts. The first examines the Primary Health care (PHC) physicians’ attitudes and beliefs towards the implementation of EMR and the second, examines the impact of EMR on the management of diabetes in a diabetes mini-clinic in a PHC health centre. The overall finding was that non-users of EMR had higher expectations of what computers could achieve than did users. The majority of EMR users and non-users believed that (1) physicians should computerise their medical records; (2) EMR were a useful tool for physicians; and (3) using EMR will improve the quality of healthcare in the health centre and in the UAE overall. A significantly higher proportion of non-users than EMR users believed that using EMR would enable them to accomplish tasks more quickly and reduce their risk of making medical errors. The intervention part of the study found that the introduction of an EMR system has significantly improved documentation and the performance of processes of care for diabetic patients. However, its impact on outcomes was limited. A significant improvement in the proportion of patients with blood pressure <140/80 mm Hg and a significant reduction in the proportion of patients with blood pressure >160/95 mm Hg was found. An improvement in the proportion of patients with LDL-C<100 mg/dl was also found. The limitations of the study should be considered before generalising these results.

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Nylund, Johanna. "MediYoga som metod för ökat välbefinnande? : Självskattad stress och upplevd symptomförändring 5-12 månader efter avslutad kurs i MediYoga." Thesis, Högskolan i Gävle, Avdelningen för arbets- och folkhälsovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-21945.

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Introduction The purpose of this study was to investigate to which extent people exercise MediYoga after completed course, if any symptoms change had occurred, and investigate the level of self-rated stress. Method A quantitative method was used and the data was collected through an online survey. The sample included people who had completed a course in MediYoga within primary healthcare some time during 2015. The survey contained a validate questionnaire (SEQ-LT) to investigate self-rated stress during leisure time the past week, as well as a number of questions specific for this study. The survey was distributed to 123 people and 56 responded. Result The majority of people participating (n=30, 65 %) had not exercised MediYoga for the past week, most (n=31, 67 %) indicated that their symptoms had improved, and most (n=29, 63 %) rated stress as medium. Statistically, the results revealed that there was no significant difference in perceived symptoms change among those who had/had not exercised MediYoga for the past week (p=0,24). Furthermore, there was no statistic significant difference in levels of self-rated stress among those who had/had not exercised MediYoga for the past week (p=0,66). Conclusion The complexity of this study topic means that the result can be explained in several ways and can be due to different factors.
Syftet med denna studie var att undersöka i vilken mån personer utövar MediYoga efter avslutad kurs, om någon symptomförändring hade skett en tid efter kursen, samt undersöka självskattad stress. Studien var empirisk med en kvantitativ ansats. Urvalet inkluderade personer som hade genomfört kurs i MediYoga inom primärvården någon gång under år 2015. En webbenkät mejlades ut till 123 personer och det var 56 personer som besvarade enkäten, varav ett internt bortfall på 10 personer. Enkäten bestod av ett antal frågor som var specifikt utformade för denna studie, samt ett validerat frågeformulär (SEQ-LT) för att undersöka självskattad stress på fritiden den senaste veckan. Resultatet visade att en majoritet (n=30, 65 %) inte hade utövat MediYoga den senaste veckan, de flesta (n=31, 67 %) angav att symptomet hade förbättrats, och flest antal personer (n=29, 63 %) självskattade sin stress som mellan. Resultatet visade att det inte fanns någon statistisk signifikant skillnad i upplevd symptomförändring bland de som hade/inte hade utövat MediYoga den senaste veckan (p=0,24). Det fanns inte heller någon statistisk signifikant skillnad i självskattad stress på fritiden bland de som hade/inte hade utövat MediYoga den senaste veckan (p=0,66). Resultatet indikerade att det inte förelåg någon skillnad i upplevd symptomförändring och självskattad stress bland de som hade utövat MediYoga, samt de som inte hade utövat MediYoga. Det är ett komplext ämne vilket innebär att detta resultat kan förklaras på ett flertal sätt och bero på många olika faktorer.

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Furtado, Nathalia Vidigal. "Contribuições psicanalíticas à clínica médica na Atenção Primária em Saúde." Pontifícia Universidade Católica de São Paulo, 2013. https://tede2.pucsp.br/handle/handle/15307.

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Made available in DSpace on 2016-04-28T20:38:46Z (GMT). No. of bitstreams: 1 Nathalia Vidigal Furtado.pdf: 1148548 bytes, checksum: 8d9d3ae18a02499396c16fda90f03f24 (MD5) Previous issue date: 2013-11-06
The present work aims to study the clinical practice performed by medical professionals in the context of services of Primary Health Care and think about some possible contributions from psychoanalysis to the theme, focusing a discussion on the social and subjective aspects that are present in this field of acknowledge. This articulation was built using the bibliography of the area and material of the interview carried out with two physicians and three users/clients of these services. Following the tracks of Balint, our hypothesis is that there will always be, in the relationship of doctor and his patient, a place for psychotherapy, although some contexts have a prominent position. We believe that this is the case of services of Primary Health Care as they involve problems with a unique complexity and the task of understanding them should be pursued before any intervention. It is concluded that this understanding is achieved only when the presence of the patient is considered in a proper manner. This change implies necessarily to recognize, at the same time, the presence of the singularity of the medical profession, without which no change is possible. First, we aim to contextualize clinical practice in the Primary Health Care, highlighting its importance in the process of refocusing the logic of health services, and rescue the method of clinical work, considering the proximity and differences in Medicine and Psychoanalysis. Following, we reflect on the need for a psychotherapeutic dimension in the practice of clinical medicine, the importance of issues of transference in the doctor-patient relationship and the need to recognize the disease as a particular/subjective construction of a subject, conceiving clinical practice as a task of caring and construction of meaning in the face of illness experience. From a psychoanalytical study we discuss the status of the body in Medicine, as well as the social bond present in the clinic, considering some issues present from medical training to clinical practice
O presente trabalho tem como objetivo estudar a prática clínica realizada por profissionais médicos no contexto dos serviços de Atenção Primária em Saúde (APS), e pensar algumas possíveis contribuições ao tema a partir da Psicanálise, visando a uma discussão sobre aspectos sociais e subjetivos que se fazem presentes nesse campo. Essa articulação foi construída utilizando a bibliografia da área e o material de entrevistas com dois profissionais médicos e três usuários/pacientes destes serviços. Seguindo as trilhas de Balint, nossa hipótese é de que haverá sempre no espaço de uma relação como a do médico com o seu paciente, um lugar para a Psicoterapia, embora alguns contextos tenham um destaque especial. Acreditamos ser esse o caso dos serviços de APS, pois envolvem problemas com uma complexidade particular e a tarefa de compreendê-los deve ser perseguida antes de qualquer intervenção. Conclui-se que esta compreensão será alcançada, apenas, no momento em que a presença do paciente for considerada de maneira adequada. Essa mudança implica, necessariamente, em se reconhecer, concomitantemente, a presença da singularidade do profissional médico, sem a qual, nenhuma mudança é possível. Procuramos primeiro contextualizar a prática clínica na APS, destacando sua importância no processo de reorientação na lógica dos serviços de saúde, e resgatar o método de trabalho clínico, considerando as proximidades e divergências no campo da Medicina e da Psicanálise. Na sequência, buscamos refletir sobre a necessidade da dimensão psicoterápica na prática da clínica médica, a importância das questões transferenciais na relação médico-paciente e sobre a necessidade de reconhecer a doença como construção particular/subjetiva de um sujeito, concebendo a clínica como uma prática de cuidado e de construção de sentido diante da experiência de adoecimento. A partir de um olhar psicanalítico, discutimos sobre o estatuto de corpo presente na Medicina, assim como o (en) laço social presente na clínica médica, considerando algumas questões presentes desde a formação médica até a prática clínica

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Van, Soelen Nelda. "An evaluation of the cost-effectiveness of the introduction of an isoniazid prophylaxis treatment (IPT) register for tuberculosis contact management in children less than five years of age in a high-burden community healthcare clinic (CHC) setting in the Western Cape, South Africa." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/97286.

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Thesis (MBA)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Childhood tuberculosis is an infectious disease that can cause serious illness and mortality in especially young children. Following contact with an infectious adult tuberculosis case, the disease is easily preventable through preventive isoniazid treatment, yet very few exposed and at-risk children currently access this healthcare service in most high-burden settings. Previous research pointed out the multifactorial and complex nature of the barriers to accessing preventive care. Specifically, the lack of a formalised recording and reporting tool, such as the universally used tuberculosis treatment registers, possibly contribute to the operational barriers of preventive care delivery to these children. The purpose of this research was to evaluate the cost-effectiveness of an isoniazid preventive treatment register tool used at community level. The study utilised previously reported data from the study population and other high-burden settings to construct a decision analysis model that included varying probabilities of isoniazid preventive treatment across three high risk age groups (<1 year of age, 1 – 2 years of age, 3 – 5 years of age), coupled with disease probabilities and associated treatment costs. The scenarios simulated included 1) the routine isoniazid preventive treatment service (3% started on treatment, 17% identified as eligible); and 2) an isoniazid preventive treatment service supported by a recording register (15% (adherent to six months of treatment) and 38% (started on IPT treatment)). In addition, two hypothetical simulations were included for 76% and 100% isoniazid preventive treatment uptake; these hypothetical simulations required additional community based healthcare worker resources in addition to the register tool. The observations from the literature indicated that more children were identified (24(17%) vs. 54(38%)) and started (4(3%, base case) vs. 54) on isoniazid preventive treatment following the implementation of the register. As expected, the mean number of tuberculosis cases prevented, increased as the proportion of eligible children that received isoniazid preventive treatment, improved; the change in the number of cases prevented per simulation showed incremental improvements which were all significantly better (p<0.01) than the base case.. The incremental cost-effectiveness ratios incurred savings for each of the scenarios simulated since the mean costs for each of the simulations were significantly less (p<0.01) than the costs associated with the base case. The current evidence suggests that the proposed isoniazid preventive treatment register tool is a cost-effective alternative to the current standard of care in place at community level for at-risk children exposed to tuberculosis. It is therefore recommended that the tool be used incrementally on a bigger scale, until such time that sufficient evidence has been generated to support widespread implementation.

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Souza, Mariana de Figueiredo. "A acessibilidade da atenção à saúde: uma análise da procura pelo pronto-atendimento na ótica dos usuários." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-14012011-101959/.

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Iniciamos a construção desta investigação o durante o processo de acolhimento vivenciado em um serviço de pronto-atendimento (PA) da Unidade Básica Distrital da Saúde do Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto - USP (UBDS oeste), onde pudemos perceber que os mesmos usuários procuravam com grande frequência o serviço, sem o caráter de urgência ou emergência, resultando em uma demanda maior do que suporta o serviço, e sem uma efetiva resolutividade da atenção. Podemos pensar que nas UBSs o usuário não encontrou a resolução do seu problema; não fez vínculo com a equipe; não teve acesso ao serviço ou o cuidado não foi integral, entre outras possibilidades. A partir destes pressupostos, supomos que a acessibilidade aos serviços de saúde pode ser uma das causas disparadoras para a justificativa da procura pelo PA e mesmo sendo serviço de urgência, o serviço atende a prontidões e também atende os usuários considerados não urgentes, resultando no aumento da demanda do PA. Isto pode trazer dificuldades para a equipe que não consegue proporcionar um atendimento acolhedor por meio de orientações sobre a existência de outros serviços disponíveis na rede básica de atenção para seguimento de saúde. Objetivamos com este estudo analisar a procura pelo PA do distrito oeste de saúde do município de Ribeirão Preto, na ótica dos usuários. Trata-se de uma abordagem quantiqualitativa sobre os usuários que procuraram o PA. Coletamos dados de 330 fichas de atendimento do PA, a fim de caracterizar os usuários atendidos no PA quanto ao sexo, à faixa etária, ao bairro de procedência, à justificativa para a procura, à conduta e aos encaminhamentos realizados. Fizemos entrevista semiestruturada com 23 usuários do PA abordando questões relativas à acessibilidade, ao acesso e acolhimento aos serviços de saúde, aos aspectos relativos ao atendimento, à resolução das necessidades de saúde, ao motivo da procura do PA e à integralidade da atenção à saúde. Como resultados, encontramos que a demora pelo atendimento e agendamento das consultas na rede básica de atenção constituem uma das principais razões para a procura ao PA; o acesso mais facilitado à tecnologia e aos medicamentos no PA também justificou a preferência por este serviço. O horário de funcionamento coincidindo com a jornada de trabalho dos usuários também trouxe dificuldades para agendar ou procurar atendimento na rede básica. A obtenção de atendimento médico ainda pode ter forte influência na satisfação que o usuário tem por um serviço de saúde. Concluímos que diversas foram as justificativas para a procura pelo PA e entendemos que, se estes usuários fossem acolhidos e tivessem acesso aos atendimentos nas UBSs e USFs, consequentemente, a demanda pelo PA tenderia a diminuir e atenderia com maior tranquilidade às urgências e emergências.
Began this investigation during the reception experienced in an emergency care (PA) Basic Unit of district health, health center´s medical school , Ribeirão Preto- USP, Where we could see that the same users looking at higher frequency service, without the character of urgency or emergency, resulting in a greater demand service that supports and without the effective outcomes of primary health. we think that the basic health unit the users did not find the resolution of your problem, did not link with the team, did not have access to the service or the care was not fully, between other possibilities. From these assumptions ,we assume that accessibility to health services may be one of the cause triggering to the justification for seeking emergency care and even if the emergency service, the service meets the users considered non- urgent, resulting in increased demand for emergency care. This can cause difficulties for the team that can not provide a friendly service through orientations about the existence of other services available in the basic attention to health monitoring. We ain with this study to analyze to demand for emergency care at the west of the district health the municipality of Ribeirao Preto, the viewpoint of users. It is a quantitative and qualitative approach about the users who sought emergency care. We collect data from 330 medical records of emergency care , in order to characterize users assisted in the emergency care , about whether a man or woman, will age , the neighborhood of provenance, the justification for seeking, will conduct and referrals. We semistructured interview with 23 users of emergency care addressing questions related to accessibility access to care and health services, and aspects of the care, the resolution of health needs of the reason for seeking emergency care and comprehensive health care to health. As results ,found that the delay for serving and scheduling of consultations in the primary care are a major reason for seeking emergency care to; easier access to technology and medication in the emergency room also justified the preference for this service. .Opening hours coinciding with the day´s work also brought difficulties of users to schedule or seek care in the primary. Obtaining medical care can still have a strong influence on satisfaction that the user is a health service. Conclude that there have been several reasons for the demand for emergency care and understand that, if these users were welcomed and had access to basic care unit, (USF) health and, consequently, the demand for emergency care would tend to decrease with greater peace and meet urgencies and emergencies.

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Favoreto, César Augusto Orazem. "A narrativa na e sobre a clínica na atenção primária: uma reflexão sobre o modo pensar e agir dirigido ao diálogo, à integralidade e ao cuidado em saúde." Universidade do Estado do Rio de Janeiro, 2007. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=8892.

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A incorporação do sujeito que adoece e suas expectativas de cuidado é um apelo que acompanha as propostas de mudança da prática clínica no campo da APS. Esta perspectiva implica em um novo modo de ver o processo de adoecimento que procura romper com o reducionismo biomédico onde a clínica e sua ação são, praticamente, independentes do discurso do paciente. Este trabalho usou a narrativa, aplicada como uma ferramenta conceitual e prática na clínica na APS, para investigar as possibilidades de ampliar o universo discursivo e interpretativo, isto é, a competência narrativa do médico, para além de um modelo biomédico restritivo. Foi realizada uma busca, não sistemática, na literatura médica e de ciências sociais procurando identificar os aspectos conceituais, significados e perspectivas que podem ser assumidos para substantivar a narrativa como um conceito/idéia e suas possíveis interfaces e aplicações na clínica. Esta apropriação da narrativa instrumentalizou a observação participante nos módulos do Programa Médico de Família de Niterói, assim como a realização e análise dos resultados de entrevistas semi-estruturadas com seus médicos. Observou-se que a formação da identidade e da legitimidade profissionais do médico de família é dirigida, principalmente, pelo arranjo organizacional promovido pelo modelo de atenção e não pelo desenvolvimento de um saber que o diferencie e qualifique. Identificou-se que as capacidades dialógicas desenvolvidas nas experiências com a clínica na APS eram compreendidas e assumidas pelos médicos como habilidades pessoais e/ou como aspectos morais. Percebeu-se que este modo de pensar dá margem a uma tensão, externada por um discurso ambíguo e fragmentado, entre a proximidade, o vínculo e o diálogo com o paciente e a estruturação do saber e da prática clínica. A limitação dos médicos em incorporar novos saberes a partir de suas vivências, associada à forma como a racionalidade biomédica dirige a clínica, se constituem como obstáculos epistemológicos e práticos para a ampliação da competência narrativa e interpretativa médica. Estas são condições que dificultam o desenvolvimento de um estilo de pensamento médico que reflita, desenvolva e integre o saber prático e os saberes não biomédicos como algo legítimo, sistematizável, avaliável e reprodutível no âmbito da clínica.
The incorporation of the fellow who falls ill and his expectations of care is an appeal of the proposals to change primary care clinical practices. This perspective implies a new viewpoint of the sickening process which tries to break with the biomedical reductionism in which the clinic and its action are almost apart of the patients discourse. This work employed the narrative as a conceptual and practical tool in primary care clinic to investigate the possibilities of enlarging the universe of discourse and interpretation, that is, the physicians narrative competence beyond a restrictive biomedical model. A non- systematic search was carried out, in medical and social sciences literature, trying to identify the conceptual aspects, meanings and perspectives that can be assumed to turn the narrative into a concept/idea, and its possible interfaces and applications to clinic. This appropriation of narrative instrumentalized the participant observation in the Family Health Program, in Niterói, as well as the analysis of results of semi-structured interviews with physicians. We noticed that the formation of the family doctors professional identity and legitimacy is mostly guided by the organization promoted by the healthcare model, and not by the development of knowledge able to distinguish and qualify it. We found that the dialogic abilities developed in experiences in primary care clinic were apprehended and assumed by physicians as personal abilities and/or moral aspects. This thought created tension, translated in an ambiguous and fragmented discourse among proximity, liaison and dialogue with patients, and the formation of knowledge and clinical practice. The physicians limitations to incorporate new knowledge, based on their own experience, and the way biomedical rationality guides clinic, are epistemological and practical obstacles to enlarge medical narrative and interpretative competences. Such conditions hinder the development of a type of medical thought to reflect, develop and integrate practical knowledge and nonbiomedical knowledge as legitimate, able to be systematized, evaluated and reproduced within the clinic.

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Askerlund, Maria, and Catrina Ikonen. "Komplexa vårdsituationer på vårdcentral : Att balansera mellan det oförutsägbara och det förutsägbara." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-37205.

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Background: Primary Healthcare Centers [PHC] represent the first healthcare contact that patients have, unless they are critically ill or their state is life-threathening. Distric nurse´s work in PHC requires preparedness to meet people in different ages and varying cultural and ethnical backgrounds. This preparedness includes an independent and person-centred workway. The study´s theoretical framework therefore proceeds from person-centred care. Challenging encounters occur in district nurse´s meetings with patients. The concept complex healthcare encounters exists in the competence description of the district nurses and in educational regulatory contexts. Despite of this, there is no general definition of the concept and what it is characterized by. Aim: The aim of this study is to describe district nurse´s experiences of complex healthcare encounters. Method: A qualitative, descriptive, inductive content analysis is used as the analysis method. Six focusgroup-interviews were contucted with nurses and districs nurses working in PHC. Results: District nurse´s experiences of complex healthcare encounters contains to balance unpredictable encounters with predictable organizational terms. This is described as: To meet people with varying lifesituations and To care professionally within organizational conditions. Conclusion: District nurses experience complex healthcare encounters characterized by the coexistence of unpredictable meetings with people and predictable organizational terms. By developing the knowledge about complex healthcare encounters, district nurses can streamline the care simultaneously as the mission of the district nurse can be explicated.
Bakgrund: Vårdcentraler är vårdsökandes första vårdinstans om inte vårdbehovet är akut eller livshotande. Distriktssköterskors arbete på vårdcentraler medför beredskap att möta människor i olika åldrar och med varierande kulturella och etniska bakgrunder. Denna beredskap inrymmer ett självständigt och personcentrerat arbetssätt. Examensarbetets teoretiska referensram utgår därmed från personcentrerad vård. Utmanande vårdsituationer uppstår i distriktssköterskors möten med vårdsökande människor. Begreppet komplexa vårdsituationer förekommer i distriktssköterskors kompetensbeskrivande och utbildningsreglerande dokument. Dock saknas en gemensam bild av vad detta begrepp karaktäriseras av. Syfte: Syftet är att beskriva distriktssköterskors erfarenheter av komplexa vårdsituationer på vårdcentral. Metod: En kvalitativ, deskriptiv innehållsanalys med en induktiv ansats har används som analysmetod. Sex fokusgruppsintervjuer med distriktssköterskor och sjuksköterskor som arbetar på vårdcentral har genomförts. Resultat: Distriktssköterskors erfarenheter av komplexa vårdsituationer på vårdcentral innehåller att balansera mellan oförutsägbara möten med människor och förutsägbara organisatoriska villkor. Detta beskrivs som: Att möta människor i varierande livssituationer och Att vårda professionellt med givna organisatoriska förutsättningar. Slutsats: Distriktssköterskorna erfar komplexa vårdsituationer som karaktäriseras av att oförutsägbara möten med människor och förutsägbara organisatoriska villkor samexisterar. Genom kunskapsutveckling om komplexa vårdsituationer kan distriktssköterskor effektivisera vården samtidigt som distriktssköterskors uppdrag förtydligas.

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Godoy, Daniele Cristina. "O ensino da Clínica Ampliada na Atenção Primária à Saúde a prática de professores tutores e alunos de graduação médica /." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/154787.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
A crise contemporânea da medicina e os desafios à educação médica tem sido objeto de um grande debate internacional nas últimas décadas. Dentre estes desafios destacam-se a desumanização da prática, a fragmentação do cuidado médico individual e a desigualdade de acesso a atenção à saúde. Diante deste contexto têm se recomendado inúmeras medidas de mudança da formação médica para superar tais problemas dentre as quais uma maior aproximação desta formação com os sistemas públicos de saúde. A estruturação do Sistema Único de Saúde (SUS) no Brasil, ainda que tardiamente, vem produzindo uma nova agenda de reorientação da formação profissional a partir de programas, do Ministério da Saúde e da Educação, de incentivo à mudança das graduações das profissões da saúde. A Faculdade de Medicina de Botucatu (FMB), com uma longa trajetória de ensino médico na comunidade vem participando dos referidos programas de incentivo à reestruturação do ensino médico. Dentro deste escopo de mudanças foi criado o Programa Interação Universidade-Serviços-Comunidade (IUSC) em 2003. Em seu desenvolvimento estruturou-se como um conjunto de disciplinas dirigidas à graduação em medicina e enfermagem, tendo como cenário de ensino-aprendizagem o território, equipamentos públicos, em especial as unidades básicas de saúde, e instituições comunitárias. As práticas destas disciplinas se desenvolvem orientadas pela metodologia da problematização e pelas concepções da humanização da prática e a integralidade do cuidado. Este estudo tomou como campo a disciplina IUSC III, ministrada aos alunos do 3º ano de graduação médica, que tem como atividade principal a consulta médica supervisionada e orientada pela concepção da “Clínica Ampliada”. Para alcançar seu objetivo de “desenvolver competências e habilidades para a atenção e promoção da saúde da comunidade” a IUSC III tem como estratégias pedagógicas: o vínculo longitudinal, o uso de roteiro de “anamnese ampliada”, discussões de casos com diferentes profissionais dos serviços de saúde e o uso de diário de campo. Esta pesquisa se propõe a reconhecer a prática de professores-tutores e alunos no processo de ensino-aprendizagem da Clínica Ampliada na Atenção Primária à Saúde, mediante estudo etnográfico do cotidiano desta disciplina. O campo desenvolveu-se durante 14 meses por meio de estudo bibliográfico e documental e observação participante com registro em diário de campo dos seguintes momentos: módulo de introdução, atividade de observação e reconhecimento da unidade de saúde pelos alunos, consulta médica supervisionada, reuniões de discussão de casos, supervisão clínica e reuniões da coordenação da disciplina com os professores-tutores. A partir da análise dos diários de campo e do estudo documental e bibliográfico das estratégias pedagógicas da IUSC III elaborou-se uma descrição densa do seu cotidiano, mediante diálogo com o referencial da Clínica Ampliada e estudos do trabalho médico e da Clínica. O estudo mostra a potência das estratégias pedagógicas para o desenvolvimento de um olhar ampliado do aluno sobre as necessidades de saúde dos usuários. Em que pese a significativa receptividade dos alunos a uma disciplina de prática clínica na qual o aluno tem um papel ativo já no terceiro ano, parte deles mostram-se resistentes à produção de narrativas dos encontros clínicos. A experiência da clínica na atenção primária é desafiadora para os alunos, diante de uma demanda que se coloca numa fronteira entre os problemas da vida e o diagnóstico bem definido, a qual se soma a ambiguidade e a incerteza do próprio conhecimento e da prática médica. A análise desta experiência de alunos e professores-tutores com o ensino da Clínica Ampliada na Atenção Primária à Saúde, embora ocupe um pequeno espaço no currículo, mostra-se fértil para a reflexão sobre o ensino médico e possíveis caminhos e estratégias para a mudança da graduação. Palavras-chave: Educação Médica; Atenção Primária à Saúde; Clínica Ampliada; Pesquisa Etnográfica; Estratégias Pedagógicas para o Ensino.
The contemporaneous crisis in the medicine and the challenges to the medical education have been issue for a huge international debate in the last decades. Among those challenges, there are some highlights: practice dehumanization, the individual health care fragmentation and the inequality of access to health care. In the light of this context, it has been recommended several measures to change medical training, in order to overcome such problems, among which, a closer approximation of this training with the public health systems. The structuring of the Unified Health System (SUS) in Brazil, although late, has been producing a new reorientation schedule of professional training from programs of Ministry of Health and Education, of incentives to change the graduations of the health professions. The Faculty of Medicine of Botucatu (FMB), with a long history of medical education in the community has been participating of the before mentioned programs of incentive to the restructuring of medical education. Within this scope of changes, the University-Services-Community Interaction Program (IUSC) was created in 2003. In its development, it was structured like a set of disciplines directed to undergraduation in medicine and nursing, having as teachinglearning scenario the territory, public facilities, especially basic health units, and community institutions. The practices of these disciplines are developed guided by the problematization methodology and by the conceptions of the practice humanization and the integrality of care. This study took as a field the discipline IUSC III, given to the students of the 3rd year of medical undergraduation, whose main activity is supervised medical consultation and guided by the design of the "Expanded Clinic". To achieve its goal of "developing skills and abilities to care for and promote community health" IUSC III has as pedagogical strategies: the longitudinal link, the use of the "extended anamnesis" script, case discussions with different health professionals and the use of field diaries. This research proposes to recognize the practice of professors and students in the teaching-learning process of the Expanded Clinic in Primary Health Care, through an ethnographic study of the daily life of this discipline. The field was developed during 14 months by means of bibliographical and documentary study and participant observation with record in field diary of the following moments: introduction module, observation activity and health unit recognition by the students, supervised medical consultation, case discussion meetings, clinical supervision and coordination meetings of the discipline with the professors. From the analysis of the field diaries and the documentary and bibliographic study of IUSC III pedagogical strategies, a dense description of his daily life was elaborated through dialogue with the framework of the Expanded Clinic and studies of the medical and clinical work. The study shows the power of pedagogical strategies for the development of a broader student’s view about the health needs of the users. Besides the significant receptivity of the students to a discipline of clinical practice in which the student has an active role already in the third year, part of them are resistant to the production of narratives from clinical encounters. The clinical experience in primary care is challenging for students, faced with a demand that is placed on a border between the problems of life and the well-defined diagnosis, Abstract which adds to the ambiguity and uncertainty of knowledge itself and medical practice. The analysis of this experience of students and professors with the teaching of the Expanded Clinic in Primary Health Care, although takes just a little space in the curriculum, it is fertile for reflection on medical teaching and possible paths and strategies for graduation change.
CAPES: 024/2010-40

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39

Fröler, Agnes, and Linda Eriksson. "Besök på livsstilsmottagningar : Patienters upplevelser." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-68698.

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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.

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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.

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Lin, Li-Hsiang, and 林莉翔. "To Determine the Key Factors for Selecting Primary Care Clinic, Dental Clinic and Medical Treatment Clinic." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/58861104439579324777.

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碩士
國立中興大學
行銷學系所
101
Because of rising general incomes in recent years, Taiwan’s health expenditure also increases. The public asks for evident effects of the treatment, comfortable medical environment, fine service quality, friendly service attitudes, etc. accordingly On the other hand, Taiwanese Government enforces “global budget system” for National Health Insurance Act, which draws up the maximum expenditure of next year’s National Health Insurance and arouses more intense competition among medical institutes. Therefore, the operators of these medical institutes manage to fulfill their patients’ demands; in this way, their patients will stick to their medical institutes. In light of this phenomenon, this study discusses and compares the difference of key factors when the public chooses clinics. This study investigates primary care clinics and dental clinics, both of which the public visits the most frequently and the number overpasses that of all the primary medical institutes by over 50%. In addition, the public in Taiwan gradually accepts cosmetic surgery in recent years, and the government also regards medical cosmetology as one of the important items in promoting health industry internationalization; seeing the potential of medical cosmetology, we take cosmetic medical treatment clinics into this study’s investigation subjects too. We collected 31 factors among abroad and domestic literary review about the public’s choice of medical institutes and satisfaction degree of the medical treatment. We classified these 31 factors into three groups: before, during, and after the medical treatment. We further combined related factors into 25 factors, and extracted 17 key factors when the public chooses primary care clinics, dental clinics, and cosmetic medical treatment clinics by means of grey relational analysis. There are four factors classified into before medical treatment group: dental clinics: the professional background of the dentists, previous experiences in the dental clinic; cosmetic medical treatment clinics: the professional background of the doctors, the evaluation of the cosmetic medical treatment clinic. There are ten factors classified into during medical treatment group: primary care clinics: the doctors’ techniques, doctors’ explanation before treatment, nurses’ service attitudes, doctors’ service attitudes; dental clinics: the doctors’ techniques, nurses’ service attitudes, doctors’ service attitudes; cosmetic medical treatment clinics: the doctors’ techniques, doctors’ explanation before treatment, concealment of the treatment spaces. There are three factors classified into after medical treatment group: primary care clinics: the effects of the treatment; dental clinics: the effects of the treatment; cosmetic medical treatment: the effects of the treatment. At the end, we compared the difference between the three kinds of clinics, and offered our advices about how the operators of these three kinds of clinics can manage their clinics based on each key factor. Key Words: choices of medical institutes, primary care clinics, dentists, cosmetic medical treatment clinics, grey relational analysis.

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Tsai, Che-Hung, and 蔡其洪. "Constructing A Management Opportunity Grid of Primary Medical Clinic－An Example of Tsai Che-Hung ENT Clinic." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/wmxy8v.

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碩士
國立中興大學
高階經理人碩士在職專班
101
The main purpose of this research is to extract the core competence of primary medical clinic, construct the management opportunity grid and competitive matrix of Tsai Che-Hung ENT clinic and nearby. In this research, the primary medical clinic will comprehend (1) how to distribute their resources efficiently, (2) the sequence of medical service item, (3) how to manage competitive strategies. According to previous primary medical clinic service, development and management studies, the researcher developed five capable sectors of primary medical clinic service items, generalized 26 questions, and then designing questionnaire method to survey. The researcher retrieved 107 questionnaires. After statistical analysis, this research found out most of the service items of primary medical clinic are distributed into specialist image and equipment structure. Therefore, the primary medical clinic should maintain the basic service quality of a doctor’s profession when they are trying to develop other service items. Lastly, focal clinic should distribute their resources to improve the unsatisfied but most important service item to attract the patients.

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Hussain, Tahseen 1986. "Building Evalution Tools to Assess the Usability of Primary Care Clinics." Thesis, 2012. http://hdl.handle.net/1969.1/148226.

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Primary care clinics play a vital role in the US healthcare system, providing preventative and cost-effective care. New trends in healthcare such as the development of the medical home model for care, the application of electronic medical records (EMRs), the effort to increase access to care, and the need to adhere to the Health Insurance Portability and Accountability Act (HIPAA) will have direct impacts on the work flow and spatial delineation of primary care clinics. To ensure the success of primary care practices, the architectural design of primary care clinics needs to address these changes to satisfy both patients and staff, and to improve efficiency and outcomes of care. There is limited literature on the design usability (efficiency, effectiveness, and user satisfaction) of primary care clinics. This study developed a set of building usability evaluation tools to collect, analyze and interpret the “usability” of a primary care facility. The study used previous literature as well as a case study primary care clinic in Maryland as a basis to develop these tools. In the clinic, data were collected through an initial interview with the head nurse, a forty-hour behavioral observation, and a staff survey. A behavioral observation tool and a survey questionnaire were developed for the data collection. For data analysis, JMP Pro 9 software was used to analyze the data collected through behavioral observation and the staff survey. The literature review developed a “Building Usability Framework” specifically for healthcare design. A data analysis tool, the “Usability Matrix” was created to integrate and understand the analyzed data within the Building Usability Framework. Integrating the analyzed data from the case study within the Usability Matrix, a primary care clinic usability evaluation survey was developed at the end of the study. This survey along with the behavioral observation tool and design analysis tools were compiled together to produce the “Building Usability Evaluation Tool-Kit for Primary Care Clinics.” This tool-kit can be used by architects and researchers interested in designing and analyzing “usable” primary care clinics.

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Huang, Cheng-Ru, and 黃政儒. "A Design of Medical and Nursing Information System for Primary Healthcare Center." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/53147162364645372594.

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碩士
嘉南藥理科技大學
醫療資訊管理研究所
96
In the social environment, an important factor in health service policy and system is health-care system. The professional healthcare industry has an obviously different with the manufacturing industry. The processes of medical activities different are due to the technology, equipment, professional or disease uncertainties. So, it is necessary for healthcare industry using a large amount of information technology and management such as patients related medical information, images and so on. Recently the main purpose of medical information system for patients is focus on medical service. If primary healthcare center can be integrated with the healthcare information of medical center, it will be able to provide a more comprehensive national healthcare service network. Now the primary healthcare center in the situation of lack of medical resources and financial tension, but it stills need to support the policy of dealing with large health care work. Therefore, use the characteristics of information technology to reduce costs and increase efficiency is the best option. The government health department development the information systems for primary healthcare center to improve healthcare, clinical and vaccination and other work in 1992. However the system belongs to internal operations and it does not require the mandatory use, so the penetration rate is not high. The few of self-developed healthcare system does not integration with primary healthcare information systems. This situation makes the staff of primary healthcare center need to duplicate entry the data. Therefore the system promotion needs to be improved. In this research, the information need is analyzed for primary healthcare center by referred foreign-related integration model and waterfalls model of system analysis and design. In this paper, data flow diagram, data dictionaries, database design and structure and flow charts of each subsystem are included in system analysis and design for developing healthcare system of primary healthcare center. The developing tools are Visual Basic 6. and SQL Server 2005. So, it can work in the internet for developing present primary health information system by using web service components. Now, the software developers and the government units in Taiwan have not yet combined the medical service and care service. The main topic of medical care system-related information system is focus on medical services. The study object of this research is combing the nursing care system for nursing system and the healthcare information system for primary healthcare center. This study purpose was to develop a more functional healthcare information system of individual and household. It would help to establish an integrated medical and healthcare network for community health care system in Taiwan.

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Haman, Goitsemang Mida. "The motivational needs of primary health care nurses in a mine clinic setting." Thesis, 2013. http://hdl.handle.net/10210/8710.

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M.Cur. (Nursing Management)
Motivation is a process that influence and directs behaviour in order to satisfy a need. Motivation of nurses is important in the primary health care environment since low levels of motivation among Primary Health Care (PHC) nurses; who are in a critical position in health service delivery; could have a negative impact on the achievement of high standards in the nursing profession. This situation is also relevant in a mine clinic setting. The main factor in motivating nurses may be a sense of success. However, levels of stimulation and individual requirements also significantly influence the motivation of a person. As a manager at a mine clinic setting, the researcher became aware; by means of staff progress reports and performance appraisals; that PHC nurses (professional nurses) were demotivated. The research questions were therefore posed: - What are the motivational needs of PHC nurses in the workplace at mine clinic settings? - What should be done to assist these nurses to acquire motivation in the work place? Therefore, it was imperative to explore and describe the motivational needs of PHC nurses in their work place and to describe recommendations for nurse managers at a mine clinic setting to motivate PHC nurses. The study was conducted within the theoretical framework of McClelland’s Acquired Motivation Theory that consists of three basic needs, i.e. the need for achievement, the need for power, and the need for affiliation. A quantitative, explorative, descriptive design was followed and the researcher used a structured questionnaire to explore the perceptions of PHC nurses about their needs to acquire motivation in their workplace. The accessible population in this study was PHC nurses (N = 30) working at the 13 mine clinics. The accessible population served as the total sample.

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Shih, Chia-chi, and 石佳琦. "Strategy for Medical Cosmeceutical Business in Primary Dermatological Clinics – A Case Study of C Dermatological Clinic." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/ddn48g.

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碩士
國立中山大學
高階經營碩士班
96
Medical cosmeceutical business, combining medical and cosmetic profession, is considered one of the booming sectors among self-provided services under the National Health Insurance program in Taiwan. In the past, dermatological clinics had the advantages of medical profession; however, without strict law restrictions, numerous medical “cosmeceutical centers” have emerged rapidly and intensified the market competition significantly. This research investigated and analyzed the current status of medical cosmeceutical industry in detail by collecting the second source data and studying the case of C Dermatological Clinic. The SWOT and five-force analysis are used to analyze the strengths, weaknesses, opportunities, and threats of C Dermatological Clinic, thereby, business strategies are provided. The results indicate that minimally invasive treatment is the trend of medical cosmeceutical business in the future. Due to the excellent location, professional medical teams, advanced equipments, individual proprietorship and strong marketing task force, C Dermatological Clinic, has built up a great reputation in this industry and now provides its customers total solution packages by incorporating plastic surgeon into the services. Catching the opportunities of the continuous progress in biotechnology and growing public awareness of cosmeceutical therapy, C Dermatological Clinic has successfully become one of the most important players in the growing medical cosmeceutical market. However, after the Taiwan high speed rail in operating (which broke the entry barrier of distance between cities), the threats of new entrants including medical laser suppliers, cosmetic or salon shops, and other special medical institutes, the medical cosmeceutical market becomes more competitive. Facing the emerging medical tourism demand and the pervasion of internet, We suggest that C Dermatological Clinic should aggressively improve its weaknesses such as poor computer knowledge, lack of service attitude and bad decision quality, strengthen its customer service training, pay more attention to the customer relationship management, make best use of internet to promote the clinic, and ally with tourist bureaus or hotels to expand its share in this market and develop a sustainable business model.

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Ramalho, André Luís Charro. "Healthcare Human Resources and Quality Indicators: Approaches to Strengthening Primary Care." Doctoral thesis, 2021. https://hdl.handle.net/10216/137128.

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Petrocchi-Bartal, Luisa. "Clinic based hearing screening protocols : the feasibility of implementing the Health Professions Council of South Africa Year 2007 Guidelines." Thesis, 2011. http://hdl.handle.net/10539/10134.

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Purpose: This study aimed to assess the feasibility of implementation of the Health Professions Council of South Africa's (HPCSA) clinic-based hearing screening subsection of its 2007 Position Statement on Early Hearing Detection and Intervention (EHDI) programmes in South Africa. Specific sub-aims included (a) establishing the prevalence of hearing screening conducted at Maternal Child Woman’s Health (MCWH) immunisation clinics; (b) determining the hearing screening procedures and protocols in use at MCWH immunisation clinics; (c) determining and exploring the possible concomitant personnel-associated factors which may influence the implementation of newborn and infant hearing screening programmes; (d) determining and exploring other factors that may have influenced implementation of newborn and infant hearing screening; and lastly, (e) comparing any hearing screening procedures and protocols in use to the HPCSA (2007) EHDI position statement clinic guidelines and associated clinic benchmarks Participants: Thirty primary healthcare immunisation clinic managers/acting managers were interviewed in two South African sample groups, in the North West province (NW) and Gauteng (GP). Design: An exploratory, non-experimental, qualitative research design was employed incorporating both quantitative and qualitative information within the two sample groups. Methods and Materials: An interview using a questionnaire was administered with primary health care (PHC) clinic nursing manager/acting manager, placed within the identified sites. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics. Data Analysis: Content analysis was used to code emergent themes into specific categories. Frequency calculations of the emergent themes were calculated and results described qualitatively. Results: No PHC clinics placed within the identified sites offered or provided formalised newborn/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with HPCSA (2007) clinic guidelines. Most respondents were willing to implement formalised hearing screening to coincide with their immunisation schedules. The immunisation context was considered favourable for implementation of formalised hearing screening. Other factors such as reduced parental awareness of the importance of hearing screening, and caregiver cultural issues were considered surmountable by respondents. Conclusions: HPCSA (2007) implementation of clinic hearing screening protocols at PHC immunization clinics (level one) does not appear to be feasible based on current evidence. Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA (2007) clinic guidelines for EHDI at immunisation clinics in South Africa. Future research implications include formal investigations of central directorate versus district differences in PHC Package Integrated Management of Childhood Illnesses (IMCI); Otitis Media, and Road to Health Chart (RtHC) protocols; provincial and district inequities in funding as they impinge on hearing health care service delivery; costing of rudimentary protocols in place versus formalised HPCSA (2007) EHDI service delivery; research into parental awareness, education and willingness in specific reference to certain procedures such as otoacoustic emissions; and replication of the current study throughout the country for quantitave data with increased ability to draw causal inferences and generalize findings.

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Mubaiwa, Loice. "Factors influencing access to primary healthcare services in Berejena Village, Guruve South District, Zimbabwe." Diss., 2015. http://hdl.handle.net/11602/835.

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Westheimer, Joshua Mark. "Efficacy of the Doctor Interactive Group Medical Appointment : examining patient behavioral and attitudinal changes attributed to an integrated healthcare model." 2008. http://hdl.handle.net/2152/6821.

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The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective.
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