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1
Walshe, Catherine. "What influences referrals in community palliative care services? : a case study." Thesis, University of Manchester, 2006. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:77832.
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Equity of access to healthcare services is a concept which underpins current UK health policy. However evidence suggests that this is not achieved within community palliative care. Referrals can be tardy or not made at all. Most literature describes inequality in service utilisation, but does not aid understanding of why such inequalities exist. There is little research exploring the processes underpinning referral making rather than the outcomes of referrals such as service utilisation. The aim of this research was to investigate the influences on referral decisions made within community palliative care services. A qualitative case study strategy was chosen as the research approach as it provided a framework for facilitating the incorporation of multiple perspectives in a complex context, in a field where there has been little previous research, and where there is little theory to guide the investigation. Three cases (Primary Care Trusts) were studied. Data collection used multiple methods (interviews, observation and documentary analysis, as well as mapping and profiling the palliative care services provided within the cases) from multiple perspectives (general and specialist palliative care professionals, managers, commissioners and patients). Detailed data analysis followed a framework approach, comparing and contrasting patterns within and across cases with existing and developing theoretical propositions. Two core influences on the way health care professionals made referral decisions were found. First, their perception of their own role in providing palliative care. Autonomous professionals made independent judgements about referrals, influenced by their expertise, workload, the special nature of palliative care and the relationship they developed with patients. Second, their perception about those to whom they may refer. Professionals needed to know about services to refer, and then made a complex judgement about the professionals involved and what they could offer the referrer as well as the patient. These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and inter-professional factors have the potential to shape referral practices. It may be that the combination of these factors has an influence on equitable access to community palliative care services. Practitioners could be more explicit about referral or non-referral rationales, and policy makers take account of these complex influences on referrals rather than just mandating change.
2
Beynon, Teresa Anne. "Developing education in palliative care for primary health care professionals." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408772.
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Dunkley-Hickin, Catherine. "Effects of primary care reform in Quebec on access to primary health care services." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123121.
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Primary health care reform has become an area of priority in health policy with a strong importance placed on interdisciplinary teams of health care professionals. Quebec's model, the groupes de médicine de famille (GMFs), were introduced late in 2002 emphasizing team-centered approaches to service delivery and aiming to improve access to primary health care, especially to improve after-hours access and to increase the number of Quebecers with a family doctor.A decade after their implementation, I investigated the impact of GMFs on various measures of access to primary health care and perceived remaining barriers. I emphasize potential access – i.e. measures that capture whether an individual has the ability to access needed health care including having a regular medical doctor.I used data from seven waves of the Canadian Community Health Survey to capture reported access to primary care and barriers to access. GMFs emerged at different rates in different health regions across Quebec allowing the construction of a GMF 'participation' measure using the share of primary care physicians practicing in GMFs in each health region and year. I employed a modified difference-in-difference analysis design that uses multivariate regression analysis to control for time trends in the outcomes, time-invariant differences between regions and individual-level covariates in an attempt to estimate the causal impact of GMF implementation on access to primary health care.I verified that pre-policy differences in terms of population and socioeconomic characteristics between regions with ultimately high vs. low rates of GMF participation are reasonable and remain fixed over time, making comparisons of these regions appropriate. Results suggest that rates of reported access have increased over time in most Quebec health regions. However, these measures of access vary across regions and some always report lower rates of access. Controlling for time trends, fixed differences between regions, and individual characteristics, reported access does not change significantly as GMF participation increases. Improved access to primary health care was one of the principal objectives of Quebec's primary care reform a decade ago. My findings suggest that increased GMF participation has not improved several important measures of access, and that additional policy measures may be necessary to increase potential access to primary health care.La réforme des soins de santé de première ligne occupe une place prioritaire parmi les réformes de santé, notamment avec une grande importance accordée à des équipes interdisciplinaires de professionnels de santé. Le modèle choisi par Québec, les groupes de médecine de famille (GMFs), a été mis en place à la fin de 2002. Ce modèle met l'emphase sur des équipes interprofessionnelles et vise à augmenter le nombre de Québécois avec un médecin de famille, ainsi qu'à offrir une plus grande accessibilité des services de la première ligne, notamment hors les heures normales de travail. Une décennie après leur implantation, j'ai étudié l'impact des GMFs sur diverses mesures d'accès aux soins de santé de première ligne. Je mets l'emphase sur l'accès potentiel – c'est-à-dire les mesures permettant de déterminer si un individu a la possibilité d'accéder aux soins de santé nécessaires, y compris d'avoir un médecin régulier.J'ai utilisé des données de sept cycles de l'Étude sur la santé dans les collectivités canadiennes pour capturer l'accès déclaré aux soins de première ligne et obstacles à cet accès. Il existe une variation régionale dans l'implantation des GMFs à travers les différentes régions sociosanitaires du Québec, ce qui me permet de construire une mesure de participation aux GMFs constituée de la proportion des médecins de première ligne pratiquant en GMF par région sociosanitaire et par année. J'ai employé une analyse qui consiste de modèles de différence-dans-les-différences modifiées qui utilise une analyse de régression multivariée pour contrôler les tendances temporelles, les différences constantes entre les régions, et les covariables au niveau individuel, le but étant d'estimer l'effet causal de la mise en œuvre des GMFs sur l'accès aux soins de santé de première ligne.J'ai vérifié que les différences de caractéristiques populationnelles et socio-économiques dans la période pré-politique entre les régions ayant un taux élevé par rapport à celles ayant un faible taux de participation aux GMFs sont raisonnables et fixes au cours des années de mon étude, rendant ainsi toute comparaison de ces régions appropriées. Les résultats suggèrent que les taux d'accès déclarés ont augmenté au fil du temps dans la plupart des régions sociosanitaires du Québec. Toutefois, ces mesures d'accès varient selon les régions et certains signalent toujours des taux inférieurs d'accès. Contrôlant pour les tendances temporelles, les différences fixes entre les régions, et les caractéristiques individuelles, l'accès déclaré ne change pas de manière significative avec l'augmentation de la participation aux GMFs.Un meilleur accès aux soins de santé de première ligne constituait l'un des principaux objectifs explicites de la réforme des soins de santé de première ligne de 2002. Mes résultats suggèrent que l'augmentation de la participation aux GMFs n'a pas amélioré plusieurs mesures importantes d'accès. En conséquence, des politiques supplémentaires pourraient être nécessaires pour accroître l'accès potentiel aux soins de santé de première ligne.
4
Marshall, Emily Gard. "Universal health care? : access to primary care and missed health care of young adult Canadians." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/30948.
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Prevalence of missed health care by life course stage is examined with a critique of the
measure of missed care. Canadians reporting missed care has increased from 4.2% in
1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2.
What are the relationships among life course stages, social support, predisposing,
enabling and need factors to the reporting of missed care? 3. What is the role that life
course stages play in the relationships among social support, predisposing, enabling, and
need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What
reasons are provide for missing care?; and 6. Who accesses primary care and what is the
relationship to reporting missed care? Methods: Analysis was done using the Canadian
Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore
the relationships among variables of interest predicting missed care. Results: Young
adults (18-30) are more likely to report missed care compared to other age groups and
are least likely to have a regular doctor. Social support is most significantly protective
against missed care for young adults. Weak sense of belonging to a local community
and lower income are stronger predictors of missed care for young adults. Young adults
differ from others in the reasons they report for missed care (i.e., more likely to report
cost as a barrier). Discussion: It's not clear if the difference between young adults and
other life course stages is in actual missed care or expectations of primary care. Yet, the
literature on emerging adulthood invites curiosity about how delayed adulthood leaves
them in less stable, financially insecure, socially and institutionally isolated situations
that have subsequent consequences for primary care access. Changes in models of
primary care have led to a decline in comprehensive care and more drop-in clinics; while,
not having a regular doctor is associated with missed care. If patterns of inadequate
primary care access established in young adulthood are perpetuated in later life, this may
foretell undesirable consequences for the health of Canadians. A new model for
measuring unmet health care needs is proposed.Graduate and Postdoctoral Studies
Graduate
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Eneh, Ann. "Access to Primary Care in Pennsylvanian Rural Townships." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5075.
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Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch's extension of Colaizzi's 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents' ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.
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Eneh, Ann Ogorchukwu. "Access to Primary Care in Pennsylvanian Rural Townships." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10787679.
Full textAbstract:
Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas’s model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch’s extension of Colaizzi’s 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents’ ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.
7
Soogun, Olusoji. "An assessment of the current status of integration of palliative care into primary health care centers in Alexandra community." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31269.
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Introduction-The WHA resolution in 2014 to strengthen PC as a continuum of health care service delivery mandated member states to incorporate PC into their NHS using the PHS. An assessment of a health system will only be complete when the four elements of the PHS that (entrenches palliative care) are assessed alongside preventative, curative and rehabilitative care. Aim-To assess the current status of integration of PC into the PHC centers in Alexandra community in Johannesburg, South Africa. Objectives - 1) to identify the existing policies including budgets available in the clinics relating to PC, 2) to identify the availability of PC essential medicines in the PHC and 3) to survey the HCPs training in PC. Methodology- Each objective has different targets. Objective number 1) has clinic managers as its targets. Objective 2), HCPs and people involved in procuring and prescribing essential medications and objective 3), all the HCPS. Data was collected using structured questionnaires administered by the researcher and analyzed using statistical tables. Results-The clinic mangers are not aware of NPFSPC, there is no provincial policy, budget or any existing policy on PC in any of the clinics. The essential medicines are available in the clinics, only recent graduates has undergraduate trainings in PC, no HCP has any post graduate training in PC at any level (Certificate, Diploma or Masters) as recommended by the WHA resolution to member countries. Skills in PC is close to zero in the PHCs. Conclusion-The study confirm the findings in previous literature and highlights the needs for PC policies and continuous training in PC for HCPs, essential medicines for PC are in the clinics contrary to findings in other LMIC.
8
Ellis, Susan Eileen. "Barriers Among Primary Care Providers to Utilizing Palliative/Hospice Care for Patients with Non-Cancerous Terminal Illness." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/612875.
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Patients with terminal illness may benefit greatly from hospice and palliative care. Studies of patients with chronic terminal illness revealed that those who did not received palliative or hospice care experienced poor quality medical care characterized by untreated symptoms, unmet spiritual and personal care needs, increased burden for the caregiver, and low patient and family satisfaction (Meier, 2011). According to the World Health Organization (2011), palliative care is offered at the time of diagnosis alongside potentially curative treatment and can be utilized during the trajectory of illness until death. Hospice is a Medicare benefit considered the model for quality, compassionate care during the last 6 months of life and is available to all patients regardless of age, religion, race, or illness (Medicare Hospice, 2011). This study examined why patients with non-cancerous terminal illness were not receiving timely palliative or hospice care by interviewing primary care providers. A systemic literature review suggested possible barriers including confusion between palliative and hospice care, lack of understanding about the scope and intent of hospice care (McAteer & Wellberry, 2013), prognostic uncertainty, timing, and no clear point to originate a referral (LeMond & Allen, 2011). Insufficient training for primary care providers, including the lack of familiarity with various prognostic tools that aid in determining eligibility for the patient with a non-cancerous, terminal diagnosis might also be a barrier to referral (McAteer & Wellberry, 2013). Lastly, primary care providers lacked confidence in communicating the need for advanced care planning in non-cancerous terminal illnesses according to a survey done by Karlekar, Collier, Paish, Olson, & Elsay (2014). The findings of this study confirmed the available literature. Much work is needed to educate providers and incorporate palliative care and hospice guidelines in academic institutions and in practice. Regulatory issues need continuous attention as the landscape of coverage, payment, and reimbursement changes rapidly. Further research is needed so that this vulnerable population will benefit from early interventions and a better understanding and acceptance of their non-cancerous terminal illness.
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Waters, Leland. "Factors Associated with Access to Palliative Care in a Large Urban Public Teaching Hospital with a Formal Hospital-Based Palliative Care Program." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2746.
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Hospital-based specialist palliative care services are designed to address the needs of critically ill patients by psychosocial and spiritual support, improving symptoms management, and offering discussions on goals of care. Integrating palliative care upstream in the care continuum for patients who eventually die in the hospital will help to address the many individualistic needs of the critically ill patient. The diffusion of specialist hospital-based palliative care services requires an understanding of patterns of utilization by patients. The purpose of this study was to examine the population characteristics of decedents who may or may not have utilized specialist palliative care services in a hospital setting in order to develop a model of predictors of access to specialist palliative care services. The basic constructs of this study are grounded in the Behavioral Model of Health Services Use. Potential access is measured in terms of population characteristics, which include predisposing characteristics, enabling resources, and evaluated need. Building on this theoretical model, the study sought to better understand equitable and inequitable access to specialized palliative care services and to define which predictors of realized access were dominant. The research question asked was: What are predictors of access to specialized palliative care within a large urban public teaching hospital? A model of access to a palliative consult and a predictor of access to a palliative care unit were explored. Findings from this study revealed that factors encouraging access to a palliative care consult include older age, White non-Hispanic ethnic membership, a diagnosis with solid cancer and insurance. Factors encouraging access to a palliative care unit include older age, gender (female), insurance, and either a solid cancer or hematologic malignancy diagnosis.
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Boyd, Kirsty Jean. "Early palliative care for people with advanced illnesses : research into practice." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/23389.
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Identifying people with advanced illnesses whose health is deteriorating, assessing their needs and planning care proactively with them are healthcare priorities given the demographic trend of ageing populations in the UK and internationally. Over the past 10 years (2004-2014), I have led a series of research studies that have made an important academic contribution to improving palliative care services for patients with heart disease and advanced multimorbidity. My first paper reported secondary analysis of data generated from a qualitative study of the illness and care experiences of patients with advanced heart failure. This work used innovative, qualitative research methods to explore and understand patient, carer and health professional perspectives over time. My second study then evaluated whether health and social care services were configured and delivered in response to the needs of people with heart failure and their families. This led me to recommend an anticipatory care framework which integrated a palliative care approach with other aspects of treatment and care. Around this time, advance care planning (planning ahead to facilitate end-of-life care aligned with people’s goals and preferences) was being strongly advocated by NHS health policy makers despite limited research in the UK. For my third study, I evaluated an evidence-based, educational intervention for general practitioners while also exploring barriers and facilitators to advance care planning in primary care for patients with cancer or other advanced conditions. It was becoming increasingly clear that failure to identify people with deteriorating health and a high risk of dying in a timely way was a major barrier to more effective palliative care. The problem was greatest for patients with non-malignant conditions whose illness trajectory is much less easy to predict than in cancer populations. I therefore started to research and develop a new clinical tool designed to prompt early, proactive patient identification in routine clinical practice – the Supportive and Palliative Care Indicators Tool (SPICT). My fourth research paper reported an evaluation of the SPICT in a mixed-methods study in a large tertiary care hospital. The SPICT was then used to identify people with multimorbidity for my fifth study, a longitudinal exploration of patient and carer experiences of hospital admission and ongoing community care. In my final paper, I drew on my previous research and combined this with well-developed approaches to timely identification and effective communication. I described the design of a successful pilot randomised trial of future care planning with people who had advanced heart disease and their carers. This thesis presents a critical review of these six research studies setting them in context and demonstrating the impact they have had in ensuring that high quality research evidence informs current and future developments in palliative care policy and clinical practice.
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Ighomereho, Abosede Bolarinwa Oladoyin. "Primary eye care in the United Kingdom : describing access, utilization, patients' preferences and quality care." Thesis, University of East Anglia, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.577633.
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Objective: To describe access, utilisation, patients' preferences and quality of primary eye care. Methods: Three studies were carried out (1) Project one: This was a cross sectional study of consultations for eye conditions in seven general practices in Norfolk and Waveney, located in rural, urban and inner city areas. Anonymised data about age, sex, Read codes, and ophthalmic prescriptions were extracted from electronic records using MIQUEST. All patients with an ophthalmic (that is, eye- related) diagnosis or prescription between 1 st May 2008 and 30th April 2009 were identified. The annual period prevalence, consultation and prescription for eye conditions rates in each practice's population were estimated, and directly standardised using the age and sex distribution of the population of East of England. (2) Project two: This was a cross sectional postal questionnaire survey of the patients with eye conditions identified in project one. The questionnaire included questions on: utilisation of eye care during the previous year, patients' preferences for sources of eye care and indicators of quality of care for selected sight-threatening conditions. The relationships between these variables and individuals' socio-demographic characteristics were investigated. (3) Project three: investigated primary care of ophthalmic conditions recorded in the General Practice Research Database (GPRD). It had two components. The first component included all patients who had any ophthalmic Read code recorded during one year. The second component included all patients who had a Read code recorded for the following chronic sight-threatening conditions during five years: glaucoma, diabetic retinopathy, age related macular degeneration (ARMD) and giant cell arteritis. For both components, rates of consultations, prescriptions and referrals were estimated, and their possible associations with patients' demographic characteristics were investigated. Poisson regression analysis was also performed. Results: Project one: Of a total practice population of 60739,4646 (7.7%) patients had either an ophthalmic condition or prescription or both, of which 3089 (5.1 %) people had an eye condition and 3328 (5.5%) had ophthalmic prescriptions. More females than males had an ophthalmic consultation or obtained a prescription except in preschool children who had more ophthalmic consultations than females. Project two: The response rate was 46.3% (568/1228). The main findings were that patients had a clear preference for seeing their GP for treatment of a red eye which appeared to be associated with geographical proximity to the GP's practice. Females tend to seek eye care more than males. There are also results on quality of care which suggests disparity in care received by deprivation levels. Project three: Overall prevalence of consultation was 13.4%, more females than males. Incidence of consultation for four eye condition (Glaucoma, ARMD, diabetic retinopathy and giant cell arteritis. Prevalence was highest for conjunctivitis 3.11 % in component two, the annual incidence rates of glaucoma, ARMD, diabetic retinopathy and giant cell arteritis were respectively, 9.3, 7.0 , 4.8 and 2.0 per 10,000 population. Conclusion This study provides an original overview of the burden of ophthalmic conditions and of utilisation, access, patients' preferences for sources of eye care and quality of primary eye care in the United Kingdom, Norfolk and Waveney in particular. Such evidence is essential for planning future improvements in eye care in the United Kingdom's National Health Service.
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Leung, Wai-Ching. "Equity of access to health care : case studies in primary care and coronary artery surgery." Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249587.
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Equity of access to health care was the founding aim of the NHS and a recent White Paper on NHS reforms re-emphasised its importance. This thesis consists of two contrasting studies on equity of access using individual patients as units of analysis. The main objective of the first study was to examine the equity of access to primary care services including GP consultation, out-of-hour services and referral to specialist services. The study involved secondary analysis of patient questionnaire data from a national survey. The objectives of the second study were to examine the equity of access to coronary artery surgery in one health district among those who underwent coronary angiography, and to examine whether the waiting time for coronary artery surgery was correlated with clinical need. It involved retrospective collection of data from medical records using the New Zealand Priority scores as an indicator of need. The first study showed that the following patient groups subjectively experienced disadvantages in several aspects of primary care services:- younger people, those with poor subjective physical and mental health, females, non-whites, residents in Inner London and those in paid work or full-time education. The possible reasons for these findings were discussed. It was recommended that the delivery of primary care services should take into account these results and that further research should be conducted into the extent and nature of differential patient expectation amongst different patient groups. The second study did not show any significant inequity of access to coronary artery surgery according to sex, age, smoking status and socio-economic status. However, there was little correlation between clinical need and waiting time for coronary artery surgery. These results informed subsequent development of cardiology and cardiac surgery services in the health district. The methodologies used in these two studies were compared and contrasted.
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Burt, J. A. "Equity, need and access in health care : a mixed methods investigation of specialist palliative care use in relation to age." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/19633/.
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The equitable provision of care is a core principle of the NHS. Previous research suggests that older cancer patients may be less likely to use specialist palliative care than younger patients, but studies have failed to fully define and measure clinical need. The aim of this study was to examine use of specialist palliative care in relation to age, after controlling for need. I used a mixed methods approach, grounded in a pragmatic philosophy and drawing upon a health capability account of equitable healthcare. I undertook a focused ethnography of three specialist palliative care services, using documentary evidence, observation of meetings, and interviews to investigate conceptualisations of need for care. I derived two models of need. The first ‘aspirational’ model encompassed physical, psychological, social and spiritual care for patients and carers. However, with limited resources, a predominantly physical model of need was applied. Additionally, observations suggested that care may vary in relation to patient characteristics including age. To locate a suitable measure of need, I conducted a systematic literature review and critical and content appraisal of health-related quality of life instruments. I chose the EORTC QLQ-C30 instrument as the indicator of need in a cross-sectional survey of patients and carers, conducted to measure use of specialist palliative care in relation to age. 252 patients and 137 carers attending four outpatient lung cancer clinics participated. 39% received specialist palliative care. Age was not associated with use of specialist palliative care; metastatic disease, global quality of life (‘need’) and the clinic where treatment was provided were. These findings suggest equitable use of specialist palliative care. However, a comprehensive account of equity must consider both use and quality of care. There were some suggestions that, within a resource-limited context, the quality of care may vary. Future equity research should prospectively consider variations in use and quality of specialist palliative care for different patient groups across all care settings, and from diagnosis to death.
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Arrowsmith, Myat. "Improving access to contraception : long-acting reversible contraception in primary care." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/18663.
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Background The majority of unintended pregnancies are attributed to contraceptive failures from incorrect and inconsistent use. Long-Acting Reversible Contraception (LARCs) are highly effective in reducing unintended pregnancies, however, use of LARC is low in the United Kingdom (UK), and the intrauterine device (IUD) is the least used method in the UK. This thesis examines the impact of the pay for performance incentive on prescribing of long-acting reversible contraception in UK primary care, and also investigates the effectiveness of interventions to improve uptake of copper-IUD devices. Methods (1) Mixed-level logistic regression analysis of data from the UK Office of National Statistics ONS (2) Longitudinal data analysis of long-acting reversible contraception before and after the introduction of pay for performance in a sample of general practices across the UK (3) Cochrane systematic review on the effectiveness of interventions to improve the use of copper-IUD internationally. Results (1) Women who accessed their contraception from family planning clinics were more likely to use LARCs than those who accessed it from general practices. (2) Since pay for performance indicators on offering contraceptive information were implemented in 2009, the prescribing of LARCs has increased by 4% annually. This has resulted in 8700 more women being prescribed LARC at the practices included in this study. (3) Provision of contraceptive counselling and appointment and recall systems for IUD insertions was found to be effective in increasing uptake of copper-IUD, and the timing of counselling on pre- or post-natal patients was found to be important. Conclusions Uptake of more effective contraceptive methods such as LARCs was associated with financial incentives for contraceptive information provision in general practices. Provision of consistent and structured contraceptive counselling in primary care for women of reproductive age may improve the use of LARCs and should in turn reduce unintended pregnancies in the long-run.
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Cowling, Thomas Edward. "Access to primary health care in England : policy, theory, and evidence." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/42497.
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Background: The U.K. Government plans to improve access to general practice services in England, partly by extending the opening hours of these services. The Government expects this to enhance patient experience and reduce use of emergency hospital services. The thesis aims to provide empirical evidence relevant to these policy expectations. Methods: Three observational studies of a cross-sectional questionnaire-based survey—the GP Patient Survey—from 2011-12 to 2013-14 (2,912,535 respondents aged ≥18 years old and registered to 8,289 general practices in England). Respondent-level data were deterministically linked at the practice level to Hospital Episode Statistics Accident and Emergency (A&E) and Inpatient data and to routine data on practice characteristics. Multivariable regression estimated associations between: (1) participation in the Extended Hours Access Scheme and patient experience; (2) several patient experience measures; and (3) patient experience and rates of A&E visits and emergency hospital admissions. Results: Most patients were very (40.0%) or fairly (42.3%) satisfied with the opening hours of their practices; results were similar for experience of making an appointment and overall experience. Practices that participated in the Extended Hours Access Scheme had greater adjusted mean values of these measures than non-participants, but the mean differences were small (≤1.25 on 0-100 scales). Overall experience was most strongly associated with doctor interpersonal quality of care (standardised coefficient=0.38; 95% CI: 0.38 to 0.38). A standard deviation increase in the practice-level mean experience of making an appointment predicted a 2.7% decrease (rate ratio=0.973; 95% CI: 0.966 to 0.979) in A&E visit rates and a 1.7% decrease (rate ratio=0.983; 95% CI: 0.978 to 0.988) in emergency admission rates. Conclusions: Changes to opening hours under existing policies are unlikely to improve patient experience of general practice substantially. Realistic short-term improvements in experience would likely have modest effects on use of emergency hospital services.
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Barnett, Eve Grinnell, and Eve Grinnell Barnett. "Access to Primary Care Among Vulnerable Patients in a Rural Setting." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625460.
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Background/Objectives: Vulnerable populations, particularly those with mental illness, are at a significantly higher risk of developing chronic health comorbidities and facing barriers to regular healthcare, often resulting in a shorter lifespan than the average population. The purpose of this needs assessment of a rural population utilizing a local food bank and soup kitchen is to assess the health status of the population in relation to mental health and chronic illness, and to determine this population’s access and utilization of primary care services. The data collected in this assessment will identify potential needs for formal community partnerships and help develop recommendations to improve health status of this potentially vulnerable community.
Design: This study consisted of a needs assessment involving an orally administered survey to a potentially vulnerable population evaluating socio-demographic factors, chronic illness, mental health diagnoses, and questions regarding primary care access and utilization using the Primary Care Assessment Tool (PCAT).
Setting: The study took place at the Flagstaff Family Food Center (FFFC), a local food bank and soup kitchen in Northern Arizona. Data collection took place during the free dinner meal over two site visits.
Participants: Clients utilizing the FFFC who are English speaking, 18 years of age and older, able to give informed consent.
Results: Data collected shows that a large number of FFFC clientele would be classified as vulnerable, and several report mental illness and other chronic illness. One hundred percent of survey participants report having health insurance, yet two participants report not having a primary care provider (PCP) and using the emergency department for their healthcare needs. While the majority of clients report having easy access to their PCP, the ongoing care and coordination of services appears to be lacking.
Conclusion: Based on this pilot needs assessment, there is a need for more formal partnerships between healthcare providers and organizations and the FFFC to ensure this vulnerable population receives adequate care for chronic disease management, mental illness and prevention. By providing connections at the FFFC where clients come to receive a free meal, some of the common barriers of stigma, transportation and system navigation may be eliminated.
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Graham, Erin L. D. "Rural-urban differences in self-care behaviours of older Canadians: the effects of access to primary care /." Burnaby B.C. : Simon Fraser University, 2005. http://ir.lib.sfu.ca/handle/1892/2346.
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Dalkin, Sonia. "The realist evaluation of a palliative integrated care pathway in primary care : what works, for whom and in what circumstances?" Thesis, Northumbria University, 2014. http://nrl.northumbria.ac.uk/18251/.
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Background: Finding effective ways to care for people with palliative care needs is a national priority. A primary care locality has developed and implemented an Integrated Care Pathway (ICP) for those with life limiting illnesses. It focuses on identifying patients early, regardless of disease type, and uses proactive and patient centred interventions to plan for a good death. Although palliative care pathways present a promising practice framework, the literature does not allow for an assessment of how and when they work best. This thesis aimed to explain which parts of the ICP worked best, for whom and in what circumstances. Design: Realist evaluation was used to guide the analysis of multiple data strands: quantitative data from the GP practices; interviews with palliative care patients and bereaved relatives; bereaved relatives and matched health care professional questionnaires; focus groups with health care professionals; consultation recordings with palliative care patients and their GPs. Results: The results of this study are multifaceted, and focus on the conditions of successful implementation, such as the presence of a champion; palliative care registration decisions for all diagnoses and the importance of leadership and peer support; advance care planning, including the roles of mental capacity and time constraints; communication in consultations and the role of patient and GP traits; and using open multicomponent communication strategies to facilitate home deaths. Discussion: A realist approach has exposed how the ICP implementation has led to positive practice and patient level outcomes. The ICP can be construed as a translational tool, which enables the operationalisation of policy directives on shared decision making, proactivity and patient centeredness in primary care. In the context of palliative care, this study allows important reconceptualisations of shared decision making and advance care planning to be presented.
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Chauhan, Jyoti. "The experiences of primary caregivers providing palliative care to women living with advanced breast cancer." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3534_1194347235.
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The aim of this explorative study was to understand the experiences and challenges of primary caregivers providing palliative care to women with advanced breast cancer. This study was conducted within a qualitative research design framework underpinned by phenomenology. The significance of this study was to contribute to the knowledge that would help care professionals understand the experiences and challenges that primary caregivers face whilst providing palliative care to women with advanced breast cancer.
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Cameron, Barbara. "Palliative Care Services Utilization and Location of Death." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/22907.
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In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.
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Laditka, James Nicholas. "Health outcome disparities associated with access to primary care for vulnerable groups: Hospitalization for ambulatory care sensitive conditions." Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2002. http://wwwlib.umi.com/cr/syr/main.
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BRAGA, RAFAELA COSTA. "HOME DEATH: THE EXPERIENCE OF PRIMARY FAMILY CAREGIVERS OF CANCER PATIENTS IN PALLIATIVE CARE." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2018. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=34667@1.
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PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROCOORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTS. DE ENSINO
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTITUIÇÕES COMUNITÁRIAS DE ENSINO PARTICULARES
Apesar da filosofia paliativista defender o direito do doente de escolher o local do óbito, existe uma valorização do óbito em domicílio e uma política de desospitalização nas unidades de saúde com o objetivo de otimizar recursos, diminuir os riscos de infecção hospitalar e favorecer o bem-estar do paciente. Entretanto, óbito no domicílio não é por si só indicativo de qualidade da assistência prestada. Torna-se importante saber como ocorreu o processo de morrer. O objetivo deste trabalho foi investigar a experiência de acompanhamento do processo de morte no domicílio para o cuidador familiar principal de paciente oncológico adulto em cuidados paliativos. Para tal, discutiu-se sobre as seguintes temáticas: a relação do ser humano com a morte e o morrer a partir de referenciais sócio antropológicos, os estudos contemporâneos sobre o luto e as especificidades dos cuidados ao fim de vida no domicílio. Utilizou-se a metodologia qualitativa de pesquisa, submetendo o material discursivo das entrevistas a uma análise de conteúdo. Conclusão: Constatou-se que a abordagem quanto às decisões de fim de vida costuma ser tardia e prevalece a falta de diálogo sobre o assunto entre o paciente e a família. Portanto, as escolhas são majoritariamente da família. Sobrecarga, bem como dificuldades durante a alimentação e os curativos foram alguns dos desafios enfrentados pelos cuidadores familiares principais. A experiência foi avaliada de forma positiva pela maioria dos entrevistados, havendo valorização do suporte da equipe de assistência domiciliar e da oportunidade de usufruir do convívio familiar. Contudo, para alguns o domicílio permaneceu impregnado de lembranças do período de adoecimento e do momento da morte.
Although the palliative philosophy defends the patient s right to choose the place of death, there is a valuation of death at home and a policy of dehospitalization in the health units with the objective of optimizing resources, reducing the risks of hospital infection and favoring the well-being of the patient. However, death at home is not in itself indicative of the quality of care provided. It becomes important to know how the dying process occurred. The objective of this study was to investigate the experience of monitoring the death process at home for the main family caregiver of an adult oncologic patient in palliative care. For that, the following themes were discussed: the relation of the human being with death and dying from socio-anthropological references, the contemporary studies on grief and the specifics of end-of-life care at home. The qualitative research methodology was used, subjecting the discursive material of the interviews to a content analysis. Conclusion: It was found that the approach to end-of-life decisions is usually late and there is a lack of dialogue on the subject between the patient and the family. Burden, as well as difficulties during feeding and dressing were some of the challenges faced by leading family caregivers. The experience was evaluated in a positive way by most of the interviewees, valuing the support of the home care team and the opportunity to enjoy family life. However, for some the household remained impregnated with memories of the period of illness and the time of death.
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Allu, Selina Omar. "Access to primary health care for low-income women in urban Kenya." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ64900.pdf.
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Holdsworth, Lesley K. "A study of direct access to physiotherapy in a primary care setting." Thesis, Glasgow Caledonian University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251175.
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The ability of a patient to access physiotherapy directly (patient self-referral), although used widely in the private sector, is not the mechanism in use within the NHS where there exists a system of open access controlled by doctors. This study aimed to develop, implement and investigate a direct access physiotherapy service within a primary care setting in a health district of Scotland. The service was introduced and compared to the existing system of open access over a twelve-month period (1997-1998). Demographic and clinical data was collected relating to two samples: Control Year Group: All GP referrals for a year prior to the study year collected retrospectively. Study Year Group: General practitioner (GP) and direct access (DA) referrals. All patients were followed up one-month after discharge, and the number of associated GP consultations collated together with patient, physiotherapist, general practitioner and service non-user views of physiotherapy generally and direct access specifically. There were similar numbers of referrals (339 vs. 340) with no significant differences with regard to patient age or gender between the Control and Study Year Groups. The Study Year Group however revealed significant differences between DA and GP referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total referrals in comparison to 77.6% GP referrals. DA patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, who were more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care. This group also demonstrated a greater confidence in knowing when to access physiotherapy and were highly supportive of the effectiveness of physiotherapy. DA patients also consulted their general practitioner significantly less often than GP referrals (p = 0.001). Support for direct access was strongly expressed by service users and nonusers, physiotherapists and general practitioners. Direct access to physiotherapy is an example of an innovative, flexible approach to primary care service provision encouraged by current health policy.
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Velupillai, Yoganathan. "A comparison of palliative care needs and palliative care services for community based patients with cancer and non-cancer illnesses in the Greater Glasgow NHS Board area." Thesis, Connect to e-thesis, 2004. http://theses.gla.ac.uk/1022/.
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Thesis (Ph.D.) - University of Glasgow, 2004.Ph.D thesis submitted to the Departments of Public Health and Palliative Medicine, Faculty of Medicine, University of Glasgow, 2004. Includes bibliographical references (p. 272-293). Print version also available. Mode of access : World Wide Web. System requirements : Adobe Acrobat reader required to view PDF document.
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Kufa, Erica. "The timing of first antenatal care visit and factors associated with access to care among antenatal care attendees at Chitungwiza municipal clinics, Zimbabwe." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4553.
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Magister Public Health - MPHBackground and Rationale: Antenatal care (ANC) is vital for accessing prevention of mother to child transmission (PMTCT) services. The timing of the first ANC visit is critical for HIV infected pregnant women to access antiretroviral (ARV) prophylaxis as recommended. In addition pregnant women access other interventions like syphilis screening and treatment, provision of ferrous iron supplements, malaria prevention and treatment, health education, identification and management of risk factors. There is however paucity of information on factors associated with the timing and adequate use of ANC services in Chitungwiza Township, Zimbabwe. Aim: This study aimed to determine the factors associated with early access to and adequate use of ANC services among women attending ANC in the four polyclinics in Chitungwiza Township.Method:The study included a retrospective record review of women who registered for ANC in 2010 and a cross sectional study of pregnant women attending ANC clinic for the first time during the current pregnancy during the survey period. Data on gestation age at first ANC visit, number of ANC visits, age, gravidity, parity, tetanus, iron sulphate, rhesus results, HIV test result, WHO clinical stage, CD4 count, cotrimoxazole, PMTCT option accepted, date of initiation of AZT or ART; partner HIV test results; and infant feeding adherence done was abstracted into an MS Excel spreadsheet from the 2010 ANC registers in the four primary health care clinics. Every fourth record was captured. Exit interviews were also conducted on all women attending ANC for the first time during the current pregnancy using a structured questionnaire. Questions on socio-economic status, pregnancy history, reasons for seeking ANC, knowledge and belief about ANC services and their perception of the service received were asked. The outcome variables were gestation age at first ANC visit and the number of ANC visits. The spreadsheet was imported into Epi Info 7.0.9.7 and STATA 11 for analysis. The questionnaires were captured into an Epi Info 7 database exported to STATA 11 for analysis. A sample of 1,236 of first ANC visit records were abstracted from the 2010 ANC registers in the four primary care clinics and 80 women coming for ANC were interviewed in three clinics. The prevalence of pregnant women attending ANC for the first time at gestation age less or equal to 14 weeks and the prevalence of women with less than 4 ANC visits were computed. Pearson Chi-square tests were used to determine the strength of the relationships between the dependent variable (gestation age at the time of the first visit) and independent variables of age, marital status, level of education, parity, gravidity. All statistical tests were performed at 5% significance level and estimates were calculated at 95% confidence interval. Multiple logistic regression analysis was used to investigate the association between the outcome and the independent variables. Model interpretation was done using odds ratios (OR). Levels of knowledge and perception about ANC services as well as service content during the visit were also summarized. Results: Less than 1% of the women who attended ANC in 2010 came for 1st visit at week 14 or less, while of the women interviewed, 2.5% came at similar gestation age. Thirty-nine percent of women attending ANC in 2010 had at least four visits. Lower parity and tetanus immunization were significantly associated with early ANC initiation, while tetanus immunization and syphilis screening were associated with the number of visits.Among the interviewed women (n=80), 72.1% believed that a pregnant women should start ANC at 14 weeks or earlier. Most women (61.7%) cited having no money for booking as the reason for not coming earlier. Need for husband or partners permission, procrastination and not having any health problems with previous pregnancies were also a barrier to access. Uptake of HIV testing was very high at 94.7% of the women. However partner testing was very low at 2.1%. Knowledge of the appropriate time of the first ANC visit was somewhat high but not universal. Conclusions and Recommendations: Timely and adequate uptake of ANC services is very low in Chitungwiza Township. The user-fees appeared to be a major barrier to accessing ANC timely. While correct knowledge about when to go for ANC and the health problems women face during pregnancy and childbirth is prevalent,other factors like the need for permission from spouse or partner and procrastination were barriers to seeking service. Abolishing maternity fees should be seriously considered in order to increase access to timely ANC services. Sustainable means of financing services without reducing quality should be sought. There was variable uptake of various interventions in the ANC package due in part to supplies stock outs. There is need for strengthening the procurement and distribution systems so as to ensure continuous supplies at service delivery level.
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Ou, Christine Hui-Kuan. "Health behavior, primary care access, and unmet health needs in Chinese young adults." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/36752.
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Background and Purpose: According to the Canadian Community Health Survey conducted in 2000-1, 12% of Canadians reported experiencing an unmet health need compared to four percent in 1994-5. There is growing reason to investigate the increasing number of Canadians reporting unmet health needs, particularly among young adults (between 18 and 30 years of age) who access health services less frequently than any other age group. In particular, the growing population of Chinese living in Canada present unanswered questions regarding the health needs of Chinese young adults. The purpose of this study was to examine: 1) if Chinese young adults who primarily speak Chinese experience more unmet health needs when compared to English-speaking Chinese young adults and, if there are, 2) the reasons why Chinese young adults have unmet health needs.
Methods: A mixed methods approach was taken; in-depth interviews (n=8) with Chinese young adults were used to complement and explain findings from a secondary analysis of a larger cross-sectional survey of the primary health care seeking behaviours of Chinese-, English-, and Punjabi-speaking Canadians.
Findings: Fifty-eight Chinese young adults participated in the primary health care survey; ten percent (n=6) reported having an unmet health need related to the availability and accessibility of health care. Language preference was not found to be associated with unmet health needs. Close to two out of three young adults reported seeing a physician in the past year. Twenty-four percent reported accessing health care outside of Canada. In-depth interviews revealed that Chinese young adults had unmet needs due to the lack of a primary care provider and not accessing preventive care. Acculturation and health behaviour was found to be more predictive of unmet health care needs than language.
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Jenkins, Tania. "Arduous access: a look at the primary health care crisis in Quebec, Canada." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66865.
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This manuscript-based thesis attempts to scrutinize the current crisis surrounding access to primary health care (PHC) in Quebec, Canada through mixed methods and multiple perspectives. Using logistic regression, the relationship between socioeconomic status and access to PHC was closely examined from the individuals' perspective (i.e. access from 'below'). These results reveal that household income, size of household, region of residence and marital status are all factors which threaten equitable access to family doctors in the province. From a micro perspective in Montreal, Quebec, access from 'above' was then studied through in-depth qualitative interviews with family physicians. Arduous access to PHC in Quebec was thus found to be the possible result of supply-side regulation mechanisms adopted by the provincial government in an attempt to cut healthcare costs. In response to these findings, a series of recommendations was finally made to improve access to PHC in the province, all whilst balancing the sometimes conflicting goals of universal healthcare and curbing costs.Cette thèse vise à mieux comprendre la crise concernant l'accès aux soins de santé primaires au Québec, en employant de multiples méthodes et perspectives. Avec l'aide de la régression logistique, le lien entre le statut socio-économique et l'accès aux soins primaires a été étudié à partir de la perspective de l'individu (c'est-à-dire, la demande de soins). Ces résultats démontrent que le revenu du ménage, la taille du ménage, la région de résidence et le statut marital sont tous des facteurs qui affectent l'accès équitable aux médecins de famille dans la province. Ensuite, en employant une perspective plus microsociale, l'offre de soins a été étudiée à l'aide d'entrevues avec des médecins de famille à Montréal, Québec. La difficulté d'accès aux soins de santé primaires semble être le résultat d'une série de politiques qui régulent l'offre des soins afin de réduire les coûts associés à la santé. À la lumière de ces résultats, des recommandations sont offertes afin d'à la fois améliorer l'accès aux soins de santé primaires tout en étant conscient du but à long-terme de limiter l'augmentation des coûts de santé.
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Batista, Ricardo. "Access and Enrollment of Immigrants in Primary Care in Ontario: Which Immigrants Are Getting in and Which Are Not?" Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36571.
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Research in Canada and abroad has shown that newcomers face multiple obstacles in their search for health care during their resettlement and integration to the host society. In Ontario, primary care services are organized in three main models based on the remuneration scheme to physicians: fee for service, capitation, and salaried. During the Primary Care reforms in early 2000s, the province introduced new models of primary care practices to enhance the quality of care through the expansion of comprehensive multidisciplinary care, applying more preventive measures and enhanced chronic disease management strategies. Along with these innovative reforms, the province promoted an enrollment system with a family doctor in the primary care practices. This research examined the access of immigrants to the enrollment system in Ontario. A review of the literature contrasting a PMC and PHC approaches showed that the latter has more potential to address social determinants of health of immigrant populations. Taking into account the organization of health services in the province, immigrants can receive primary care services mainly through PMC practices (FFS and capitation-based), but also through PHC-type of models, such as Community Health Centers. The analysis of enrollment in primary care was conducted using a secondary analysis of administrative data. The main findings have shown that immigrants’ enrollment in primary care services has increased over time, but the levels of enrollment remain lower compared to long-term residents. Moreover, compared to long-term residents, immigrants have less access to the most comprehensive models of care, which represents an important inequity. In exploring the perceptions of immigrants in two major cities of the province, most of the participants perceived that important factors, such as information, knowledge, language barriers, cultural issues; are affecting their capacity to understand and navigate the system. Hence, it takes a long time for them to make sense and learn how to connect and use the system.
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Nassali, Musoke Maria G. "Health information access and use in rural Uganda : an interaction-value model." Thesis, University of Sheffield, 2001. http://etheses.whiterose.ac.uk/14829/.
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The study investigated the accessibility and use of health information within the lower echelons of Primary Health Care service delivery. Hence, it focused on women and health workers' experiences with information in rural Uganda. Face-to-face interviews were conducted using an interview schedule that consisted of open questions and one relating to health information critical incidents. The qualitative interviews added depth, detail and meaning at a very personal level of experience. A holistic inductive paradigm was used in the study with a grounded theory analysis. This approach was adopted because of its ability to generate findings inductively from empirical data. An 'Interaction-value model' emerged from the study. The model was driven by the value and impact of information unlike previous information models which have been driven by information needs. This study has demonstrated that although an information need could trigger off an information activity, the subsequent information process could only be sustained by the value of information. Hence, access and use of information depends on the value and impact of information to overcome or reduce constraints. The value of information is therefore the core category, while the moderation of constraints and interaction with sources for latent or apparent needs are the two main categories that make up the model. The study has also shown that not all information users are active seekers. The main difference between the two groups of interviewees was that health workers' needs were generally apparent and led to active information seeking, whereas the women's needs were generally latent. Women mainly accessed information passively. Passivity, however, was generally limited to the act of accessing information. After passive information access, the subsequent user behaviour was active. Hence, women passively accessed information, but actively used it. Women's information behaviour was therefore dynamic. This was confirmed throughout the study when, for example, their information needs changed from latent to active and vice versa. The difference in the findings appears to stem from the fact that for women, the process of information access and use was dependant on the relationship and interaction between their social and information environment in everyday life; while for the health workers, professional matters added a further dimension to their information activities. The ways in which women and health workers accessed and used information as elaborated in this study have a number of implications for improving information provision, policies, training of health workers, and further research.
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Bomfim, Ana Helena AraÃjo. "Familiares e profissionais de saÃde: cuidados domiciliares no final da vida." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=7525.
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FundaÃÃo de Amparo à Pesquisa do Estado do CearÃPropÃe-se compreender como à cuidar de pessoas com doenÃa em estÃgio terminal no domicÃlio na perspectiva dos familiares e profissionais de saÃde de Sobral/CE, com o objetivo de refletir sobre os cuidados domiciliares no final da vida no Sistema Ãnico de SaÃde (SUS). Considerando os cuidados no final da vida como campo de estudos que engloba um conjunto de teorias e prÃticas que tÃm por objeto central o processo de morrer, esse tema torna-se relevante no contexto atual de transiÃÃo demogrÃfica e epidemiolÃgica, na qual hà um crescente envelhecimento populacional e um aumento da prevalÃncia de doenÃas cronicodegenerativas (doenÃas cardiovasculares e neoplasias), alÃm da maior longevidade proporcional da populaÃÃo de idosos, que demandam uma reorganizaÃÃo dos serviÃos de saÃde. AlÃm disso, observa-se maior visibilidade nacional dos cuidados paliativos, modelo da gestÃo dos cuidados no final da vida, apesar de ausÃncia de uma polÃtica efetiva. Abordar o cuidado no processo de morrer exige um esforÃo interdisciplinar, recorrendo aos estudos histÃricos sobre a morte, a Tanatologia e aos conceitos e teorias das ciÃncias humanas e sociais do campo da SaÃde Coletiva. Por meio de pesquisa de abordagem qualitativa, foram entrevistados sete familiares de pessoas com uma doenÃa terminal ou que jà faleceram, trÃs profissionais da EstratÃgia SaÃde da FamÃlia (enfermeiros e mÃdico) e dois profissionais do serviÃo pÃblico de Home Care do municÃpio. Estabeleceu-se como categorias de anÃlise: os cuidados no final da vida, as necessidades dos doentes e familiares, a relaÃÃo dos familiares com os serviÃos de saÃde, a formaÃÃo e capacitaÃÃo profissional, relaÃÃo dos profissionais de saÃde com a famÃlia; e o papel dos serviÃos de saÃde nos cuidados no final da vida. Considera-se que, apesar do discurso da humanizaÃÃo dos cuidados, refletida na prerrogativa de viver os Ãltimos momentos de vida com a famÃlia, esconde-se um grave problema de descontinuidade dos cuidados. Ao identificar a impossibilidade de cura, o doente à encaminhado para casa, sem a devida referÃncia à ESF ou a outro serviÃo de assistÃncia domiciliar. Desse modo, apesar dos esforÃos da famÃlia e dos profissionais de saÃde, considera-se que pouco se logra melhora na qualidade de vida de quem morre por uma doenÃa.
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Boucher, Duane Eric. "An information privacy model for primary health care facilities." Thesis, University of Fort Hare, 2013. http://hdl.handle.net/10353/d1007181.
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The revolutionary migration within the health care sector towards the digitisation of medical records for convenience or compliance touches on many concerns with respect to ensuring the security of patient personally identifiable information (PII). Foremost of these is that a patient’s right to privacy is not violated. To this end, it is necessary that health care practitioners have a clear understanding of the various constructs of privacy in order to ensure privacy compliance is maintained. This research project focuses on an investigation of privacy from a multidisciplinary philosophical perspective to highlight the constructs of information privacy. These constructs together with a discussion focused on the confidentiality and accessibility of medical records results in the development of an artefact represented in the format of a model. The formulation of the model is accomplished by making use of the Design Science research guidelines for artefact development. Part of the process required that the artefact be refined through the use of an Expert Review Process. This involved an iterative (three phase) process which required (seven) experts from the fields of privacy, information security, and health care to respond to semi-structured questions administered with an interview guide. The data analysis process utilised the ISO/IEC 29100:2011(E) standard on privacy as a means to assign thematic codes to the responses, which were then analysed. The proposed information privacy model was discussed in relation to the compliance requirements of the South African Protection of Personal Information (PoPI) Bill of 2009 and their application in a primary health care facility. The proposed information privacy model provides a holistic view of privacy management that can residually be used to increase awareness associated with the compliance requirements of using patient PII.
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Catalano, Natalie, and Brittney Dewey. "Assessing Self-Reported Quality and Access to Primary Care for Patients with Psychiatric Disorders." The University of Arizona, 2017. http://hdl.handle.net/10150/624164.
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Class of 2017 AbstractObjectives: (1) To assess the access to and quality of primary care for patients living with a psychiatric condition(s). (2) To identify demographic factors that may influence the access and quality of primary care services. Methods: Subjects were recruited at HOPE Inc., a behavioral health resource center, in Tucson, Arizona, during pharmacy student-run health fairs. Participants were surveyed using the Primary Care Assessment Tool (PCAT) a questionnaire developed by Johns Hopkins, which assess four domains of primary care. Participants were also surveyed about demographics, mental health diagnosis and their SMI designation. For objective (1): Descriptive statistics for each domain of the PCAT were performed to assess the level of access and quality of care, including comparison to a hypothesized score. For objective (2): Due to the small sample size only descriptive analysis of the demographic data was performed. Results: A total of 11 subjects were surveyed using the PCAT with an average score of 67.64±12.18. This was higher than the hypothesized score of 46. On average, in all four PCAT domains participants scored higher than the hypothesized, value. The lowest scoring domains were, “Care at first contact - Access” and “Coordination of care” (10.45±3.62, Hypothesized score: 8) and (12.36±5.82, Hypothesized score: 10) respectively. The highest scoring domain was “Care at first contact - utilization” (11.09±1.92, Hypothesized score: 12). Conclusions: This study helped to provide a framework for future studies of primary care services using the PCAT survey.
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Al, Magrabi Katibah Saad Aldean. "Geographical aspects of health and use of primary health care services in Jeddah, Saudi Arabia." Thesis, University of Strathclyde, 2001. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=21426.
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This thesis examines the contribution that geographical analysis can make to the study of the variation in the patterns of human health and subsequently to the discussion on the type and level of use of the public health service in a rapidly developing country. The current study was conducted in Jeddah Governorate, Kingdom of Saudi Arabia during the period 1994 and 2000. One of the main aims was to examine the pattern of health services provided in Saudi Arabia and this aim was achieved by investigating the provision and use of the Public Healthcare services. An attempt was made to clarify the complex web of relations that existed between, on the one hand, the different socioeconomic and geographic factors and on the other, the distribution of common ailments together with the level of utilization of health services. Shortcomings in the nature of the official health statistics regarding socioeconomic conditions of the patients were remedied through the use of a questionnaire. A tot al of 1000 patients from the eight PHCCs were surveyed for their use of the public health service. Data was collected from the same patients on their socio-economic, education and habitation details. This sample was used to supplement the data collected from the official government health statistics. These two data sets permitted an evaluation of the occurrence of different ailments and the variations in geographic distribution among the eight selected PHCCs. Difficulties persisted in the availability of official 1992 census data until publication of census data became available in 1999. In contrast to the problems of the census data, the availability of accurate and up-to-date patient records compiled by Ministry of Health staff was of considerable benefit to this research project. Use was made of Geographic Information Systems software for the analysis of data collected at the level of the PHCC. This allowed visual identification of the spatial variation in the use of the different health services and also allowed the identification of gaps in healthcare provision. The study showed that a density of habitation index used as a prime indicator of socio-economic status could be used as an indicator of the occurrence level for a number of common diseases. A pattern of disease was observed that suggested that the number of visits to PHCCs was substantially higher in low socio-economic districts compared to medium and higher socio-economic districts. It can be shown that the most common ailment was Upper Respiratory Tract Infections followed by Dental and Gingival diseases. Persons aged between 15 and 44 years made most visits to PHCCs although children under 15 years made proportionately greater use of PHCC facilities. No difference could be found between Saudi and Non Saudi as regards the occurrence of the most common ailments and diseases. The lack of difference was probably due to the close integration of the two population groups and the sharing of the same local environment. This similarity occurred despite considerable differences in income levels and socio-economic status. The level of utilisation of health centers in the selected districts showed differences, being higher in those districts categorized as low socio-economic in the south of Jeddah when compared to higher socio-economic districts in the north of the city. It was evident that the difference in socio-economic factors had an impact on the occurrence of some frequently occurring diseases e.g. URI, Dental, Ophthalmic, musculoskeletal and skin diseases. Although not primarily concerned with private health care facilities, for completeness sake some information was collected on the use of private health care in conjunction with public health care facilities. The author was surprised to discover that greatest use of private facilities occurred among women and children patients from Al Nuzla al Yamaneyyah and Al Thaalebah, districts that were characterised by low socio-economic conditions. The use of traditional folk healing was also briefly studied as this form of treatment remains important for some patients. Results showed that there was no difference between the educational standards of patients and their use of traditional folk healers. Again, children and women constituted the majority (86.6%) of users of traditonal healing with Saudi users (18.9%) higher than non Saudi (11.4%). There remains the supposition that alternative medicine may be of far greater importance than the sparse official data suggests. The unquantified illegal immigrant population may be totally reliant on unofficially operating alternative medicine centres. The thesis concludes by recommending a number of improvements to the existing public health care system. Some changes in the policy and practice of PHCC services will inevitably require more financial resources. These include an extension of the opening times of PHCCs and an increase in the number of specialist facilities such as dental surgeries. Other changes may not require more finances. These include a strengthening of communication and co-operation between PHCCs and hospitals to improve the referral of patients. Expansion of the existing computer network connecting PHCCs with hospitals should be given high priority.
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Côbo, Viviane de Almeida. "Cuidados paliativos na atenção primária à saúde sob a perspectiva dos profissionais de saúde." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/17/17139/tde-25052015-104647/.
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Os Cuidados Paliativos (CP) são uma abordagem de cuidado em saúde que visa qualidade de vida dos pacientes e de seus familiares, que enfrentam uma doença terminal, através de cuidados físicos, psíquicos, sociais e espirituais. Já a Atenção Primária à Saúde é o primeiro nível da rede de saúde, oferta serviços clínicos e é responsável pela coordenação do cuidado e organização dessa rede. Caracteriza-se por um conjunto de ações de saúde individuais e coletivas, que abrangem a promoção e a proteção da saúde, a prevenção de agravos, o diagnóstico, o tratamento, a reabilitação e a manutenção da saúde, utilizando tecnologias de elevada complexidade e baixa densidade, que devem resolver os problemas de saúde de maior frequência e relevância em seu território. O principio de Integralidade do SUS se relaciona intimamente com essas duas vertentes de saúde, os CP e a APS. O estudo teve como objetivo Identificar como são compreendidos e realizados os CP na APS por profissionais de saúde. Trata-se de estudo descritivo e exploratório que pretende descrever padrões de ocorrência de cuidados paliativos na atenção primária em saúde, assim como o conhecimento e a percepção sobre estes cuidados de todos os atores envolvidos. Participaram do estudo 13 profissionais de saúde que trabalham na APS, 17 pacientes e/ou cuidadores que estavam em CP, todos maiores de 18 anos. Para a análise dos dados, utilizou-se de Estatística Descritiva e Análise de Conteúdo segundo Bardin. Os indivíduos caracterizam-se pelo discreto predomínio do sexo feminino tanto quanto na amostra de profissionais de saúde quanto nos pacientes/cuidadores. Como resultados e conclusão têm-se que os profissionais possuem, como conhecimento, conceitos gerais e empíricos de CP e mais específicos de APS. Há a demanda de CP na APS e a sensibilização dos profissionais de saúde que atuam neste nível sobre o que tange a CP, mas não se pode dizer que realizam em toda a plenitude os CP na APS, entretanto há a possibilidade de inserção dessa abordagem de cuidado nestes serviços. Faltando, para isso, capacitação e estrutura adequada. Não há a formação especifica dos trabalhadores da APS para CP, muito menos sua discussão na prática. E sua formação ou elucidação sobre CP possuíam uma formação empírica vinda da prática que ainda privilegia os cuidados físicos, mas que visam à qualidade de vida e cuidados humanizados. Os cuidados prestados, tanto em CP quanto em APS, são avaliados positivamente tanto pela comunidade quanto pelos profissionais de saúde. A APS é feita por profissionais identificados com os princípios e diretrizes desse nível em saúde, é direcionada por sua demanda, que emerge da comunidade adstrita ao seu território, sendo que há uma cultura que impõe uma visão imediatista sobre a saúde por parte da população.Palliative Care (PC) is a health care approach that seeks quality of life of patients and their families facing a terminal illness through physical, psychological , social and spiritual. Have the Primary Health Care is the first level of the health network, offer clinical services and is responsible for the coordination of care and organization of the network. Characterized by a set of individual and collective health actions, which include the promotion and health protection, disease prevention, diagnosis, treatment , rehabilitation and health maintenance , using high- complexity and low-density technologies which should solve the health problems of greater frequency and relevance in their territory. The principle of the SUS Completeness is closely related to these two health aspects, the CP and the APS. The study aimed to identify how is understood and carried out palliative care in Primary Health professionals from health. This is a descriptive and exploratory study aimed to describe the occurrence of palliative care standards in primary health care, as well as the knowledge and perception about these care of all the actors involved. Study participants were 13 health professionals working in PHC, 17 patients and/or caregivers who were in CP, all 18 years . For data analysis, we used the descriptive statistics and content analysis according to Bardin. Individuals are characterized by slight predominance of females in the sample as much as health professionals and the patients/caregivers. As results and conclusion are that the professionals have, as knowledge, general and empirical concepts of PC and more specific PHC. There is demand for PC in the PHC and the awareness of health professionals working at this level on the respect to PC, but we cannot say that perform in all its fullness the PC in the PHC, however there is the possibility of inclusion of this approach care in these services. Missing, for this, training and appropriate structure. There is no specific training of PHC workers to PC, much less his discussion in practice. And their training or elucidation of PC had an \"empirical training\" practice coming that still favors the physical care, but aimed at quality of life and humanized care. The care provided in both PC and in PHC, are evaluated positively by both the community and by health professionals. The PHC is made by professionals identified with the principles and guidelines of health level, is driven by your demand, emerging the enrolled community to its territory, and there is a culture that imposes a short term view on health for the population.
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Starks, Helene Elizabeth. "Dying on one's own terms : access to care, timing of death, and effects on family members /." Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/5413.
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Chaiyakae, Sonngan, Nobuyuki Hamajima, Pajjuban Hemhongsa, Yoshitoku Yoshida, and Tawatchai Yingtaweesak. "ACCESSIBILITY OF HEALTH CARE SERVICE IN THASONGYANG, TAK PROVINCE, THAILAND." Nagoya University School of Medicine, 2013. http://hdl.handle.net/2237/18473.
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McKernan, Susan Christine. "Dental service areas: methodologies and applications for evaluation of access to care." Diss., University of Iowa, 2012. https://ir.uiowa.edu/etd/1362.
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Significant efforts have been undertaken in medicine to identify hospital and primary care service areas (eg, the Dartmouth Atlas of Health Care) using patient origin information. Similar research in dentistry is nonexistent. The goal of this dissertation was to develop and refine methods of defining dentist service areas (DSAs) using dental insurance claims. These service areas were then used as spatial units of analysis in studies that examined relationships between utilization of oral health services, dentist workforce supply, and service area characteristics.
Enrollment and claims data were obtained from the Iowa Medicaid program for children and adolescents ages 3-18 years during calendar years 2008 through 2010. The first study described rates of treatment by orthodontists in children ages 6-18 years. Orthodontic DSAs were identified by small area analysis in order to examine regional variability in utilization. The overall rate of utilization was approximately 3%; 19 DSAs were delineated. Interestingly, children living in small towns and rural areas were significantly more likely to have received orthodontic services than those living in metropolitan and micropolitan areas.
The second study identified 113 DSAs using claims submitted by primary care dentists (ie, general and pediatric dentists). Characteristics of these primary care DSAs were then compared with counties. Localization of care was used as a measure of how well each region approximated a dental market area. Approximately 59% of care received by Medicaid-enrolled children took place within their assigned service area versus 52% of care within their county of residence.
Hierarchical logistic regression was used in the final study to examine the influence of spatial accessibility and the importance of place on the receipt of preventive dental visits among Medicaid-enrolled children. Children living in urban areas were more likely to have received a visit than those living in more rural areas. Spatial accessibility assessed using measures of dentist workforce supply and travel cost did not appear to be a major barrier to care in this population.
More studies are needed to explore the importance of spatial accessibility and other geographic barriers on access to oral health services. The methods used in this dissertation to identify service areas can be applied to other populations and offer an appropriate method for examining revealed patient preferences for oral health care.
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Vitale, Michele. "Evaluating access barriers to primary health care servcies for Hispanic residents in toombs County, Georgia." Auburn, Ala., 2007. http://repo.lib.auburn.edu/2007%20Spring%20Theses/VITALE_MICHELE_14.pdf.
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Alfaqeeh, Ghadah Ahmad. "Access and utilisation of primary health care services in Riyadh Province, Kingdom of Saudi Arabia." Thesis, University of Bedfordshire, 2015. http://hdl.handle.net/10547/603523.
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The Kingdom of Saudi Arabia (KSA) faces an increasing chronic disease burden. Despite the increase in numbers of primary health care centres (PHCCs) current evidence from the KSA, which is limited overall, suggests that access and utilisation of PHCCs, which are key to providing early intervention services, remain unequal with its rural populations having the poorest access and utilisation of PHCCs and health outcomes. There is a dearth (lack) of information from the KSA on the barriers and facilitators affecting access and utilisation of primary health care services (PHCS) and therefore this study aimed to examine the factors influencing the access and utilisation of primary health care centre (PHCC) in urban and rural areas of Riyadh province of the KSA. The behavioural model of health services use (Andersen’s model) provided the contextual and individual characteristics and predisposing, enabling and need factors which assist with an understanding of the barriers and facilitators to access and utilisation of PHCCs in Riyadh province. A mixed methods approach was used to answer the research questions and meet the objectives of the study. The converged qualitative and quantitative findings show that there are a number of predisposing (socio-demographic characteristics; language and communication and cultural competency) enabling barriers such as; distance from PHCCs to the rural residence, lack of services, new services, staff shortages, lack of training, PHC infrastructure, and poor equipment. Facilitators: service provider behaviour/communication, free PHCS, service provision and improvements, primary health care (PHC) infrastructure, manpower, opening hours, waiting time, and segregated spaces and need (increasing prevalence of chronic diseases, PHC developments in the KSA) factors influencing access and utilisation of PHCS. This study highlights important new knowledge on the barriers and facilitators to access and utilisation of PHCS in Riyadh province in the KSA. The findings have some important policy and planning implications for the MOH in the KSA. Specifically, the findings suggest: the need for clear documentation/guidance on minimum standards against which the PHCS can be measured; an audit of service availability at the PHCCs, regular patient satisfaction evaluations of PHCS, that the MOH take a parallel approach and continue to resource and improve buildings and equipment in existing PHCCs, the recruiting of more GPs, nurses, pharmacists, nutritionists and physiotherapists to meet patient demand and more Saudi health care staff, more targeted health education and interventions for the prevention of chronic diseases in the KSA and the need for an appointment system for attending the PHCCs. There is a need for further research into the barriers and enablers to accessing and utilising health care in Riyadh and the KSA overall. This research would be made easier with a clearer definition of rural and urban in the KSA context which would allow a greater comparability between urban and rural PHCS for future research, audit and evaluation as well as comparison with PHCS in other parts of the world. The Andersen model provided a useful conceptual model to frame this research and provided a structure for contrasting and comparing the findings with other studies that have used the Andersen model to understand the barriers and enablers to accessing and utilising health care services.
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Brom, Heather. "The Changing Landscape of Ambulatory Care: Provision and Utilization as Influenced by the Patient Protection and Affordable Care Act." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1491814890562107.
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Pacholski, Denise C. "Patient Feedback Regarding Telehealth." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1594983499602595.
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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 AbstractObjectives: 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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Meuwissen, Louise Elisabeth Margaretha Magdalena. "Improving sexual and reproductive health care for poor and underserved girls impact of a voucher program on access and quality of primary care in Nicaragua /." Maastricht : Maastricht : Universiteit Maastricht ; University Library, Universiteit Maastricht [host], 2006. http://arno.unimaas.nl/show.cgi?fid=9930.
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Lebrun, Lydie Anne. "Access to primary and preventative health care among foreign-born adults in Canada and the United States." THE JOHNS HOPKINS UNIVERSITY, 2012. http://pqdtopen.proquest.com/#viewpdf?dispub=3463581.
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Pitcher, Claire. "Homeless and street-involved youth access to primary health care services : what helps and what gets in the way?" Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/60255.
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Introduction: On any given night, thousands of Canadian youth face homelessness in either absolute (living on the street) or relative (couch surfing) terms. Youth experiencing homelessness report disproportionately high rates of illness and unique influences on their access to health care as compared to their stably housed peers. Method: I conducted a mixed methods study to examine influences on homeless youth access to health care. First, I interviewed eight homeless youth about their experiences accessing health care. Next, I conducted a focused analysis of the 2014 Homeless and Street-Involved Youth Survey which was conducted in 13 communities across British Columbia with 671 youth. Finally, I facilitated a solutions-focused dialogue with a panel of 4 health care and allied service providers who work with homeless youth. Data analysis was informed by procedures consistent with interpretive description as the methodological orientation. Results: I identified three themes from the interviews: youth experiencing homelessness feel powerless when interacting with health care providers; health care systems exist as ‘rule-based’ bureaucracies; and homeless youth are in ‘survival mode’ when it comes to their health. At the same time, findings from the focused survey analysis suggest that the effect of individual factors (e.g., age) on access to health care is confounded by more systemic factors, such as discrimination and access to stable shelter, which are themselves associated with foregone care. The expert panel supported these findings and further suggested that hurtful interactions may damage not only a youth’s relationship with the health care system but also their overall trust in others. The panel also suggested that before health care providers can ‘do health stuff’ with a youth they need to have had several opportunities to cross paths and connect in more informal ways first. Discussion and Implications: A multi-pronged intersectoral approach founded on communication, collaboration and coordination of care is needed to facilitate access to health care for homeless youth. Additionally, specialized training is needed for people who work with these youth. More work is also needed across health care and social service sectors to empower youth in relation to their health and seeking health care.Applied Science, Faculty of
Nursing, School of
Graduate
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Salako, Abiodun. "The impact of state nurse practitioner scope-of-practice regulations on access to primary care in health professional shortage areas." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/7025.
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Primary care physician (PCP) shortages have been a barrier to accessing care for millions of Americans, particularly those living in areas facing the worst shortages - primary care health professional shortage areas (HPSAs). Increased use of nurse practitioners (NPs) has been proposed as a solution to the shortages as NPs can effectively substitute for PCPs. However, this proposal has been hampered by regulatory restrictions on NP scope-of-practice (SOP) that exist in many states. While some states permit NPs to practice and prescribe medications independent of physicians (NP independence), others require extensive physician supervision that limit NPs ability to provide care and substitute for PCPs. Despite the limitations that restrictive regulations pose to improving access to primary care, research evidence of their effect on access in primary care HPSAs is limited. This dissertation fills this gap in the literature.
Using individual-level data from the Medical Expenditure Panel Surveys (1996-2015) and a difference-in-differences approach, I exploit variation in NP independence across states and over time to evaluate the impact of NP independence on access to primary care in HPSAs Further, I examined for heterogeneity in the effect of NP independence between HPSAs and non-HPSAs as well as effect heterogeneity in HPSAs based on individual (age, insurance status, and insurance type) and health system characteristics (availability of primary care facilities and NP Medicaid reimbursement rate)
I find that NP independence led to a 5% increase in the number of individuals with a primary care provider and a 2% increase in the use of non-physicians (relative to physicians) as the primary care provider in HPSAs. However, non-HPSAs experienced no significant changes in access to care. Further, I find evidence of heterogeneity in the effect of NP independence in HPSAs for all three individual characteristics but find no significant effect heterogeneity for any of the health system characteristics. Non-elderly individuals experienced greater improvements in access following NP independence compared to their elderly counterparts, and while both insured and uninsured individuals experienced improvements in access to care, uninsured individuals benefitted more from NP independence. Further, I find evidence of greater improvements in access to care among Medicaid beneficiaries relative to their privately insured and Medicare counterparts.
These findings imply that removing regulatory restrictions on NP SOP could be an effective policy strategy for mitigating the effects of PCP shortages and improving access to care in HPSAs. Further, they demonstrate that NP independence could be a viable tool for addressing access to care issues in two traditionally underserved populations – the uninsured and Medicaid beneficiaries. Beyond addressing access issues, NP independence could also mitigate rising health care costs. The finding of increased use of lower-cost non-physicians rather than their more costly physician counterparts after NP independence indicates that this policy change could also bring about cost savings for society.
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Ford, John Alexander. "Improving access to high quality primary care for socio-economically disadvantaged older people in rural areas : a mixed method study." Thesis, University of East Anglia, 2018. https://ueaeprints.uea.ac.uk/69464/.
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Objectives The research objectives were to: 1) explore barriers to primary care access for socio-economically disadvantaged older people in rural areas; 2) develop an intervention to improve access for this group; and 3) test the feasibility of the trial design and intervention. Methods A mixed method design, drawing on realist principles and guided by a triangulation protocol, was used to explore barriers for this group using three studies: first, a realist review; second, a qualitative study of semi-structured interviews with older people and focus groups with health professionals; and third, an analysis of the English Longitudinal Study of Ageing using structural equation modelling (SEM). Findings were integrated using a mixed method matrix. Two strong themes from the integrated theory, the booking system and transport, were identified for intervention. Based on stakeholder dialogues with health professionals and patient representatives, an intervention was developed which was explored in a cluster feasibility trial. The intervention allowed practices to develop their own service changes assisted by a £1500 grant, four development meetings and support manual. The feasibility trial recruited four general practices, with three randomised to intervention and one to usual care. Findings The realist review generated a seven-step patient pathway highlighting important contexts and mechanisms. The qualitative study explored barriers, such as engaged telephone lines and limited appointments, and proposed the concept of a social contract, where patients are careful not to bother the doctor in return for goodwill. The cohort study was restricted by limited data but demonstrated the potential of SEM to quantify realist theory. Participant recruitment in the feasibility study was low (3%), but retention was good (91%) and data collection methods acceptable to participants. Practices were successfully able to develop their own service changes that gave them the freedom, time and resource to be innovative or provided an opportunity to implement existing ideas. Conclusion Some vulnerable older people face multiple challenges in accessing primary care. Practices were able to develop their own context-dependent solutions to address local issues.
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Willoughby, Jo-Anne. "Acceptability of collectors of medicine parcels for noncommunicable disease patients from a primary health care facility in the Western Cape." University of the Western Cape, 2019. http://hdl.handle.net/11394/7631.
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Doctor EducationisBackground: Since 2005 the Chronic Dispensing Unit (CDU) has been part of the Western Cape Government’s strategy to address increasing demand for chronic medication for patients with non-communicable diseases. However, some patients are unable to collect their pre-packed chronic medication parcels from health care facilities on the due date. Recent research reported that some patients utilise collectors or medicine agents to collect their prepacked chronic medication parcels. Currently little is known about this phenomenon of collectors. Aim and Objectives: This study explored the acceptability of collectors of CDU chronic medication parcels to improve access to medicines for patients with non-communicable diseases at Lotus River Community Day Centre (LRCDC). Methodology: An exploratory descriptive qualitative study using semi-structured interviews in English and Afrikaans was conducted with six purposively selected collectors, three patients who use collectors and three key informants who have intimate knowledge of the collectors and system at the health facility. Interviews were recorded, transcribed, translated into English (where applicable) and thematically coded to derive themes from the data. Ethical approval was provided by the University of the Western Cape Bio-Medical Research Ethics Committee and informed consent was obtained from all study participants. Results: Patients reported that their collectors exhibited positive characteristics such as trust, patience and reliability, as well as, a passion for helping the community and organisational skills. All patients acknowledged the benefits of utilising a collector and found them to be highly acceptable. Key informants, however, had some reservations about the characteristics of collectors and their role in medication distribution and were sceptical as to whether collectors were suitably equipped to perform this function. Patients were grateful when their collector had some knowledge about their condition and were able to converse with them regarding their medication. Key informants suggested that with sufficient training and skills development, collectors could potentially improve access to chronic medication parcels and impart basic knowledge about chronic medication adherence to patients. iv Conclusion: The collector system that has emerged at LRCDC is highly acceptable to patients, but health facility staff were more measured in their assessments. Health facility staff, however, acknowledged the potential of collectors to improve access to chronic medication parcels for patients with chronic conditions and the benefit of upskilling collectors to perform this function. Recommendations: As a short-term measure, collectors should be formally accepted at facilities as medicine agents. They should receive basic education about safe medication distribution practices. Patients should screen collectors to ensure that they have the desired positive attributes. Furthermore, future research is necessary to comprehensively understand the current scope of practice of collectors within communities
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Ward, Megan Lynn. "Barriers to Decreasing Hospital Readmission Rates for Chronic Disease Patients in North Dakota as Perceived by Primary Care Nurse Practitioners." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/613136.
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Patients who have chronic diseases are often readmitted to the hospital within 30 days of being discharged. In the United States preventable hospital readmissions cost approximately $12-$17.4 billion annually. The Institute of Healthcare Improvement [IHI] has identified one key measure for reducing preventable readmissions and that is a timely post hospital follow-up visit. Although this seems to be a simple task, studies have revealed that as many as one-third of patients discharged from the hospital are not following up with their primary care provider. In North Dakota the percentages of patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, type 2 diabetes, and pneumonia have steadily increased over the last several years. A North Dakota critical access hospital report revealed a high percentage of patients with a chronic disease are being readmitted within 30 days. Identifying barriers to care in North Dakota can help to reduce the rate of readmission within the state. This study seeks to identify perceived barriers as observed by primary care nurse practitioners to improve patient outcomes and reduce hospital readmission rates.