Dissertations / Theses: 'Primary health care'

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Bumgarner, D., K. Owens, J. Correll, W. T. Dalton, and Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.

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Polaha, Jodi. "Primary Care Behavioral Health." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6676.

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Skånér, Ylva. "Diagnosing heart failure in primary health care /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-784-3/.

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Foskett-Tharby, Rachel Christine. "Coordination of primary health care." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/coordination-of-primary-health-care(987d5002-cf2f-4ece-8f53-f89ea2127e1e).html.

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Background: Improving coordination of care is a major challenge for health systems internationally. Tools are required to evaluate alternative approaches to improve coordination from the patient perspective. This study aimed to develop and validate a new measure of coordination for use in a primary care setting. Methods: Four methods were used. Firstly, a concept analysis was undertaken to identify the essential attributes of coordination drawing upon literature from health and organisational studies and to establish its boundaries with related concepts such as continuity of care, integration and patient centred care. Secondly, existing measures of coordination were reviewed to assess the extent to which item content reflected the definition arising from the concept analysis and to appraise psychometric properties. Thirdly, a new instrument, the Care Coordination Questionnaire (CCQ), was developed utilising items from existing questionnaires and others developed following focus groups with 30 patients. Ten cognitive interviews were used to evaluate the items generated. Finally, the CCQ was administered in a cross sectional survey to 980 patients. Item and model analyses were performed. Test-retest reliability was evaluated through a second administration of the CCQ after two weeks. Concurrent validity was evaluated through correlation with the Client Perceptions of Coordination Questionnaire (CPCQ). Construct validity was evaluated through correlation with responses to a global coordination item and a satisfaction scale and the testing of two a prior hypotheses: i) coordination scores would decrease with increasing numbers of providers and ii) coordination scores would decrease with increasing numbers of long-term conditions. Results: The concept analysis suggested that coordination should be considered as a process for the organisation of patient care characterised by: purposeful activity, information exchange, knowledge of roles and responsibilities, and responsiveness to change. The systematic review identified 5 existing measures of coordination and a further 10 measures which incorporated a coordination subscale. Only one demonstrated conceptual coverage but had poor psychometric properties. A new instrument was therefore developed and tested as described above. 299 completed surveys were returned. Respondents were predominantly elderly and of white ethnicity; approximately half were female. Five items were deleted following item analyses. Model analysis suggested a four factor two-level model of coordination comprising of 18 items. This correlated well with the CPCQ, the global coordination item and satisfaction scale. The a priori hypotheses were upheld. Retest reliability was acceptable at the patient group level. Conclusions: The CCQ has demonstrated good psychometric characteristics in terms of item responses, reliability and construct validity. Further exploration of these properties is required in a larger, more diverse sample before it can be recommended for widespread use, but it shows potential utility in the evaluation of different approaches to coordinating care.

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Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.

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Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.

Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.

Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.

Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.

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Polaha, Jodi. "Integrating Behavioral Health Into Primary Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6648.

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Onwuliri, Michael O. "Primary health care management in Nigeria." Thesis, Aston University, 1987. http://publications.aston.ac.uk/12207/.

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This research sets out to assess if the PHC system in rural Nigeria is effective by testing the research hypothesis: 'PHC can be effective if and only if the Health Care Delivery System matches the attitudes and expectations of the Community'. The field surveys to accomplish this task were carried out in IBO, YORUBA, and HAUSA rural communities. A variety of techniques have been used as Research Methodology and these include questionnaires, interviews and personal observations of events in the rural community. This thesis embraces three main parts. Part I traces the socio-cultural aspects of PHC in rural Nigeria, describes PHC management activities in Nigeria and the practical problems inherent in the system. Part II describes various theoretical and practical research techniques used for the study and concentrates on the field work programme, data analysis and the research hypothesis-testing. Part III focusses on general strategies to improve PHC system in Nigeria to make it more effective. The research contributions to knowledge and the summary of main conclusions of the study are highlighted in this part also. Based on testing and exploring the research hypothesis as stated above, some conclusions have been arrived at, which suggested that PHC in rural Nigeria is ineffective as revealed in people's low opinions of the system and dissatisfaction with PHC services. Many people had expressed the view that they could not obtain health care services in time, at a cost they could afford and in a manner acceptable to them. Following the conclusions, some alternative ways to implement PHC programmes in rural Nigeria have been put forward to improve and make the Nigerian PHC system more effective.

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Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.

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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.

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Mukiapini, Shapi. "Baseline measures of Primary Health Care Team functioning and overall Primary Health Care performance at Du Noon Community Health Centre." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24504.

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Background: The importance of effective team work for improving quality of care has been demonstrated consistently in research. We conducted a baseline measure of team effectiveness and a baseline measure of primary health care performance. Aim: To improve Primary health care team effectiveness and ultimately the quality and user experience of primary care at Du Noon Community Health Centre. (CHC) Setting: Du Noon CHC in the southern/western substructure of the Cape Town Metro district services. Methods: A cross sectional study using a combination of Nominal Group Technique (NGT) method and a questionnaire survey to assess PHC team effectiveness and to obtain baseline measure for Primary Health Care (PHC) organization and performance. Results: Data from 20 providers from the primary health care team, showed that the PHC team members perceived their team as a well functioning team (70% agreement on the 7 items of the PHC team assessment tool, incorporated in the ZA PCAT. The NGT method reveals that communication and leadership are the main challenges to effective team functioning, The NGT also provides ideas on how to deal with these challenges. Data from 110 users and 12 providers using the ZA PCAT: 18.2% of users rated first contact-access as acceptable to good; 47,3% rated ongoing care as acceptable to good. The remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 65% of the users. 33% of the providers (doctors and clinical nurse practitioners) rated first contact-access as acceptable to good; 25% rated ongoing care as acceptable to good, the remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 50% of providers. First contact-access received the lowest acceptable to good score (18.2%) and comprehensiveness (service available) received the highest score (88.2%) from the users. For the providers the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team (100%). The total primary scores are good (above 60%) for both users and providers but moderately higher for the providers. Conclusions: How teams perceive their effectiveness can motivate them to generate ideas for improvement. There were discrepancies between ZA PCAT (PHC team functioning) results and the NGT method results. The ZA PCAT (8 pre-existing domains) baseline results show a contrast between providers' and users' perceptions of the PHC system at Du Noon consistent with the finding of the Western Cape ZA PCAT study. We encourage Du Noon CHC to use these results to improve the user experience of primary health care services there.

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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.

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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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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.

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Master of Public Health - MPH
Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

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Riley, Marie Danielle Melinda Mylo. "Building collaborative partnerships in primary health care." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44214.

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Collaboration is an increasingly adopted strategy for addressing many of society's most complex and pressing public challenges. The General Practice Services Committee’s Divisions of Family Practice initiative offers a rich example of collaborative partnerships in action within the context of the primary health care system of British Columbia. Divisions of Family Practice are community-based nonprofit organizations consisting of family physician members. Division members work in partnership with health authority administrators and other community organization representatives with the goal of working at local and regional levels, through collaborative processes, to co-design locally feasible solutions for better delivery of primary health care services leading to improved provider and patient satisfaction. The research focuses on the question, “How can Divisions create and sustain effective collaborative practices”? This question is explored through a practitioner inquiry. The inquiry includes: a description of the General Practice Services Committee and the Divisions of Family Practice initiative; a review of the relevant literature; observations and reflections on the experience of collaborative process within the Divisions initiative from my perspective as an administrator supporting the initiative; and concludes by suggesting that further study in the areas of initiative sustainability, inclusive patient involvement, and a more culturally diverse leadership would be beneficial. The findings of the inquiry support the notion that educating about the processes of collaboration, the inherent obstacles and challenges, and the role of the behaviours of the participants, are instrumental in supporting effective collaborative partnerships. The inquiry has informed the second part of thesis, a participation guide and process handbook designed to share a model, processes and tools to foster the collaborative work of the Divisions and their partners.

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Iveson, Claire. "From primary care to mental health services:." Thesis, University of Liverpool, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490634.

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Purves, Andrew Geoffrey. "The design of primary health care buildings." Thesis, University of Newcastle Upon Tyne, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.501068.

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A study to consider the influence of architectural design on the relationship between doctor and patient and how this has changed over the ages: an examination of how political, financial and social factors have modified this relationship and the importance of understanding the design ethos expected in a building. The study is illustrated with examples of modern medical buildings.

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Poulton, Brenda Christine. "Effective multidisciplinary teamwork in primary health care." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339905.

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Filipe, Luís Alexandre Coelho. "Estimating demand for primary health care services." Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9543.

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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics
Primary health services exist with the purpose of providing basic health care to every person at a cost they can afford. But is it fully available to everyone? The objective of this work project is to estimate the demand for primary health care services having into account that in some regions the citizens are not using as much health care as they would like due to supply side constraints. Using the number of consultations as proxy for demand, and applying an econometric tool called switching regression, the demand for primary health care services will be estimated.

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Dyer, Halie, Byron Brooks, Karen Schetzina, and Jodi Polaha. "Behavioral Health Referrals in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6624.

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Integrated care is rapidly becoming the new paradigm of healthcare and with the transition into integrated practice, many providers from various disciplines must determine how best to work as a team to improve patient outcomes. One particular setting where the logistics of integrated practice must be scrutinized is pediatric primary care, specifically in rural areas, as many psychological problems are presented in pediatric primary care, and rural children are at greater risk for engaging in unhealthy behaviors, such as sedentary lifestyle, poorer nutrition, and greater substance use. All of these concerns can be ameliorated with successful referral to behavioral health consultants (BHC) who can assist in treating these various psychosocial issues. In order for the BHC to assist with patients with psychosocial concerns, other medical providers must be able to recognize and refer these patients to the BHC. The purpose of this study was to determine the prevalence of psychosocial concerns in pediatric primary care and how often the attending medical provider noticed these concerns and referred the patient for behavioral health services. The study also examined what types of psychosocial concerns were raised, and if the referral was not addressed during the same visit, the latency between the initial referral and the behavioral health service. Retrospective electronic health record data (N=300) was collected from the well visits of all 4 and 5 year old patients in 2014 from a rural Appalachian pediatric primary care clinic. Results indicated that when a psychosocial issue was raised, the majority of medical providers appropriately referred the patient to the BHC. Psychosocial concerns were raised in 21.3% (n=64) of visits. When psychosocial concerns were raised, 62.5% (n=40) were referred for behavioral health services with 87.5% (n=35) to the in house BHC. When patients were referred to the in-house BHC, 83.3% (n =30) received services immediately, while patients who were not seen immediately, 16.7% (n=5), waited for an average 21 days to be seen by the BHC. The most common psychosocial concerns raised were related to toilet training, temper tantrums, sleep hygiene, and hyperactivity. These findings highlight the high prevalence of psychosocial issues presented in rural pediatric primary care and the continued education of providers about recognizing these concerns so the appropriate referral can be made. These findings also highlight the need for more integrated practice as primary care is the often the primary source of healthcare in rural areas and by addressing all concerns about patient well-being in this setting via integrated care, patient physical and mental health outcomes can be greatly improved.

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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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Baker, Robin Lynn. "Primary Care and Mental Health Integration in Coordinated Care Organizations." PDXScholar, 2017. https://pdxscholar.library.pdx.edu/open_access_etds/3616.

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The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings. The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health? Using a case study approach, this study drew upon qualitative methods to examine and identify the factors throughout the system, organizational, professional, and clinic levels that support CCO efforts to facilitate the integration of primary care and mental health. Fourteen primary interviews were conducted with executive and senior staff. In addition, eleven secondary interviews from a NIDA funded project as well as twenty-four key CCO documents from three CCOs were also included in this study. The RMIC was successful in differentiating extent of CCO integration of primary care and mental health. Findings demonstrate that normative and functional enablers of integration were most prevalent at the system and organization level for integrating mental health into primary care for these three CCOs. However, there was variation in CCO involvement in the development of functional and normative enablers of integration at the professional and clinic levels. Normative and functional enablers of integration were limited at all of the RMIC levels for integrating primary care into community mental health settings across all three CCOs. The Patient-Centered Primary Care Home model provided CCOs with an opportunity to develop functional and normative enablers of integration for integrating mental health in primary care settings. The lack of a fully developed model for integrating primary care services in community mental health settings serves as a barrier for reverse integration. An additional barrier is the instability of community mental health as compared to primary care; contributing factors include historically low wages and increased administrative burden. System wide conversations about where people are best served (i.e., primary care or community mental health) has yet to occur; yet these conversations may be critical for facilitating cross-collaboration and referral processes. Finally, work is needed to create and validate measures of integration for both primary care and community mental health settings. Overall findings confirm that integrating primary care and mental health is complex but that organizations can play an important role by ensuring the development of normative and functional enablers of integration at all levels of the system.

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Jones, Roger Hugh. "Self care and primary care of dyspepsia." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241615.

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Wright, Trudy, and n/a. "Primary health care : the health care system and nurse education in Australia, 1985-1990." University of Canberra. Education, 1994. http://erl.canberra.edu.au./public/adt-AUC20061110.171759.

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Primary health care as a model for the provision of health services was introduced by the World Health Organization In the mid 1970s. Initially viewed as a means of health promotion and advancement of wellness in developing countries., it was soon to be adopted by industrialised countries to assist in relieving the demand on acute care services. This was to be achieved through education of the community towards good health practices and the preparation of nurses to practice in the community, outside of the acute care environment Australian nurses were slow to respond to this philosophy of health care and this study has sought to examine why this is so. It has been found that there are a multitude of reasons for the lack of action In the decade or more following the Declaration of Alma Ata and the major Issues have been identified and elaborated. Some of the major reports of the time that were associated with and had some Influence on health care and nurse education have been examined to identify recommendations and how much they support the ethos of primary health care. These include the Sax committee report of 1978 and a submission by the Department of Employment and Industrial Relations In 1987. As part of the investigation, nursing curricula from around Australia in the mid 1980s have been examined to determine the degree of the primary health care content according to guidelines recommended by the World Health Organization. It was found that generally at that time, there was a deficit In the preparation of undergraduate students of nursing for practice In the area of primary health care when the world, including industrialised nations, was making moves towards this model of health care delivery. Factors Influencing the slow response of nursing have been examined and finally recommendations for further studies have been put forward.

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Al-Tuwaijiri, A. M. "Primary eye care in Saudi Arabia : an integral part of the primary health care system." Thesis, Swansea University, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.635734.

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Blindness is a serious socioeconomic handicap and most causes of blindness are preventable. The Primary Health Care System has been identified by the World Health Organisation as the 'first line of defence' in tackling the health care problems of developing countries. This is as true for eye care as it is for the whole range of other diseases and illnesses that affect a country's population. The Primary Eye Care system is, therefore, essential in the prevention of many ocular disorders that may cause blindness. The aim of the thesis is to define the current status of primary eye care systems in the Kingdom of Saudi Arabia. It will concern itself with identifying and assessing the current resources and facilities that are available for eye patients at the primary health care level. It will also determine the strengths and weaknesses of the existing primary eye care system in the country according to geographical location, covering both urban and rural areas. Specific recommendations for action are formulated, in the light of the data collected, aimed at the reduction, control or elimination of avoidable and curable blindness. The ultimate goal of this thesis is, therefore, to add to the existing knowledge of eye care problems in the Kingdom and to put forward a series of recommendations to help in the prevention of blindness in the Kingdom of Saudi Arabia.

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Höfter, Ricardo Andres Henriquez. "Preferred providers, health insurance and primary health care in Chile." Thesis, Queen Mary, University of London, 2006. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1772.

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Reforms in the early 1980s created Chile's mixed system of health care provision and finance. Since then Chileans have had to choose between a statesubsidised public health insurance system or the private health plans offered by several insurance companies. In the public system, users may be restricted to the public facility network, with no choice of doctor or medical centre, or they may opt for a free choice mode (preferred providers), which lets them choose both doctor and place of attention. Private insurance providers offer a wide variety of health plans, giving the customer a reasonable range of care options. Although this public-private mix has now been operating for more than 20 years, there has been no empirical study of the factors determining the choice of the preferred providers' mode by public beneficiaries. Likewise, few studies have looked at the determinants in the choice between public and private insurance, and the relationship between the latter choice and the use of health services. The first two empirical chapters of this thesis look at the determinants of these sources of choice, using different econometric tools: the choice of preferred providers is examined using a logit model; the analysis into the choice between public and private insurance uses a probit model; and the impact of holding private insurance as a factor in determining use of health services is estimated through a two-stage tobit model. A further significant aspect of the reforms of the '80s was the process of decentralisation for primary health care provision. Since then a substantial part of preventive health care and promotion occurs locally, and among these services children's health checks are an important policy objective. To encourage attendance parents are given free food supplements if they keep to the timetable for their child's check-ups. However these free food handouts partially account for attendance at the check-ups. Thus the final empirical chapter of the thesis uses a probabilistic model to look at the monetary and non-monetary factors that lead parents to request health checks for their children.

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Karki, Jiban Kumar. "Health system actors' participation in primary health care in Nepal." Thesis, University of Sheffield, 2016. http://etheses.whiterose.ac.uk/15799/.

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Background: Nepal was an early adopter of World Health Organization's (WHO) Primary Health Care (PHC) approach with Community Participation (CP) for delivery of basic health care service. These approaches have formed the mainstay of efforts related to provision of health care services in Nepal. However, it has struggled with its implementation because of developmental challenges, poverty, civil war and geography. Hence, it becomes important to seek to understand the dynamics around CP and PHC and how these relate to broader development challenges in the country. The main aim of this research is to understand how various Health System Actors participate in PHC in Nepal and what its implications are in PHC Methods: In order to understand CP in PHC a qualitative case study method was undertaken. Forty-one semi-structured interviews, four focus group discussions (FGD) and observation were conducted with 26 groups of grass root level and district level health systems actors in two Village Development Committees (VDC) of Sindhupalchok district of Nepal in 2014. This study examined how these actors understand PHC and CP, how they participate in it and what motivates or hinders them to participate in PHC. The results are based on data collected from interviews, FGDs, observation and the field notes. Results: There was very low understanding about PHC and CP among actors in these VDCs. Often, CP for these actors was a 'tokenistic participation' which was limited to material contribution, voluntary labour and financial donation in PHC infrastructure development and maintenance. Participation in Health Facility Management Committees and Female Community Health Volunteer were the only mechanisms of CP in PHC, which rarely represented community views. Existing traditional health system was not taken into account. Decisions were imposed top down without considering local context, practices and without involvement of local actors. The main motivations for CP amongst participants were material benefit, social recognition and religious merits whereas geography, opportunity cost, lack of awareness and socio-cultural discrimination, were barriers to participation. Discussions/Conclusions: PHC with CP needs to be contextualized to accommodate, learn and benefit from the existing traditional health system. Similarly, a stronger policy measure is needed to minimize if not to eradicate the discrimination against gender, caste, ethnicity and poverty to increase CP in PHC. In the current socio political situation, geography and current status of infrastructural development in Nepal, neither the government nor the nongovernmental / private sector alone are able to address the increased health care need. Therefore, a wider broad partnership based PHC with CP is recommended as a way forward to ensure basic health care service in Nepal. This has been even more important where reconstruction of the health system is underway after the devastating 2015 earthquake, for the community to feel ownership of local health system.

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Eisenbrandt, Lydia L., and Jill D. Stinson. "The Need for Mental Health Professionals Within Primary Health Care." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7900.

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Mental health concerns are presented in primary care settings regularly, yet a majority of these issues go undetected or are misdiagnosed by primary care physicians (PCPs). This may be due to a lack of mental health training for PCPs during their medical education. Over time, medical school curricula have evolved to include mental health training in order to bridge this gap in the healthcare system and to more readily identify patients in need of mental health services. The current study investigated AMA-accredited medical school curricula from universities across the US and US territories (N = 170) who train physicians in primary care, family medicine, or other generalist tracks. Data on mental health training were collected from the public websites of each school. Results showed that most universities indicated at least some type of required mental health training (85.3%), which were either didactic or experiential in nature. Although this result appears encouraging, further examination reveals that this training was most often limited to only one 4-week psychology-related course and a 6-week psychiatry rotation. Overall, many universities indicated at least one required course (N = 95), and most universities reported a required psychiatry rotation (N = 135). Moreover, only 12.9% of the sample reported having at least both didactic and experiential training required. The implications of this are varied. First, PCPs often have only a short amount of time with their patients, reducing their ability to fully assess both medical and mental health. A lack of exposure to mental health needs may lead to missed opportunities for intervention and improvement in patient health. Second, it is important for mental health professionals to work closely with PCPs in primary healthcare settings in order to improve rates for detection and treatment of mental health problems. In addition to improved patient outcomes, having mental health professionals integrate within primary healthcare can serve to decrease the stigma associated with seeking mental health treatment, as well as reduce long-term healthcare costs. This can also increase access to care for those individuals who are unable to see a mental healthcare provider, especially in rural areas. Finally, overall health may improve in relation to better mental healthcare, since medical and mental health have been consistently shown to significantly influence one another.

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Jama, Mahmud Amina. "Designing ICT-Supported Health Promoting Communication in Primary Health Care." Doctoral thesis, Blekinge Tekniska Högskola, Sektionen för hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-00571.

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Increasing lifestyle-related ill health, escalating health care costs, expanding health inequalities within and between nations, and an aging population are challenges facing governments globally. Governments, especially in industrialized countries like Sweden, are investing in health promotion and health communication, especially in ICT-supported health communication as a way to increase health literacy and empowerment at individual and population levels. Studies show that many eHealth communication efforts are narrow in scope, medical oriented and therefore not enough to address the complexity of lifestyle-related ill health and equity issues. This thesis proposes integrating health promotion values and principles in the design process of eHealth systems for health promotion in order to develop usable, sustainable, engaging, eHealth resources that are adaptable to their context of use and user’s skills. The overall aim of this thesis was study the participatory development process of an interactive ICT-supported health communication channel for health promotion and enhancing health literacy in PHC context. Participatory Action Research (PAR) with a multi-phase and multi-method approach was used in this thesis. A model entitled Spiral Technology Action Research’ (STAR) was used to guide the development of the health channel. This design process was framed in three developmental and evaluation phases corresponding to formative, process and outcome evaluation. A total of 146 participants consisting of professionals from primary health care services, information technology and academia, and local citizens participated in the project’s different phases. A triangulation of methods was used to collect the data; survey, document analysis, participatory observations with field notes, individual interviews, focus groups, think aloud protocols and log statistics. Qualitative and quantitative content analyses were used to analyse data. The results revealed that integrating health promotion values and principles in the design process proved to be valuable not only to the content of the channel, but also in PHC practice. The different design phases yielded valuable results that built into each other and contributed to an eHealth channel that was perceived as relevant to the local people’s need for health communication; accessible and user friendly. The results also indicated that an Internet based interactive health channel, could be a valuable resource for enhancing health literacy if users are involved in the design.

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Haas, Marion. "The benefits of health care beyond health an exploration of non-health outcomes of health care /." Connect to full text, 2002. http://hdl.handle.net/2123/854.

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Thesis (Ph. D.)--University of Sydney, 2002.
Includes tables and questionnaires. Title from title screen (viewed Apr. 28, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Includes bibliography. Also available in print form.

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Meebunmak, Yaowaluck. "Community mental health care in Thailand: Care management in two primary care units." Thesis, Meebunmak, Yaowaluck (2009) Community mental health care in Thailand: Care management in two primary care units. PhD thesis, Murdoch University, 2009. https://researchrepository.murdoch.edu.au/id/eprint/6502/.

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Thailand faces increasing mental health problems, however mental health services are limited. In particular, mental health services provided in communities across the country are not clearly structured. Research in regard to community mental health care is rare. The purpose of this study was to explore mental health care management in two primary care units (PCUs) in Thailand in order to understand the ways they operate within Thai communities. The specific objectives were to identify mental health care practices and roles of health providers, models of care and influences on mental health care practices in the two PCUs as case studies. An ethnographic approach using participant observation, semi-structured interview, quantitative questionnaire and document analysis was used in gathering data. The participants were seven nurses and three public health workers practising in the PCUs. Findings enhanced understanding in the context of two PCUs located in communities of the Northern and Central Thailand. Both were local health centres providing a wide range of health services based on the principles of primary health care (PHC). The PCUs were operated without mental health specialists, however nurses were the main resource in providing mental health care in terms of primary and secondary prevention. Primary prevention was provided through counselling sessions, drug prevention activities and seniors clubs. In addition, the health providers conducted activities of mental health promotion towards particular risk groups after assessing risks. They also gave support to mental health and normal cases that had possible mental health problems. Secondary prevention was provided in home visits, primarily in giving injections. The health providers played four main roles as educator, consultant, agent and manager in primary and secondary prevention. There was no single model of mental health care practice provided in the PCUs. Information derived from the present study showed a variety of models underpinning care practices. The nursing process was clearly adopted, as well as integrated care, community participation, collaboration and consultation, and using standard guidelines. Personal knowledge and interest in mental health were mentioned as an important factor in practising mental health care. Environmental factors such as adhering to policy, being family-oriented, being mindful of economic factors, using Buddhist Principles to guide interactions, guarding against occupational risks, maintaining a teamwork approach and the lack of specialists appeared to be factors influencing mental health care. This study contributes to the body of knowledge of community mental health care management in Thailand. The findings suggest implications for practices, education, and policy making to improve quality of care.

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Ninh, Teresa T. "Driving factors that affect primary care utilization." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1523084.

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This study was conducted to identify the driving factors that affect primary care utilization. It hypothesizes that the cost of treatment is the driving factor that affects a patient's decision to seek medical care from their primary care physician. Furthermore, it also hypothesizes that the uncomfortable conversation with the physician, the concern of someone else finding out about the patient's personal health problems, and the trouble of making an appointment are three independent factors that do not affect primary care utilization. In order to test these hypotheses, secondary data from the CHIS 2009 was collected and analyzed. Unfortunately, the data sets concerning these three independents variables were not released as they were classified to contain confidential data. As a result, healthcare coverage and emergency care utilization were served as proxy variables and were used instead to determine the factors associated with primary care utilization. Statistical analysis of these proxy variables indicates that primary care utilization is associated with health insurance coverage and emergency care utilization.

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Welschhoff, Anja. "Community Participation and Primary Health Care in India." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-69547.

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Petersson, Håkan. "On information quality in primary health care registries /." Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/tek805s.pdf.

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Salminen, Helena. "Osteoporosis in elderly women in primary health care /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-371-9/.

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Arvidsson, Eva. "Priority Setting and Rationing in Primary Health Care." Doctoral thesis, Linköpings universitet, Utvärdering och hälsoekonomi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-88086.

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Background: Studies on priority setting in primary health care are rare. Priority setting and rationing in primary health care is important because outcomes from primary health care have significant implications for health care costs and outcomes in the health system as a whole. Aims: The general aim of this thesis has been to study and analyse the prerequisites for priority setting in primary health care in Sweden. This was done by exploring strategies to handle scarce resources in Swedish routine primary health care (Paper I); analysing patients’ attitudes towards priority setting and rationing and patients’ satisfaction with the outcome of their contact with primary health care (Paper II); describing and analysing how general practitioners, nurses, and patients prioritised individual patients in routine primary health care, studying the association between three key priority setting criteria (severity of the health condition, patient benefit, and cost-effectiveness of the medical intervention) and the overall priority assigned by the general practitioners and nurses to individual patients (Paper III); and analysing how the staff, in their clinical practise, perceived the application of the three key priority setting criteria (Paper IV). Methods: Both qualitative (Paper I and IV) and quantitative (Paper II and III) methods were used. Paper I was an interview study with medical staff at 17 primary health care centres. The data for Paper II and Paper III were collected through questionnaires to patients and staff at four purposely selected health care centres during a 2-week period. Paper IV was a focus group study conducted with staff members who practiced priority setting in day-to-day care. Results: The process of coping with scarce resources was categorised as efforts aimed to avoid rationing, ad hoc rationing, or planned rationing. Patients had little understanding of the need for priority setting. Most of them did not experience any kind of rationing and most of those who did were satisfied with the outcome of their contact with primary health care. Patients, compared to medical staff, gave relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions when prioritising individual patients in day-today primary health care. When applying the three priority setting criteria in day-to-day primary health care, the criteria largely influenced the overall prioritisation of each patient. General practitioners were most influenced by the expected cost-effectiveness of the intervention and nurses were most influenced by the severity of the condition. Staff perceived the criteria as relevant, but not sufficient. Three additional aspects to consider in priority setting in primary health care were identified, namely viewpoint (medical or patient’s), timeframe (now or later) and evidence level (group or individual). Conclusion: There appears to be a need for, and the potential to, introduce more consistent priority setting in primary health care. The characteristics of primary health care, such as the vast array of health problems, the large number of patients with vague symptoms, early stages of diseases, and combinations of diseases, induce both special possibilities and challenges.

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Ferreyra, Galliani Mariella. "Cultural Competency in the Primary Health Care Relationship." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23467.

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Cultural competency is theorized as the sensitivity of practitioners from the dominant culture towards the diverse cultural backgrounds of their patients. Less attention is placed on how communication between providers and patients can enable patients to share their health care beliefs. An evidence review of the literature around the conceptualization of cultural competency in health care was performed, and interviews were conducted aiming to understand what immigrant patients perceive as culturally competent care and its effect on the relationship between them and their providers. Definitions of cultural competence varied, and no conclusive studies linking cultural competence to improved health outcomes were found. Findings from the participant interviews helped to address gaps in the literature by confirming a preference for a patient-centred approach to culturally competent care, in addition to identifying pre-existing expectations for the health care encounter and patient-dependent factors as additional elements influencing the physician-patient relationship.

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Stewart, Sharon Louise. "Primary care groups : implementing the public health agenda." Thesis, University of Liverpool, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.425660.

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Black, Sheila. "Teamwork in primary health care : a case study." Thesis, University of Essex, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323029.

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Webb, Katie Louise. "Management of common mental health in primary care." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/66867/.

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Mental health is recognised as a global burden of disease and amongst the leading contributors to disability, with common mental health affecting one in six adults. The impact of these conditions on individuals and the economy are significant. Primary care is the first point of contact and general practitioners, as public health gatekeepers are of key importance in the recognition and management of these. It is suggested that general practitioners find consultations challenging, though it is not clear what these difficulties are. The aim of this thesis was to investigate what, if any, problems general practitioners experience with regards to the common mental health consultation. A scoping study and survey provided information on general practitioners’understanding of common mental health and its management. Another survey investigated the perceptions, beliefs and understanding of the general public in relation to common mental health and its management. A theory of planned behaviour study looked at factors that influenced general practitioners’ prescribing and referral behaviours. And finally, a triangulation study examined the findings from the programme of research with other key professionals who are also part of the pathway of care - primary care counsellors and clinical psychologists. Results of this thesis suggest that general practitioners do experience difficulties with the management of common mental health. Challenges were shown to be associated with the general practitioner’s role as the patient’s advocate, lack of knowledge and education, confidence, personal experience, patient expectation and management systems. Results also showed General practitioners’ and lay persons’ understanding of common mental health in everyday practice was different to that in public policy. General practitioner treatment management was shown to be in conflict with clinical guidelines. Furthermore, prescribing and referral behaviours were shown to be influenced by their attitude, significant others and whether they possessed adequate skills or knowledge.

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Davis, Meagan Chase. "Adolescent Depression Screening in Primary Care Practice." Thesis, The University of Arizona, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13864970.

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Purpose: The purpose of this DNP quality improvement project was to increase primary care provider knowledge about indications for adolescent depression screening.

Background: Approximately 13.3% of adolescents experienced depression in the past year. In Oklahoma alone, rates are increasing, with depression totaling 60% of all mental health illness among adolescents. Primary care providers see approximately 75% of adolescents; however, mental health conditions are missed 84% of the time. Current clinical guidelines recommend screening for adolescent depression during wellness visits or when risk factors are present.

Methods: The providers of interest were nurse practitioners, physicians, and physician assistants providing primary care to children between the ages of 12 and 17 in a private pediatric practice group consisting of three clinics. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention through use of a pre-test/post-test quantitative design. An email invited participants to complete an anonymous pre-test survey to evaluate knowledge and beliefs surrounding adolescent depression, then view an educational presentation on adolescent depression and screening guidelines, then complete a post-survey to evaluate any changes in knowledge and intention to screen. Results were shared with clinic representatives to help refine the education for future testing cycles and other clinic sites.

Results: Data collection took place over one week. Five providers completed both the pre-test and post-test surveys. Provider knowledge scores significantly increased 29% after participating in the education and self-reported knowledge on screening increased.

Conclusions: DNP quality improvement projects like this help develop strategies to increase best practices, leading to improved patient outcomes. Nurse-led improvement programs like this contribute to healthcare literature and the advancement of the nursing profession by developing patient-centered interventions applicable to a wide variety of providers. Results may be used to develop strategies to increase and align provider practices with best standards to help promote early identification and treatment of adolescents with depression.

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Cornoc, N. S. "Quality improvement cycle for cardiac failure in primary health care : Elsies River community health centre, Cape Town." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97226.

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Abstract Introduction The study aimed to assess and improve the quality of care for congestive cardiac failure in a public sector, primary health care setting, in Cape Town. There is currently no literature available on the quality of care for the management of congestive cardiac failure in primary health care in South Africa. Methods A disease register was constructed by identifying patients prescribed Furosemide and checking the medical records. Altogether 95 patients with CCF were identified. The study followed the usual steps for a quality improvement cycle: Formation of an audit team; agreeing on criteria based on current CCF guidelines; collection of data from medical records to measure the criteria; analysis and feedback of results to the staff; critical reflection, planning and implementing change; re-audit of the medical records. Results There was a mean age of 63.4 years, 21% were male and 75% were females. The results of the initial audit revealed suboptimal management of patients diagnosed with CCF: 53% had an aetiological diagnosis recorded in the clinical notes, 24% had a documented functional capacity, 12% of patients had documented precipitating/exacerbating factors, 58% had fluid status documented, and 37% had documentation of their cardiac rate and rhythm. The intervention consisted of feedback on the audit results and critical reflection with the relevant staff members. The doctors were provided with a printed protocol to refer to for the management of CCF. Clinicians were resistant to change and to taking on new tasks in relation to the management of patients with CCF and decided to only focus on improving the clinical assessment of patients. The results of the re-audit after 5-months in 40 patients demonstrated improvement in the clinical assessment criteria: 95% of the patients had an aetiological diagnosis recorded in the notes, 50% had a documented functional capacity, 42% had documented precipitating/exacerbating factors documented, 72% had their fluid status documented, and 85% of patients had their cardiac rate and rhythm documented. None of the five assessment criteria were met at baseline but post-intervention three of the five met the target set and all showed substantial improvement. There was no improvement noted in any of the other criteria, which were not specifically focused on in the plan to improve clinical practice. Conclusion The current quality of care for CCF in primary health care is poor and needs to be improved. The quality improvement cycle led to substantial improvement in the clinical assessment of patients with CCF. Recommendations are made regarding future criteria, which could be included in local audit tools.

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Hanna, Elizabeth Gayle (Liz), and lizhanna@netc net au. "Environmental health and primary health care: towards a new workforce model." La Trobe University. School of Public Health, 2005. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20061110.152550.

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Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals. The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure. A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys. The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure. The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.

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Sundquist, Kristina. "Individual health, neighborhood characteristics, and allocation of primary health care resources /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-595-6/.

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Hanna, Elizabeth Gayle. "Environmental health and primary health care : towards a new workforce model /." Access full text, 2005. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20061110.152550/index.html.

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Thesis (Ph.D.) -- La Trobe University, 2005.
Research. "A Thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy [to the] School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria". Includes bibliographical references (leaves 255-293). Also available via the World Wide Web.

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Steward, Jocelyn Louise. "Development and testing of the Primary Care Homeless Organizational Assessment Tool (PC-HOAT) to evaluate primary care services for the homeless." Thesis, The University of Alabama at Birmingham, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3634634.

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The purpose of this dissertation is to develop and test an organizational assessment tool that can used to evaluate primary care services for the homeless. The research evaluates the importance, feasibility, reliability, and validity of organizational processes and structures of primary care services for the homeless. The final product is the validated Primary Care Homeless Organizational Assessment Tool (PC-HOAT). This tool provides stakeholders with information regarding the organizational structures and processes associated with greater quality of primary care for the homeless. This tool will help managers better understand their organization's strengths and weaknesses, guide discussions regarding operations, and provide information to inform future strategies.

The researcher conducted a mixed-method study of key informants and organizations receiving federal health care for the homeless funding. The study used eight key informants to refine the initial PC-HOAT. The researcher distributed the final instrument through a web-based survey to determine reliability and validity of the PC-HOAT. Data analysis included descriptive statistics, factor analysis, and regression analysis.

The study yielded a 7-factor scale, 34-item tool focused on evaluation and delivery of primary care services, organizational structures relevant to effective delivery of care, and patient and family centeredness. In particular, the scale describing access and quality of care provided a positive statistical association with the proportion of patients with controlled hypertension. The study yielded results that provide a better understanding of the vital organizational characteristics that contribute most appropriately to the design of health care for the homeless organization.

Keywords: homeless, primary care, organizational assessment, reliability, validity, factor analysis

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Snyman, J. S. "Effectiveness of the basic antenatal care package in primary health care clinics." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.

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Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.

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Boardman, Helen Fiona. "Headache in primary care : epidemiology, management, and use of health care services." Thesis, Keele University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275244.

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Polaha, Jodi, and J. Hodgeson. "INTRA-Disciplinary Care: Can Mental Health Professionals Work Together in Primary Care?" Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6767.

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Excerpt: Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project.

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Wood, David L. "Engaging Primary Care Providers in Health Care Transition For Persons with Hydrocephalus." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5171.

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Slater, Julie Anne. "Occupational stress in primary health care : an investigation of the sources of stress in primary health care, the effects of these stressors on primary health care team members and the moderating effects of individual differences." Thesis, Cardiff University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362503.

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Schokking, Ian David. "Effectiveness of outreach primary health care in Karachi, Pakistan." Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23297.

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This study evaluated the Aga Khan University Urban Primary Health Care Program's effectiveness, six years after implementation in lower-middle class Karachi. The study supplemented surveillance data which showed two-fold improvements in health indicators.
One Program and one Comparison area were successfully matched post hoc on ethnicity and socioeconomic status. Study participants included women in both areas who had been pregnant in the last 5 years and resident for over 1 year.
The Program achieved 88% community coverage: 85% with outreach visits and 65% with clinic-based services. Factors which potentially confounded the surveillance estimates included secular improvements in water, sanitation, and socioeconomic status, along with the utilization of other health-care providers and health education resources. The Program's unique services were community health worker outreach (home visits and educational meetings) and growth monitoring.
The Program was found to be effective in improving most knowledge scores, some healthy behaviours, and no impacts. Positive results included: increased immunization and family planning knowledge scores by 5-10%, higher maternal-child immunization rates by 10-20%, and greater colostrum feeding practice by 10%. Negative results included: no additional diarrhea knowledge; no change in healthy behaviours towards diarrhea treatment, breast feeding, family planning or maternity care; and no health impact on fertility or childhood nutritional status. (Abstract shortened by UMI.)

Dissertations / Theses on the topic 'Primary health care'

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