Articles de revues : « Tanykina Community Healthcare Plan »

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Källmén, Håkan, Anders Hed et Tobias H. Elgán. « Collaboration between community social services and healthcare institutions ». Nordic Studies on Alcohol and Drugs 34, n^o 2 (avril 2017) : 119–30. http://dx.doi.org/10.1177/1455072517691059.

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Background: Well-functioning care of people with substance use and psychiatric disorders presumes collaboration between different parties such as psychiatric care and substance use treatment centres, as well as social services. According to Swedish law, a collaborative individual plan, i.e., a written action plan to support structured inter-organisational collaboration, should be established. However, there are indications that such action plans are not used to a satisfactory extent. Aim: To explore current inter-organisational collaboration and use of collaborative individual plans among healthcare units and social services in Stockholm County. Design: The study uses a cross-sectional design. Participants ( N = 797) in a course specifically aimed at improving the knowledge and use of collaborative individual plans were invited to take part in the study prior to attending the course. A total of 705 participants accepted. Data were collected through an electronic questionnaire sent to each participant’s workplace. Non-respondents were offered a paper version to fill out. Results: Respondents reported participating in one to two collaborative individual plans per month and about 70% reported using a particular template. Respondents perceived mainly positive consequences of establishing a collaborative individual plan, for instance that it clarifies what measures are to be performed and who is responsible. Conclusions: Although respondents were generally positive about establishing a collaborative individual plan and the consequences thereof, they reported low use of such action plans.

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Fekadu, Abebaw, Charlotte Hanlon, Girmay Medhin, Atalay Alem, Medhin Selamu, Tedla W. Giorgis, Teshome Shibre et al. « Development of a scalable mental healthcare plan for a rural district in Ethiopia ». British Journal of Psychiatry 208, s56 (janvier 2016) : s4—s12. http://dx.doi.org/10.1192/bjp.bp.114.153676.

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BackgroundDeveloping evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority.AimsTo outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia.MethodA mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation).ResultsThe community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability.ConclusionsThe MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC.

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Hoye, Robert S., et Kathy Drew. « Implementing a Pharmaceutical Care Plan in the Community Pharmacy Setting ». Journal of Pharmacy Practice 7, n^o 6 (décembre 1994) : 255–59. http://dx.doi.org/10.1177/089719009400700606.

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The quickly changing healthcare environment has forced many healthcare professionals, including pharmacists, to justify the necessity of their roles in the provision of quality patient care. Pharmaceutical literature has strongly advocated the need for pharmacists to expand their roles into more interactive positions with physicians and other providers. The reasons are not only to increase their level of involvement in patient care, but also to educate professionals to the pharmacist's expertise and capabilities in pharmacotherapeutic treatment of patients. Hepler and Strand1 have written about the value and benefits of including pharmaceutical care planning programs and cognitive services into the daily routines of pharmacists in all settings. This article will explain how a community pharmacy conducted a pilot study to develop and implement its own formalized pharmaceutical care planning program for the treatment of patients with acute and chronic pain.

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Halilaj, G. « Developing Community Mental Healthcare : Kosovo Case ». European Psychiatry 41, S1 (avril 2017) : S606. http://dx.doi.org/10.1016/j.eurpsy.2017.01.953.

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BackgroundCommunity mental healthcare in Kosovo is still in its developmental stage and thus pose an ongoing challenge for the health system and population.ObjectivesThe purpose of this study is to describe the processes of preparation, implementation, challenges and future of community mental health service in Kosovo as an economically struggling society with underdeveloped health care system.MethodsReview of the current state of community services provision for mentally ill peoples in Kosovo in the light of the objectives and targets of the WHO comprehensive mental health action plan 2013–2020.ResultsThe implementation of a new community mental health service in Kosovo still is characterized by considerable shortages, beside substantial effort on various levels. On the policy and financial level, it was made possible by a clear intent/initialization of international bodies and coordinated commitment of all responsible national stakeholders and authorities. Obstacles remain regarding improvements of service development indicators: financial and human resources; capacity building; stakeholder involvement and service availability. Lack of strategies for promotion and prevention in mental health and lack of information systems, evidences and research for mental health is vital need.ConclusionsCommunity mental healthcare in Kosovo despite struggles faced is successfully installed and represents one of Kosovo health system achievements. Comprehensive, integrated and responsive mental health services in community-based settings in line with international and regional human rights instruments is goal to be addressed.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Patrick, Kevin, Michael Pratt et Robert E. Sallis. « The Healthcare Sector’s Role in the U.S. National Physical Activity Plan ». Journal of Physical Activity and Health 6, s2 (novembre 2009) : S211—S219. http://dx.doi.org/10.1123/jpah.6.s2.s211.

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Background:Healthcare professionals are influential sources of health information and guidance for people of all ages. However healthcare providers do not routinely address physical activity (PA). Engaging health professionals in a national plan for physical activity will depend upon whether proven strategies can be found to promote PA within clinical settings.Methods:The literature on promoting PA in healthcare settings was reviewed, as were recommendations from healthcare organizations and evidence-gathering entities about whether and how PA should be promoted in healthcare.Key recommendations:Evidence is mixed about whether interventions based in healthcare settings and offered by healthcare providers can improve PA behaviors in patients. Brief stand-alone counseling by physicians has not been shown to be efficacious, but office-based screening and advice to be active, followed by telephone or community support for PA has proven effective in creating lasting PA behavior improvement. Healthcare delivery models that optimize the organization of services across clinical and community resources may be very compatible with PA promotion in health care. Because of the importance of PA to health, healthcare providers are encouraged to consider adding PA as a vital sign for each medical visit for individuals aged 6 years and older.

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Kigozi, Fred N., Dorothy Kizza, Juliet Nakku, Joshua Ssebunnya, Sheila Ndyanabangi, Blandina Nakiganda, Crick Lund et Vikram Patel. « Development of a district mental healthcare plan in Uganda ». British Journal of Psychiatry 208, s56 (janvier 2016) : s40—s46. http://dx.doi.org/10.1192/bjp.bp.114.153742.

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BackgroundEvidence is needed for the integration of mental health into primary care advocated by the national health sector strategic investment plan in Uganda.AimsTo describe the processes of developing a district mental healthcare plan (MHCP) in rural Uganda that facilitates integration of mental health into primary care.MethodMixed methods using a situational analysis, qualitative studies, theory of change workshops and partial piloting of the plan at two levels informed the MHCP.ResultsA MHCP was developed with packages of care to facilitate integration at the organisational, facility and community levels of the district health system, including a specified human resource mix. The partial embedding period supports its practical application. Key barriers to scaling up the plan were identified.ConclusionsA real-world plan for the district was developed with involvement of stakeholders. Pilot testing demonstrated its feasibility and implications for future scaling up.

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Jordans, M. J. D., N. P. Luitel, P. Pokhrel et V. Patel. « Development and pilot testing of a mental healthcare plan in Nepal ». British Journal of Psychiatry 208, s56 (janvier 2016) : s21—s28. http://dx.doi.org/10.1192/bjp.bp.114.153718.

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BackgroundMental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries.AimsTo present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility.MethodA mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities.ResultsThe resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates.ConclusionsThe MHCP follows a collaborative care model encompassing community and primary healthcare interventions.

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Khozhamkul, Rabiga, Lyazzat Kosherbaeva, Ainur Bakdaulet, Talapkali Izmukhambetov, Arnoldas Jurgutis et Saule Tolegenova. « PP422 Including Empowering Community Into Primary Healthcare Team Scope Of Practice – A Technology For Ensuring Universal Healthcare Coverage ». International Journal of Technology Assessment in Health Care 36, S1 (décembre 2020) : 35. http://dx.doi.org/10.1017/s0266462320001750.

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IntroductionConsidering the World Health Organization (WHO) Astana Declaration, in order to provide universal healthcare coverage, Kazakhstan through ongoing healthcare reform committed to the promotion of a people-centered Primary Healthcare (PHC) system. Since the implemented top-down policies showed low buy-in from community members and put more constraints on PHC facilities and teams, the Kazakh National Medical University, the Medeo district mayor's office and the WHO European Centre for PHC supported the initiative of a local non-governmental organization “Community health committee” and Outpatient clinic of Almaty State hospital #5, for creation of an integrated plan to develop people-centered PHC through better coverage and engagement of patients with non-communicable disease and enhancing the health literacy of the population above 65 years.MethodsWe used a community-based participatory approach. The process consisted of: forming a steering committee with at least one member from each stakeholder group; two interactive workshops where the community worked jointly with PHC professionals in defining priority health needs and proposing actions to address selected priorities; and, after, joint development by all stakeholders of an action plan for empowerment of the community, and for assessment and review of the scope of practice of PHC teams.ResultsThe interactive workshops identified priority health needs such as low health literacy, low responsibility for health, low engagement of the elderly in prevention and self-management of non-communicable diseases. The main findings of semi-structured interviews were that there are no planning approaches (neither shared planning by a PHC team, or individually by PHC professionals) for addressing defined priority needs of the community, families and/or patients, and that the role of a PHC team in community empowerment is very limited.ConclusionsUsing results of the review on PHC teams’ scope of practice, we will develop, discuss and agree with the national and local stakeholders’ proposal of a conceptual model of PHC service delivery. Further, we will implement and evaluate the results of implementation.

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BABATUNDE, Raphael, Adeyemi OMONIWA et Oluwafemi OYEDEJI. « Insure them and improve their welfare : effect of Hygeia Community Health Insurance on households’ welfare in Kwara State, Nigeria ». Acta agriculturae Slovenica 113, n^o 1 (1 avril 2019) : 5. http://dx.doi.org/10.14720/aas.2019.113.1.01.

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The Hygeia Community Health Plan was designed such that agriculture-based households can have access to affordable healthcare services. It is also aimed at providing financial risk protection against catastrophic healthcare costs which if persistent, could possibly drive them into poverty. This paper used a well-structured questionnaire to solicit responses on the effect of the Hygeia Community Health Plan on the welfare of farming households in Kwara State, Nigeria. A two-stage sampling technique was used to sample 175 farming households comprising of 115 beneficiaries and 60 non-beneficiaries from Shonga, Bacita and Lafiagi districts of Edu local government area of Kwara State, Nigeria. The ordinary least square and logit model were used in the analysis of the data for this study. The results of the analysis showed that the Hygeia community health plan was positively and statistically significant in influencing the per capita income, per capita calorie intake and the food security status of farming households in the area. Therefore, it was recommended that the government should create an enabling environment or partner with private insurance organizations. This will help them work out a plan to help rural households in other parts of the country access affordable healthcare services easily. This will help in the attainment of the universal access to health services in Kwara State and country Nigeria at large.

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Guzys, Diana, Guinever Threlkeld, Virginia Dickson-Swift et Amanda Kenny. « Rural and regional community health service boards : perceptions of community health – a Delphi study ». Australian Journal of Primary Health 23, n^o 6 (2017) : 543. http://dx.doi.org/10.1071/py16123.

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Much has been written about the composition of health service boards and the importance of recruiting people with skills appropriate for effective and accountable governance of health services. Governance training aims to educate directors on their governance responsibilities; however, the way in which these responsibilities are discharged is informed by board members’ understanding of health within their communities. The aim of this study was to identify how those engaged in determining the strategic direction of local regional or rural community health services in Victoria, Australia, perceived the health and health improvement needs of their community. The Delphi technique was employed to facilitate communication between participants from difference geographic locations. The findings of the study highlight the different ways that participants view the health of their community. Participants prioritised indicators of community health that do not align with standard measures used by government to plan for, fund or report on health. Devolved governance of healthcare services aims to improve local healthcare responsiveness. Yet, if not accompanied with the redistribution of resources and power, policy claimed to promote localised decision-making is simply tokenistic.

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Coşkun, Sevim, et Nüket Örnek Büken. « Medical Ethics during the COVID-19 Pandemic ». Acta Medica 52, n^o 2 (15 juin 2021) : 92–101. http://dx.doi.org/10.32552/2021.actamedica.505.

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WHO states five ethical principles for the care of patients with COVID-19: Equal moral respect, duty of care, non-abandonment, protection of the community, and confidentiality. Healthcare professionals might have to make difficult decisions such as selecting patients and withholding or withdrawing mechanical ventilation of critically ill patients. In such difficult situations, a well-prepared action plan which considers ethical principles and prioritizes both public health and the safety of healthcare professionals, can help them. In this case, the development of an effective pandemic action plan, together with a triage plan based on emergency and disaster medicine is necessary. The only parameter of selection in this plan must be the correct application of triage, which respects every human life and depends on the criteria of clinical suitability. In this context, the fundamental ethical principles and human rights must be considered when allocating resources and prioritizing patients. Additionally, all protective measures for healthcare professionals must be taken, including all necessary equipment being adequately provided. If healthcare professionals become infected or face a life-threatening risk, then their obligations will be limited. Therefore, it is necessary to realize these limitations which may arise while providing appropriate health services.

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Lizarondo, Lucylynn, Kate Kennedy et Debra Kay. « Development of a Consumer Engagement Framework ». Asia Pacific Journal of Health Management 11, n^o 1 (16 mars 2016) : 46–49. http://dx.doi.org/10.24083/apjhm.v11i1.241.

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Objective: The purpose of this project was to develop a Consumer Engagement Model to plan for effective baby boomer engagement to inform policy makers in the healthcare system. This is the first stage of that process. Design: Initial model development for healthcare systems based on literature review and author group experience in evidence-based practice and research, and consumer advocacy and engagement. Setting and population: South Australian health and community service systems, and healthcare professionals that work with baby boomers. Findings: To develop an evidence-based Consumer Engagement Plan, it is recommended that policy makers undertake the four steps outlined in this document to design a question, determine consumer and community segments and scope of engagement, determine the breadth and depth of engagement and address the implications, assess risk and develop strategic partnerships to ensure the Plan is evidencebased,reasonable and achievable. Conclusions: We believe this process provides a framework for planning consumer engagement and for implementation, monitoring, evaluation and review of consumer engagement for policy excellence. We propose to undertake a validation of the model thus populating the model with examples of practice-based strategies and revising the model accordingly. Abbreviations: EBP – Evidence-Based Practice; IAP2 – International Association of Public Participation; PIO – Patient Intervention and Outcome.

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Caneja, Cielito. « Impact of Community Collaboration in the COVID-19 Pandemic ». Sushruta Journal of Health Policy & ; Opinion 14, n^o 1 (26 décembre 2020) : 1–7. http://dx.doi.org/10.38192/14.1.4.

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Background: SARS-COV-2 the cause of COVID-19 has sparked a global pandemic with devastating consequences on health, wellbeing, and the economy. Healthcare workers from the frontline of defence, yet, the pandemic affects not only healthcare workers but also their families. There is growing awareness of the benefits of COVID-19 support groups, for professionals and for the wider community. Migrant professionals make up a significant proportion of the human resources in delivering health care globally, as in the UK. Therefore any such initiative, should be culturally tailored to address their needs. Aim: To outline the development of a community support initiative, in the form of a non-profit organisation, for migrant minority Filipino healthcare professionals and their communities. Method: A mixed-method study with retrospective data collection. A dedicated helpline was set up during the pandemic. A Plan-Do-Study-Act (PDSA) method was adopted. The cohort was divided into two groups, health care professionals and non-healthcare group, with interventions delivered by four divisions, which were health care, non-healthcare, information governance and public relations - social media divisions. Interactive focus group and webinars were facilitated and data collected via Emotions Behind the Mask questionnaire. Results: PDSA outcomes, the dedicated helpline responded to 40 phone calls in 6 weeks, calls were linked to basic needs of daily living or work-related issues. In 5 months, the organisations collaborated with 25 local, national, and international organisations delivering community and professional support. The online platform audience reached an audience of 27,795. Conclusion: The combined professional healthcare and community support initiative demonstrated an impact on healthcare staff with possible benefits in workforce retention. Further studies are required in a larger population exploring mental health and well-being specific to minority ethnic groups.

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Inacio, Maria C., Sarah Catherine Elizabeth Bray, Craig Whitehead, Megan Corlis, Renuka Visvanathan, Keith Evans, Elizabeth C. Griffith et Steve L. Wesselingh. « Registry of Older South Australians (ROSA) : framework and plan ». BMJ Open 9, n^o 6 (juin 2019) : e026319. http://dx.doi.org/10.1136/bmjopen-2018-026319.

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IntroductionAustralia’s ageing population puts significant demands on the aged care and healthcare sectors. To monitor the provision of aged care and healthcare services to older people, each government body has an individual data collection system. Together these systems can be the basis for creating the evidence necessary to support future allocation of resources for our ageing community. The Registry of Older South Australians (ROSA) is a cross-sector multidisciplinary (ie, aged care and healthcare) platform built to address the challenges of monitoring people in aged care settings. This protocol describes the ROSA’s framework and plans.Methods and analysisA registry to capture 16 000 South Australians/year undergoing an aged care eligibility assessment was designed. ROSA will contain information captured by the Commonwealth and South Australian state Health Authority, linked by two data integrating authorities, and housed on a secured data platform. ROSA will contain information on the sociodemographic, health, function, psychological, social, home and safety assessment and concerns characteristics, aged care services, general health services, and mortality of people receiving aged care services. Registered participants will be prospectively monitored until their death and yearly updates of their aged care and healthcare services information will be added to the registry.Ethics and disseminationROSA will longitudinally monitor the services provided to a population that puts costly demands on the state healthcare and aged care systems, identify unwanted variation, and underpin future research. ROSA’s expected outputs include an annual report, a research agenda that focuses on high burden conditions and potentially economically impactful questions, educational materials, and risk profiling tools. ROSA was approved by the South Australian Department for Health and Ageing HREC (HREC/17/SAH/125) and the Australian Institute of Health and Welfare HREC (EO2018/2/429).

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Ruud, Torleif, et Svein Friis. « Community-based Mental Health Services in Norway ». Consortium Psychiatricum 2, n^o 1 (20 mars 2021) : 47–54. http://dx.doi.org/10.17816/cp43.

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Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding. Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community. The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.

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Blaha, Arlene. « The 1996???2000 Strategic Plan of the Home Healthcare Nurses Association ». Home Healthcare Nurse : The Journal for the Home Care and Hospice Professional 16, n^o 8 (août 1998) : 567–69. http://dx.doi.org/10.1097/00004045-199808000-00011.

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Winter, Paul A., Joseph M. Petrosko et Glenn Rodriguez. « Using Economic Incentives to Recruit Community College Faculty : Effects of Starting Salary and Healthcare Benefits Plan ». Community College Journal of Research and Practice 31, n^o 1 (janvier 2007) : 19–35. http://dx.doi.org/10.1080/10668920600857248.

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Petersen, Inge, Lara Fairall, Arvin Bhana, Tasneem Kathree, One Selohilwe, Carrie Brooke-Sumner, Gill Faris et al. « Integrating mental health into chronic care in South Africa : The development of a district mental healthcare plan ». British Journal of Psychiatry 208, s56 (janvier 2016) : s29—s39. http://dx.doi.org/10.1192/bjp.bp.114.153726.

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BackgroundIn South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level.AimsTo develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care.MethodMixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP.ResultsCollaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified.ConclusionsThe plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up.

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Haynes, N., SF Raine et P. Rushing. « Discharging ICU ventilator-dependent patients to home healthcare ». Critical Care Nurse 10, n^o 7 (1 juin 1990) : 39–47. http://dx.doi.org/10.4037/ccn1990.10.7.39.

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Patients who are ventilator dependent have few alternatives to continued hospitalization. Within our institution and community, intensive care unit (ICU) bed occupancy and lack of skilled nursing facilities forced us to look for other ways to meet their healthcare needs. The only placement alternative to continued hospitalization for some patients appeared to be home care, because it was available and cost-effective. The possibility of using home care for the ventilator-dependent patient was a new concept for many of the staff, and generated a moderate degree of anxiety among them. Overcoming the anxiety and developing and implementing the discharge plan became our goals. The goals were achieved when the patient was effectively and safely discharged from the ICU to his home.

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Nardi, Deena, et Carol Wilson. « A Faculty Practice Plan for the Acute Care and Critical Care Nurse ». AACN Advanced Critical Care 19, n^o 1 (1 janvier 2008) : 78–84. http://dx.doi.org/10.4037/15597768-2008-1010.

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This article discusses faculty clinical practice and explains the steps that one group of nursing faculty used to develop a faculty practice plan at a private college of nursing in a small, faith-based university in a mid-western city. The goal of the faculty practice plan was to link faculty interests and advanced practice skills with targeted populations and community needs. This was done to provide healthcare services to schools, agencies, health and human services programs, and populations in need. Examples of faculty roles in the faculty practice domains of educator, researcher, and expert clinician in an acute care setting illustrate how nurses can individualize their participation in the faculty practice plan to support their professional career goals. Faculty practice plans can benefit not only nursing faculty but also the college of nursing, its students, and its community and populations of interest.

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Olij, Branko, Vicki Erasmus, Lotte Barmentloo, Alex Burdorf, Dini Smilde, Yvonne Schoon, Nathalie van der Velde et Suzanne Polinder. « Evaluation of Implementing a Home-Based Fall Prevention Program among Community-Dwelling Older Adults ». International Journal of Environmental Research and Public Health 16, n^o 6 (26 mars 2019) : 1079. http://dx.doi.org/10.3390/ijerph16061079.

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We aimed to describe and evaluate the implementation of a home-based exercise program among community-dwelling adults aged ≥65 years. In an observational study, the twelve-week program was implemented in a community setting. The implementation plan consisted of dialogues with healthcare professionals and older adults, development of an implementation protocol, recruitment of participants, program implementation, and implementation evaluation. The dialogues consisted of a Delphi survey among healthcare professionals, and of individual and group meetings among older adults. The implementation of the program was evaluated using the framework model RE-AIM. In the dialogues with healthcare professionals and older adults, it was found that negative consequences of a fall and positive effects of preventing a fall should be emphasized to older adults, in order to get them engaged in fall prevention activities. A total of 450 older adults enrolled in the study, of which 238 started the program. The process evaluation showed that the majority of older adults were recruited by a community nurse. Also, a good collaboration between the research team and the local primary healthcare providers was accomplished, which was important in the recruitment. Future fall prevention studies may use this information in order to translate an intervention in a research project into a community-based program.

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Palmer, Sarah Jane. « An overview of enteral feeding in the community ». British Journal of Community Nursing 26, n^o 1 (2 janvier 2021) : 26–29. http://dx.doi.org/10.12968/bjcn.2021.26.1.26.

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Enteral feeding in community settings is becoming increasingly common, and this article aims to help nurses and other healthcare professionals to refresh their knowledge of the important concepts in the community-based care of patients receiving enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The article provides an overview on the management and care of the patient, the basic principles surrounding the equipment used, identifying the wider team and essential communication to bear in mind, as well as the importance of tailoring a care plan to the individual's needs, taking into consideration cognition, mental health, social needs and other factors. The article also covers red flags that may be seen in the community after tube insertion that require immediate medical attention.

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Hwong, Alison, Djibo Maiga Douma, Soumana Zamo et Julian Eaton. « Scaling up mental healthcare in the Republic of Niger : priorities for and barriers to service improvement ». BJPsych. International 12, S1 (mai 2015) : S—6—S—9. http://dx.doi.org/10.1192/s2056474000000763.

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As part of a pilot programme to scale up community mental health services, local health centre directors, community health workers and key informants were interviewed in two neighbouring political districts of Niger. Major priorities for improving services included training staff on the diagnosis and treatment of mental illness, collaborating with traditional healers, educating the community about the origins of psychiatric illness and building infrastructure for medication delivery. Barriers to care included long distances for travel to the nearest hospital and lack of funding for home-based visits by health workers. This study was the first step in Niger's plan to implement the World Health Organization's Mental Health Gap Action Programme (mhGAP) at a national level.

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Holden, Richard J., et Rupa S. Valdez. « Town Hall on Patient-Centered Human Factors and Ergonomics ». Proceedings of the Human Factors and Ergonomics Society Annual Meeting 62, n^o 1 (septembre 2018) : 465–68. http://dx.doi.org/10.1177/1541931218621106.

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A central paradigm in the current era of health and healthcare is the centrality of patients, families, and community members in their own health. Patients and other nonprofessionals are increasingly recognized as working independently or in concert with healthcare professionals in an effort to achieve health-related goals. This patient work has been the topic of much recent research in an area of human factors and ergonomics (HFE) we call patient-centered HFE. The town hall on patient-centered HFE draws on the community of healthcare HFE researchers and practitioners to communicate and document the scope of existing work, identify future opportunities, and develop recommendations for future work in this area. The town hall primarily consists of an open floor session with a 40-minute comment period and 40-minute generative exercise to discuss and plan with one another future work in patient-centered HFE.

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Harrison, Krista Lyn, et Holly A. Taylor. « Healthcare resource allocation decisions affecting uninsured services ». Journal of Health Organization and Management 30, n^o 8 (21 novembre 2016) : 1162–82. http://dx.doi.org/10.1108/jhom-01-2016-0003.

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Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies. Organizational values of access to care and stewardship most frequently affected resource allocation and policy decisions, while economic and political pressures affect the relative prioritization of values. Research limitations/implications Small sample size, the potential for social desirability or recall bias, and the exclusion of provider, member or community perspectives beyond those represented among participating board members. Practical implications Program directors or researchers can use this study to assess the extent to which resource allocation and policy decisions align with organizational values and mission statements. Social implications The description of how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions. Originality/value This study addresses a gap in literature regarding how CAPs actually make resource allocation decisions that affect access to healthcare services.

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Milne, Jeanette, et Joanne Nichols. « Optimising resources : an evidence-based pathway using UrgoStart for community-based patients with wounds ». British Journal of Community Nursing 26, n^o 3 (2 mars 2021) : 130–35. http://dx.doi.org/10.12968/bjcn.2021.26.3.130.

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Providing a co-ordinated and strategic approach to the assessment, treatment and management of chronic wounds in healthcare is central to the provision of effective nursing practice and optimisation of resources in community nursing. This article describes a project conducted in Northumberland by a tissue viability team and a district nursing team to implement an evidence-based treatment pathway for patients with leg ulcers. It discusses the multiple positive benefits of this project—to the NHS, nursing staff and patients—and provides detailed information for other nursing teams to implement such a plan.

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Shidhaye, Rahul, Sanjay Shrivastava, Vaibhav Murhar, Sandesh Samudre, Shalini Ahuja, Rohit Ramaswamy et Vikram Patel. « Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India ». British Journal of Psychiatry 208, s56 (janvier 2016) : s13—s20. http://dx.doi.org/10.1192/bjp.bp.114.153700.

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BackgroundThe large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.AimsTo operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.MethodMixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.ResultsThe MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.ConclusionsThere are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.

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Morris, G. Scott. « Holistic Healthcare for Medically Uninsured : The Church Health Center of Memphis ». Ethnicity & ; Disease 25, n^o 4 (10 novembre 2015) : 507. http://dx.doi.org/10.18865/ed.25.4.507.

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The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry, optometry, counseling, social work, and nutrition and fitness education, to promote wellness in every dimension of life. A 2012 economic analysis estimated that a $1 contribution to the CHC provided roughly $8 in health services. The CHC has trained >1200 Congregational Health Promoters to be health leaders and is conducting research on the effectiveness of faith community nurses partnering with congregations to assist in home care for patients recently discharged from Memphis hospitals. The MEMPHIS Plan, CHC’s employer-sponsored health care plan for small business and the self-employed, offers uninsured people in lower-wage jobs access to quality, affordable health care. The CHC also conducts replications workshops several times a year to share their model with leaders in other communities. The Institute for Healthcare Improvement (IHI) recently completed a case study that concluded: “The CHC is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual’s health care experience, and controlling costs. All three have been part of the Center’s DNA since its inception, and as a transforming force in the community, the model is well worth national attention.” Ethn Dis.2015;25(4):507-510; doi:10.18865/ ed.25.4.507

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Aziz, Ann-Marie. « Strategies to reduce Gram-negative infections : a community perspective ». British Journal of Community Nursing 25, n^o 5 (2 mai 2020) : 240–46. http://dx.doi.org/10.12968/bjcn.2020.25.5.240.

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Infections caused by Gram-negative bacteria continue to be on the rise, despite efforts by the Government and health service to curb their numbers. Most of these infections arise in the community. The case for targeting community-onset healthcare-associated infections is stark and requires a shift in focus from traditionally providing increased efforts in the hospital setting to a diversion of attention to the community. This article describes the challenges faced with increasing Gram-negative bloodstream infections and explores measures being taken to reduce transmission. As recent guidance has highlighted a proliferation within the community setting this article particularly focuses on a three-point plan for primary care. The strategies laid out are to reduce urinary tract infections, improve hydration and control antibiotic usage. Adopting these strategies will assist in reducing infection and targeting efforts where they are needed most.

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Hopson, Betsy, Elizabeth N. Alford, Kathrin Zimmerman, Jeffrey P. Blount et Brandon G. Rocque. « Development of an evidence-based individualized transition plan for spina bifida ». Neurosurgical Focus 47, n^o 4 (octobre 2019) : E17. http://dx.doi.org/10.3171/2019.7.focus19425.

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OBJECTIVEIn spina bifida (SB), transition of care from the pediatric to adult healthcare settings remains an opportunity for improvement. Transition of care is necessarily multidimensional and focuses on increasing independence, autonomy, and personal responsibility for health-related tasks. While prior research has demonstrated that effective transition can improve health outcomes and quality of life while reducing healthcare utilization, little is known about the most advantageous transition program components/design. The individualized transition plan (ITP) was developed to optimize the readiness of the adolescent with SB for adult healthcare. The ITP is a set of clearly articulated, mutually developed goals that arise from best available data on successful transition and are individualized to meet the individual challenges, needs, and attributes of each patient and family.METHODSProspectively completed ITPs were retrospectively reviewed from June 2018 to May 2019. Demographic and disease characteristics were collected, and specific goals were reviewed and categorized.RESULTSThirty-two patients with an ITP were included. The cohort was 50% male and had a mean age of 16.4 years. For goal 1 (maximize education), the most common goal was to complete a career interest survey (44%), followed by researching application/admission requirements for programs of interest (25%), shadowing in and/or visiting a workplace (16%), and improving high school performance (16%). For goal 2 (bowel management), most patients (59%) had a working bowel program with few or no bowel accidents. Eight patients (25%) were having more than the desired number of bowel accidents and received formal consultation with a gastroenterologist. Five patients (16%) needed only minor adjustments to their bowel management regimen. Goal 3 (SB program coordinator goal) focused on documenting medical and/or surgical history for the majority of patients (66%). Other goals aimed to increase patient communication in healthcare settings or utilize available community resources.CONCLUSIONSThe authors developed an evidence-based ITP that focuses around 5 goals: maximizing education, bowel continence, and goals set by the SB clinic coordinator, parent/caregiver, and patient. Although developed for the authors’ SB clinic, the ITP concept is applicable to transition of care in any chronic childhood illness.

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Murray, P. J. « The IMIA Strategic Plan - Towards IMIA 2015 ». Yearbook of Medical Informatics 17, n^o 01 (août 2008) : 7–15. http://dx.doi.org/10.1055/s-0038-1638572.

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Summary Objective To present the IMIA Strategic Plan, ‘Towards IMIA2015’, to a wide audience within and outside the ‘IMIA family’, so as to aid in turning the vision of the plan into reality. Methods IMIA, the International Medical Informatics Association, unanimously adopted the IMIA Strategic Plan, ‘Towards IMIA2015’, at its 2007 General Assembly meeting in Brisbane, Australia. The wide dissemination of this plan is one of the first stages in the developing IMIA Transition Plan, which will develop a roadmap and specific projects for implementing the strategy. The IMIA Strategic Plan is presented here, and we welcome dialogue with all who wish to work with IMIA to achieve the vision and the strategic goals, of providing leadership and expertise to the multidisciplinary health focused community and policy makers to enable the transformation of healthcare to improve the health of the world population. Results and conclusions IMIA and its members are now engaged in work to support implementation of the IMIA Strategic Plan. IMIA invites all with an interest in our activities to work with us towards achieving the strategic goals and making the vision a reality by 2015.

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Lau, Annie. « Delivering race equality in mental health services ». Advances in Psychiatric Treatment 14, n^o 5 (septembre 2008) : 326–29. http://dx.doi.org/10.1192/apt.bp.107.004986.

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‘Delivering race equality’ is a 5-year action plan for tackling race inequalities in mental healthcare in England and Wales, based on the main themes of improved services, better community engagement and better information. The perception is that clinical teams have not been sufficiently engaged with the plan and progress is slow. This article shares insights from the author's work across government departments over the past 2 years and explores the potential for linking up different initiatives across the patient care pathway in support of the plan's delivery. A summary of conclusions from a pilot survey of consultant psychiatrists, commissioned by the Department of Health in June 2007, addresses the main controversial areas in the action plan, with suggestions for improvement. Areas for clinical engagement are identified that exploit new funding, investment and policy initiatives. Examples of good practice are offered.

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Ponce, Allison N., Rebecca Miller, Milania D. Al-Jammaly, Edwin F. Renaud, Margaret A. Bailey, Susan Devine et Lindsay Oberleitner. « Suicide prevention in community mental health : changing systems ». Journal of Public Mental Health 19, n^o 4 (20 janvier 2020) : 359–66. http://dx.doi.org/10.1108/jpmh-06-2019-0062.

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Purpose This paper aims to describe a performance improvement process related to suicide assessment in a community mental health center. As suicide rates rise in the USA, it is crucial that community mental health providers are capable and comfortable to assess for suicide risk among individuals with mental illness. Support for healthcare providers is emphasized in the quadruple aim model of enhancing healthcare delivery and patient experience. The quadruple aim model is applied in the present performance improvement project in a community mental health center. Design/methodology/approach An interprofessional team used provider survey responses, critical incident data and other stakeholder input to implement a new assessment mechanism and education plan to support direct care staff to address suicide risk. Findings Although the rate of patient death by suicide at the community mental health center is low, managing risk is a frequent provider concern. Providers’ comfort assessing and managing suicide risk varied widely based on survey responses. A structured suicide assessment process was implemented to offer clarity and direction for providers. Education to address assessment and management was designed and implemented. Research limitations/implications Suicide data were retrospective and limited to known deaths, thus there may have been higher numbers of deaths by suicide historically. Providers’ comfort with suicide risk management was based on self-report and future work should also integrate skills-based assessment. Originality/value Improving the provider experience in mental health care must be explored. Focusing on provider input and voice in suicide-related efforts in community settings is a step toward integrating the quadruple aim ideals into mental health care.

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Beaton, S. J., S. B. Robinson, A. Von Worley, H. T. Davis, A. Boscoe, R. Ben-Joseph et L. J. Okamoto. « Abstract C-A3-03B : Cardiometabolic Risk and Healthcare Utilization for Hispanic and Non-Hispanic Female Health Plan Members ». Clinical Medicine & ; Research 6, n^o 3-4 (1 décembre 2008) : 121. http://dx.doi.org/10.3121/cmr.6.3-4.121-a.

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Striegel-Moore, R. H., L. DeBar, G. T. Wilson, J. Dickerson, F. Rosselli, N. Perrin, F. Lynch et H. C. Kraemer. « Health services use in eating disorders ». Psychological Medicine 38, n^o 10 (2 novembre 2007) : 1465–74. http://dx.doi.org/10.1017/s0033291707001833.

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BackgroundThis study examined healthcare services used by adults diagnosed with an eating disorder (ED) in a large health maintenance organization in the Pacific Northwest.MethodElectronic medical records were used to collect information on all out-patient and in-patient visits and medication dispenses, from 2002 to 2004, for adults aged 18–55 years who received an ED diagnosis during 2003. Healthcare services received the year prior to, and following, the receipt of an ED diagnosis were examined. Cases were matched to five comparison health plan members who had a health plan visit close to the date of the matched case's ED diagnosis.ResultsIncidence of EDs (0.32% of the 104 130 females, and 0.02% of the 93 628 males) was consistent with prior research employing treatment-based databases, though less than community-based samples. Most cases (50%) were first identified during a primary-care visit and psychiatric co-morbidity was high. Health services use was significantly elevated in all service sectors among those with an ED when compared with matched controls both in the year preceding and that following the receipt of the incident ED diagnosis. Contrary to expectations, healthcare utilization was found to be similarly high across the spectrum of EDs (anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified).ConclusionsThe elevation in health service use among women both before and after diagnosis suggests that EDs merit identification and treatment efforts commensurate with other mental health disorders (e.g. depression) which have similar healthcare impact.

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Gaston, Czar Louie Lopez, Johann Proceso Pag-ong, Emilleo Dacanay et Albert Jerome Quintos. « Radical change in osteosarcoma surgical plan due to COVID-19 pandemic ». BMJ Case Reports 13, n^o 7 (juillet 2020) : e237197. http://dx.doi.org/10.1136/bcr-2020-237197.

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A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.

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Aiswariya Milan, K., et Niharika P. Kumar. « Machine Learning Techniques in Healthcare—A Survey ». Journal of Computational and Theoretical Nanoscience 17, n^o 9 (1 juillet 2020) : 4276–79. http://dx.doi.org/10.1166/jctn.2020.9061.

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The development of science and technology has led to a very busy lifestyle among urban people across the globe. Due to the advent of cutting-edge technologies, connectivity and networking is a boon to the people living in urban areas. Thus, a vast amount of patient data from admission, treatment and discharge is collected across the clinical community. These rich data being available online has been under-utilized and the question arises on how best the data can be utilized. With the centralized data and powerful data analytical algorithms are running in powerful machines, until recent past, the machine learning is yet to be used for improving the diagnosis, prediction and secure data access process in healthcare. In this proposal, machine learning algorithms are used for enhanced medical diagnosis, personalized healthcare, predicting disease outbreaks in certain regions and measures for securing healthcare data from malicious attacks. The work focuses on 3 major chronic diseases such as Heart Attack, Stroke and Diabetics. Enhanced medical diagnosis involves the methods for predicting readmissions to hospital after X days of their discharge. Personalized healthcare involves methods for disease diagnosis and building treatment plan. The predictions are based upon on the patient’s medical reports and living habits. Disease outbreaks in an area involves methods for monitoring and predicting epidemic outbreaks in an area, during certain period of time based on information from social media.

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Khan, Uzma Rahim, Naveed Ahmed, Rubaba Naeem, Umerdad Khudadad, Sarwat Masud, Nadeem Ullah Khan et Junaid Abdul Razzak. « Heat Emergencies : Perceptions and Practices of Community Members and Emergency Department Healthcare Providers in Karachi, Pakistan : A Qualitative Study ». International Journal of Environmental Research and Public Health 18, n^o 9 (29 avril 2021) : 4736. http://dx.doi.org/10.3390/ijerph18094736.

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Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.

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Shrivastava, Richa, Yves Couturier, Felix Girard, Christophe Bedos, Mary Ellen Macdonald, Jill Torrie et Elham Emami. « Appreciative inquiry in evaluating integrated primary oral health services in Quebec Cree communities : a qualitative multiple case study ». BMJ Open 10, n^o 6 (juin 2020) : e038164. http://dx.doi.org/10.1136/bmjopen-2020-038164.

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ObjectiveThe Strategic Regional Plan of the Cree Board of Health and Social Services of James Bay (CBHSSJB), serving the Quebec Cree communities, mandates the objective of integrating oral health within primary healthcare. Emerging evidence suggests that the integration of oral health into primary healthcare can decrease oral health disparities. This research study aimed to answer the following research question: how and to what extent does the integration of oral health into primary healthcare address the oral health needs of the Cree communities?DesignWe used a multiple-case study design within a qualitative approach and developmental evaluation methodology. The Discovery, Dream, Design and Destiny model of appreciative inquiry was selected as a study framework among existing frameworks of the developmental evaluation.SettingFour purposefully selected Cree communities.ParticipantsHealthcare providers, administrators and patients at the community wellness centres and hospital.Outcome measuresIntegration of oral health into primary healthcare.ResultsA total of 36 interviews and 6 focus group discussions were conducted. We identified ten themes in discovery and dream phases. The Discovery phase identified the strengths of the organisation in facilitating enablers of integration including strategic planning, organisational structure, cultural integration, coordinated networks and colocation. In the Dream phase, participants’ oral healthcare stories expressed various dimensions of integration and their wish for strengthening integration via extending public oral healthcare programmes, increasing resources and improving organisational management. In the Design phase, recommendations were formulated for a future action plan within the CBHSSJB.ConclusionThis study results suggested that the CBHSSJB has been successful in implementing oral health integration into primary care following its strategic planning. At present, the organisation could extend the level of integration into full integration by following study recommendations derived from the perspective of local stakeholders.

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Brals, Daniella, Heleen Nelissen, Marijn Van der List, Cheikh Faye, Collins Juma, Chris Elbers, Ferdinand Wit, Michael Boele van Hensbroek et Constance Schultsz. « Impact of the community healthcare plan and the free maternity services programme on maternal and child healthcare utilisation in rural Kenya : a dairy farmer population-based study ». African Health Sciences 19, n^o 3 (6 novembre 2019) : 2600–2614. http://dx.doi.org/10.4314/ahs.v19i3.36.

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Background: Access to and utilisation of quality maternal and child healthcare services is generally recognized as the best way to reduce maternal and child mortality.Objectives: We evaluated whether the introduction of a voluntary family health insurance programme, combined with quality improvement of healthcare facilities [The Community Health Plan (TCHP)], and the introduction of free access to delivery services in all public facilities [Free Maternity Services programme (FMS)] increased antenatal care utilisation and use of facility deliveries among pregnant women in rural Kenya.Methods: TCHP was introduced in 2011, whilst the FMS programme was launched in 2013. To measure the impact of TCHP, percentage points (PP) changes in antenatal care utilisation and facility deliveries from the pre-TCHP to the post-TCHP period between the TCHP programme area and a control area were compared in multivariable difference-in-differences analysis. To measure the impact of the FMS programme, PP changes in antenatal care utilisation and facility deliveries from the pre-FMS to the post-FMS period in the pooled TCHP programme and control areas was assessed in multivariable logistic regression analysis. Data was collected through household surveys in 2011 and 2104. Households (n=549) were randomly selected from the member lists of 2 dairy companies, and all full-term pregnancies in the 3.5 years preceding the baseline and follow-up survey among women aged 15-49 at the time of pregnancy were eligible for this study (n=295).Results: Because only 4.1% of eligible women were insured through TCHP during pregnancy, any increase in utilisation attributable to the TCHP programme could only have come about as a result of the quality improvements in TCHP facilities. Antenatal care utilisation significantly increased after TCHP was introduced (14.4 PP; 95% CI: 4.5–24.3; P=0.004), whereas no effect was observed of the programme on facility deliveries (8.8 PP; 95% CI: -14.1 to +31.7; P=0.450). Facility deliveries significantly increased after the introduction of the FMS programme (27.9 PP; 95% CI: 11.8–44.1; P=0.001), but antenatal care utilisation did not change significantly (4.0 PP; 95% CI: -0.6 to +8.5; P=0.088).Conclusion: Access to the FMS programme increased facility deliveries substantially and may contribute to improved maternal and new-born health and survival if the quality of delivery services is sustained or further improved. Despite low up-take, TCHP had a positive effect on antenatal care utilisation among uninsured women by improving the quality of existing healthcare facilities. An alignment of the two programmes could potentially lead to optimal results.Funding: The study was funded by the Health Insurance Fund (http://www.hifund.org/), through a grant from the Dutch Ministry of Foreign Affairs.Keywords: Free Maternity Services programme, maternal and child healthcare utilisation rural, Kenya, a dairy farmer population-based study.

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Ackermann, Ronald T., Barbara Williams, Huong Q. Nguyen, Ethan M. Berke, Matthew L. Maciejewski et James P. LoGerfo. « Healthcare Cost Differences with Participation in a Community-Based Group Physical Activity Benefit for Medicare Managed Care Health Plan Members ». Journal of the American Geriatrics Society 56, n^o 8 (août 2008) : 1459–65. http://dx.doi.org/10.1111/j.1532-5415.2008.01804.x.

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Sharma, Avinash, Olusegun Isaac Alatise, Kelli O'Connell, Samson Gbenga Ogunleye, Adewale Abdulwasiu Aderounmu, Marquerite L. Samson, Funmilola Wuraola, Olalekan Olasehinde, T. Peter Kingham et Mengmeng Du. « Healthcare utilisation, cancer screening and potential barriers to accessing cancer care in rural South West Nigeria : a cross-sectional study ». BMJ Open 11, n^o 7 (juillet 2021) : e040352. http://dx.doi.org/10.1136/bmjopen-2020-040352.

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Background/aimsCancer burden is predicted to double by 2030 in sub-Saharan Africa; access to healthcare services for cancer management is a priority in the region. In Nigeria, National Cancer Control Plan aims to ensure >50% cancer screening of eligible populations by 2022 for all Nigerians. We describe healthcare utilisation, cancer screening activities and potential barriers to accessing cancer care within an understudied rural community-based adult population in South West Nigeria.MethodsIn April 2018, we conducted a cross-sectional study of community-based adults (>18 years) ~130 km east of Ibadan, 250 km from Lagos in Osun State, South West Nigeria. Participants completed a face-to-face survey in local dialect. We used a questionnaire to assess demographics, health status, income, medical expenditures, doctor visits and cancer screening history.ResultsWe enrolled 346 individuals: with median age of 52 years and 75% women. Of the entire cohort, 4% had medical insurance. 46% reported a major medical cost in the last year. Cancer screening activities were infrequent in eligible participants: 1.5% reported having had cervical cancer screening, 3.3% mammogram and 5% colonoscopy screening. Cancer screening assessment was less frequent in those with less income and lower education levels. Using a multivariable logistic regression model including personal income, insurance status and education, higher personal income was associated with more cancer screening activity (OR 2.7, 95% CI 1.3 to 5.7, p<0.01). Despite this, most individuals had contact with a primary healthcare doctor (52% in the last year), and over 70% access to radio and TV suggesting the opportunity to expand community-based screening interventions and awareness exists.ConclusionsDespite national increases in cancer cases, we highlight a deficiency in cancer screening and universal healthcare coverage within a community-based adult Nigerian population. Subject to availability of governmental resources, increasing financial risk protection, awareness and targeted resource allocation may help expand access in Nigeria.

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Arego, Judy, Ken Ondenge, Isdorah Odero, Eucabeth Awuonda, Tereza Omoro, Victor Akelo, Victor Mudhune et Deborah A. Gust. « Medical pluralism and rationalities for HIV care utilization among discordant couples in Siaya County, rural western Kenya ». International Journal of STD & ; AIDS 30, n^o 9 (3 juin 2019) : 868–74. http://dx.doi.org/10.1177/0956462419843691.

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Understanding healthcare seeking and utilization of members of discordant couples can help in implementing effective HIV treatment, care, and support. We conducted a qualitative study comprised of in-depth interviews (n = 26) and ten focus group discussions (n = 73) with community members including opinion leaders, healthcare workers, and members of discordant couples. A portion of the latter group had been participants in the HIV Prevention Trials Network (HPTN) 052 study. Themes that emerged from the data were pragmatism and the realities of hospital care, quest for a cure through traditional medicine, and religious dogma. Medical pluralism is practiced by members of discordant couples seeking HIV care through intersections of hospital facility services and traditional and religious therapeutic options. It would be prudent for healthcare policy makers and conventional medical providers to recognize the importance of traditional medicine and religion in the lives of members of HIV discordant couples and make efforts to integrate the positive concepts of both into the couples’ overall health plan.

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Nuriddin, Azizeh, Mohamed F. Jalloh, Erika Meyer, Rebecca Bunnell, Franklin A. Bio, Mohammad B. Jalloh, Paul Sengeh et al. « Trust, fear, stigma and disruptions : community perceptions and experiences during periods of low but ongoing transmission of Ebola virus disease in Sierra Leone, 2015 ». BMJ Global Health 3, n^o 2 (mars 2018) : e000410. http://dx.doi.org/10.1136/bmjgh-2017-000410.

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Social mobilisation and risk communication were essential to the 2014–2015 West African Ebola response. By March 2015, >8500 Ebola cases and 3370 Ebola deaths were confirmed in Sierra Leone. Response efforts were focused on ‘getting to zero and staying at zero’. A critical component of this plan was to deepen and sustain community engagement. Several national quantitative studies conducted during this time revealed Ebola knowledge, personal prevention practices and traditional burial procedures improved as the outbreak waned, but healthcare system challenges were also noted. Few qualitative studies have examined these combined factors, along with survivor stigma during periods of ongoing transmission. To obtain an in-depth understanding of people’s perceptions, attitudes and behaviours associated with Ebola transmission risks, 27 focus groups were conducted between April and May 2015 with adult Sierra Leonean community members on: trust in the healthcare system, interactions with Ebola survivors, impact of Ebola on lives and livelihood, and barriers and facilitators to ending the outbreak. Participants perceived that as healthcare practices and facilities improved, so did community trust. Resource management remained a noted concern. Perceptions of survivors ranged from sympathy and empathy to fear and stigmatisation. Barriers included persistent denial of ongoing Ebola transmission, secret burials and movement across porous borders. Facilitators included personal protective actions, consistent messaging and the inclusion of women and survivors in the response. Understanding community experiences during the devastating Ebola epidemic provides practical lessons for engaging similar communities in risk communication and social mobilisation during future outbreaks and public health emergencies.

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Heilbrunn-Lang, Adina Y., Lauren M. Carpenter, Seona M. Powell, Susan L. Kearney, Deborah Cole et Andrea M. de Silva. « Reviewing public policy for promoting population oral health in Victoria, Australia (2007–12) ». Australian Health Review 40, n^o 1 (2016) : 19. http://dx.doi.org/10.1071/ah15013.

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Objective Government policy and planning set the direction for community decisions related to resource allocation, infrastructure, services, programs, workforce and social environments. The aim of the present study was to examine the policy and planning context for oral health promotion in Victoria, Australia, over the period 2007–12. Methods Key Victorian policies and plans related to oral health promotion in place during the 2007–12 planning cycle were identified through online searching, and content analysis was performed. Inclusion of oral health (and oral health-related) promotion initiatives was assessed within the goals, objectives and strategies sections of each plan. Results Six of the 223 public health plans analysed (3%) included oral health ‘goals’ (including one plan representing nine agencies). Oral health was an ‘objective’ in 10 documents. Fifty-six plan objectives, and 70 plan strategies related to oral health or healthy eating for young children. Oral health was included in municipal plans (44%) more frequently than the other plans examined. Conclusion There is a policy opportunity to address oral health at a community level, and to implement population approaches aligned with the Ottawa Charter that address the social determinants of health. What is known about the topic? Poor oral health is a significant global health concern and places a major burden on individuals and the healthcare system, affecting approximately 50% of all children and 75%–95% of adults in Australia. The Ottawa Charter acknowledges the key role of policy in improving the health of a population; however, little is known about the policy emphasis placed on oral health by local government, primary care partnerships and community health agencies in Victoria, Australia. What does this paper add? This is a review of oral health content within local government (municipal) and community health plans in Victoria, Australia. What are the implications for practitioners? The findings identify several opportunities for public health and community health practitioners and policy makers to place greater emphasis on prevention and improvement of the oral health of Victorians through policy development.

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Riley, Sheryl, et Samantha Manns. « Effects of community-embedded care management model on patients, providers, and payors. » Journal of Clinical Oncology 36, n^o 7_suppl (1 mars 2018) : 44. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.44.

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44 Background: Comprehensive oncology care management is commonly built on expert clinical support and coordinated services, but lacks a community focus during critical phases of the cancer journey. However, a community-embedded approach extends past practice walls by incorporating local resources and identifying barriers to care in-between office visits. The cycle of care management adheres to the following objectives: Improve health outcomes; Engage the patient, their family and healthcare team; Advance payor efficiency and cost savings; Support the treatment plan in the community. Methods: Stratification Technology Platform & Levels of Care: A risk-based process is implemented through proprietary stratification software, which combines all data points of the healthcare system. A three-step risk acuity score is calculated for each patient based on claims data, diagnoses and disabilities to assure care is tailored to meet individual needs. Patients are then designated to care programs in accordance to their various risk levels. This allows for personalized care plans and staff workflows. Care Teams: Teams of a care coordinator, registered nurse and social worker provide consistent healthcare navigation, monitor patients’ treatment adherence and improve health outcomes. They act as a safety net for patients and their families at all times. Results: 31% decrease in ER visits; 51% decrease in hospital admissions; Hospice conversion at 8x national average; Improved side effects management; ROI of 3:1. Conclusions: Through community-embedded oncology care management, patients not only receive the proper level of care, but also show various improved health outcomes. Providers and patients see decreased emergency room visits, shorter hospital stays and improved quality of life, while payers experience tremendous cost savings due to smarter spending and utilization management. Practices continue to recognize community-embedded care management as a transformative standard of treatment that is central to positive health outcomes. However, there is always more to learn and improve upon, so constant evaluations of quality metrics are essential to provide the very best to patients, providors and payers.

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Salgado, Teresa M., Meagen M. Rosenthal, Antoinette B. Coe, Tana N. Kaefer, Dave L. Dixon et Karen B. Farris. « Primary healthcare policy and vision for community pharmacy and pharmacists in the United States ». Pharmacy Practice 18, n^o 3 (18 septembre 2020) : 2160. http://dx.doi.org/10.18549/pharmpract.2020.3.2160.

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The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.

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Jagannathan, Aarti, Sreekanth Nair Thekkumkara, Jagadisha Thirthalli et Sekar Kasi. « A Community Participation Initiative During COVID-19 Pandemic : A Case Study From India ». Indian Journal of Psychological Medicine 43, n^o 2 (19 février 2021) : 154–57. http://dx.doi.org/10.1177/0253717621991012.

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Background: A community participation initiative of stitching personal protective equipment (PPE), masks, and face shields for healthcare professionals working in the hospital during the COVID-19 pandemic was conducted using a case study design. Methods: The hospital tailoring unit was used to cater to the in-house demand for stitching safety gear kits for healthcare professionals. A transect walk was conducted to survey hospitals for selecting material for stitching the safety gears and to draw up a plan to meet future demand. The psychiatric social worker induced a community participatory initiative using the method of social work of community organization. A flyer was prepared to invite participants with prior experience in tailoring for this initiative. All participants were trained by the master trainers of the tailoring unit. The participants were also interviewed about their views on this initiative in an informal interview. Results: A total of 83 participants, including 26 individuals (8 volunteers and 18 who received an honorarium), 2 boutiques ( n = 12), and 1 government organization, participated in the activity ( n = 45). A total of 1700 complete PPE kits and 13,000 masks were stitched during this period. The participants reported that the benefit of being a part of this initiative was reduced boredom, sense of purpose and satisfaction, and improved mental health due to structured activity. Conclusions: A community participation initiative using the principles of community organization, a method of social work, can help produce desired outputs and improve the well-being of the participants.

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Corry, Dagmar, Julie Doherty, Adrienne McCann, Frank Doyle, Christopher Cardwell, Gillian Carter, Mike Clarke et al. « Anticipatory care planning for older adults : a trans-jurisdictional feasibility study ». British Journal of General Practice 70, suppl 1 (juin 2020) : bjgp20X711197. http://dx.doi.org/10.3399/bjgp20x711197.

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BackgroundAs the population of older adults’ increases, the complexity of care required to support those who choose to remain in the community has also increased. Anticipatory Care Planning (ACP) through earlier identification of healthcare needs is evidenced to improve quality of life, decrease the number of aggressive futile interventions, and even to prolong life.AimTo determine the feasibility of a cluster randomised trial to evaluate the implementation and outcomes of Anticipatory Care Planning (ACP) in primary care to assist older adults identified as at risk for functional decline by developing a personalised support plan.MethodGP practices were randomised into control/intervention groups stratified by jurisdiction [Northern Ireland (UK) and the Republic of Ireland (RoI)], and by setting (urban and rural). Participants were included if they were a) aged ≥70 years, b) 2 or more chronic medical conditions, c) 4 or more prescribed medications. The Anticipatory Care Plan consisted of home visits where the study nurse discussed patients’ goals and plans. An action plan was put in place following consultation with patient’s GPs and study Pharmacist.ResultsEight primary care practices participated; four in the UK and four in the RoI. Sample n = 64. Data was collected pertaining to patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and the use of potentially inappropriate medication.ConclusionUnique insights relating to the trans-jurisdictional delivery of healthcare services in the UK and RoI were observed which has implications on service delivery for older adults.

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Akpan, Ekerette U., William O. Murray, Mario A. Vergara, Sarah J. Murray, Christopher H. Stucky, Marla J. De Jong et Elba Villacorta. « Nursing Leadership During COVID-19 : Leading an Inpatient Response at a Regional Military Medical Center ». Military Medicine 186, Supplement_2 (1 septembre 2021) : 50–55. http://dx.doi.org/10.1093/milmed/usab179.

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ABSTRACT The coronavirus disease 2019 pandemic stressed healthcare systems worldwide and exposed major flaws in military and civilian healthcare systems. Landstuhl Regional Medical Center (LRMC) serves as the only military medical center for over 205,000 U.S. service members, beneficiaries, and coalition partners stationed throughout Europe, Africa, and the Middle East. The pandemic response required LRMC leaders to reconfigure services to meet pandemic concerns while providing lifesaving care to injured service members from combatant commands. The quickly evolving pandemic challenged leaders to ensure healthcare delivery amid constant change and imperfect information. While LRMC senior leaders developed a strategic pandemic response plan, a multidisciplinary team of nurses, doctors, and technicians collaborated to create an inpatient team to support the dual mission of coronavirus disease 2019 response and casualty care for the warfighter. In this manuscript, we discuss how a multidisciplinary clinical working group at a regional medical center prepared and responded to the pandemic, strategically planned patient care, and ensured support to combatant commands for ongoing forward military operations. Additionally, we share our experiences and lessons learned to inform other military facilities across the medical community and global healthcare systems.

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