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PubMedDate not supplied

How to make a difference in the health care of a population. One person at a time.

Individual clinical and fiscal outcomes can be realized with implementing a community-based advance practice nurse case management program (CBCM) for a self-insured employer. The personalized partnership and interventions for high-risk, complex clients have proven to be the key for their self-management outcomes. The case management service was at no cost to the client. The cost savings came from the decrease in patterned utilization of total health care dollars.

Case Management↗
PubMed1998

Defining characteristics of community-based health promotion programs.

Community-based health promotion programs have flourished over the past twenty years. These programs have varied considerably in their goals and in their approaches to reaching these goals. While some flexibility is critical to program effectiveness, it is also important to determine a set of defining characteristics in order to distinguish community-based programs from other types of health promotion activities. In this article, we examine some of the defining characteristics of community-based health promotion programs, and the challenges faced by practitioners who with to engage in this type of work.

Community Health Planning↗
PubMed1998

Priorities and strategies for promoting community-based prevention policies.

The public health community faces major choices in priorities for its mission in a rapidly changing environment. One option is to place greater emphasis on public health policy development. Policy making requires a grasp of the interplay among stakeholders, policy makers, the press, and the public. A framework for gathering relevant information and guiding strategic action is a useful tool for participation in community, state, and national arenas in the interests of population health. Organization-targeted approaches can make policy advocacy, community mobilization, and public education about policy issues more effective. This requires investment in public health infrastructure.

Attitude to Health↗
PubMed1999

Mobilizing a mass HIV counseling and testing program in Chautauqua County.

In October 1997, the staff of the New York State Department of Health's Anonymous HIV Counseling and Testing Program were mobilized to assist the Chautauqua County Department of Health to respond to an unprecedented demand for HIV counseling and testing. This demand followed the release of the name of an HIV-infected individual who was suspected of infecting 13 young women in Chautauqua County. This article reviews essential elements of New York's efforts to assist Chautauqua County in meeting increased demands for HIV counseling and testing services during the emergency response. New York's experience can help inform other jurisdictions that may encounter similar public health emergencies in the future.

AIDS Serodiagnosis↗
PubMedDate not supplied

The economic impact of several hospitals on their community.

This study quantifies the value that several hospitals in a hospital system have on their local communities. Also included is an analysis of the types of value-added services and resources offered by the hospitals. The hospitals are assessed in 3 arenas: as an employer, as a major provider of healthcare services, and as a contributor to the quality of life of the region through the involvement of its employees in community services activities. The results indicate that the hospital system contributes almost dollars 1.7 billion (or 6.6%) toward the dollars 25 billion local economy.

Catchment Area, Health↗
PubMed2005

'Working at the margins' or 'leading from behind'? A Canadian study of hospital-community collaboration.

Collaboration between hospitals and community organisations has been promoted over the past 20 years by various levels of government, hospital associations, health promotion advocates, and others at the state/province, national and international levels as a way to improve the 'efficiency of the system', reduce duplication, enhance effectiveness and service coordination, improve continuity of care, and enhance community capacity to address complex issues. Nevertheless, and despite a growing literature on interagency collaboration, systematic documentation and empirical analysis of hospital-community collaboration (HCC) is almost completely lacking in the literature, particularly as regards collaborations that address the determinants of health beyond the hospital walls. In this paper, we describe the methodology and key findings from a research study of HCC. The Hospital Involvement in Community Action (HICA) study undertook detailed qualitative case studies (in four urban, suburban, rural and northern locations) and a telephone survey (of 139 community organisations in a large urban centre) in order to learn about the range of collaborations and working relationships that exist between hospitals and community agencies in the province of Ontario (Canada), and the factors that influenced (enabled and/or hindered) HCC. Particular attention was paid to barriers and enablers at three nested levels of context (policy, hospital and community) and, drawing primarily on the qualitative case studies, it is this aspect that is the focus of this paper. That such collaborations continue to be widespread despite a generally unfavourable policy environment and hospital institutional culture that poses significant barriers, suggests that the extent to which HCC flourishes (or exists at all) crucially depends on the presence and ongoing enthusiasm/commitment of one or more 'champions' within the hospital, and the commitment of both parties to overcome the marked cultural differences between hospital and community. We conclude with a discussion of implications for policy and practice.

Canada↗
PubMed2000

Organisation and cost-effectiveness of antenatal haemoglobinopathy screening and follow up in a community-based programme.

OBJECTIVE: To consider the organisation cost and effectiveness, of universal, community-based antenatal screening for the haemoglobinopathies, and to estimate the cost-effectiveness of programmes at different levels of prevalence and mix of haemoglobinopathy traits. DESIGN: Retrospective review of laboratory and Sickle Cell and Thalassaemia Centre worksheets with costing of capital equipment, consumables, salaries and overheads, and estimation of costs in a range of circumstances. SETTING: A haematology department, including a Sickle Cell and Thalassaemia Centre, providing antenatal and neonatal screening programmes in Inner London. PARTICIPANTS: Two thousand one hundred and one women booking at the antenatal clinic whose samples were referred for screening during 1994. MAIN OUTCOME MEASURES AND RESULTS: In addition to assessing the cost-effectiveness of antenatal haemoglobinopathy screening in a number of settings, the following specific financial information was assembled for the service in Brent: 1. cost of identifying abnormal haemoglobin in mother (ł209); 2. cost of identifying at-risk fetus before confirmation by prenatal diagnosis (ł2,455); 3. cost of providing genetic information and counselling to mother with abnormal haemoglobin (ł109); 4. programme savings from cases averted (ł61,000). Conclusions Antenatal screening with follow up counselling can be self-financing at most prevalences of haemoglobinopathy traits, with greater savings where a high proportion of the traits are beta thalassaemia. There is a net financial cost (ł1,350) only at prevalences below 2.5% of traits if these are mainly for sickle cell disease. Since there are other benefits is it likely that antenatal screening will be considered cost-effective even at quite low levels of trait prevalence.

Algorithms↗
PubMed2000

Community leader education to increase epilepsy attendance at clinics in Epworth, Zimbabwe.

OBJECTIVE: To determine whether educating community leaders about epilepsy would lead to an increase in epilepsy cases being diagnosed and treated at primary health centers. METHODS: This was a single-arm cohort study performed in Epworth, a periurban township outside Harare, Zimbabwe. The subjects were Epworth community leaders (Local Board members, teachers, nurses, police officers, traditional healers, prophets). Educational workshops were given on epilepsy, its cause, and its management, and the number of new epilepsy cases on local primary health clinic registers 6 months after the workshops was measured. RESULTS: Six new cases were recorded, all among patients previously diagnosed with epilepsy. This was a significant increase (p = 0.02) compared with the null hypothesis. CONCLUSION: Although there was a significant increase in new cases, these did not represent newly diagnosed patients. Significant prejudice within the community may still prevent identified patients with epilepsy from seeking treatment. Alternative methods must be sought to increase the awareness of epilepsy within low-income communities and to reach "hidden" people with epilepsy.

Attitude to Health↗
PubMed2001

The impact of a community-wide self-care information project on self-care and medical care utilization.

This study assesses the effects of the Healthwise Communities Project (HCP) on use of self-care resources and health care utilization. The intervention included the distribution of the Healthwise Handbook, the provision of a telephone advice line, and a Web site. All of these products use a symptom-based approach and are aimed at a general population. A quasi-experimental design was used with two comparison communities. Measurements over time assessed the effects of the HCP while controlling for secular trends. Survey and utilization data are used to assess the effect of the intervention. Findings indicate that the community intervention increased the use of self-care resources. Users believe that these products help them make better decisions regarding when to seek care and how to self-treat problems. Most believe that using the self-care resources saved them from seeking unnecessary care. The findings from the utilization data provide some evidence to support this conclusion.

Community Health Planning↗
PubMed2003

Identifying and recruiting Mexican American partners and sustaining community partnerships.

In this article, how community partners were identified and recruited and how community partnerships have been sustained during a current program of study designed to eliminate health and use disparities are described. Hispanic elders use in-home community services less often than do Anglo elders. The critical social paradigm, community development theories, and participatory research methods have guided a partnership with Mexican American elders and their care-givers during five research studies. Although the process of partnering with communities evolves within specific contexts and cannot be precisely predicted, strategies can be transferred to research and transcultural nursing practice to improve preventive care and sustainability of healthful changes in vulnerable populations.

Aged↗
PubMed2004

Participation, health and the development of community resources in Southern Brazil.

This article seeks to contribute to the debate about participation and health by presenting a framework for psychosocial interventions in primary health care. It highlights the social psychological dimensions of participation and the role it plays in improving conditions of living and thus health. The Freirean concepts of dialogue, recognition and conscientization, combined with understanding of local knowledge are suggested as guiding notions for psychosocial interventions seeking to enhance community participation and develop the local level. The article discusses the challenges as well as the potential gains experienced in the process of participation presented. It concludes by reaffirming the importance of participation and empowerment in health interventions struggling against health inequalities and seeking health for all.

Brazil↗
PubMed2003

How do we know if we are making a difference with our program or community initiative?

In this article, the authors discuss issues related to knowing if health workers are making a difference with their community initiatives or programs being delivered in a community setting. Issues relating to the choice of evaluation questions, relevance of data sets used to answer those questions, and the rigor by which the answer can be evaluated--and the ability to generalize to other communities or populations--are explored. Finally, relevant resources to help you pursue these issues are provided.

Community Health Planning↗
PubMed2005

A conceptual model of community capacity development for health promotion in the Alberta Heart Health Project.

PURPOSE: The objective of this study was to derive a conceptual model of community capacity development for health promotion based on the 5-year demonstration phase of the Alberta Heart Health Project. METHOD: Community actions associated with successful implementation and uptake of initiatives in four diverse target sites were identified by case study evaluation. RESULTS: Thirteen common elements of capacity development were found across the projects and categorized to define three primary dimensions of the process: (a) leadership that provided a driving force for implementation, (b) policy making that ensured diffusion and sustainability, and (c) use of local community resources and infrastructure. A conceptual model was constructed using these 3 dimensions and their interactions. CONCLUSION: Effective implementation of community health initiatives to promote heart health can be conceptualized as the involvement of local leadership, policy advocacy, and enhancement of existing infrastructure. The model highlights building these dimensions of community capacity development for health promotion.

Alberta↗
PubMed2006

A lay health advisor program to promote community capacity and change among change agents.

The Charlotte REACH 2010 project focuses on cardiovascular disease and diabetes among African Americans in a geographically defined community. The goal of the project is to create changes in individual behaviors, community capacity, change agents, and systemic policies and actions that will result in the reduction of health disparities related to cardiovascular disease and diabetes. The project consists of three main components: lay health advisors as change agents, targeted interventions (exercise, nutrition, smoking cessation, primary care), and environmental and systemic interventions. The purpose of this article is to describe the lay health advisor intervention using qualitative methodologies that were developed to document changes in community capacity and change among change agents. Lay health advisors report that they have internalized their role as a community advocate and have made positive changes in their own personal health behavior. Their understanding of the underlying causes of poor health has expanded to include social and institutional factors and they have begun to shift their emphasis toward advocacy for social and institutional change.

Black or African American↗
PubMed2006

Costs of the 'Hartslag Limburg' community heart health intervention.

BACKGROUND: Little is known about the costs of community programmes to prevent cardiovascular diseases. The present study calculated the economic costs of all interventions within a Dutch community programme called Hartslag Limburg, in such a way as to facilitate generalisation to other countries. It also calculated the difference between the economic costs and the costs incurred by the coordinating institution. METHODS: Hartslag Limburg was a large-scale community programme that consisted of many interventions to prevent cardiovascular diseases. The target population consisted of all inhabitants of the region (n = 180.000). Special attention was paid to reach persons with a low socio-economic status. Costs were calculated using the guidelines for economic evaluation in health care. An overview of the material and staffing input involved was drawn up for every single intervention, and volume components were attached to each intervention component. These data were gathered during to the implementation of the intervention. Finally, the input was valued, using Dutch price levels for 2004. RESULTS: The economic costs of the interventions that were implemented within the five-year community programme (n = 180,000) were calculated to be about euro900,000. euro555,000 was spent on interventions to change people's exercise patterns, euro250,000 on improving nutrition, euro50,000 on smoking cessation, and euro45,000 on lifestyle in general. The coordinating agency contributed about 10% to the costs of the interventions. Other institutions that were part of the programme's network and external subsidy providers contributed the other 90% of the costs. CONCLUSION: The current study calculated the costs of a community programme in a detailed and systematic way, allowing the costs to be easily adapted to other countries and regions. The study further showed that the difference between economic costs and the costs incurred by the coordinating agency can be very large. Cost sharing was facilitated by the unique approach used in the Hartslag Limburg programme.

Cardiovascular Diseases↗