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PubMedDate not supplied

[Nursing work in primary health care -- family health care].

This article is part of an integrated research project called The Organization of Primary Health Care (a perspective for nursing practice). Its objective is to investigate the perception of nursing personnel concerning their practice in family-centered primary health care. This article presents a case study focuses on nursing personnel workers from the Family Health Program (PSF), in the city of Batatais. Data collection was done through semi-structured interviews with those professionals. Thematic analysis of the data was realized in which initial categorization was done with the help of the Ethnograph software. The topics identified in the workers' narratives were: comprehensiveness, health care, bonding and active case-frading. These themes suggested that the work in family-centered care is difficult, therefore it leads to a more comprehensive health care practice in which decision-making is shared with clientele.

Brazil↗
PubMed1995

Preserving the physician-patient relationship in the era of managed care.

Even without comprehensive health care reform legislation, the US health care system is undergoing significant changes. Probably the most important change is the expansion of managed care with significant price competition. One of the major concerns about this change is the effect of managed care on the physician-patient relationship. To provide a normative standard for evaluating the effect of changes, we need an ideal conception of the physician-patient relationship. This ideal can be summarized by six C's: choice, competence, communication, compassion, continuity, and (no) conflict of interest. For the 37 million uninsured Americans there is little chance of realizing the ideal physician-patient relationship, since they lack the choice of practice setting and physician, receive care in a rushed atmosphere that undermines communication and compassion, and have no continuity of care. While many insured Americans may believe they have an ideal physician-patient relationship, the relationship is threatened by lack of a regular assessment of competence, by financial incentives that undermine good communication, and by the persistence of conflict of interest. The shift to managed care may improve the choice of practice settings, especially in sections of the country that currently lack managed care; increase choice of preventive services; make quality assessments more routine; and improve communication by making greater use of primary care physicians and nonphysician providers. However, the expansion of managed care and the imposition of significant cost control have the potential to undermine all aspects of the ideal physician-patient relationship. Choice could be restricted by employers and by managed care selection of physicians; poor quality indicators could undermine assessments of competence; conductivity requirements could eliminate time necessary for communication; changing from one to another managed care plan to secure the lowest costs could produce significant disruption in continuity of care; and use of salary schemes that reward physicians for not using medical services could increase conflict of interest.

Conflict of Interest↗
PubMed2000

Preventive health care, 2000 update: prevention of child maltreatment.

OBJECTIVES: To update the 1993 report from the Canadian Task Force on the Periodic Health Examination (now the Canadian Task Force on Preventive Health Care) by reviewing the evidence for the effectiveness of interventions aimed at preventing child maltreatment described in the scientific literature over the past 6 years. OPTIONS: Screening: a variety of techniques including assessment of risk indicators. PREVENTION: programs including home visitation; comprehensive health care programs; parent education and support, combined services and programs aimed specifically at preventing sexual abuse. OUTCOMES: Occurrence of one or more of the subcategories of physical abuse, sexual abuse, neglect and emotional abuse in childhood. EVIDENCE: MEDLINE, PSYCINFO, ERIC and several other databases were searched, experts were consulted, and published recommendations were reviewed. Original research articles and overviews that examined screening for or prevention of child maltreatment were included in the update. No meta-analysis was performed because the range of manoeuvres precluded comparability. BENEFITS, HARMS AND COSTS: Because of the high false-positive rates of screening tests for child maltreatment and the potential for mislabelling people as potential child abusers, the possible harms associated with these screening manoeuvres outweigh the benefits. Two randomized controlled trials showed a reduction in the incidence of childhood maltreatment or outcomes related to physical abuse and neglect among first-time disadvantaged mothers and their infants who received a program of home visitation by nurses in the perinatal period extending through infancy. It is expected that a reduction in incidence of child maltreatment and other outcomes will lead to substantial government savings. Evidence remains inconclusive on the effectiveness of a comprehensive health care program, a parent education and support program, or a combination of services in preventing child maltreatment. Education programs designed to teach children prevention strategies to avoid sexual abuse show increased knowledge and skills but not necessarily reduced abuse. VALUES: The systematic review and critical appraisal of the evidence were conducted according to the evidence-based methodology of the Canadian Task Force on Preventive Health Care. RECOMMENDATIONS: There is further evidence of fair quality to exclude screening procedures aimed at identifying individuals at risk of experiencing or committing child maltreatment (grade D recommendation). There is good evidence to continue recommending a program of home visitation for disadvantaged families during the perinatal period extending through infancy to prevent child abuse and neglect (grade A recommendation). The target group for this program is first-time mothers with one or more of the following characteristics: age less than 19 years, single parent status and low socioeconomic status. The strongest evidence is for an intensive program of home visitation delivered by nurses beginning prenatally and extending until the child's second birthday. There is insufficient evidence to recommend a comprehensive health care program (grade C recommendation), a parent education and support program (grade C recommendation) or a combination of home-based services (grade C recommendation) as a strategy for preventing child maltreatment, but these interventions may be recommended for other reasons. There is insufficient evidence to recommend education programs for the prevention of sexual abuse (grade C recommendation); whether such programs reduce the incidence of sexual abuse has not been established. VALIDATION: The members of the Canadian Task Force on Preventive Health Care reviewed the findings of this analysis through an iterative process. The task force sent the final review and recommendations to selected external expert reviewers, and their feedback was incorporated. SPONSORS: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Adolescent↗
PubMed1976

Lowering appointment failures in a neighborhood health center.

Failure to keep appointments constitutes a barrier to the delivery of continuous care in many comprehensive health care facilities. At a neighborhood health center in Pittsburgh, Pa., 336 appointments were studied to determine whether reminder letters or reminder calls could improve compliance with appointments scheduled more than three weeks in advance. The failure rate in the control group was 38 per cent compared with 10 per cent for the letter reminder group and 9 per cent for the telephone reminder group. The differences in kept, cancelled, and failed rates between letter and telephone groups were not statistically significant (p greater than .05). The kept rate increased with patient's age in all three groups. Complicance was not affected by sex of the patient, length of time that appointment was scheduled in advance, or day of the week. Compliance was greatest among appointments scheduled for chronic illness follow-up and physical examinations, and least among appointments scheduled for "screening."

Adolescent↗
PubMed1988

The Simavi-Tanga project for self-help in health. An assessment of a comprehensive primary health care programme.

Primary Health Care (PHC) is the major strategy for achieving the goal of Health for All. Lessons are to be learnt from a variety of experiences. The Simavi-Tanga project for self-help in Health is a comprehensive PHC-project with a limited input of external financial and advisory assistance. The short term outcome in terms of effectiveness and efficiency does not differ essentially from comparable Tanzanian projects with a higher degree of external input. The main limiting factors with regard to effectiveness and efficiency proved to be the insufficient preparation phase, limited commitment of some and the inappropriate use of human resources. This paper describes the results and constraints. Some recommendations are given to overcome these constraints.

Child, Preschool↗
PubMed1976

Building a comprehensive geriatric health care system: a case study.

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

Aged↗
PubMedDate not supplied

Emergency contraception for midwifery practice.

Every year in the United States, there are an estimated 3.5 million unplanned pregnancies with nearly one third of these attributed to contraceptive failures. Despite the availability of effective contraceptive methods, far too many women still experience unwanted pregnancies. It has been estimated that emergency contraception, also referred to as postcoital contraception or "the morning after pill," can reduce the risk of pregnancy after unprotected intercourse by as much as 75%. When administered within 72 hours of unprotected intercourse, emergency contraception, inhibits implantation of a fertilized ovum. The most common method of emergency contraception, the administration of ethinyl estradiol and dL-norgestrel, was initially described by Yuzpe in 1977. In the past 20 years, multiple studies have demonstrated the effectiveness of commonly prescribed combination oral contraceptives containing ethinyl estradiol and levonorgestrel. For those women in whom estrogen is contraindicated, progestin-only pills or the synthetic androgen Danazol have been used with comparable effectiveness rates. For appropriately selected women, an intrauterine device such as the Paraguard T380A (Ortho Pharmaceuticals, Raritan, NJ) also may be inserted within 5-7 days after unprotected intercourse to reduce the risk of unintended pregnancy. Despite its success and safety, emergency contraception is underused by women and their health care providers. As providers of comprehensive health care, midwives should provide patients with accurate information concerning pregnancy prevention. For many women, obtaining emergency contraception is an entry into the health care system and provides them an opportunity to be educated about safer sex practices, contraception, and the importance of regular health screening. Regularly discussing emergency contraception with patients at routine health visits will enable them to participate fully in their health care decisions and diminish the physical, psychological, and societal stressors associated with unplanned pregnancy.

Contraceptives, Postcoital↗
PubMedDate not supplied

[Evaluation of a comprehensive adolescent health care service].

The authors evaluate the Adolescent Health Clinic in the Emaús community in Belém, Pará, Brazil with regard to coverage, adequacy, accessibility, and utilization for the period 1994 to 1996. Coverage was calculated on the basis of clinical records and information collected from the target population. Adequacy was analyzed by comparing the service performance with goals established by PAHO/WHO for this kind of institution. Accessibility and utilization patterns were evaluated from information obtained by a population-based survey among adolescents living in the area. Results showed: a good degree of program adequacy vis-à-vis the final purpose, although some adjustments are needed, especially in human resources; lack of barriers to user access; reasonable coverage, despite the low proportion of consultations by adolescents; and utilization pattern compatible with the service provision profile, mainly directed towards curative and individual care. Recommendations are made to revise the hegemonic health care model to emphasize preventive, collective, and educational activities.

Adolescent↗
PubMed1979

The hospital: how will it survive?

The federal government is under pressure to implement and enforce a program to provide economic and social relief from the rapidly escalating health care costs which now consume 8.5% of the Gross National Product. Glick predicts that within the next twenty years, the character of health care institutions will be reshaped and only the most adaptable hospitals, health maintenance organizations and health-related governmental organizations will survive. He urges hospitals to develop appropriate strategies to deal with the problems of cost-containment, state-operated cost review and control agencies, and the competition for limited health care resources. The author warns the health care industry that if it does not adjust to these changes, it runs the risk of becoming heavily rgulated. It is suggested that health care institutions be integrated into comprehensive health care systems and the article includes a model for assigning patients to medical care facilities on a regional basis. Glick forecasts that hospitals will enter into a competition for survival, resulting in mergers of some and the closing of others. He believes that as the number of health care institutions decreases, the remaining ones will become more specialized and geographically dispersed.

Delivery of Health Care↗
PubMed1978

The comprehensive child health care centres in the Sudan.

In 1963, Morley initiated the concept of clinics for children under five years old. This paper describes our experience in applying that concept in Omdurman town (Sudan) where existing maternity and child health centres and hospitals in the area were involved in the scheme. It was found necessary to establish a main centre to develop methodology and to provide a specialized training of staff. The medical problems were similar to those described by Morley. The approach to their solution was essentially the same except that we used more professional staff and placed more emphasis on nutrition education than hitherto advocated. It is concluded that, in theory, Morley's concept provides a system of comprehensive child health care which suits the needs of developing countries. But our adaptation of Morley's ideas to existing health structures, even on the small scale we achieved in Omdurman, was difficult because of the high initial and running costs and in view of the long established dichotomy between curative and preventive medicine.

Child Health Services↗
PubMed1975

Comprehensive mental health care in a pediatric dialysis-transplantation program.

The dialysis-transplantation (D-T) program at The Hospital for Sick Children, Toronto has a mental health component directed by a psychiatrist and a social worker. As of Jan. 1, 1975, 53 kidney transplants had been carried out on 44 children. Patients and their families are counselled continuously by the psychiatrist and the social worker before, during and after transplantation. Members of the multidisciplinary team meet regularly to plan treatment for the children. Mental health issues are an integral part of team discussions and help determine D-T program policy. Psychological preparation, mental health consultation, therapeutic intervention and continuous counselling prevent many of the mental health problems that plague a D-T program.

Adolescent↗