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PubMed2001

Policy implications of the inadequate support systems for orphans in western Kenya.

This paper describes the support systems available for orphans in a rural Luo community in Nyang'oma sub-location in Bondo District of Western Kenya. Qualitative data were collected through in-depth interviews with orphaned children and their caretakers as well as key informants, and through focus group discussions with orphaned children, widows and community elders. Quantitative data were obtained by questionnaires administered to 100 caretakers of orphaned children. The most serious problem was inability of the orphan households to afford school fees, although lack of food, medicare and clothing were also prominent. The traditional, kinship-based support systems made a major contribution to catering for the orphans though the resources were far from enough. Various community-based groups in the area did not contribute significantly. The problem is getting desperate due to a combination of an exponentially increasing prevalence of orphans, poor socio-economic conditions and decline of the traditional support systems. For health planners and policy makers there are two major concerns. In the short term, a big and rapidly growing group of children are without adequate access to health services, while in the long term, the negative consequences for (in particular the girl) orphans' schooling pose a serious threat to the health of their future children. Based on the study findings, two recommendations are made: that the responsible parties address the issue of education for orphans rapidly and sufficiently and with due consideration of their food security and medicare; and that potential community resources such as kinship networks and community groups are mobilised in order to assist in achieving the goal.

Child↗
PubMed1991

Psychosocial impacts in populations exposed to solid waste facilities.

This interdisciplinary study uses a parallel case study design to investigate psychosocial impacts in populations exposed to three solid waste facilities in Southern Ontario. Impacts are examined at three social scales: individual, social network and community levels. The objectives and design derive from a feasibility study recently completed by the same research team. A two stage approach is adopted. The first is an epidemiologic survey to determine the prevalence of psychosocial impacts in the populations within a prescribed area around each site. A disproportionate stratified (by distance) random sample of 250 households is surveyed at each site. Data on awareness, knowledge, concern and action regarding the site are also obtained. Scores on pre-validated health measurement scales will be compared with population norms to determine the frequency distribution above, within and below the range of normal. The second stage involves the use of qualitative methodologies to provide an in-depth analysis of the individual, social network and community level factors affecting psychosocial impacts and reactions to the situation. Depth interviews with a sub-sample of survey respondents explore individual perceptions, attitudes and actions. Focus groups composed of members of relevant organizations and discussion groups comprising non-members uncover social network and community perspectives in an interactional setting. Interviews and group sessions are taped and transcribed for content analysis of salient themes. Textual analysis of media reports and other relevant documentation provide insights regarding the informational environment and the community context of the issues.

Adaptation, Psychological↗
PubMedDate not supplied

The use of key informant networks in assessment of community health.

Program planning requires the acquisition of current, reliable information to accurately define the need for the program and to aid in developing its basic structure. In a time of financial restraint, a cost- and time-efficient method for collecting information for program development is important. This paper presents a strategy, borrowed from anthropology, that develops a network of key individuals in the community as a source of information and as a potential resource in program development. The effectiveness of this approach as a method for data collection is illustrated through application to a health and medical needs assessment of a geriatric population. A community diagnosis of this population was obtained.

Anthropology↗
PubMed2005

Providing patient care in community pharmacies in Australia.

OBJECTIVE: To describe Australia's community pharmacy network in the context of the health system and outline the provision of services. DATA SYNTHESIS: The 5000 community pharmacies form a key component of the healthcare system for Australians, for whom health expenditures represent 9% of the Gross Domestic Product. A typical community pharmacy dispenses 880 prescriptions per week. Pharmacists are key partners in the Government's National Medicines Policy and contribute to its objectives through the provision of cognitive pharmaceutical services (CPS). The Third Community Pharmacy Agreement included funding for CPS including medication review and the provision of written drug information. Funding is also provided for a quality assurance platform with which the majority of pharmacies are accredited. Fifteen million dollars (Australian) have been allocated to research in community pharmacy, which has focused on achieving quality use of medicines (QUM), as well as developing new CPS and facilitating change. Elements of the Agreements have taken into account QUM principles and are now significant drivers of practice change. Although accounting for 10% of remuneration for community pharmacy, the provision of CPS represents a significant shift in focus to view pharmacy as a service provider. Delivery of CPS through the community pharmacy network provides sustainability for primary health care due to improvement in quality presumably associated with a reduction in healthcare costs. CONCLUSIONS: Australian pharmacy practice is moving strongly in the direction of CPS provision; however, change does not occur easily. The development of a change management strategy is underway to improve the uptake of professional and business opportunities in community pharmacy.

Australia↗
PubMed1983

Acceptance of a volunteer first-responder system in rural communities: a field experiment.

This article describes a randomized control field experiment that was used to evaluate the impact of an organized volunteer-based emergency first-responder system in 36 rural, medically underserved communities in central Georgia. The system created an information network within communities, which allowed rapid contact with trained resident volunteers when emergencies occurred. The evaluation examined selected environmental variables related to creating an information network and their effect on the general public's willingness to use a first responder for medical emergencies. Measurements of community awareness and attitudes were made using a household telephone survey conducted immediately before project initiation, 3 months and 13 months after implementation. Willingness to use the system was greatest for individual respondents living in communities with less than 800 population and who were participants in the social network of the community. Implications for administrating this type of project through statewide EMS systems are discussed.

Adult↗
PubMedDate not supplied

Using a community cancer treatment trials network for cancer prevention and control research: challenges and opportunities.

Using data collected as part of a larger evaluation of the National Cancer Institute-funded Community Clinical Oncology Program (CCOP), this paper examines the degree to which selected community, interorganizational, and structural characteristics associated with accrual to cancer treatment protocols share equal importance in accruing patients to cancer prevention and control research protocols. Analysis reveals that there are similarities in the factors that prove to be effective for accrual to both types of protocols; however, the two are not isomorphic. CCOP structure was an important predictor of treatment accrual but was not significant for cancer control accrual. Variables measuring the community health resources available to the CCOP were not significant for either treatment or cancer prevention and control research accrual when CCOP structure and interaction with participating research bases were considered. Only CCOP interaction with participating research bases was a significant predictor of both treatment and cancer prevention and control research accrual. The policy implications of these findings are discussed.

Clinical Protocols↗
PubMed1994

Increasing coordination of the dementia service delivery network: planning for the Community Outreach Education Program.

Dementia is an emerging public health concern because of its prevalence and the cost and extent of care typically needed for people with cognitive disorders. When family members seek assistance in providing care, they frequently encounter a fragmented service delivery network. To increase the coordination of services for people with dementia, the Community Outreach Education Program (COEP) has been designed to provide educational interventions to disseminate information about the diagnosis, assessment, management, and treatment of dementia to health care professionals, service providers, staff of volunteer and community organizations, and family members. This article describes plans for the COEP within the context of a community development perspective.

Aged↗
PubMed2000

Fox Chase Network: Fox Chase Cancer Center's community hospital affiliation program.

Fox Chase Cancer Center developed a format for affiliation with community providers in 1986. Fox Chase Network was formed to establish hospital-based community cancer centers to increase access to patients involved in clinical research. Under this program, the Fox Chase Network now contributes 500 patients per year to prevention and clinical research studies. As relationships with community providers form, patient referrals have increased at Fox Chase Cancer Center and for each Fox Chase Network member. A dedicated staff is required to operate the central office on a day-to-day basis as well as at each affiliate. We have found this to be a critical element in each program's success. New challenges in the cancer business-increasing volumes with declining revenue-have caused us to reconfigure the services offered to affiliates, while maintaining true to our mission: to reduce the burden of human cancer.

Cancer Care Facilities↗
PubMed2004

[Construction of pharmacy network to support home care].

Today, as medical care specialization and medical fee system coverage are rapidly progressing, hospitals have no choice but to reduce the number of hospital-stay days for patients. As a result, patients are being placed in home for medical care. Home care entails the transfer of care to the home of patients who are highly dependent on medical care. Consequently, it is expected that the number of cases requiring medical treatment also will increase. To support this type of home care, pharmacies will promote the supply of not only oral drugs but also injectables for use in nutrient management and pain control as well, while pharmacists will promote an appropriate drug therapy for patients who are convalescing at home, by visiting patients and providing advice for drug management. However, the reality is far from that because there are fewer than 50 pharmacies in the nationwide scale that can supply injectables. Considering future home care development, it is urgent that a pharmacy network should be constructed and facilities be created for supplying drugs.

Aged↗
PubMed2006

Comprehensive management of the access to the electronic patient record: towards trans-institutional networks.

BACKGROUND: A system ensuring tight control access is used since 5 years at the University Geneva Hospitals (HUG) over a four campuses health care system with ambulatory care settings behaving like a small community care network. Access to identified clinical information is limited to care providers that have a therapeutic relationship with the patient and to those data needed for that relation. The same policy applies to administrative or scientific research accesses. This paper presents how the HUG met the challenging goal of protecting patient privacy within regulatory limits while keeping the system operational in terms of use and management. SOLUTION: The main characteristics of the system are: (a) an institution-wide policy for access rights to the computerized patient record; (b) an institutional management of the contracts of the collaborators; (c) access profiles based on application-independent, fine-grained access rights; (d) a decentralized attribution of profession-specific access profiles; (e) a complete, centralized log of all accesses to the clinical information system; and (f) a decentralized verification of the accesses. Many of these characteristics can be maintained when evolving towards a trans-institutional computerized patient record, but new constraints need to be taken into account.

Access to Information↗
PubMed2001

The Ministry of Public Health telemedicine network of Thailand.

The concept of telemedicine is rather new in Thailand and initially, the introduction of telemedicine into the country was hampered by technological limitations. The problem was further aggravated by the inadequacy of telecommunications infrastructures in the rural areas. However, recent rapid advances in info-communications technology, together with the launch of Thailand's first communication satellite, THAICOM I in December 1993, have made it possible for health care to be delivered to remote areas of the country via telemedicine. This paper documents the experience of implementing Thailand's nationwide Telemedicine Network by the Ministry of Public Health (MOPH), beginning with a pilot project in 1994 to the current system, launched in January 1998, that links the Information Technology Office of the MOPH and 19 hospitals with health facilities all over the country via satellite and computer networks.

Communication↗
PubMed1992

Coping with the threat of AIDS: the role of social support.

OBJECTIVE: There has been relatively little clinical research on how asymptomatic HIV-positive men cope with the threat of AIDS. The present study was intended to 1) describe the coping strategies used by asymptomatic HIV-positive homosexual men, 2) examine the relationship of coping to dysphoria and self-esteem, and 3) explore how race and social support correlate with coping. METHOD: The study group was composed of 52 asymptomatic HIV-positive homosexual men. A group of 53 HIV-negative homosexual men was used for descriptive comparison. Data on coping, social support, dysphoria, and self-esteem came from self-report measures; depression was also determined by interviews with the Hamilton Rating Scale for Depression. RESULTS: The authors found that 1) subjects primarily coped with the threat of AIDS by adopting a fighting spirit, reframing stress to maximize personal growth, planning a course of action, and seeking social support; 2) more helpless coping, less fighting spirit, and less personal growth were related to dysphoria and poor self-esteem, whereas denial was related to more depression, anger, and helpless coping; 3) satisfaction with one's social support networks and participation in the AIDS community were related to more healthy coping strategies (e.g., fighting spirit, personal growth); and 4) black subjects expressed more denial, more helplessness, and less social support. CONCLUSIONS: These results suggest that health professionals should encourage more adaptive coping strategies, help patients use existing sources of positive social support, and assist patients, particularly black patients, in finding community support networks.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Alaska telemedicine: growth through collaboration.

The last thirty years have brought the introduction and expansion of telecommunications to rural and remote Alaska. The intellectual and financial investment of earlier projects, the more recent AFHCAN Project and the Universal Service Administrative Company Rural Health Care Division (RHCD) has sparked a new era in telemedicine and telecommunication across Alaska. This spark has been flamed by the dedication and collaboration of leaders at he highest levels of organizations such as: AFHCAN member organizations, AFHCAN Office, Alaska Clinical Engineering Services, Alaska Federal Health Care Partnership, Alaska Federal Health Care Partnership Office, Alaska Native health Board, Alaska Native Tribal health Consortium, Alaska Telehealth Advisory Council, AT&T Alascom, GCI Inc., Health care providers throughout the state of Alaska, Indian Health Service, U.S. Department of Health and Human Services, Office of U.S. Senator Ted Steens, State of Alaska, U.S. Department of Homeland Security--United States Coast Guard, United States Department of Agriculture, United States Department of Defense--Air Force and Army, United States Department of Veterans Affairs, University of Alaska, and University of Alaska Anchorage. Alaska now has one of the largest telemedicine programs in the world. As Alaska moves system now in place become self-sustaining, and 2) collaborating with all stakeholders in promoting the growth of an integrated, state-wide telemedicine network.

Alaska↗