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PubMed2002

The Zambia quality assurance program: successes and challenges.

OBJECTIVES: The objectives of the evaluation were to review the performance of the Zambia Quality Assurance Program (ZQAP) and provide recommendations to help design its next phase. DESIGN AND METHODS: Topics for evaluation were identified from a systems analysis of what an 'ideal' quality assurance (QA) program might look like. The evaluation team was made up of six experts who developed questionnaires to guide the interviews and related scoring tools. The evaluation team visited 24 health facilities in nine districts, representing all four regions of Zambia, and interviewed 140 persons, including health personnel from the public and private sectors, and non-health personnel. FINDINGS: In 5 years, senior staff built a QA structure and capacity throughout Zambia, generated enthusiasm for QA, and initiated teamwork on quality of care issues by motivated health staff. Some challenges remain: lack of integration of QA, uncoordinated standards, weak methods of standards communication, poor measurement of compliance with clinical care standards, constraints on the work of the quality improvement teams, and inconsistent support systems. RECOMMENDATIONS: The evaluation team made recommendations regarding a national QA policy, mechanisms to develop standards of care, monitoring of health providers' performance, needs of quality improvement teams, training in QA, and documentation of QA activities. CONCLUSIONS: Despite its success in covering the entire country with a network of QA coaches and trainers, the capacity of the public sector to sustain QA activities at the central and district levels remains a challenge. Lessons from the Zambia experience can benefit QA programs in other developing countries.

Developing Countries↗
PubMedDate not supplied

Implementing reproductive health awareness: progress to date.

This paper describes the experience of various institutions in integrating a reproductive health awareness (RHA) approach into different health, school and community-based programs. RHA, an educational approach that evolved from the Institute's client empowerment approach to natural family planning and fertility awareness, is based on helping women and men to participate actively in their own family planning and reproductive health care by developing skills in self-observation, communication and self-advocacy. In addition to providing the Institute with an avenue for responding to the Cairo and Beijing mandates, RHA has also provided a means to introduce family planning, particularly natural methods of family planning, into programs and institutions. RHA has continued to evolve and strengthen during the process of field testing its contributions to existing reproductive health programs.

Awareness↗
PubMed1999

Common reasons why peer education fails.

Peer education frequently fails. The reasons are numerous and can usually be avoided with clear planning. The most common reasons cited for failure relate to project design and implementation difficulties. The aim of this review is to identify the primary reasons for the failure of peer education programmes in order to help project managers avoid making similar mistakes in the future.

Adolescent↗
PubMed2006

The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors.

BACKGROUND: With increased breast cancer survivor rates among older women, the negative outcomes of breast cancer treatment may linger for years. METHOD: We designed and implemented an oncologist referred, exercise self-management program to increase physical activity and health-related quality of life using a pretest-posttest, single group design. We recruited 34 breast cancer survivors seen for a follow-up oncology visit at two university cancer treatment centers. Women with a mean age of 59.6 years (S.D.=66) comprised the sample. Average time since diagnosed was 3.1 years; 45% had stage I breast cancer and 55% had stage II; 62% received chemotherapy and 59% received a mastectomy. Following a baseline assessment on exercise support, self-efficacy, barriers and benefits; quality of life; and a functional performance test, subjects participated in self-management classes and received telephone support. Participants (n=30) repeated the assessment at 6-months. We compared scores between time periods using t-tests. RESULTS: Older women increased frequency of weekly, moderate physical activities (p<or=0.04), and weekly caloric expenditure (p<or=0.02). Perceived exercise barriers (p<or=0.02), aerobic endurance (p<0.04) and lower body strength (p<0.03) approached significance, and health-related quality of life (p<or=0.001) significantly improved. CONCLUSION: An exercise self-management format referred by an oncologist is efficacious for implementing a lifestyle modification change among older breast cancer survivors.

Breast Neoplasms↗
PubMed2000

The implementation of the DHHS guidelines for the use of antiretroviral agents in HIV-infected adults: a pilot study.

The objective of this study was to assess whether United States DHHS guidelines for treatment with antiretroviral therapies are being implemented by health care providers when discussing treatment options with newly diagnosed HIV patients. Health care providers were observed interacting with HIV patients while making decisions about treatment. Observers assessed whether providers and patients discussed the five benefits and six risks of initiating antiretroviral therapy, as recommended in the DHHS Guidelines. Preliminary results indicate that the DHHS Guidelines are not being implemented in the way they were intended. The risks and benefits of antiretroviral therapy were infrequently discussed. No more than four of the 11 risk/benefit items were discussed with any patient, and four of the six risk items were never mentioned to any patient. Potential reasons why the guidelines are not being implemented are discussed.

Adult↗
PubMed2003

Surveillance of human Campylobacter infections in France--part 2--implementation of national surveillance.

In 2001, one year after the study of microbiological laboratories that showed the feasibility of a surveillance of Campylobacter infections, 1389 private laboratories were asked whether they would be willing to participate. The high proportion of positive responses (48%, 661) allowed the implementation on 1 April 2002 of surveillance of human Campylobacter infections.

Campylobacter↗
PubMed2004

Adding insight: a qualitative cross-site study of physician order entry.

The research questions, strategies, and results of a six-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative nature of qualitative inquiry stimulates a consecutive stream of research foci which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question "what are the success factors for implementing CPOE?" Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process.

Data Collection↗
PubMed2003

Translating research into practice: how are guidelines implemented?

Numerous guidelines have now been produced both nationally and internationally for the management of respiratory and nonrespiratory disease. They should be regarded as useful tools designed to aid the busy clinician, but their method of production, their value and especially their applicability to primary care and to low income countries need to be assessed critically. The production of guidelines needs to be carefully incorporated into a planned dissemination and implementation programme. This is likely to be most successful when use is made of interactive educational methods associated with intraconsultation prompting and use of reminders. Updating and life-long learning is necessary and guideline revisions need to be closely incorporated into continuing medical education programmes. National campaigns, the use of media and the "training" of patients to make them more effective partners in healthcare can all enhance a beneficial change in health professional behaviour. Recent research has enhanced the knowledge of a wide range of respiratory conditions and very effective therapies now exist for many conditions. However, too little attention is often given to the ways in which care is organised and to the important aspects of management that are nonpharmacological. When dealing with long-term conditions, long-term supervision and the teaching of self-management skills are as important as the prescription. In many parts of the world the ideals, as laid out in guidelines, remain dreams and will continue to be dreams until there is some global redistribution of wealth. Only then will research be translated into practice everywhere.

Attitude of Health Personnel↗
PubMed2006

The GP's response to pandemic influenza: a qualitative study.

BACKGROUND: Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring. OBJECTIVE: Our aim was to assess general practice preparedness to respond to pandemic influenza and to identify issues that need to be addressed to enhance preparedness for the next pandemic. METHODS: We conducted a series of semi-structured interviews to explore GPs' views regarding their role in responding to pandemic influenza, practice preparedness and planning issues, and the expectations and requirements of GPs for provision of professional services during a pandemic. The subjects were 60 Australian GPs, purposively selected to maximize diversity within the sample. RESULTS: GPs in this study expressed a willingness to provide professional services in a pandemic. The motivation for this was largely altruistic and was in the context of high personal risk of becoming infected. Participants did not have stockpiles of antivirals or personal protective equipment within their practices and felt that government had a duty of care to stockpile on behalf of the general practice workforce. Participants were enthusiastic about receiving further information and training in pandemic preparedness. The most appropriate setting for this was within practices. CONCLUSIONS: GPs were willing to provide clinical services in a pandemic. However, appropriate education, training and supply of equipment were necessary to support them in this role. This information will inform further planning for the public health response to pandemic influenza.

Adult↗
PubMed1998

[Conception and conversion of medical technology assessment--an international comparison].

The outcome of adjusting health care spending to the overall economic performance of the country has become a major issue of health care policy of the industrialized nations. How can progress in medicine be consistently financed under the restriction of fixed contributions to mandatory sickness funds? Medical Technology Assessment is an interdisciplinary concept that proposes solutions to this issue. This article discusses the concept of Medical Technology Assessment and shows how Medical Technology Assessment should be implemented into the health care system. This article depicts how Medical Technology Assessment is implemented in the United States of America, in the United Kingdom and in the Netherlands. It also discusses which institutions take steps towards Medical Technology Assessment in Germany. The second article examines how to implement Medical Technology Assessment into the German health care system.

Cross-Cultural Comparison↗
PubMed2001

[Quality management in German rehabilitation clinics - a stratified representative survey].

BACKGROUND: As of January 1, 2000 rehabilitation clinics in Germany are obliged to implement and develop a quality management system. OBJECTIVE: This study aims to depict the implementation of quality management (QM), to trace the preferred QM models, identify the reasons for and experience with the introducing quality management, and inquire into the quality tools used in rehabilitation clinics. METHODS: Postal study of a representatively selected random sample of 298 rehabilitation clinics, stratified along the criteria state, number of beds and financially responsible agency, using six questions with nominally scaled items. Questionnaire design provided no clues as to the responding clinics. The study was designed along the Total Design Method. RESULTS: 89 % of the responding clinics have implemented a QM system, or are about to or planning to do so. Only 11 % reject quality management. 59 % implemented their system in 1998, 1999 or 2000. Among the reasons for implementing a QM system, items related to potentials of quality management predominate, whereas demands by third parties are given only very rarefy. DISCUSSION: The response rate was 59 %, i. e., the study can be considered representative. The high share of clinics taking a positive view on quality management is however somewhat modified by the fact that 40.4 % of the clinics have adopted or are planning far traditional quality assurance methods. Whether these systems will satisfy the legal requirements in place (SGB V) is doubtful. Adjusted, responses show that 48.9 % of the clinics are running QM systems, are about to or planning to implement one. CONCLUSIONS: Many of the responding clinics have already implemented a QM system or are about to do so. A majority of the clinics however rely on traditional quality assurance methods. Whether quality assurance will satisfy the legal requirements in place (SGB V) re an internal quality management system must be awaited.

Germany↗
PubMed2001

Predicted impact on Victoria's ambulance services of a new major trauma system.

BACKGROUND: In 1999, a new major trauma system was proposed for the state of Victoria, Australia. The guidelines for the new system were aimed at delivering major trauma cases to definitive trauma care in the least time possible. The aim of the present study was to analyse the potential effect of this system on Victoria's ambulance services. METHODS: The present study modelled the workload of major trauma cases in Victoria's ambulance service for one year pre- and post-introduction of the guidelines. Cases were analysed regarding whether their first hospital destination would change under the proposed guidelines, and, subsequently, whether they would require interhospital transport to a higher level trauma service. The impact on the ambulance services was modelled as annual changes in distances travelled due to predicted changes in hospital destinations. RESULTS: Analysis of the predicted changes indicated that, in general, Victoria's metropolitan and rural road ambulance crews would not be greatly affected. However, some metropolitan road crews may have to travel extra distances for up to 110 cases per year. The major impact was on air retrieval crews, where the annual number of interhospital transfers is predicted to increase from approximately 150 to 330. CONCLUSIONS: The present study demonstrated that most of the impact of a new trauma system on Victoria's ambulance services could be readily absorbed into the current workload. However, it also highlighted areas affected disproportionately within the ambulance services; in particular, air retrieval. Such studies are important to enable the effective implementation of new trauma systems.

Aged↗
PubMed1999

Implementation of substance use screening in prenatal clinics.

BACKGROUND AND OBJECTIVES: To reduce women's consumption of alcohol and other drugs during pregnancy, the Department of Epidemiology for the Aberdeen Area Indian Health Service (AAIHS) promoted a maternal substance use screening program for prenatal clinics in 1992. This report describes the adherence to the screening protocol at AAIHS facilities and barriers to such screening. METHODS: Prenatal clinic staff members at 20 AAIHS health care facilities were surveyed to determine the extent of prenatal substance use screening and the barriers to its implementation. The medical records of a random sample of 235 women who sought prenatal care at five hospitals were reviewed to determine whether prenatal clinic staff adhered to the screening protocol. RESULTS: Of the 20 health care facilities, 13 (65%) had implemented the screening. The major barriers to implementing screening were lack of training in prenatal substance use screening and lack of clinic staff designated to administer the screening protocol. Though not statistically significant, our data suggest that women not administered the screening questionnaire were more likely to be multiparous (prevalence ratio = 2.1; 95% confidence interval = 0.9, 4.5). CONCLUSIONS: To improve screening of pregnant women for substance use, prenatal clinic staff members should address administrative barriers and assess adherence of health care providers and patients to the screening protocol. Training of prenatal clinic personnel is essential to implement optimal maternal substance use screening in prenatal clinics.

Female↗
PubMed2001

Development and implementation of a clinical pathway for severe traumatic brain injury.

BACKGROUND: Clinical pathways (CPs) have been shown to be beneficial in optimizing patient care and resource use. METHODS: A multidisciplinary CP for the treatment of severe traumatic brain injury (Glasgow Coma Scale score of 3-7) was developed. Data from these patients (group I) were collected prospectively and compared with a retrospective database (group II). RESULTS: There were a total of 119 patients managed in conjunction with the CP and 43 patients in the control group. No statistical differences were found between the groups in age, Glasgow Coma Scale score at 24 hours, or Injury Severity Scores. There was a significant decrease in the length of hospital stay, intensive care unit stay, and length of ventilator support in the study group (group I: 22.5, 16.8, and 11.5 days, respectively; group II: 31.0, 21.2, and 14.4 days, respectively; p < 0.03). CONCLUSION: The use of this CP helped to standardize and improve patient care with fewer complications and a potential cost savings of approximately $14,000 per patient.

Adolescent↗
PubMed2006

The impact of subspecialty services on health care delivery--a community health centre based study.

OBJECTIVES: The objective was to evaluate the role of a paediatric surgical consultant at a primary health care facility. DESIGN: Descriptive and prospective. SETTING: In the process of planning and implementation of the 2010 health plan of the Provincial Government of the Western Cape, a shift occurred in the delivery of health care to children from a provincially based hospital system to a municipally based primary health care system. To contribute towards enabling this process, the Department of Paediatric Surgery at Red Cross War Memorial Children's Hospital established a paediatric surgical day clinic at a local community health centre during 2001. SUBJECTS: Information was obtained from patient data sheets containing details of consultations at the sub-specialist surgical clinic at Michael Mapongwana Community Health Centre. RESULTS: Over a 58-month period 1 171 children were seen, of whom 655 were male and 427 female. Their ages ranged from 0 to 19 years, the largest group being under 1 year. Eighty per cent of patients were accompanied by their mothers. The correct diagnosis was established by the nurse practitioners in 71%. General paediatric surgical conditions predominated, followed by medical, dermatological, orthopaedic, trauma, otolaryngo-pharyngology, infectious diseases, ophthalmology, urology, neurosurgery, malignancy and maxillofacial conditions. The details are set out in the report. In total 597 patients were referred directly to an appropriate care facility and 574 patients could be managed entirely at the clinic level. CONCLUSIONS: This study demonstrated the significant public health problem of paediatric surgical disease. It emphasized the preventative and cost-effective role of a surgical clinic at primary health care level. The clinic allowed for timely surgical intervention in 65% of surgical cases, thereby decreasing inappropriate tertiary referrals. We believe that bringing specialists into the community can only strengthen the 2010 health care plan.

Adolescent↗
PubMed1992

The use of selected interventions in monitoring primary health care implementation in rural Nigeria.

Nigeria's Primary Health Care (PHC)-based health system development aims to strengthen PHC in the local government areas (LGA) through technical planning and implementation that emphasize maternal and child health services. Convenient variables, including expanded programme on immunization (EPI), antenatal care (ANC) utilization and attended births, were selected as interventions to monitor the progress of implementation of PHC activities during 1985-90 in Odukpani LGA. Analysis of available data at the LGA showed that immunization coverage for most EPI antigens increased; ANC services showed increased utilization; health worker-attended births increased as traditional birth deliveries declined during the period. Some of the increases were modest but are considered important. The study offers a pilot approach to monitoring implementation of PHC activities in Odukpani LGA. The implications of the findings for similar studies are discussed.

Adolescent↗