Numerose ambivalenze, conflitti interpretativi e problemi di traduzione culturale sorgono quando si usa il concetto di care. Per l’antropologia medica, esso ha offerto la possibilità di criticare forme di riduzionismo bio-medico della... more
Numerose ambivalenze, conflitti interpretativi e problemi di traduzione culturale sorgono quando si usa il concetto di care. Per l’antropologia medica, esso ha offerto la possibilità di criticare forme di riduzionismo bio-medico della cura. Allo sviluppo di questa visione morale ha contribuito l’aumento di malattie croniche per cui non esiste “cura”, nel senso di guarigione – cure. Allo stesso tempo, il lavoro di cura informale ha assunto un’importanza strategica nello scenario di ristrutturazione dei servizi pubblici di assistenza. In questo senso, la visione morale del “prendersi cura” è stata accusata di distogliere l’attenzione dalle forme di diseguaglianza sociale che si riproducono nell’ambiente domestico e familiare attraverso la cura stessa. Attraverso il racconto etnografico di un convegno di antropologia medica a Edimburgo e un’ulteriore riflessione su una ricerca fra un servizio territoriale di assistenza ad anziani e caregiver in Emilia-Romagna, questo articolo offre alcune indicazioni analitiche sull’antropologia del prendersi cura. Sostengo che la distinzione fra “cura” e “prendersi cura” non rispecchi fino in fondo ciò che c’è davvero in gioco nelle pratiche di assistenza. Per superare le ambivalenze che derivano dallo stesso linguaggio morale che adotta, è necessario che l’antropologia del prendersi cura sposti l’attenzione sui modi in cui è classificata la relazione fra l’accudimento nella sfera domestica e il sistema istituzionale dei servizi di assistenza. Altrimenti, il rischio è quello di perdere di vista la questione di come, in quali circostanze e con quale sostegno pubblico, vengono assegnate le responsabilità di assistenza. Parole chiave: caregiving, ambivalenza, morale, assistenza, invecchiamento
US Latino adults are disproportionately affected by the HIV epidemic and experience disparities in access to HIV care. However, relatively little is known about how acculturation affects perceived barriers to engagement in care among... more
US Latino adults are disproportionately affected by the HIV epidemic and experience disparities in access to HIV care. However, relatively little is known about how acculturation affects perceived barriers to engagement in care among Latinos. This article examines factors that may be associated with engaging HIV-infected persons in primary care by using interview data from 651 Latino and non-Latino adults presenting for services at five agencies that participated in a multisite demonstration project Latinos (n=219) were more likely than non-Latino Whites (n=117) to be male, recently diagnosed with HIV, less educated, without health insurance, not on Medicaid, taking HIV medications, and in better physical health. In addition, Latinos were more likely to report facing numerous structural barriers, stigma-related worries/concerns, and belief barriers than were non-Latino Whites. Upon closer examination of the Latino subsample, acculturation (based on language) was associated with repo...
Conveying Health Care in America, Seventh Edition is the most current and extensive outline of the essential structures and activities of the U.S. wellbeing framework from its verifiable birthplaces and assets, to its individual... more
Conveying Health Care in America, Seventh Edition is the most current and extensive outline of the essential structures and activities of the U.S. wellbeing framework from its verifiable birthplaces and assets, to its individual administrations, cost, and quality. Utilizing a novel "frameworks" approach, the content unites an uncommon broadness of data into an exceptionally open, simple to peruse asset that explains the complexities of medical services association and account while introducing a strong diagram of how the different segments fit together.
With refreshed information and figures all through, the new seventh release is an exhaustive update that features numerous new patterns in medical services; analyzes current difficulties in cost, access, and quality; and investigates the tradition of Obamacare and the fate of medical services change considering the new administration.
Pay-for-performance (P4P) programs which reward clinical providers with incentive payments based on one or more measures of quality of care are now common in the United States and the United Kingdom and it is likely they will attract... more
Pay-for-performance (P4P) programs which reward clinical providers with incentive payments based on one or more measures of quality of care are now common in the United States and the United Kingdom and it is likely they will attract increasing interest in Australia. However, empirical evidence demonstrating effectiveness of such programs is limited and many existing programs have not had rigorous outcome evaluation. To maximise success, future P4P programs should incorporate the lessons and insights obtained from previous experience. Based on a review of published trials, program evaluations and position statements, the following principles that may guide future program design and implementation were synthesised: 1) formulate a rationale and a business case for P4P; 2) use established evidencebased performance measures; 3) use rigorous and verifiable methods of data collection and analysis; 4) define performance targets using absolute and relative thresholds; 5) use rewards that ar...
Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify... more
Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field. We distributed a brief online survey to...
There has not yet been an audit of achievement rates of therapeutic targets for cholesterol management in the rural Italian primary care setting. The purpose of this study was to measure the percentage of patients with... more
There has not yet been an audit of achievement rates of therapeutic targets for cholesterol management in the rural Italian primary care setting. The purpose of this study was to measure the percentage of patients with hypercholesterolaemia in a rural primary care setting in southern Italy, classify their risk category and measure the proportions of those patients who achieved optimal cholesterol levels according to the Adult Treatment Panel III guidelines. The audit was completed using records from 1 January 2005 to 31 December 2007. An electronic search key was entered into the electronic clinical records of 10 family doctors in a rural area of southern Italy for subjects with a diagnosis of or being treated for hypercholesterolaemia. A total of 194 hypercholesterolaemic patients were randomly selected from a cohort of patients registered with these family doctors. The low density lipoprotein cholesterol (LDL-C) target level was 100 mg/dL (2.6 mmol/L) in patients with existing car...
Primary health care encompasses laboratory testing where the entire analysis is performed by health care professionals in close proximity to the patient. The purpose of this survey was to understand the range of testing performed in... more
Primary health care encompasses laboratory testing where the entire analysis is performed by health care professionals in close proximity to the patient. The purpose of this survey was to understand the range of testing performed in primary health care in Sweden. The results obtained from the survey have been compared to data on the same topic published twenty years ago. The most frequently performed analyses in primary health care have barely changed in the last twenty years. For example, hemoglobin and sedimentation rate analyses are still prevalent. The variety of analyses performed in primary health care has increased, however. C-reactive protein is now a commonly performed analysis. Moreover, in this survey, the degree to which laboratories are quality assured and accredited has been investigated. Accreditation and quality assurance of laboratories varies regionally in Sweden with those facilities meeting the criteria varying from 0% in a province to 100%.
There is increasing importance placed on conducting clinical trials in dentistry to provide a robust evidence base for the treatment provided, and models of care delivered. However, providing the evidence upon which to base such decisions... more
There is increasing importance placed on conducting clinical trials in dentistry to provide a robust evidence base for the treatment provided, and models of care delivered. However, providing the evidence upon which to base such decisions is not straightforward, as the conduct of these trials is complex. Currently, only limited information is available about the strategies to deliver successful clinical trials in primary care settings, and even less available on dental clinical trials. Considerable knowledge and experience is lost once a trial is completed as details about effective management of a trial are generally not reported or disseminated to trial managers and researchers. This leads to loss of vital knowledge that could assist with the effective delivery of new trials. The aim of this study is to examine the conduct and delivery of five dental clinical trials across both Australia and the UK and identify the various factors that impacted upon their implementation. Findings ...
This qualitative study used the grounded theory method to investigate district nurses' experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centres in Stockholm, Sweden. Group... more
This qualitative study used the grounded theory method to investigate district nurses' experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centres in Stockholm, Sweden. Group interviews were conducted with 30 nurses. The results describe how district nurses strive to stay on track in order to follow clinical guidelines and remain motivated despite prolonged wound treatment and feelings of hopelessness. Three main obstacles to following the guidelines were found. District nurses used compensating strategies so the obstacles would not lead to negative consequences. If the compensating strategies were insufficient, perceived prolonged wound treatment and feelings of hopelessness could result. District nurses then used motivating strategies to overcome these feelings of hopelessness. Sometimes, despite the motivating strategies, treatment in accordance with guidelines could not be achieved. With some patients, district nurses had ...
Purpose. The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training... more
Purpose. The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. Methods. Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). Results. The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. Conclusions. The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended.
T o examine whether quality of care (QOC) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk... more
T o examine whether quality of care (QOC) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk of experiencing adverse health outcomes. Randomized controlled trial. A family health network with 8 family physicians, 5 nurses, and 11 administrative personnel serving 10 000 patients in a rural area near Ottawa, Ont. Patients 50 years of age and older at risk of experiencing adverse health outcomes (N = 241). At-risk patients were randomly assigned to receive usual care from their family physicians or Anticipatory and Preventive Team Care (APTCare) from a collaborative team composed of their physicians, 1 of 3 nurse practitioners, and a pharmacist. Quality of care for chronic disease management (CDM) for diabetes, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease. Controlling for baseline demographic cha...
Drug switching is a common medical practice. It indicates continuation of treatment regardless of the reason why the original therapy was stopped and switched. Therefore, the aims of this study were to develop a novel method for... more
Drug switching is a common medical practice. It indicates continuation of treatment regardless of the reason why the original therapy was stopped and switched. Therefore, the aims of this study were to develop a novel method for determining drug switching from routinely acquired NHS health data and to explore the aspect of continuation of care for patients. Patients who were first prescribed ramipril, simvastatin and an angiotensin receptor blocker (ARB) between 1 March 2004 and 28 February 2007 and discontinued their medication within 6 months of the index prescription were identified from the PTI database. The identified patients were then categorized into three groups: i) patients who were switched to a different drug for the same medical condition, ii) patients who were being prescribed with other types of antihypertensive/lipid-regulating drug prior to the initiation of study; and iii) patients who were without any continuation of care or therapy. Twenty percent (808), 29%(1429...
RESUMO: Este artigo propõe-se a construir uma possibilidade de utilização dos Grupos Balint- Paidéia como ferramenta pedagógica para a supervisão prática no Programa Mais Médicos para o Brasil, que incluiu o Programa de Valorização do... more
RESUMO: Este artigo propõe-se a construir uma possibilidade de utilização dos Grupos Balint-
Paidéia como ferramenta pedagógica para a supervisão prática no Programa Mais Médicos para
o Brasil, que incluiu o Programa de Valorização do Profissional da Atenção Básica (PROVAB)
e o Projeto Mais Médicos para o Brasil (PMMB). Realizou-se uma breve revisão teórica sobre a
metodologia Balint-Paidéia e construiu-se uma proposta de utilização adaptada às finalidades e
tarefas da Supervisão Prática, que foi discutida à luz das necessidades de provimento e fixação de
profissionais médicos para a Atenção Básica no Sistema Único de Saúde atrelado à necessidade de
formação e educação permanente para estes profissionais.
Palavras-chave: Recursos Humanos em Saúde; Educação Permanente; Saúde Pública; Atenção
Básica à Saúde.
ABSTRACT: This article proposes to build a possibility to use Balint-Paidéia Groups as a
pedagogical tool to practice supervision in the “Programa Mais Médicos para o Brasil”, that include
Professional Valorization Program of Primary Care (PROVAB) and More Doctors for Brazil Project to use adapted to the purposes and tasks of Practice Supervision, which was discussed in the light
of the needs of providing and fixing of medical professionals for the Primary Care in the System
National Health linked to the need for training and continuing education for these professionals.
Keywords: Health Manpower; Education, continuing; Public Health; Primary Health Care.
A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers... more
A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHW...
OBJECTIVES The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the... more
OBJECTIVES The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children. METHODS: A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm (“early-arm”); or (2) usual care until review and use of cough algorithm (“delayed-arm”). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm’s reliability, validity, and feasibility. RESULTS: Cough resolution (at week 6) was significantly more likely in the ear...
O avanço verificado no enfrentamento de neoplasias malignas por meio dos sistemas de saúde envolve melhorias nas áreas de vigilância, organização de redes de assistência, programas específicos voltados às prevenções primária e secundária... more
O avanço verificado no enfrentamento de neoplasias malignas por meio dos sistemas de saúde envolve melhorias nas áreas de vigilância, organização de redes de assistência, programas específicos voltados às prevenções primária e secundária e, obviamente, aos avanços técnico-científicos que caracterizam a abordagem diagnóstica e terapêutica. Embora seja notável o reconhecimento de avanços no manejo de neoplasias malignas em todas as áreas citadas, o câncer da boca permanece com indicadores de morbidade e mortalidade que parecem não acompanhar o acúmulo científico no conhecimento da doença. O presente manuscrito objetiva discutir os motivos desse descompasso, a necessidade de reorientação de prioridades na abordagem do câncer da boca e sua efetivação como política pública de saúde.
This paper describes the development of and lessons learned in implementing the Primary Health Care Access Program (PHCAP) in the Northern Territory. The implementation of the PHCAP is a major Aboriginal health policy reform. PHCAP... more
This paper describes the development of and lessons learned in implementing the Primary Health Care Access Program (PHCAP) in the Northern Territory. The implementation of the PHCAP is a major Aboriginal health policy reform. PHCAP provides an opportunity for Aboriginal people to gain access to properly resourced comprehensive primary health care (PHC) services. PHCAP is described in its unique funding model that attempts to address tensions within the federal governance system. In this paper we argue that access to PHC services is a key determinant of health and that funding of PHC services has been inadequate and inequitable throughout the Northern Territory. The implementation of PHCAP is reforming the existing health system and leading to the establishment of new PHC services. We analyse the barriers encountered in this process. The PHCAP funding model is analysed for its adequacy and design strength to address federal relations. We consider issues of workforce shortage that wil...
Abstract: “You can tell the condition of the nation by looking at the status of women.”Jawaharlal Nehru.Women's empowerment is vital to sustainable development and the realization of human rights for all. When women are empowered,... more
Abstract: “You can tell the condition of the nation by looking at the status of women.”Jawaharlal Nehru.Women's empowerment is vital to sustainable development and the realization of human rights for all. When women are empowered, whole families benefit, and these benefits often have ripple effects to future generations. But the study of women’s empowerment has raised a lot of concerns and issues that are associated with other demographic and health outcomes. The WHO constitution states: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic and social condition. " A major obstacle to enjoying the right to health is being born female. Women’s health is of crucial importance, which is greatly affected by the ways in which they are treated and the status they are given in the society as a whole. Studies have indicated that women are biologically a...
BACKGROUND Recommendations suggest that all patients with diabetes who use insulin should home test their blood glucose. Recommendations for those not using insulin remain contradictory. These recommendations are in part based upon the... more
BACKGROUND Recommendations suggest that all patients with diabetes who use insulin should home test their blood glucose. Recommendations for those not using insulin remain contradictory. These recommendations are in part based upon the assumption that people with diabetes cannot make an accurate estimate. AIM To explore whether people with diabetes can accurately estimate their blood glucose levels and to assess which factors explain variability in these estimates. DESIGN A cross-sectional design. SETTING One general practice in Oxfordshire, UK. PARTICIPANTS One hundred and fifteen consecutive patients with diabetes attending a diabetic clinic were invited to estimate their blood glucose level prior to having it routinely measured. RESULTS One hundred and four patients made estimates. Of these, 45 (43.3%) underestimated their blood glucose, 18 (17.3%) overestimated, and 41 (39.4%) made guesses that fell into the range defined as accurate. Of those not using insulin (n = 85), 37 (43....
Lifestyle factors (eg, smoking, diet) and compliance with screening recommendations play a role in cancer risk, and emerging technologies (eg, new vaccines, genetic testing) hold promise for improved risk management. However, optimal... more
Lifestyle factors (eg, smoking, diet) and compliance with screening recommendations play a role in cancer risk, and emerging technologies (eg, new vaccines, genetic testing) hold promise for improved risk management. However, optimal outcomes from cancer control efforts require better preparation of health professionals in risk assessment, risk communication, and implementing health behavioral change strategies that are vitally important to cancer control. Although physician assistants (PAs) are substantively engaged in cancer-related service delivery in primary care settings, few models exist to facilitate integration of cancer control learning experiences into the curricula used in intense, fast-paced, 24- to 30-month PA training programs.