Global ETD Search

141	Quantitative determinants of need and demand for primary care in the district of Columbia Andoh, Jacob Yankson 08 May 2015 (has links) This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study attempted to answer the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to demand decreased, from 2.62 (1985) to 1.80 (in 2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC’s small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city’s overall primary care visits need. Epidemiological profiles and physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs / Health Studies / D. Litt. et Phil. (Health Studies) Primary care Need methodology Census tract grouping Physicians distribution Primary care service index Composite need score Primary care priority score Potential demand Satisfied demand Primary care visits shortage Primary care planning 362.109753
142	The need for social work intervention for the elderly patients and their family members Abo, Yasuyo 01 January 2005 (has links) Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals. Older people Hospital care United States Medical social work United States Continuum of care United States Continuum of care Hospitals Admission and discharge Hospitals After care Planning Medical social work Older people Hospital care Social work with older people. Gerontology Social Work
143	Le droit de l'imagerie médicale et ses enjeux de santé publique : étude comparative France, Angleterre, Allemagne et Québec / Medical imaging law and public health issues : comparative study France, England, Germany and Quebec Benyahia, Nesrine 06 June 2017 (has links) L'imagerie médicale est une activité de soins à la croisée de toutes les spécialités médicales. Elle est devenue une activité de soins primordiale au coeur du diagnostic et du traitement de nombreuses pathologies en oncologie, neurologie et cardiologie, par exemple. Son rôle essentiel dans le parcours de soins du patient est le résultat du développement important des technologies, mais également des indications cliniques. L'encadrement de l'imagerie médicale dans le système de santé français reste néanmoins flou et bordé de contraintes juridiques et économiques. Ce flou juridique et économique est un frein à l'accès effectif aux techniques d'imagerie médicale pour les patients à travers notamment un contrôle exacerbé des installations des équipements et une tarification des actes désorganisée. Par ailleurs, l'absence d'évaluations médico-économiques retarde l'implémentation des innovations et crée même des risques d'atteinte à la sécurité et à la qualité des examens d'imagerie réalisés. / Medical imaging is a care activity at the crossroads of all medical specialties. It has become a primary care activity at the heart of the diagnosis and treatment of many pathologies in oncology, neurology and cardiology, for instance. Its essential role in the care path of the patient is the result of the important development of the technologies, but also of the clinical indications. The framing of medical imaging in the French healthcare system remains nevertheless unclear and bordered by legal and economic constraints. This legal and economic uncertainty is an obstacle to the effective access to medical imaging technology for patients through, in particular, an exacerbated control of equipment installations and a disorganized acts pricing procedure. Furthermore, the lack of medico-economic evaluations delays the implementation of innovations and even creates risks to the safety and quality of the imaging tests performed. Imagerie médicale Radiologie Autorisation Organisation des soins Planification Tarification Forfait technique Accès aux soins Patients Prévention Évaluation médico-économique Innovation Produits de santé Précaution Sécurité sanitaire Santé publique Medical imaging Radiology Authorization Mri Computer tomography Ultrasound system Care organization Care planning Pricing Efficiency Technical package Care access Patient Prevention Health economics assessment Innovation Health products Caution Safety Public health 344.041
144	Screening for Adverse Childhood Experiences in Primary Care. Ameh, Mary 07 April 2022 (has links) Adverse Childhood Experiences (ACEs) include childhood exposure to abuse or violence, a parents' divorce, mental illness, substance use disorder, and are identified as risk factors for negative life outcomes. While ACEs screenings are commonly used in mental health and pediatric settings, screening for ACEs in primary care settings is less prevalent. The purpose of this project is to integrate screening for ACEs into a primary care setting and make appropriate referrals for follow-up, thus reducing potential negative life outcomes. The process was designed for a primary care practice located in Winston-Salem, North Carolina. Part one assessed level of awareness and screening history which determined training focus. Each provider and staff member received 30-45 minutes of training on ACEs screening algorithm, a detailed approach to guide treatment. The training was followed by question-and-answer sessions to address concerns. Part two, involved screening using the Center for Youth Wellness, Adverse Childhood Experiences Questionnaire for Children (CYW ACE-Q Child) which was initiated by the front office employee. Front office employee identified patients present for an annual well visit, briefly explained the screening tool, and handed it to the patient on a clipboard. The patient returned the completed form to the Certified Medical Assistant (CMA) when called in from the waiting room. The provider reviewed the ACEs screening and made referrals as appropriate. Part three involved data collection and analysis. Responses were collected weekly for nine weeks. The responses collected will be analyzed using quantitative statistics. The expected outcome is to note progressive increase in screening activities and when appropriate, followed by referrals to community agencies and organizations. The project educated clinicians about ACEs and created awareness among clinicians in a primary care setting to mitigate potential negative life outcomes. Barriers to integrating ACEs screening included employees' absence of training, lack of confidence in the subject matter, limited time frame to complete the screening, and fear of damaging patient-provider relationships. Barriers were mitigated through employee training, repetitive implementation of ACEs screening, and therapeutic communication with patients. The CYW ACE-Q was reserved for those arriving early or on time for their annual wellness visit to allow adequate time for completion. Recommendations include incorporating the CYW ACE-Q into all primary care visits to further intervene with referrals thereby enhancing patients' overall quality of life. Adverse Childhood Experiences Screening Prevention Healthcare and Medicine Ambulatory Care Family Health Services Health Care Cost Containment Health Care Management Health Information Technology Health Maintenance Organizations Health of Underserved Populations Health Services Delivery Patient Care and Education Patient Care Planning Public Health Quality of Life Safety
145	“... ja, ingen mår egentligen bra i den här organisationen av att allt ska gå så fort.” : Biståndshandläggares röster om utskrivningsprocessen inom äldreomsorgen / "... well, no one really feels good in this organization that everything has to go so fast." : Care managers' voices about the discharge process in elderly care Danielsson Wiklund, Jessica, Olausson, Jennifer January 2023 (has links) Syftet med denna studie har varit att undersöka om biståndshandläggares arbete inom äldreomsorgen har förändrats i samband med utskrivningsprocessen från sjukhus mot bakgrund av den nya lag som tillkom januari 2018, lag (2017:612) om samverkan vid utskrivning från sluten hälso- och sjukvård. Vi har velat synliggöra vilka förändringar av arbetet som skett i och med att lagändringen trädde i kraft, vad dessa i praktiken inneburit för biståndshandläggarna i arbete med äldre samt undersöka vad de upplever sig behöva för hanteringen av detta. Studien har en kvalitativ ansats och det empiriska materialet består av totalt åtta intervjuer med yrkesverksamma socionomer inom biståndshandläggning äldreomsorgen vid en stadsdelsförvaltning belägen i Stockholms kommun. Det insamlade materialet har analyserats genom användningen av en perspektivanalys och analysschema av Håkan Jönson. Vidare har vi analyserat våra resultat utifrån Michael Lipskys teori om gräsrotsbyråkrater och även använt oss av teoretiska begrepp som handlingsutrymme och makt. Resultatet av studien visar att det finns flera bakomliggande faktorer som påverkar biståndshandläggarnas upplevelser av sin yrkesroll utifrån den nya lagändringen, en har medfört ett förändrat arbetssätt och bland annat ställt krav på en högre grad av effektivisering i deras arbete. Respondenterna uttrycker att arbetssättet blivit mer akutstyrt, kravfyllt och de har svårigheter att förfoga över sin egen arbetstid vilket leder till att utskrivningar prioriteras framför hembesök och uppföljningar som därmed skjuts upp. Vidare framgår att det har blivit en sämre kvalité i arbetet då biståndshandläggarna pressas till att arbeta bakvänt i handläggningen till följd av bristande och uteblivna ADL-bedömningar (aktiviteter i det dagliga livet) från vårdens sida och de förkortade handläggningsdagarna i samband med utskrivningsprocessen. Biståndshandläggarna påverkas av stress i arbetet då tempot avsevärt har ökat vilket kan leda till felaktigheter i handläggningen och i förlängningen en känsla av otrygghet och rättsosäkerhet för den äldre. / The purpose of this study has been to investigate how the work of care managers has changed in connection with the discharge process from hospital against the background of the new law that was added in January 2018, Law (2017:612) on collaboration during discharge from inpatient health care. We wanted to make visible the changes to the work that took place as a result of the change in law coming into force, what these meant in practice for the care managers, and to examine what they feel they need to handle this. The study has a qualitative approach and the empirical material consists of a total of eight interviews with professional care manager in the field of elderly care assistance at a district administration located in Stockholm municipality. The collected material has been analyzed through the use of a perspective analysis and analysis scheme by Håkan Jönson. Furthermore, we have analyzed our results based on Michael Lipsky's theory of the street-level bureaucrats and also used theoretical concepts such as discretion and power. The results of the study show that there are several underlying factors that affect the care managers experiences of their professional role based on the new law change, one has brought about a changed way of working and, among other things, set demands for a higher degree of efficiency in their work. The respondents express that the way of working has become more urgent, full of demands and they have difficulties managing their own working hours, which leads to discharges being prioritized over home visits and follow-ups, which are therefore postponed. Furthermore, it appears that there has been a lower quality in the work as the care managers are pressured to work backwards in the processing as a result of insufficient and absent ADL assessments (activities in daily life) from the care side and the shortened processing days in connection with the discharge process. The care managers are affected by stress at work as the pace has increased significantly, which can lead to errors in the processing and, by extension, a feeling of insecurity and legal uncertainty for the elderly. Elderly care Social work Social worker Care manager Care planning Hospital discharge Working conditions Workload Work-related stress Street-level bureaucrat Discretion Power Äldreomsorg Socialt arbete Socionom Biståndshandläggare Vårdplanering Utskrivningsplanering Arbetsvillkor Arbetsbelastning Arbetsrelaterad stress Gräsrotsbyråkrat Handlingsutrymme Makt Social Work Socialt arbete
146	Worlds of Connection: A Hermeneutic Formulation of the Interdisciplinary Relational Model of Care McCune, Susana Lauraine 15 October 2015 (has links) No description available. Psychology Psychotherapy Health Care Medical Ethics Medicine Oncology Philosophy of Science Public Health Education Therapy Aging Communication Clinical Psychology Counseling Psychology Health Education Gerontology Health Sciences Advance care planning advance directives end-of-life care psychology relational psychoanalysis compassion communication hermeneutics aging gerontology health care health education medical ethics
147	Ontario’s Home First Approach, Care Transitions, and the Provision of Care: The Perspectives of Home First Clients and Their Family Caregivers English, Christine 23 May 2013 (has links) Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323 home support workers home health care community care older home support clients elder care discharge planning relationships family relationships nursing home Ontario health care Canadian health care placement Home First transition management care transitions aging in place maintaining independence caregiving community health and support services community long-term care family carers frail seniors client satisfaction hospital discharge health care older people aged frail elderly aging elderly supportive home care client perspectives long-term care quality of care evaluation of services care planning risk decisions case management communication independence home care constraints on care provision maintaining independence qualitative research family caregivers nursing home placement qualitative description program evaluation alternative level of care patient discharge self-care formal care aged care informal care post-discharge care home support community support services health services research

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