Thesis (M.Public Health) -- University of the Western Cape, 2009. / Includes bibliographic references (leaves 118-126).

The high prevalence of HIV has been a major cause for concern in Lesotho and the clinical course has witnessed some service lapses, complications and deaths. The researcher was therefore motivated to conduct this study with the aim to assess care and outcomes offered to HIV patients at St. Joseph’s Hospital. The objectives were to describe patient socio-demographic and clinical characteristics at initiation of antiretroviral therapy, to describe clinical parameters of haemoglobin, AST, CD4 count levels as outcome proxy of care and to analyze the rate and predictors of patient retention and lost to follow-up. Methods A retrospective cohort study of 1060 patients initiated on ART at the Thusong ART Clinic in St. Joseph’s Hospital, Roma between August 2005 and July 2008 was conducted. Relevant documentation was captured from the patients’ clinical records hard copy files onto the Therapy-Edge (TE) database tool used. Patient confidentiality was respected The dataset was closed on 31st October 2012. Data were analyzed using STATA version 11. Results The total number of patients enrolled during the study period of August 2005 – July 2008 was 1060. The findings on the patients studied showed that 99.5% were Sotho with the majority of 70.2% being female. Patients in the age group of 16-35 years were 22.2%, in the age groups of 36-55 years and >55 years were 58.3% and 19.5% respectively. Median age was 43 years. Employed persons were 24.3%, students were 2.3%, unemployed persons were 44.8% and 28.6% were of unknown employment status. On WHO classification, 18.1% was WHO Stage I, 34.6% was Stage II, 43.4% was Stage III and 3% was Stage IV. Median weight at enrollment was 55.6kg. Baseline CD4 count < 50 cells/mm3 was 13.3%, count of 50 – 199 cells/mm3 was 43.2%, CD4 count ≥ 200 cells was 38.7%. Patients with Hb <10g/dl were 17.3%. On patient retention over a period of about 6 years, 57% of the patients were still alive and in care, 11.3% had been transferred out to the health centers and clinics, 29.5% were lost to follow up. It is noteworthy that only 2.2% were recorded as dead. Conclusion The study showed that more than half of the HIV patients on ART were female, thus suggesting better access to care and health seeking behaviour. Clinical parameters of haemoglobin, AST, CD4 cell counts used to monitor progress over follow-up period showed results comparable with other similar studies. Baseline CD4 count, WHO stage, age, gender and employment status were agreeable with studies in other settings to predict those lost to follow-up (LFTU). The low percentage of documented deaths suggests that some deaths may have been included in LTFU. Better documentation, staff training and retention, decentralization of care and proper follow-up measures are steps in the right direction for better ART monitoring and outcomes.

Doctor of Philosophy(PhD) / This thesis consists of a series of studies of new models of multidisciplinary community health care in four compartments. These compartments are acute, subacute, outpatient and maintenance care. The purpose of the individual studies is to demonstrate the benifits of munltidisciplinary community health care in delivering alternatives to current practice by replacing hospital care or improving traditional community care.

Doctor of Philosophy(PhD) / This thesis consists of a series of studies of new models of multidisciplinary community health care in four compartments. These compartments are acute, subacute, outpatient and maintenance care. The purpose of the individual studies is to demonstrate the benifits of munltidisciplinary community health care in delivering alternatives to current practice by replacing hospital care or improving traditional community care.

The purpose of this thesis was threefold – First to investigate the emergence from the existing health system of nurse practitioners as a new occupation. Second to make sense of how nurse practitioners developed as primary care providers in the province of Ontario. Third to understand the nature and development of the intra-professional relationship between primary care nurse practitioners and physicians in local practice settings. I used a case study approach, with both historical (document review) and empirical (ethnography and interview) components. The empirical data was analyzed from an interpretive perspective using thematic analysis. A number of theoretical perspectives were drawn on, including Kingdon’s Agendas, Alternatives and Public Policy model, Abbott’s Occupational Jurisdiction model, Van de Ven et al’s Innovation Journey model, and Closure Theory. The study makes 3 contributions to new knowledge. First it documents the unfolding of events and actions over time, and thus serves as a historical summary. Second it adds an analysis of the case of nurse practitioners as an emergent occupation to the existing body of sociological analyses of professions. Third, it provides insight into how nurse practitioner - physician relationships are impacted at the local level because nurse practitioners are obligated to develop a relationship with a physician in order to be able to deliver comprehensive primary care services. The empirical component of the thesis analyzes and describes the nature of this relationship at a practice level. It also describes the use of ‘workarounds’ to bypass legislated restrictions in nurse practitioners’ scope of practice. It analyzes how structural differences in the manner of regulation, payment, and employment status between nurse practitioners and family physicians contribute to different styles of practice and perpetuate the hierarchical relationships between nurses and physicians. This knowledge has potential generalization to other emerging occupations, such as physician assistants and paramedics.

Syftet med denna studie var att beskriva distriktssköterskans arbete med, och erfarenhet av livsstilsförändringar hos patienter med pre-diabetes inom primärvården. Metod var en empirisk intervjustudie med en kvalitativ ansats. Åtta semistrukturerade intervjuer utfördes, intervjumaterialet analyserades utifrån Graneheim och Lundmans innehållsanalys. Resultatet visade att patienter med pre-diabetes oftast upptäcktes i samband med årskontrollen hypertoni eller då de sökte för andra besvär. Blodsockret kontrollerades på patienter med riskfaktorer. Det var diabetessköterskan som tog hand om patienterna och gav information om pre-diabetes, typ 2-diabetes, samt råd vad gäller livsstilsförändringar. De använde sig av olika pedagogiska verktyg och metoder i arbetet med att förebygga typ 2-diabetes hos patienter med pre-diabetes. Hur ofta dessa patienter följdes upp var individuellt. Att få patienten att förstå betydelsen av livsstilsförändringar upplevdes som en utmaning. Tid- och resursbrist nämndes som hinder i det förebyggande arbetet men ändå upplevdes möjligheterna som många. Slutsats är att om strukturerade rutiner för upptäckt av pre-diabetes och förebyggande av typ 2-diabetes fanns skulle patienter med pre-diabetes hittas tidigare. Därmed skulle onödigt lidande för patienten och de samhällskostnader som typ 2-diabetes medför minska. / The Aim of this study was to describe the Community Health Care nurse´s work and experience with lifestyle changes in patients with pre-diabetes, within the primary health care. The Method was an empirical interview study with a qualitative approach. Eight semi structured interviews were accomplished, the interview material were analyzed with Graneheim and Lundmans qualitative content analysis. The Results showed that the patients with pre-diabetes was discovered during the annual check-up for hypertension, or when the patients sought care for other symptoms. Blood glucose were checked on all patients with risk factors. It was the diabetes nurse who informed the patients about pre-diabetes, type 2- diabetes, and gave advice about lifestyle changes. They used different pedagogic tools and methods in the preventive work. The follow-up was adapted individually. It was a challenge to get the patients to understand that lifestyle changes were needed. Recourses and lack of time were an obstacle in the preventive work. Still the opportunities were seen as many. The Conclusion is that patients with pre-diabetes would be found earlier if structured routines for discovery of pre-diabetes and prevention of type 2-diabetes excited in the primary health care. Therefore, unnecessary suffering for the patient, and social costs would decrease.

South Korea has been evaluated as having the weakest primary care system. In South Korea, the health care delivery system is concentrated too heavily in the private sector. Increased concern on keeping one’s health and reducing the burden of health care costs led community members to gather and form health care co-operatives. Currently, 19 health care co-operatives have been established through residents’ participation and even more are preparing to be incorporated. As a nonprofit organization, a health care co-operative is a voluntarily established co-operative organization that tries to solve health, medical, and life problems in communities. This report examines how these health care co-operatives work in the health care system, whether they can be effective alternatives to a future health care system in South Korea, and finally the report provides recommendations. Given the fact that the nation already has national health insurance, health care co-operatives in South Korea mainly operate several clinics by focusing more on managing chronic diseases and increasing access to care, rather than developing affordable health care insurance or lobbying in policy sectors as they do in other countries. Health care co-operatives’ motivation is to keep people healthy; hence, they put a great deal of effort into delivering primary care and helping patients deal with chronic diseases. Health care co-operatives are encouraging because of their democratic structure. Health care co-operatives emphasize the idea that the owners of the health care co-operatives are in fact the members. The overall satisfaction of users in the current health care cooperatives is moderately high. Taking the lessons from the examples of health co-operatives in other countries, health care co-operatives should be able to function as a good complementary to the health care system. / text

Thesis (M.P.H.M.))--Mahidol University, 1988.

Magister Public Health - MPH / From 2004 the Eastern Cape Department of Health (ECDoH) started implementing the new community health worker (CHW) programme in all its clinics, but so far little is known about its implementation process, its successes and challenges. The aim of this study was to assess the implementation of the new government funded CHW programme at three clinics of the Eastern Cape Province. / South Africa

According to the statistics from Department of Health, Executive Yuan, in 2007,brain attack has been listed as the third of the top ten reasons for death. In Taiwan, the occurrence rate of brain attack on population above 35-year-old is 3/1000. And the total amount of population above 35-year-old is nearly 10,000,000. Then the latest number of occurrence of brain attack is approximately 30,000¡COnce the stroke happens, under such a circumstance, not only the expense of acute care increases but also the long-term medical care expense, the family and social cost will become larger. In view of that, the long-term care plan for stroke patient has been in urgent need. This research, ¡¨Long-distance Community Health Care Nursing Service for Stroke Patients¡¨, which is originated from a plan conducted by a medical center in Southern Taiwan. Based on Andersen¡¦s¡]1968¡^health behavior model as the theoretical structure¡Awe studied 102 patients who had a stroke (including high stroke risk patients)within one year in Kaohsiung. In this study, we applied JMP V6.0¡]SAS Institute, Cary, NC, USA¡^to analyzing case characters¡Aconducting univariate analysis by £q2 analysis and ANOVA. Then we applied multivariate logistic regression analyses to significant variables. We hope to find out the predisposition, enabling factors and need factor from those important predictor variables in ¡§Long-distance Community Health Care and Nursing Service¡¨. We research the differences of stroke patients¡¦ behaviors, providing those research results as the reference materials for related business promotional strategy in future, hoping to advance the quality of long-term care and nursing for stroke patients. In this study, total 102 copies of the questionnaire were sent out and returned, with a return rate of 100%, and 100 copies of questionnaire were effective. The research results show that: 1. Predisposition¡GThere are significant differences on these items--¡§Number of Children¡¨(Demography), ¡§Buddhist¡¨(Religion) and ¡§Those who have a health check within nearly one year¡¨(Health Concept). 2.Enabling factors¡GThere are significant differences on these items--¡¨Monthly Family Income¡¨(Economical factor),¡¨Monthly Balance of Payment¡¨(Economical factor) and ¡§Commercial Insurance¡¨(Insurance resource). 3.Need factors¡GPeople (those who think their health state stay at the average level), Health State (¡§High Blood Pressure and Heart Attack¡¨,¡¨Eye Diseases¡¨, ¡¨Cancer¡¨,¡¨Bone and Muscle¡¨,¡¨Asthma¡¨,¡¨Ears Disease¡¨and ¡¨Neural Diseases¡¨are involved. The behavior research includes ¡§Number of Accepting Medical Treatment per month¡¨(1 to 2 times), ¡§Activity in Daily Life ¡¨¡]ADL¡BIADL-Shopping Ability¡^and ¡§Functional Behaviors¡¨. 4. To sum up, the predisposition, enabling and need factors in this research could partially influence using behaviors¡Ain accordance with Andersen¡¦s inference in health behavior model. In conclusion¡G1.¡¨Long-term Community Health Care and Nursing¡¨ can be applied to stroke patients, which can help patients to build up effective self-management and advance life quality; 2. This service combines Medical Service Chain established by Information-Telegraphic Technology. Currently, blood pressure checking and telephone consultation are most popular service among interviewees, and other kinds of service are under development; 3. Stroke patients with different demographical characters show a great difference on using behaviors; 4. To speak briefly, this service can meet the ideal long-term care and nursing standard for local aging population.