Estima-se que a adesão dos pacientes à farmacoterapia anti-hipertensiva varie entre 50 - 70%. A baixa adesão ou não adesão ao tratamento farmacológico anti-hipertensivo constituem problemas de saúde pública e devem ser compreendidos como um dos maiores obstáculos para o sucesso do tratamento da hipertensão arterial. A elevada prevalência desta condição clínica e seqüelas devastadoras no controle inadequado da pressão arterial tem sido freqüentemente relacionadas à mortes precoces. Este estudo tem como objetivo estudar a adesão ao tratamento farmacológico em pacientes hipertensos seguidos nos Núcleos de Saúde da Família I, III, IV e V do município de Ribeirão Preto - SP. Foram entrevistados 109 pacientes, utilizando-se o Teste de Morisky- Green para mensurar o grau de adesão ao tratamento farmacológico e foram estudadas variáveis que possam estar relacionadas ao grau de adesão, como: características sócio-econômicas; fatores relacionados à equipe e ao serviço de saúde; fatores relacionados à terapia; nível de conhecimento sobre a doença e fatores relacionados ao paciente. A análise dos dados foi realizada utilizando-se o programa estatístico Epi-Info versão 6.0 e o software SAS. Observou-se predomínio do sexo feminino em 84,4%, idade média de 61,4 anos, 56% casados, 81,7% de cor branca, 65,2% apresentavam baixa escolaridade e 45% eram do lar. A adesão dos pacientes foi verificada utilizando-se os critérios 1 e 2 do Teste de Morisky e Green. Através do Critério 1 do TMG, 79,8% dos pacientes foram classificados como \"mais aderentes\" e 20,2% como \"menos aderentes\". Utilizando-se o Critério 2, 43,1% dos pacientes foram \"mais aderentes\" e 56,9% \"menos aderentes\". Em relação às possíveis causas da não adesão ao tratamento, identificou-se associações estatisticamente significantes entre as variáveis \"confiança no médico\" e \"quantidade de medicamentos para HAS que utiliza\" com o grau de adesão pelo Critério 2 do TMG. O farmacêutico é um profissional de saúde que, através da Atenção Farmacêutica vem estudando e identificando as causas da baixa adesão ao tratamento e implementando estratégias, junto ao paciente, para resolvê-las. / It is estimated that patients\' adherence to medicine treatment against high blood pressure varies between 50 and 70%. The low adherence or non-adherence to high blood pressure medicine treatment is a public health problem and should be considered one of the main obstacles to a successful high blood pressure treatment. The high prevalence of such condition and devastating consequences resulting from the disease due to inadequate control of blood pressure have been frequently related to untimely deaths. The present study aims to analyze the adherence to medicine treatment of high blood pressure patients followed at the Family Health Centers I, III, IV and V in the city of Ribeirão Preto - SP. 109 patients were interviewed by using the Morisky-Green Test to measure the level of adherence to medicine treatment. Several conditions which could be related to the level of adherence were studied as well, such as: social-economic conditions, factors related to the health center\'s team and service, factors related to the therapy itself, level of knowledge about the disease and factors related to the patient. The analysis of data was accomplished by using the statistics program Epi-Info version 6.0 and the software SAS. We observed a predominance of 84% of the female sex, average age 61.4, 56% married, 81.7% white, 65.2% having low scholarity and 45% housewives. The patients\' adherence was checked by using criteria 1 and 2 of the Morisky-Green Test. According to criterion 1 of the test, 79.8% of the patients were classified as more adherent and 20.2% as less adherent. According to criterion 2, 43.1% of the patients were more adherent and 56.9% less adherent. In regard to the possible causes of non-adherence to treatment, we identified statistically important associations between the conditions \"doctor reliability\" and \"quantity of high blood pressure medicines used\" with the level of adherence, according to criterion 2 of the Morisky-Green Test. The pharmacist is a health care professional who, by means of Pharmaceutical Care has been studying and identifying the causes of low adherence to treatments and also implementing strategies in order to solve this problem in collaboration with the patients.

Estima-se que a adesão dos pacientes à farmacoterapia anti-hipertensiva varie entre 50 - 70%. A baixa adesão ou não adesão ao tratamento farmacológico anti-hipertensivo constituem problemas de saúde pública e devem ser compreendidos como um dos maiores obstáculos para o sucesso do tratamento da hipertensão arterial. A elevada prevalência desta condição clínica e seqüelas devastadoras no controle inadequado da pressão arterial tem sido freqüentemente relacionadas à mortes precoces. Este estudo tem como objetivo estudar a adesão ao tratamento farmacológico em pacientes hipertensos seguidos nos Núcleos de Saúde da Família I, III, IV e V do município de Ribeirão Preto - SP. Foram entrevistados 109 pacientes, utilizando-se o Teste de Morisky- Green para mensurar o grau de adesão ao tratamento farmacológico e foram estudadas variáveis que possam estar relacionadas ao grau de adesão, como: características sócio-econômicas; fatores relacionados à equipe e ao serviço de saúde; fatores relacionados à terapia; nível de conhecimento sobre a doença e fatores relacionados ao paciente. A análise dos dados foi realizada utilizando-se o programa estatístico Epi-Info versão 6.0 e o software SAS. Observou-se predomínio do sexo feminino em 84,4%, idade média de 61,4 anos, 56% casados, 81,7% de cor branca, 65,2% apresentavam baixa escolaridade e 45% eram do lar. A adesão dos pacientes foi verificada utilizando-se os critérios 1 e 2 do Teste de Morisky e Green. Através do Critério 1 do TMG, 79,8% dos pacientes foram classificados como \"mais aderentes\" e 20,2% como \"menos aderentes\". Utilizando-se o Critério 2, 43,1% dos pacientes foram \"mais aderentes\" e 56,9% \"menos aderentes\". Em relação às possíveis causas da não adesão ao tratamento, identificou-se associações estatisticamente significantes entre as variáveis \"confiança no médico\" e \"quantidade de medicamentos para HAS que utiliza\" com o grau de adesão pelo Critério 2 do TMG. O farmacêutico é um profissional de saúde que, através da Atenção Farmacêutica vem estudando e identificando as causas da baixa adesão ao tratamento e implementando estratégias, junto ao paciente, para resolvê-las. / It is estimated that patients\' adherence to medicine treatment against high blood pressure varies between 50 and 70%. The low adherence or non-adherence to high blood pressure medicine treatment is a public health problem and should be considered one of the main obstacles to a successful high blood pressure treatment. The high prevalence of such condition and devastating consequences resulting from the disease due to inadequate control of blood pressure have been frequently related to untimely deaths. The present study aims to analyze the adherence to medicine treatment of high blood pressure patients followed at the Family Health Centers I, III, IV and V in the city of Ribeirão Preto - SP. 109 patients were interviewed by using the Morisky-Green Test to measure the level of adherence to medicine treatment. Several conditions which could be related to the level of adherence were studied as well, such as: social-economic conditions, factors related to the health center\'s team and service, factors related to the therapy itself, level of knowledge about the disease and factors related to the patient. The analysis of data was accomplished by using the statistics program Epi-Info version 6.0 and the software SAS. We observed a predominance of 84% of the female sex, average age 61.4, 56% married, 81.7% white, 65.2% having low scholarity and 45% housewives. The patients\' adherence was checked by using criteria 1 and 2 of the Morisky-Green Test. According to criterion 1 of the test, 79.8% of the patients were classified as more adherent and 20.2% as less adherent. According to criterion 2, 43.1% of the patients were more adherent and 56.9% less adherent. In regard to the possible causes of non-adherence to treatment, we identified statistically important associations between the conditions \"doctor reliability\" and \"quantity of high blood pressure medicines used\" with the level of adherence, according to criterion 2 of the Morisky-Green Test. The pharmacist is a health care professional who, by means of Pharmaceutical Care has been studying and identifying the causes of low adherence to treatments and also implementing strategies in order to solve this problem in collaboration with the patients.

Com o objetivo de quantificar o evento psico-social \"Atitude em relação a Centros de Saúde\", uma escala Thurstone dos \"Intervalos equi-aparenciais\" foi construida e apresentada. Inicialmente montou-se um quadro teórico, onde foi inserido o conceito a ser mensurado e a partir do qual construiram-se duzentos e sete estímulos- afirmações. Quatro áreas de conteúdo foram abrangidas: atitude em relação aos médicos, atitude em relação a serviços oferecidos, atitude em relação a funcionários e atitude em relação ao ambiente psico-social dos Centros de Saúde. As afirmações foram submetidas a quatro grupos de juízes compostos de médicos, enfermeiros, educadores de saúde pública e sociólogos que trabalham na área da saúde. Os valores escalares e índices de ambiguidade foram calculados para cada grupo profissional e para o grupo como um todo. As afirmações definitivas foram selecionadas através dos seguintes critérios: valor escalar, índice de ambiguidade e área de conteúdo. Foram escolhidas cinquenta e sete afirmações: dezenove na primeira área de conteúdo, treze na segunda área de conteúdo, quinze na terceira área e dez na quarta. Esta pesquisa foi somente uma primeira abordagem ao problema de mensuração de atitudes. Um pré-teste será necessário para testar validade e fidedignidade do instrumento construido para que depois seja empregado em pesquisas ligadas à educação em saúde pública. / With the purpose of gaining quantitative knowledge about the social psychological phenomena \"Atitude toward Health Centers\", A Thurstone \"Equal Appearing Interval\" scale was developed and presented. In the begining a theoritical referal system was built ineluding the concept to be measured, and 207 statements were devised. Four content areas were included: attitude toward physicians, attitude toward health services offered, attitude toward social-psychological environment of the Health Centers. The statements were presented to four groups of judges composed of psysicians, public health educators, nurses and sociologists working in public health. Scale values and a Q value were calculated separately for each statement for each group of Judges and for de whole group. A final scale was selected by three criterion: scale values, Q value and content areas. From the 207 scored statements a scale containing 57 items was developed: 19 in the first content area, 13 in the second, 15 in the third, 10 in the fourth. This research was only a first approach to measure atitudes. A pretest will be necessary to test validity and reliability of the instrument developed, to make it useful to research applied to public health education.

Academic Health Centers (AHCs) hold a unique place in today’s health care environment. They service their communities through a tripartite mission of education, research, and provision of complex care to disadvantaged populations. To achieve this mission, AHCs face challenges in funding and cost containment compared to non-AHCs. Additionally, the implementation of government programs like the Hospital Readmission Rate Program (HRRP) and Value Based Purchasing (VBP) have the potential to affect AHCs differently from non-AHCs. While AHC’s unique features are known and there has been research to date on HRRP and VBP, literature has yet to statistically explore the financial differences between AHCs and non-AHCs and how HRRP and VBP may have differentially affected AHCs compared to non-AHCs. The objectives of this study are to explore financial differences between AHCs and non-AHCs and the impact that HRRP and VBP has had on these two types of organizations through the use of a contingency theory framework. Contingency theory is an organizational theory that seeks to explain variations in organizational performance over time by studying internal and external environmental influences. Guided by Contingency Theory, the study used a non-randomized, quasi-experimental, retrospective study design to evaluate two hypotheses. The study sample consisted of a total of 10,157 (991 AHCs) US non-rural hospital years from 2011 through 2015. The study used operating margin and total margin as the key measures of hospital financial performance for the dependent variables. HRRP and VBP were combined into a single independent variable along with hospital type differentiating AHCs from non-AHCs. Covariates of Herfindahl-Hirschman Index, Medicaid expansion, health system affiliation, and ownership structure were used to control for other environmental influences. A repeated measure analysis of variance was employed to test the difference between the two hospital groups in isolation of HRRP, VBP, and covariates and a repeated measure analysis of variance with covariance was used to test the full model, which incorporated HRRP, VBP, and covariates. The results of the analysis support the significance of HRRP and VBP on hospital operating margin, but the results did not support a differential effect of these programs on AHCs as compared to non-AHCs. While the results did not support the two main hypotheses, it did provide valuable insight into the financial differences between AHCs and non-AHCs and the importance of VBP and HRRP on hospital financial performance. The results also provide important policy implications and thoughts on potential managerial actions given the HRRP and VBP programs.

Between 20% and 57% of patients at community mental health centers miss their first mental health appointment, resulting in wasted resources and longer wait times for other patients. To date, only one peer-reviewed quantitative study examined the relationship between appointment reminder practices and children's and adolescents' first appointment attendance rates for community mental health centers. The purpose of this quantitative study was to examine the relationship between first appointment wait times, electronic appointment reminders, phone appointment reminders, and first appointment attendance for U.S. community mental health centers, along with the potential moderating effects of age, ethnicity, and gender. Blumer's symbolic interaction theory served as the theoretical framework. Secondary data on was collected from 12 Texas-based community mental health centers covering 5,260 patients. Binary logistic regression uncovered the following key study findings: (a) wait time and message type significantly predicted appointment attendance; (b) e-mail appointment and text reminders were significantly more effective than were phone reminders; and (c) age, gender, and ethnicity moderated the relationship between wait time and message type, and first appointment attendance. The implications for positive social change include improving our understanding of the optimal appointment reminder tactics that increase children's and adolescents' mental health appointment attendance rates, improve operating efficiency of community health centers, and increase the likelihood that children and adolescents will receive needed mental health services.

Quality citizen participation in processes of policy development is crucial to a democracy interested in equity of voice for all its citizens. Citizens with less political power, however, are often absent from policy development for a variety of reasons, despite legislative and advocacy efforts for inclusion. In policy development processes, community representatives are a mechanism for traditionally marginalized or disadvantaged citizens to have a voice; yet the question remains how to effectively utilize that voice. This question stems from research demonstrating an increase in quantity citizen participation but not in quality citizen participation, which is more interested in the process of policy development as opposed to a final product. To understand quality citizen participation, a critical ethnography guided by a socio-ecological perspective allowing for the investigation of contextual as well as individual factors impacting policy development processes was conducted to assist in advancing knowledge about the best practices necessary to facilitate quality citizen participation in policy development. The policy development process explored in this qualitative study was the context provided by three CHCs in a Midwestern state. Information was gathered about these three CHC boards from multiple sources to best represent the context surrounding participation on the boards and that participation experience from the perspective of board members. The data analyzed included: descriptive statistics of seven counties which comprised the patient community of the three CHCs participating in the study, descriptive statistics of the patient communities of those three CHCs, interviews with national and state policy experts, the clinic directors and board chairs of the three CHCs and interviews with 16 board members of the three CHCs. Analysis of these data identified individual, relational, organizational, community and public policy level factors which impacted the participation of board members of three CHCs. For example, the education and background experiences of board members (individual) as well as relationships between board members and the management teams of the clinics (relational) facilitated the quality of their participation on the boards. Contextual knowledge of economic, political, and cultural factors were discovered for each of the three clinics, and proved important to understanding the quality of participation of board members. Social work educators and practitioners will benefit from the advancement of knowledge about what factors facilitate the quality of citizen participation in policy development processes. The results of this study suggest that practitioners interested in empowering consumers to have a role in the provision of services need to understand what facilitates the quality of citizen participation to ensure that consumers have a legitimate voice in policy development and implementation processes. The results of this study also inform our understanding of citizen participation in multiple policy development processes. For example, because legislators will benefit when barriers to the quality of citizen participation are identified, educators teaching social work students about macro practice will have concrete lessons to draw from; practitioners who work with non-elected members of boards will benefit from barrier identification allowing them to assist in the empowerment of future board members engaged in policy development on a wide variety of boards; and finally actual board members, especially those representing traditionally disadvantaged or marginalized communities, will benefit from knowledge gleaned from similar experiences, and educators teaching social work students about the benefits of advocacy and empowerment could assist to make their participation more effective.

This capstone project was part of a team project completed by two school principals in Hillsborough County, Florida. The project began because of our passion for meeting the needs of our students in urban high poverty schools being supported by varying district turnaround initiatives. We looked at our district’s previous and current attempts to increase student success in high poverty schools. We questioned the ways in which supports and resources were provided, and we explored ways through which success in high poverty schools might be increased by redefining the supports and resources provided. Our appreciative exploration of the topic was guided by the question, what successful examples of services and supports have contributed to an increase in success for students in high poverty schools? More specifically, I was interested in school-based health centers (SBHC), their benefits, and their impact on student academic outcomes. I looked for literature using the following keywords: wrap around services, school based health centers, health and student achievement. School-Based Health Centers improve access to healthcare, which can help to identify and address health risk behaviors and contribute to more stable attendance at school. More instructional seat time can contribute to improved academic outcomes. The preventative role played by SBHCs can reduce barriers to learning, such as treating undiagnosed mental and physical illnesses. School-Based Health Centers provide wraparound services so that issues impacting students such as obesity or asthma can be addressed on a school’s campus where key mental health, medical and school professionals can collaborate to meet the needs of students.

Community Health Centers (CHCs) are the nation's primary care safety-net for vulnerable populations, including racial/ethnic minorities, migrant workers and the uninsured. Women from these populations contribute disproportionately to cervical cancer morbidity and mortality, largely due to underutilization of Pap smear screening. The purpose of this cross-sectional study was to identify factors that may be related to Pap smear screening compliance among a large cohort of women seen at 10 Community Health Centers in Florida. Building upon an ecologic framework, this research went beyond patient-level risk factors, which are generally well-known, and explored provider and organizational variables that may also be associated with Pap smear screening compliance in this population. Ten CHCs in Florida met study inclusion criteria of having at least four complete years of claims and patient registration data stored in an Electronic Health Record (HER) data system maintained at HCN. EHR data were merged with provider gender obtained from a credentialing database and with data from a short organizational survey administered to the Medical Directors of the CHCs. Descriptive statistics, chi-squared analysis, and multiple logistic regression were used to examine Pap smear screening rates for women (n=71,234) in relation to a variety of patient, provider and organizational variables. Younger, Hispanic and insured women were most likely to have had a screening in the past three years compared to older, white non- Hispanic and uninsured women. Among providers, patients who received care from female providers generally had higher Pap smear compliance rates, but these findings differed by patient insurance and race/ethnicity group. Organizational factors that appeared to be associated with higher Pap compliance rates included diffusion of an EHR system, implementation of "Care Model Principals", and having recently implemented a Pap smear screening process improvement project. Results demonstrated that multi-level factors, operating on the patient, provider and organizational levels, contribute to Pap smear compliance among women seen at CHCs. Results suggested that improving screening compliance within this population of women requires interventions that are ecologic in scope, incorporate targeted education to high-risk women and providers, and include organizational strategies that can optimize care delivery at point-of-care.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.

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