Objetivo: identificar as necessidades de aprendizagem sobre o acolhimento com classificação de risco da demanda espontânea na Atenção Primária à Saúde. Método: estudo descritivo com abordagem qualitativa; coleta de dados realizada entre junho a agosto de 2017, com 15 enfermeiros da Atenção Primária à Saúde e que participam de Núcleo de Educação Permanente e Humanização no interior do Estado de São Paulo. Resultados: os resultados foram organizados em categorias resultantes da análise de conteúdo, que são as seguintes: Entre a demanda de implantação do protocolo e a ausência de conhecimento teórico e prático; As incompreensões sobre a inserção do ACCR na Atenção Primaria à Saúde nas Redes de Atenção à Saúde; Entre a agenda do ACCR e os encaminhamentos: o que fazer?; Da obstinação ao modelo curativista às possibilidades do ACCR da demanda espontânea no SUS; A (in)compreensão das necessidades de saúde dos usuários e os possíveis preconceitos da equipe; e A necessidade da Educação Permanente em Saúde para o fortalecimento do ACCR. Assim, 80% nunca utilizaram o protocolo de Manchester; entre as necessidades de aprendizagem estão o conhecimento teórico-prático da clínica, em como articular as ações programáticas e as vulnerabilidades sociais com o atendimento da demanda espontânea, e como superar o modelo médico-centrado. Conclusão: o reconhecimento das limitações para implementação do protocolo, requer a sistematização de processo de educação permanente em saúde para problematizar a realidade da unidade de saúde e proporcionar a capacitação aos enfermeiros que são os responsáveis legais pelo protocolo de Manchester / Objective: to identify learning needs about the host with spontaneous demand risk classification in Primary Health Care. Method: descriptive study with a qualitative approach; data collection between June and August of 2017, with 15 primary health care nurses participating in the Permanent Education and Humanization Center in the interior of the State of São Paulo. Results: the results were organized into categories resulting from content analysis, which are as follows: Between the demand for implementation of the protocol and the lack of theoretical and practical knowledge; The misunderstandings about the insertion of the ACCR in the Primary Attention to Health in the Networks of Attention to Health; Between the ACCR agenda and referrals: what to do ?; From the obstinacy of the curative model to the possibilities of the CCR of spontaneous demand in the SUS; The (in) understanding of the health needs of users and the possible prejudices of the team; and The need for continuing education in health to strengthen the CRA. Thus, 80% never used the Manchester protocol; among the learning needs are the theoretical-practical knowledge of the clinic, how to articulate programmatic actions and social vulnerabilities with the attendance of spontaneous demand, and how to overcome the medicocentered model. Conclusion: the recognition of the limitations for the implementation of the protocol requires the systematization of a permanent health education process to problematize the reality of the health unit and provide training to nurses who are legally responsible for the Manchester protocol

The aim of this thesis was to assess test use from primary care. Test use is an essential part of general practice, yet there is surprisingly little data exploring and quantifying its activity. My overarching hypothesis was that test use from primary care is sub-optimal, specifically that tests are overused (overtesting) - ordered when they will lead to no patient benefit, and underused (undertesting) - not ordered when they would lead to patient benefit. Previous metrics used to identify potential over and undertesting have been categorised into direct and indirect measures. Indirect measures take a population-level approach and are 'unexpected variation' in healthcare resource use, such as geographical variation. Direct measures consider individual patient data and directly compare resource use with an appropriateness criterion (such as a guideline). In this thesis, I examined three indirect measures: temporal change in test use, between-practice variation in test use and variation between general practices in the proportion of test results that return an abnormal result. In chapter 3, I identified which tests have been subject to the greatest change in their use from 2000/1 to 2015/16 in UK primary care. In chapter 4, I identified the tests that had been subject to the greatest between-practice variation in their use in UK primary care. In chapter 5, I present a method to identify General Practices whose doctors order a lower proportion of tests that return a normal result. In chapter 6, I present a method to directly quantify over and undertesting; I conducted a systematic review of studies that measured the adherence of general practitioner's test use with guidelines. In chapter 7 I acknowledge that the use of guidelines to audit general practitioner's test use is flawed; guidelines are of varying quality and not designed to dictate clinical practice. In this chapter, I determine the quality and reporting of guidelines, the quality of the evidence underpinning their recommendations and explore the association between guideline quality and non-adherence. Overall, I have shown that most tests have increased substantially in use (MRI knee, vitamin D and MRI brain the most), there is marked between-practice variation in the use of many tests (drug monitoring, urine albumin and pelvic CT the most) and that some general practices order a significantly lower proportion of tests that return an abnormal result. I have also shown that there is marked variation in how often GPs follow guidelines, but guidelines based on highly quality evidence are adhered to significantly more frequently. Lastly, in my Discussion chapter, I discuss the implications of my thesis, how it fits into the wider literature and an idea for a proposed step-wise approach to systematically identify overtesting.

Magister Commercii (Information Management) - MCom(IM) / Long waiting times before receiving a health service, give rise to long queues and congested health facilities, both of which are unnecessary and avoidable. Since patients in part judge the quality of the service by the length of time they spent waiting for it, it is imperative to measure waiting times, and determine and mitigate the immediate and underlying causes of lengthy waits. The facility under investigation was known to have excessively long waiting times. Since the immediate causes of long waiting times were known, it was thus required to research and understand the underlying causes of long waiting times and consequently whether there were any barriers to implementing recommendations to reduce waiting times at this primary health care facility. AIM: The aim of the study was to determine the underlying causes of long waiting times and the barriers to implementing recommendations to reduce waiting times. METHODS: A quantitative cross-sectional analytical study with a small qualitative component was undertaken. The qualitative study took a workshop format by piggy-backing onto feedback sessions held to present the results of the previously conducted waiting time survey to staff. Staff commentary at the workshops on possible underlying causes and barriers to recommendations to reduce them, were then used to develop a questionnaire for the quantitative portion of the study. The population and sample for the qualitative part of the study were all staff working at the facility who attended the feedback sessions. The cross-sectional descriptive quantitative study intended to uncover what underlying causes affected long waiting times, what recommendations could be explored to mitigate long waiting times and improve the patient experience, and if there were any barriers to these recommendations. The quantitative study population and sample were all staff who worked at the facility for more than six months and all patients who had utilised the services at the facility for three or more times. Data was collected using structured questionnaires, which were different for staff and patients. A detailed descriptive analysis was conducted.

Estudo realizado com o principal objetivo de verificar a existência de atividades de assistência primária ou cuidados básicos de saúde nos serviços ambulatoriais do Instituto Nacional de Assistência Mêdica da Previdência Social (INAMPS), nos Estados do São Paulo e do Rio de Janeiro. Todos os 394 enfermeiros lotados nesses serviços, no período de novembro de 1981 a agosto de 1982, foram incluídos no estudo. Houve retorno de 84,0 por cento dos questionários enviados. Foram identificados diversos fatores institucionais e organizacionais que influenciavam favoravelmente o desempenho profissional do enfermeiro, tais como: a presença de enfermeiros nas coordenadorias regionais das superintendências, a existência de campo adequado para o enfermeiro desenvolver-se profissionalmente, o apoio da chefia, a existência de supervisão do trabalho de enfermagem e a realização de reuniões de serviço. Os resultados obtidos demonstraram que muitas atividades que podem ser enquadradas como sendo de assistência primária ou serviços básicos de saúde já vinham sendo executadas por enfermeiros e equipe de enfermagem, porem de forma esparsa e assistemática. Essas atividades foram classificadas em assistenciais subsidiárias, assistenciais independentes, educativas e tenico-administrativas. Os obstáculos na execução de mais atividades de assistência primária de saúde por esses profissionais eram, principalmente, falta de pessoal de enfermagem e falta de área física. Havia também existência de médicos em tal quantidade que algumas atividades simples tais como: controle de gestantes ou crianças sadias, controle de portadores de moléstias crônicas comuns de evolução previsível ocupavam espaço como consulta medica. A contribuição do enfermeiro na assistência primária, ou nos serviços básicos de saúde, pode ser agrupada em três níveis, de acordo com o grau de necessidade de preparaçao adicional do profissional, bem como com providências administrativas em termos de recursos humanos e materiais. Nessas condições, esses três níveis de contribuição do enfermeiro podem ser implantados, gradualmente, a curto, médio ou longo prazo. Os clientes portadores de patologias seriam encaminhados aos médicos para atendimento especializado. A esses clientes poderia ser dada assistência completa com a utilização total de recursos tecnológicos disponíveis para diagnóstico e tratamento. Dessa forma, a assistência médica curativa ficaria concentrada no paciente realmente necessitado; aos demais seria prestada a assistência primária, ou cuidados básicos de saÚde, podendo assim melhorar sensivelmente a qualidade dos serviços assistenciais prestado a população que busca a Previdência Social. / The study was carried out with the purpose of discovering what kind of primary health care was available at outpatients\' departments of the INAMPS (National Health Service) in the states of São Paulo and Rio de Janeiro. All 394 nurses engaged in this service, from November 1981 to August 1982, were included in the study. 84 per cent of the questionnaires distributed were completed. Various organizational and institutional factors were identified which favourably influenced nursing performance such as the presence of nurses on regional boards, the chances of professional development, support lent by superiors, the supervision of nursing duties as well as periodic discussion of work related topics. Results show that much of the health care at community level is already being carried out by individual nurses and by teams, but in an unsystematic way and on an irregular basis. These activities have been grouped under the following headings: subsidiary and independent care, educational and technical/administrative activities. These professionals were prevented from further developing health care at community level mainly due to a lack of trained nursing staff and of space. There were also so many doctors avaiable that certain areas of health care such as pre-natal checks, routine pediatric visits and control of patients with controllable chronic ailments were all carried out by doctors. The nurse\'s role in providing basic health care may be examined at three levels and depends on the need for further professional training, as well as human and material resources. Bearing these conditions in mind, it is possible to put into practice these recommendations either in the short or medium term or even on a long term basis. Patients suffering from pathological conditions would be sent to doctors for specialized care. For these patients complete diagnostic and technological resources would be made available as well as complete medical assistance. In this way, the role of the doctor could concentrate on cases which required actual medical attention, whereas basic health care would be provided in all other cases, thus improving the quality of National Health Assistance.

Magister Psychologiae - MPsych / An epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2010 / Introduction No health care services are available for staff or students on the Potchefstroom Campus of the North-West University. Lack of finances and the notion that the health of the campus community is not the core business of a university are reasons for not providing some form of health care service. The Declaration of Alma-Ata was adopted internationally, stating that essential health care must be made universally accessible to all people. South Africa endorses the Declaration of Alma-Ata and commits itself to ensure equitable access to health care. A needs analysis of the Higher Education AIDS Programme (HEAIDS) demonstrated that most South African universities, within reasonable means, respond to their students' health needs by providing some form of primary health care service. The researcher is adopting an ecological approach using the Healthy Campus Model. The model is based on primary health care principles and values which refer to the health needs of people as this would assist in alleviating the burden of disease and the risks thereof. The Healthy Campus Model also explores equal access and utilization of quality health care whereby these principles of primary health care and community participation would guide such a service. This approach determines whether basic human rights of access to health care have been met. Materials and Methods In this study the research design was a cross-sectional descriptive survey. The survey is part of a comprehensive health needs assessment, using a mainly quantitative questionnaire as a data collection tool. The study population consisted of full-time students enrolled at the Potchefstroom Campus. It included subgroups on gender, seniority and place of residence and was chosen specifically to identify possible high-risk activities and influences on student health. A sample size of 370 students and confidence interval of 95% were calculated. Both purposive and a volunteer sampling were used. iii Results The most significant finding is the students' need for an affordable and accessible health care facility with a high level of client confidentiality and quality of service. The survey included data of the financial needs of students regarding their primary source of financial assistance as an indication of their financial wealth. Access to finances specifically allocated for health care shows that almost half of the target population (47,54%) do not have the surety of access to a source of finance to cover their medical expenses. However, the majority (74,32%) are willing to contribute towards cost-effective and affordable health care and do not expect free health care. Accessible health care services are also of major concern. The majority of students (68,38%) stay on or within walking distance from campus. The results indicated furthermore that students’ have specific health needs and preferences. The highest priority of health care were given to acute care or minor ailments (79,5%) followed by counselling care (70,6%). A need for HIV and Aids clinical programmes (69,8%) and health awareness and prevention programmes (67,6%) was indicated. The majority (83,74%) indicated that the services of the proposed health care centre will be preferred and utilized if available and affordable. Discussion The results of the health needs analysis on the Potchefstroom Campus clearly indicate that the students have definite needs for such services. The researcher argues that the institution is at risk by NOT responding to the students’ health needs. Absence of a health care service attributes to the inauspicious health environment of the campus. By supporting the ecological approach, the researcher concurs that a healthy environment has the greatest impact on good health and that health and educational success are interdependent. Conclusion and Recommendation Educational success is a strategic priority and the core business of all institutions of learning. Establishing a primary health care service and acting on the health needs of the students is a risk abatement strategy to surmise educational success. A follow-up survey to determine the top ten health impediments on campus is recommended to measure and manage academic and health-related successes.

Thesis (M. Cur.) -- University of Limpopo, 2014 / The present study presents data about the factors that are affecting the implementation of the National Tuberculosis Control Programme by the professional nurses in the Mogalakwena Municipality of the Waterberg District in the Limpopo Province. Despite the intervention by the then Waterberg District Department of Health and Social Development through continual training and workshops of professional nurses in respect of the NTCP, there are still more challenges observed in terms of TB management. Aim of the study The aim of the study was to identify and describe the factors that are affecting the implementation of the NTCP and the findings may be utilised to describe the strategies to increase TB cure rate in the Mogalakwena Municipality of the Waterberg District. Research Methodology A quantitative research approach was used to conduct this study. One hundred and thirty one professional nurses employed at 28 clinics of the Mogalakwena Municipality were selected to participate in the study. The researcher distributed the questionnaires at the clinics. A structured questionnaire with both open and closed-ended questions was administered. The questionnaire was pretested in the Mahwelereng Local Area which did not form part of the main study. Results Of the 131 respondents, 33.6% were the largest age group of between 40 – 50 years followed by 24.4% who were older than 50 years in contrast with the smallest age group of 18 – 28 years that comprised 18.3% of the population. Sixteen per cent of the respondents were male while 84.0% were female. The findings show that 83.2% of respondents held a diploma in nursing while 16.8% had a degree in nursing. The findings indicate that 98.4% of the respondents were reported to be having knowledge about TB while 1.6% reported not having knowledge. The findings v indicate that 98.4% of the respondents had knowledge about TB suspect screening according to the NTCP in contrast with 1.6% of the participants who did not have knowledge about TB screening. About 95.4% of the respondents reported tracing of TB defaulters while 4.6% of the respondents reported that TB defaulters were not traced. Sixty point three per cent 63.3% of the respondents thought that a negative attitude of professional nurses was the main cause of poor implementation of the NTCP while 30.5% of them disagreed with the statement. Conclusion Respondents demonstrated non-compliance to the implementation of the NTCP, ignorance to acquire skills and negative attitude towards the programme that was consistently significant with other similar studies. The study recommends an updated training programme of all TB trained nurses, as well as values clarification about the importance of the implementation of the NTCP in the management of the TB disease.

Magister Scientiae (Physiotherapy) - MSc(Physio) / BACKGROUND: Access to basic health care services through the primary health care (PHC) settings, was affirmed as a fundamental human right by the World health organisation (WHO) in 1978 in Alma Ata (Kazakhstan). Internationally, interdisciplinary collaboration among health care professionals (HCPs) have been the preferred approach to addressing the health and psychosocial needs of the populace. The PHC being the first point of contact for most Nigerians and the cornerstone of health care policies in Nigeria, covers promotive, preventative, curative and rehabilitative services. Although, Physiotherapy has ideally qualified personnel to contribute to the attainment of the goals and objectives of the PHC policies, these services are mostly carried out by other HCP’s subdivided as clinicians (medical doctors, dentists, nurses/midwives, optometrists, pharmacists, radiographers, laboratory scientists) and clinical assistants (pharmacy technicians, radiography technicians, laboratory technicians and community health extension workers). Physiotherapy services are mostly concentrated at tertiary and secondary health care settings. AIM: To determine the awareness and explore the perceptions of clinicians and clinical assistants employed in the type 3 primary health care (PHC) settings of Rivers East Senatorial district of Rivers State, Nigeria, regarding the roles of Physiotherapy in a PHC setting.

This postmodern feminist ethnographies research aimed to explore the everyday meanings of primary health care (PHC) held by rural community nurses. Secondly, the research aimed to explore the everyday meanings of care held by the clients of the rural community nurses who participated in the study. The representation of this research is written in four voices which converse with each other to varying degrees in each chapter. This writing strategy is a deliberate one aimed at destabilising the usual approach to representation of research. It is also a strategy which seeks methodological coherence. The third aim therefore is to deliberately trouble the acceptable grounds concerning how nursing research is represented. The research utilised dialogical (conversational)and participant observation methods concerning the everyday meanings of nurses and their clients.The meanings I made of the information were created from a deconstruction of the texts. These texts included fieldnotes of participant observations and transcripts of conversations with nurses and their clients. The form of deconstruction utilised was informed from multiple sources and involved three levels of analysis. A realist interpretation was followed by an oppositional interpretation and then a reconstructive movement. The results revealed that rural community nurses practice is both spatio-temporally contextualised and metaphorically situated in an in-between space. This in-between space is situated between margin and the centre. Rural community nurses working on the margins traverse this space in order to overcome further marginalisation whilst working with Indigenous Australians and the aged. Moreover, the in-between space encompasses and creates opportunities to mutually exchange the gift of desire that being - empowering and compassionate relationships with clients and colleagues. Futhermore, whilst rural community nurses are strongly committed to the philosophy of PHC, their evryday working life is discursively constructed by powerful discourses which result in oppositional tensions. The tensions and the 'in-between' space allow the rhetoric of PHC to be resisted and reframed. Consequently, the oppositional constructs of their practice were displaced. Moreover, this necessitated the negotiation of space and place, and required the reconstruction of subjectivity, intersubjectivity and becoming / Doctor of Philosophy (PhD)

Thesis (M.A.(Applied))--Victoria University of Wellington, 2006. / Includes bibliographical references.