In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of this descriptive study, we investigated the impact of the Mount Zion closure on all UCSF internal medicine residents who were in training at the time. Using a cross-sectional survey, we found that a majority of residents felt the closure was harmful to their training, but that reasons varied by program affiliation. Many specific areas of training remained unaffected. Low morale correlated with abandonment of generalist career plans among some primary care residents (p=0.02). We concluded that the perception of harm reflected a temporary reaction to change rather than actual harm to the quality of the programs, and that while attrition from generalism may have resulted from disillusionment by some residents, it more likely reflected a national decline in interest in primary care since 1997. We also concluded that the closure of Mount Zion and its residency program was a consequence of the shifting emphasis toward subspecialization in the U.S. and is a harbinger of further changes in that direction.

Source: Masters Abstracts International, Volume: 47-06, page: 3553. Advisers: Michael L. Parchman; Jimmy L. Perkins. Includes bibliographical references.

Source: Masters Abstracts International, Volume: 46-05, page: 2648. Adviser: Stephanie McFall. Includes bibliographical references.

Bakgrund. Hälsosamma levnadsvanor förebygger uppkomsten och är grundläggande i behandlingen av högt blodtryck. Sjuksköterskors samtal om levnadsvanor är viktiga för att stödja patienterna att förändra ohälsosamma levnadsvanor.  Syfte. Syftet med studien är att kartlägga i vilken omfattning sjuksköterskor frågar om levnadsvanor och hur de arbetar med detta i hälsofrämjande samtal i samband med blodtryckskontroller. Dessutom har studien särskilt fokus på att också beskriva samband mellan fortbildning och sjuksköterskornas tillämpning av sådana samtal. Metod. En kvantitativ tvärsnittsstudie med enkäter utfördes. Resultat. I samtalen frågar sjuksköterskor i lägre omfattning om patienternas alkohol- och saltintag jämfört med övriga levnadsvanor. Det vanligaste sättet att tillämpa samtalen på är genom att ge enkla råd till dessa patienter. I tre av sex förekommande levnadsvanor finns det ett samband mellan fortbildning i samtalsmetodik och högt blodtryck, och mer avancerade samtal.  Slutsats. Tid, arbetssätt och fortbildning tycks vara faktorer som påverkar sjuksköterskors samtal om levnadsvanor i positiv riktning. / Background. A healthy lifestyle prevents rise of hypertension and is fundamental for the treatment of the condition. Patient-nurse conversations on lifestyle are important to support patient lifestyle change. Aim. The aim of the study is to map to what degree nurses are asking about lifestyle habits and how they work with this in health-promoting dialogues in conjunction with blood pressure controls. In addition, the study has a particular focus on describing the relationship between nurses in-service training and the application of such dialogues. Method. A quantitative, cross-sectional study by questionnaire was performed. Result. Nurses are asking about patients' intake of alcohol and salt to a lower degree than for other lifestyle habits. Short advice is the most common type of dialogue with patients. For three out of the six lifestyle habits a correlation between degree of education and more elaborate dialogue was identified. Conclusion. Time, mode of work and degree of education seem to affect nurses' conversations about patient lifestyle positively.

The aim of the study – to evaluate patients‘ and physicians‘ opinion about the satisfaction of patients needs in primary health care. The objectives: 1. To explore patients‘ opinion about satisfaction of their needs in primary health care and dimensions of health care service quality. 2. To explore physicians‘ opinion about the satisfaction of patients’ needs in primary health care. 3. To compare patients‘ and physicians‘ opinion about the satisfaction of patients’ needs in primary health care. Methods. The study was conducted in Centro outpatient clinic in January-March, year 2006. The participants of the study were 394 patients 16-65 years old and 23 physicians. The study material was gathered using self-administrated anonymous questionnaires. The questionnaire for the patients covered 31 questions, questionnaire for the doctors – 29 questions. The data analysis was performed applying the statistical package SPSS version 12,0. The statistical procedures were employed by Chi- square’s (χ2) parameters, degree of freedom and statistical significance. Results. 48,9% of patients evaluate negatively the environment of the outpatient clinic waiting – room, 51,8% – the work of the registry, 56,85% of patients‘ - possibility to get medical consultation in convenient time, 64,28% - waiting time at the physician‘s office. 51,27 % of patients consider, that doctor is not attentive enough for them, 61,42% – doctors don‘t spare enough time for them, 53,81% - don‘t thoroughly evaluate... [to full text]

Darbo tikslas - įvertinti pacientų motyvaciją renkantis šeimos gydytoją viešojoje ar privačiose pirminės sveikatos priežiūros įstaigose Jonavos mieste. Uždaviniai: 1. Nustatyti motyvacinius veiksnius, sąlygojančius pacientų pasirinkimą gydytis pas šeimos gydytoją. 2. Palyginti pacientų motyvacinius veiksnius renkantis šeimos gydytoją viešojoje ar privačiose PSP įstaigose. 3. Pateikti pasiūlymus PSP įstaigoms, pacientų motyvacijai gerinti. Tyrimo metodika. Tyrimas atliktas 2007 metų birželio mėn. naudota anketinė, anoniminė Jonavos viešojoje PSP ir privačiose įstaigoje besilankančių pacientų apklausa (n=400). Atsakas viešojoje PSPĮ – 80 proc., o privačiose PSP įstaigose – 84 proc. Tyrimo duomenų statistinė analizė atlikta naudojant MS Excel'XP bei SPSS 12.0 statistinių duomenų analizės paketą. Ryšiai tarp požymių vertinti pagal 2 kriterijų. Rezultatai. Respondentai svarbiausiais motyvaciniais privalumais, pasirenkant gydymo įstaigą ir šeimos gydytoją, laikė gerą paslaugų kokybę, nuoširdų bendravimą ir patogią įstaigos vietą. Nustatyta, kad Jonavos privačiose gydymo įstaigose lankosi pacientai (64 proc.), kurių sveikata yra gera, o VšĮ Jonavos PSPC – vidutinės sveikatos tiriamieji (42 proc.). Privačias gydymo įstaigas renkasi 49 proc. tiriamųjų, todėl, kad yra girdėję gerus atsiliepimus apie ten dirbančius gydytojus, o respondentai VŠĮ Jonavos PSPC gydymo įstaigą renkasi dėl to, kad ten tradiciškai lankosi visa šeima. Daugiausia, t.y. 60 proc. VšĮ Jonavos PSPC pasirinkusių... [toliau žr. visą tekstą] / Aim of study. To asses patients motivation in choosing primary health care doctor in public or private primary health care institutions in Jonava city. Objectives. 1. To assess factors of patients motivation, determining the choice of the doctor 2. To compare the factors of patients motivation in choosing the doctor in public or private health care institutions 3. To develop proposals for primary health care institutions for improvement of patients motivations. Methods. The study was carried out in June, 2007. 400 patients of public and private health care institutions of Jonava were involved in the survey. Response rate in public health care institution was 80% and in private health care institutions - 84 %. Statistical analysis was carried out using statistical package for social sciences - SPSS 12.0 for Windows. Associations between the variables were assessed by Chi square test. Results. The respondents considered good quality of services, sincere interaction and a convenient location of an institution as the main motivating advantages in choosing primary health institution and family doctor. It has been determined that patients of Jonava city who considered their health as good (64%) visit private health institutions, and Public Institutions Jonava primary health care center – who considered (42%) their health as normal visit public health institutions. 49% of the respondents chose private health institutions because they have heard good responses on doctors work there... [to full text]

Introduction A well-functioning primary health care system depends on all three levels of healthcare, that is, the primary, secondary and tertiary levels of care. District hospitals have a major role to play in the development of a strong referral system. This study was undertaken to evaluate whether the primary health care clinics in Area 3 possess all the key essential components for a strong referral system. Area 3 comprises 3 districts in northern KwaZulu-Natal, i.e. the Umkhanyakude, Uthungulu and Zululand districts. Aim The aim of the study was to evaluate referral support systems between fixed clinics and district hospitals in the three districts of Area 3 in KwaZulu-Natal province. Methods A descriptive study was undertaken in 58 randomly selected clinics in Area 3. Data was collected between July and August 2007, on availability of: communication technology, transport for patients being referred to the district hospital, and guidelines. Referral letters were reviewed to determine if they contained adequate information. Professional nurses were interviewed to determine the training they had attended. Results A third (34%) of clinic nurses on duty had been trained in Primary Health Care; 57% of clinics had at least one professional nurse on duty with a PHC diploma. The proportion of nurses trained in short courses ranged between 4% and 47%. Fifty-six out of fifty-eight (97%) of clinics had telephones; 57% reported problems with telephones. Eighty-eight out of one hundred and seven (88%) of selected referral letters did not have adequate information. Only 32% of urgently referred patients were collected by an ambulance within 1 hour. All 58 clinics had the Essential Drug List (EDL) available; availability of the other guidelines ranged between 29% and 79%. Discussion The percentage of clinic nurses with a PHC diploma or trained on short courses indicates that most clinic nurses render health services without or with inadequate knowledge and skills. Poor quality of referral letters and inefficient transportation of referred patients, especially emergencies, confirm a weak referral support system. User perceptions of the referral system have not been explored. Recommendations Training and support of clinic nurses needs to be prioritised to improve patient assessment and management, as well as the quality of referral letters. District management should advocate for improvement of patient transportation. Future studies should explore the use of referral letters by and training of, clinic nurses; as well as determine user perceptions. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

This research is an endeavour to highlight the state of healthcare in South Africa as seen through the eyes of professional health care workers who are at the cold face of healthcare. Having worked in an environment of inequities and unjust circumstances, healthcare workers expressed their attitudes and beliefs that healthcare are in need of radical change. There appears to be insight from these professionals that the private and public healthcare sectors should forge a relationship, ultimately benefiting South African society. More research needs to be done on a major scale to determine more deeply the attitudes and beliefs of healthcare professionals. Such an endeavour will provide a stimulus for policymakers to harness this energy and direct it in a meaningful way in the transformation of healthcare in South Africa. Chapter 1 focused on several relevant perspectives and definitions on healthcare in South Africa and other countries. In Chapter 2, attention was given to socio-economic rights as per the South African Constitution and the states obligations to fulfil these rights. These rights were examined in the context of landmark Constitutional Court cases, viz. Soobramoney versus the State; TAC versus the State; and Grootboom versus the State. These cases give one the essence of interpreting rights and the constitutional obligation of the state to deliver on them. Healthcare developments in South Africa and other countries together with the RDP and GEAR considerations are outlined in Chapter 3. Research Methodology is outlined in Chapter 4, emphasizing also the limitations of this study. Chapter 5 examines the responses to the questionnaires and analyses its findings. Chapter 6 provides the conclusions and recommendations as well as a critique of healthcare in South Africa. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

This thesis examines how the recent socio-economic and political arena in Cuba informs the relationship among the idea of population health, national statistics, and the everyday lives of individuals. Post-revolutionary Cuba has used measures of the health of individuals as a metaphor for the health of the body politic, effectively linking the efficacy of socialism and its governmental apparatus to the health conditions of the population. The creation of a model of health care that was informed by the revolutionaries' vision of a new social order, which in turn would help to create an ' hombre nuevo' (new man and new woman), effectively shaped a model of citizenship that was associated with a particular notion of health, and in addition defined a system of socialist values and ideals. Thirty months of ethnographic field research in the city of Havana focused specifically on the Family Physician-and-Nurse Program---an innovative primary health care program in which family physician-and-nurse teams live and work on the city block or in the rural community they serve. Drawing on my ethnographic findings, I explore two key themes. First, I examine how state policy, enacted through the government's public health campaigns, has affected individual lives, changing the relationship among citizens, government institutions, public associations and the state. Secondly, I examine how the collapse of the Soviet bloc (post-1989) and the strengthening of the US embargo is changing the relationship between socialist health-policies and individual practices and how it has redefined how state power becomes enacted through and upon individual bodies. In particular, I examine how individual practices play an important role in the maintenance of Cuba's population-health profile, as individual citizens give priority to their own health care needs, both material (such as food, medicines and medical supplies) and spiritual (including the re-emergence of religious

Aim of the paper: to analyze performance peculiarities of primary health care organizations (PHCO) and to propose possible ways for improvement. Methods: the analysis of scientific literature of Lithuanian and foreign authors, analysis of legal regulating documents, analysis of the results of the questionnaire of managers of PHCO, analysis of the results of the interview with experts. The object of research: performance assessment of primary health care organizations. Results: PHCO quality assessment and assessment performed by administrative organizations are the most often types of PHCO assessment in Lithuania. The results of the research show that data evaluating PHCO performance are fragmented and reflect only certain areas of PHCO activities. The quantity of the data does not correspond to the needs of PHCP managers in the strategic planning and implementation process. The assessment of PHCO performance is not dynamic and adjusted to the changing environment conditions. Experts unanimously pointed the need for the development of present PHCO performance assessment system and the need for its unification. Conclusions and practical recommendations: 1. Having done the analysis of scientific literature, we may conclude that problems of performance assessment are most often analyzed in business than in public sectors. The complex view to organization activities allows to analyze not only results of the organization, quality of performance but also to identify areas for... [to full text]