Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-21T17:44:35Z No. of bitstreams: 1 Carvalho, Jane Maria de [Dissertação, 2014].pdf: 1854525 bytes, checksum: 8314f03bac2b8f43a283a017e5cdfae7 (MD5) / Made available in DSpace on 2017-03-21T17:44:36Z (GMT). No. of bitstreams: 1 Carvalho, Jane Maria de [Dissertação, 2014].pdf: 1854525 bytes, checksum: 8314f03bac2b8f43a283a017e5cdfae7 (MD5) / A Atenção Primária à Saúde (APS) é a principal porta de entrada no sistema de saúde e se direciona para a promoção, prevenção e recuperação da saúde. No Brasil, o modelo de Estratégia da Saúde da Família (ESF) foi escolhido para fortalecimento da APS. A renovação da APS e o sistema baseado na ESF constitui uma importante abordagem para a produção de melhorias e a promoção da equidade nos serviços de saúde. Visando atender a essas necessidades a Assistência Farmacêutica precisa se reorganizar garantindo melhorias nos processos logísticos de abastecimento e qualidade na Atenção à Saúde. A Organização Pan Americana da Saúde (OPAS) apresenta uma alternativa para isto, a utilização do modelo de gestão por processos tendo como foco principal o indivíduo, família e comunidade (IFC). Ao direcionar a atenção principal do trabalho para IFC há a integração do farmacêutiuco com o usuário e a equipe multidisciplinar, promovendo saúde e o uso racional dos medicamentos. O propósito deste trabalho é aplicar o modelo de gestão por processos em uma farmácia de um serviço da atenção primária à saúde do município do Rio de Janeiro com o intuito de aproximar o farmacêutico na realização de serviços clínicos. Foi realizado um estudo de caso para demonstrar como ocorreu a aplicação do modelo de gestão por processos apresentado por autores que propõem a gestão por processos como um modelo alternativo à gestão convencional focada em funções. Os processos da farmácia foram mapeados e redesenhados. Os processos-chave e os críticos de êxito foram identificados e os indicadores foram selecionados na literatura para a mensuração destes processos. O processo de logística foi eleito como processo crítico, este processo teve seus indicadores mensurados ao longo de 6 meses, melhorias foram implantadas e foram definidos responsáveis por cada subprocesso. Os técnicos de farmácia se aproximaram do processo de logística e o farmacêutico se aproximou dos processos-chave. O processo-chave passou a ter maior destaque e participação do farmacêutico visando à melhoria do atendimento ao usuário, além disto, foi iniciado um novo processo-chave: o seguimento farmacoterapêutico de hipertensos. A reorientação do modelo de gestão do serviço de farmácia pôde contribuir com a inserção do farmacêutico na equipe multidisciplinar e na transformação do usuário do serviço no principal cliente das atividades desenvolvidas pelo farmacêutico. / The Primary Health Care (PHC) is the main gateway to the health system and is directed to the promotion, prevention and recovery. In Brazil, the model of the Family Health Strategy (FHS) was chosen to strengthen PHC. PHC renewal and based on the FHS system is an important approach for producing improvements and promoting equity in health services. Aiming to meet these needs the Pharmaceutical Assessment needs restructuring ensuring improvements in logistics processes and supply quality in Health Care The Pan American Health Organization (PAHO) presents an alternative to this, using the model of management by processes having as main focus of the individual, family and community (IFC). By targeting the main focus of the work for IFC pharmacist no integration with the user and multidisciplinary team, health and promoting rational use of medicines. The purpose of this paper is to apply the model of process management in a pharmacy of a service of primary health care in the city of Rio de Janeiro in order to approach the pharmacist in clinical services. A case study was conducted to demonstrate how the application of the management model for processes submitted by authors propose process management as an alternative model to conventional focused management functions occurred. The pharmacy processes were mapped and redesigned. The key processes and critical success were identified and indicators were selected from literature to measure these processes. The logistics process was elected as a critical process, this process had its indicators measured over 6 months, improvements were implemented and defined responsible for each subprocess. Pharmacy technicians approached the logistics process and the pharmacist approached the key processes. The key process now has greater prominence and participation of pharmacist seeking to improve the service to the user, in addition, has started a new key case: pharmacotherapeutic follow-up of hypertensive patients. The reorientation of the management model of the pharmacy service could contribute to the insertion of the pharmacist in the multidisciplinary team and the transformation of the service user in the main client of the activities performed by the pharmacist

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-21T18:20:50Z No. of bitstreams: 1 Chiarello, Sabrina Pereira [Dissertação, 2015].pdf: 1866598 bytes, checksum: 0b85478a3862187e155dac8013610e14 (MD5) / Made available in DSpace on 2017-03-21T18:20:50Z (GMT). No. of bitstreams: 1 Chiarello, Sabrina Pereira [Dissertação, 2015].pdf: 1866598 bytes, checksum: 0b85478a3862187e155dac8013610e14 (MD5) / O Sistema Único de Saúde desde a sua criação tem avançado de forma significativa. Dentro desse processo ressalta-se a importância da Atenção Primária à Saúde, que é considerada a principal porta de entrada do sistema de saúde no Brasil. Independente do nível de atenção, a maioria das ações em saúde resulta em intervenção medicamentosa. O medicamento é considerado um insumo importante na prestação dos serviços de saúde. Diante da necessidade de disponibilizar medicamentos e da utilização destes de forma racional, é fundamental a organização dos serviços farmacêuticos, bem como a capacitação dos recursos humanos. O trabalho aborda as competências para a prática dos serviços farmacêuticos na Atenção Primária. Objetivos: Analisar as competências para o desempenho dos serviços farmacêuticos ao nível de Atenção Primária, identificando o perfil dos profissionais e realizando uma avaliação dos seus conhecimentos. Metodologia: Estudo descritivo e transversal, baseado em entrevistas com profissionais que realizam dispensação de medicamentos na Atenção Primária. O estudo foi realizado nos municípios de Campos dos Goytacazes e Itaperuna do estado do Rio de Janeiro. Foi empregado um questionário do tipo estruturado com perguntas fechadas. No questionário aplicado foram solicitadas informações sobre os dados pessoais do entrevistado, como formação profissional, vínculo empregatício, carga horária, informações sobre as unidades de trabalho, faixa salarial, gênero e grau de satisfação em relação aos funcionários da farmácia e da unidade de saúde. Na segunda parte foram solicitadas para cada atividade citada o grau de importância na opinião do entrevistado, a frequência de realização das atividades e o grau de conhecimento. Resultados: Foram entrevistados 19 profissionais que fazem a dispensação de medicamentos na atenção primária. Dentre os entrevistados 12 eram farmacêuticos. Treze entrevistados possuíam mais de um vínculo empregatício. Sobre a renda mensal, 4 tinham faixa salarial de até 3 salários. Onze fizeram estágio em atenção primária. Dez entrevistados fizeram curso de atualização. Sobre as farmácias das unidades de saúde, Campos tem 8 farmácias com sistema informatizado. A média de funcionários nas farmácias foi de 2. Seis entrevistados trabalham 40 horas por semana. Doze relataram que a infra-estrutura da unidade de saúde é o seu maior desafio no trabalho. Sobre a análise das competências dos serviços farmacêuticos, o escore para a opinião do grau de importância para as atividades citadas foi alto. O escore de frequência de realização das atividades foi baixo, o farmacêutico foi o profissional que mais praticou as atividades citadas no questionário. O grau de conhecimento foi elevado entre os farmacêuticos. Conclusão: O resultado sugere a discrepância entre a opinião do grau de importância e a frequência da realização das atividades (indicadores de competência) referentes aos serviços farmacêuticos. A maioria dos participantes do estudo relatou que consideram as atividades referentes aos serviços farmacêuticos citadas no questionário importantes, porém na prática algumas atividades não são praticadas. O farmacêutico foi o profissional que obteve maiores escores para a frequência de realizações de atividades e do grau de conhecimento em relação aos demais profissionais, demonstrando assim a importância da sua participação no contexto da atenção primária / The Health System since its inception has advanced significantly. Within this process highlights the importance of primary health care, which is considered the main health system gateway in Brazil. Regardless of the level of attention, most health actions results in drug intervention. The drug is considered an important input in the provision of health services. According to the need to provide medicines and the use of these rationally, the services organization is important, as well as the training of human resources. It considers the competence for the practice of pharmaceutical services in primary care. Objectives: To analyze the competences for the performance of pharmaceutical services at the level of primary care, identifying the profile of professionals and conducting a self-assessment of their knowledge. Methodology: Descriptive, cross-sectional study, based on interviews with professionals involved in dispensing drugs in primary care. The study was conducted in Campos dos Goytacazes and Itaperuna cities of the state of Rio de Janeiro. It was used a semi-structured questionnaire type with open and closed questions. In the questionnaire were asked about the respondent's personal data, such as vocational training, employment, working hours, information on units of work, salary range, gender and degree of satisfaction with pharmacy staff and health unit. In the second part were required for each activity mentioned how important the opinion of the respondent is, the frequency of the activities and the degree of knowledge. Results: We interviewed 19 professionals who are drugs dispensers in primary care. Among the respondents were 12 pharmacists. Thirteen respondents had more than one job. About the monthly income, 4 had salary range of up to 3. Eleven had training in primary care. Ten respondents did refresher course. About pharmacies of health facilities, Campos has 8 pharmacies with computerized system. The average number of employees in pharmacies was 2. Six respondents work 40 hours a week. Twelve reported that the health facility infrastructure is your biggest challenge at work. On the analysis of the competences of pharmaceutical services, the score for the opinion of the degree of importance for the mentioned activities was high. The frequency score of carrying out activities was low, the pharmacist was the professional who carried out most of the activities mentioned in the questionnaire. The degree of knowledge was high among pharmacists. Conclusion: The results suggest the discrepancy between the opinion of the degree of importance and frequency of performing activities (competence indicators) relating to pharmaceutical services. Most of the study participants reported that think the importance of the activities related to pharmaceutical services mentioned in the questionnaire, but in practice some activities are not practiced. The pharmacist was the professional who obtained higher scores for the frequency of activities and achievements of the degree of knowledge in relation to other professionals, thus demonstrating the importance of their participation in the context of primary care

Made available in DSpace on 2014-08-20T13:49:48Z (GMT). No. of bitstreams: 1 Anelise Miritz Borges.pdf: 1036873 bytes, checksum: 7545090f87658d79ee7b2f9c1b8e391e (MD5) Previous issue date: 2010-12-06 / Medicinal plants are therapeutic resources incorporated into the plan of individuals care since the first civilization groups, which seeking strategies in nature to improve their living conditions and ensure its survival. So, many cultures, especially indigenous, African and European, influenced the building of knowledge and consumption of medicinal plants. This action contributed to the promotion of ethnic and cultural variability in Brazil and, consequently, to the emergence of various uses worldwide of plants for medical purposes. The aim of this study was to understand the use of medicinal plants in health care by residents of Ilha dos Marinheiros, southern Rio Grande do Sul state, Brazil. The research was qualitative, exploratory and descriptive and was conducted at Ilha dos Marinheiros, county of Rio Grande. This work was part of the project "Bioactive plants for human use by families of ecological farmers in southern Rio Grande do Sul state", developed by the School of Nursing, Federal University of Pelotas and Embrapa Temperate Agriculture. Twelve key informants were selected by the method of snow-ball proposed by Goodman. Data were collected from February to July 2010. The instruments used were semistructured interviews, photographic documentation of plants, eco-map, georeferencing and field observation. The theoretical approach is based on understanding the culture and health by Clifford Geertz and Madeleine Leininger. The study was approved by Ethics and Research Committee, School of Medicine, UFPel (072/2007) and received authorization by Center for Continuing Education of Rio Grande Health (42/09). A thematic analysis, structured into two themes, was: health practices and medicinal plants in the context of Ilha dos Marinheiros, discussing the interfaces with nursing. Among the results, it is emphasized that medicinal plants are part of local history and culture, and represent an important resource for the attainment of health care among the islanders. This community is composed mainly by Portuguese descents, which have a popular knowledge learned from their family generations, and use medicinal plants without any specific dosage and without taxonomic identification, both for minimize a symptom and for prevent a disease. Thus, ethnobotanical rescue and scientific knowledge needs to be connected with the process of transculturation of popular knowledge related to medicinal plants, so that nursing uses them in search of the appreciation of local culture with effective practices in health. / As plantas medicinais são recursos terapêuticos incorporados no plano de cuidado dos indivíduos desde a existência dos primeiros grupos civilizatórios, que buscavam na natureza estratégias para aprimorar a sua condição de vida e garantir a sua sobrevivência. Assim, várias culturas, em especial a indígena, a africana e a européia, influenciaram na edificação dos saberes e no consumo das plantas medicinais. Esta ação colaborou para o fomento da variabilidade étnica e cultural do Brasil e, por conseqüência, o surgimento de várias formas de utilização das plantas com fins terapêuticos no mundo todo. O objetivo do estudo foi compreender a utilização das plantas medicinais no cuidado a saúde dos moradores da Ilha dos Marinheiros, sul do Rio Grande do Sul. A pesquisa foi qualitativa, exploratória e descritiva conduzida na Ilha dos Marinheiros, município de Rio Grande. Este trabalho fez parte do projeto Plantas bioativas de uso humano por famílias de agricultores de base ecológica na região Sul do Rio Grande do Sul , desenvolvido pela Faculdade de Enfermagem da Universidade Federal de Pelotas e Embrapa Clima Temperado. Foram abordados 12 informantes-chaves, selecionados a partir do método de bola-de-neve proposto por Goodman. A coleta de dados ocorreu de fevereiro a julho de 2010. Os instrumentos utilizados foram: entrevista semiestruturada gravada, registro fotográfico das plantas, ecomapa, georreferenciamento e observação de campo. O referencial teórico adotado se fundamenta na compreensão da cultura e saúde por Clifford Geertz e Madeleine Leininger. O trabalho foi aprovado pelo Comitê de Ética e Pesquisa da Faculdade de Medicina UFPel (072/2007) e recebeu autorização do Núcleo de Educação Permanente da Saúde de Rio Grande (42/09). Foi utilizada a análise temática, estruturada em dois temas: as práticas de saúde e as plantas medicinais no contexto da Ilha dos Marinheiros, discutindo-se nesta as interfaces com a enfermagem. Dentre os resultados, destaca-se que as plantas medicinais fazem parte da história e cultura locais e representam um recurso importante para a realização do cuidado em saúde entre os ilhéus. Composta predominantemente por descendentes de imigrantes portugueses, esta comunidade é munida de um saber popular aprendido entre as suas gerações familiares, e utiliza as plantas medicinais tanto para minimizar um sintoma que interfira na saúde, como para prevenir uma situação de mal-estar ou doença. Esta ação é realizada sem dosagem e identificação taxonômica específicas. Deste modo, o resgate etnobotânico e o conhecimento científico necessitam estar conectados com o processo de transculturação dos saberes populares sobre as plantas medicinais, de forma que a enfermagem as utilize em busca da valorização da cultura local com práticas eficazes em saúde.

D.Cur. / A qualitative approach was followed to conduct a case study. Data was collected through participative observation, document analysis and interviewing of team members representing seven different disciplines. The practice model of Dickoff, James and Wiedenbach (1986:415-435) was utilized as theoretical framework to explore and describe the role players involved in team functioning within the context of primary health care. Team objectives and processes relevant to team functioning as well as the dynamics of team work were described and compared to a guide for team functioning, the elements which were derived from a literature study. The credibility of the research was enhanced through long term involvement in the activities of the study case as participative observer, through triangulation of methods to collect and verify data and through peer evaluation and auditing. It was determined that within the context of a home care service at primary health care level, it was mainly the nurse, being the team member with whom the patient and family have continued personal contact, who acts as team leader and initiates involvement of members from other disciplines. The decisions regarding whom to involve and how and when to involve them, are based on the knowledge and skills of the nurse in relation to the situation he/she has to manage, the acceptability of the team approach and compliance by the patient and family, the attitude, commitment and perception of other team members as well as the availability of facilities and infrastructure to enable team functioning. The organizational and philosophical framework within which service is delivered have a direct impact on team functioning. Community involvement and its acceptance of responsibility for health, enhances quality team functioning, but is dependant on effective empowerment strategies, a sound trust relationship and a reliable support system. Clear and agreed upon goals and objectives for team functioning are essential for effective team work. Innovative and creative strategies are necessary to enable team members representing different disciplines, who function in the context of primary health care, to have sufficient contact with each other to discuss objectives, give feedback and communicate effectively. Processes for and dynamics in team functioning are complex in nature and need to be identified, evaluated and, if necessary, adapted on a regular basis to promote effective team functioning. The objectives of the research, namely to explore and describe team functioning at primary health care level and to formulate guidelines for effective team functioning, were realized. A structure for working from the basis of a core team was proposed, as well as interdisciplinary training of team members, commencing at undergraduate level and continuing throughout professional life. The researcher recommends that the guidelines formulated with regard to the role players, context, objectives, processes and dynamics of team functioning at primary health care level be implemented. Aspects related to team functioning to be further researched have been identified, namely: assessing the quality of team functioning at primary health care level; the effect of interdisciplinary training on team functioning; the relationship between team functioning and the health status of communities; cost-efficiency of team functioning; utilizing latest technological developments for communication between and support for team members at primary health care level; the relationship between community empowerment, community involvement and interdisciplinary team functioning and the design of a model for team functioning at primary health care level. The research report is written in Afrikaans, but the conclusions reached in each of the nine chapters have also been translated into English to enhance the accessibility of research findings.

Ph.D. (Community Nursing Science) / The provision of reproductive health promotion services to females in South Africa is the responsibility of the national and provincial governments, while in primary healthcare (PHC) settings the local government is responsible for the provision of free reproductive health promotion services to females. The prevalence of sexually transmitted infections (STIs), the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) led to the development and provision of noncollaborated vertical PHC reproductive health programmes. The purpose of this study was to develop a model to collaborate the provision of reproductive health promotion services in PHC settings. A qualitative, descriptive phenomenological design, exploratory and descriptive approaches and contextual and theory generating design were used. The study was conducted in three phases. In phase 1, data collection consisted of individual indepth interviews and focus group interviews. Non-probability purposive sampling was used to include three population groups: females who utilised the reproductive health promotion services and reproductive health promotion service providers and those who provide clinical teaching regarding reproductive health promotion in two different PHC settings who were sampled through non-probability convenience sampling methods. Throughout the study, ethical principles were strictly adhered to and trustworthiness was ensured. Data analysis was done according to Tesch’s open coding data analysis method. The findings revealed four emerging themes: service provision factors that impact on reproductive health promotion provision; barrier factors towards safer sex practice; low health literacy of females regarding reproductive health promotion, and disclosure of positive HIV status. In phase 2, the conceptual framework was described according to the survey list of Dickoff, James and Wiedenbach (1968) and the Research Model in Nursing as described in the Theory for Health Promotion in Nursing (University of Johannesburg, 2009). In phase 3, the described conceptual framework served as the guideline for the model development guided by Chinn and Kramer’s (2008) theory and model generating design. Two phases of model evaluation was done: firstly by clinical experts and secondly by academic experts. The model that was developed was based on collaboration, community participation, and cooperative decision making processes and was named: A model to collaborate the provision of reproductive health promotion services in PHC settings. The outcomes from implementing this model envisaged to be the reduction of unintended pregnancy, STIs, and HIV and AIDS among females and males.

Submitted in fulfillment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Background. Unintended pregnancy is a major global challenge among sexually active women of childbearing age. Non-use of modern contraception and inconsistent use of short term contraceptive methods are the main reasons associated with unintended pregnancy. Long acting reversible contraceptives (LARCs) have proven to be highly effective with good continuation rates, and are cost-effective compared to other methods, when used more than one year. However, there is low uptake of LARC methods globally and in South Africa. Aim of the study. The aim of the study was to determine factors influencing the uptake of LARC methods among women at the primary health care (PHC) clinics in eThekwini District. Methodology. A quantitative, descriptive survey was used in this study. Purposive sampling of six fixed PHC clinics from the three sub-districts was done. Convenience sampling resulted in 371 participants. A survey questionnaire in English and isiZulu was used to collect data. Data was analysed using SPSS version 23.0. Inferential statistics were used to determine the relationship between the variables. Results. The results of this study revealed that the contraceptive injection was most common LARC used, and the least used method was the intrauterine contraceptive device. The side effects were the main reasons for discontinuation with LARCs and all other contraceptive methods. Irregular vaginal bleeding was the main side effect cited by respondents associated with contraceptive implant usage. The respondents had positive attitudes and perceptions towards LARCs; however, the majority of respondents were not interested in using LARC methods. Common myths and misconceptions were not negatively associated with LARCs, since respondents disagreed with them all. / M

Background: Physiotherapist is one health care profession with an increased exposedness for work-related burnout. Purpose: To investigate the experience of work-related stress in physiotherapists within primary health care in Sweden as well as coping strategies to manage stress at work.   Design and method: Qualitative design based on semi-structured interviews. Five physiotherapists from different workplaces in two different regions in Sweden attended in the study. Qualitative content analysis was used to analyze and process collected data. Results: The physiotherapists experienced high workload, increased stress levels, working overtime, staff shortages as well as expectations and demands as stressors in the workplace. Poor quality at work and in meetings with patients were mentioned as consequences of work-related stress. Facilitating factors and coping strategies to abate stress were used in terms of good self-efficacy in the profession, having collegial support, physical activity as well as being content with the current life-situation outside of work. Conclusion: Social support in the workplace is an important factor to abate stress among physiotherapists in primary health care in Sweden. The result illustrates the importance of being observant on contributive factors for work-related stress. Coping strategies to counteract stress were also mentioned in the study. / Bakgrund: Fysioterapeuter är en av flera vårdprofessioner som har en ökad utsatthet för arbetsrelaterad utbrändhet. Syfte: Att undersöka upplevelse av stress i arbetslivet hos fysioterapeuter inom primärvård samt hur de hanterar den stress som kan uppstå. Metod: Kvalitativ design i form av semistrukturerade intervjuer användes. Fem fysioterapeuter, från olika arbetsplatser inom primärvården samt från två olika regioner i Sverige, intervjuades utifrån författarnas intervjuguide. Intervjuerna bearbetades och analyserades genom kvalitativ innehållsanalys.   Resultat: Fysioterapeuterna upplevde bidragande faktorer i form av bland annat ökad stressnivå, hög arbetsbelastning, övertidsarbete, låg bemanning samt krav inom arbetet. Underlättande faktorer som framkom var trygghet i arbetsrollen, kollegialt stöd på arbetsplatsen samt en god livssituation utanför arbetet. Nedsatt kvalité i arbetet och patientbemötandet var konsekvenser som uppkom till följd av arbetsrelaterad stress. Stresshanteringsstrategier såsom tydlighet i mötet med patienten och ta hjälp av kollegor nämndes. Utanför arbetstid användes även fysisk aktivitet samt att ”varva ned” som strategier. Konklusion: Stöd från kollegor och ledning är viktigt hos fysioterapeuter i primärvård för att minska risken för upplevd arbetsrelaterad stress. Studien uppmärksammar vikten av att vara observant på faktorer som tyder på upplevd arbetsrelaterad stress samt att använda individuella stresshanteringsstrategier hos fysioterapeuter inom primärvård.

Abstract Telehealth adoption is a complex and challenging process that often ends in failure. In Finland, telehealth in the form of videoconferencing is used relatively little in patient care, despite the relatively long geographical distances. The aim of this study was to describe telehealth adoption within one Finnish telehealth project. The aim was also to investigate why some telehealth applications remained in permanent use after the experimental phase while others did not. This was a qualitative study in which the material was gathered using theme interviews. Document material was also used to complement the interview data. Employees working in health care centres and specialised health care (n=41) took part in the study in 2007–2009. Some of the staff members were interviewed twice, which is why the material comprised a total of 55 interviews. The material was analysed using inductive, deductive and theory-driven content analysis. Successful adoption of telehealth applications is influenced by a variety of factors. The key factor is telehealth compatibility, which must be looked at from the perspectives of individuals (staff and patients), processes and the organisation. In terms of adoption success, factors associated with the organisation and how the project was organised were particularly emphasised, such as the need for adoption and arrangement of teleconsultations as regular processes with permanent staff and due attention to technology access and functionality. As a whole, health care staff were positive towards telehealth adoption; however, a negative attitude is not a definite obstacle to adoption. Health care staff perceived telehealth as having a number of benefits for patients, employees and society as a whole. Telehealth must be suited for patients and employees, clinical healthcare processes and the organisation. Suitability can be impacted by organisation and technology. The study has generated information about the adoption of telehealth in the Finnish health care system. This information can be made use of when planning new telehealth projects. / Tiivistelmä Etäterveydenhuollon käyttöönotto on monimutkainen ja haasteellinen prosessi, jossa epäonnistutaan usein. Suomessa videoneuvottelutekniikan avulla toteutettua etäterveydenhuoltoa käytetään potilastyössä melko vähän, vaikka meillä maantieteelliset välimatkat ovat pitkiä. Tämän tutkimuksen tarkoituksena oli kuvata etäterveydenhuollon käyttöönottoa yhdessä suomalaisessa etäterveydenhuoltohankkeessa. Tarkoituksena oli myös selvittää, miksi osa etäterveydenhuollon sovelluksista jäi pysyvään käyttöön ja osa loppui kokeiluvaiheen jälkeen. Tutkimusmetodina oli laadullinen tutkimus, jossa aineisto kerättiin teemahaastatteluilla. Lisäksi dokumenttiaineistoa käytettiin täydentämään haastatteluaineistoa. Haastatteluihin osallistui terveyskeskusten ja erikoissairaanhoidon työntekijöitä (n =  41) vuosina 2007–09. Osa työntekijöistä haastateltiin kahteen kertaan, joten kokonaisuutena tutkimusaineisto käsitti 55 haastattelua. Tutkimusaineisto analysoitiin aineistolähtöisellä, teorialähtöisellä ja teoriaohjaavalla sisällönanalyysillä. Etäterveydenhuollon sovellusten käyttöönoton onnistumiseen vaikuttavat monet eri tekijät. Keskeisin tekijä on etäterveydenhuollon soveltuvuus, jota pitää tarkastella yksilön (työntekijöiden ja potilaiden), prosessien ja organisaation näkökulmista. Käyttöönoton onnistumisessa painottuvat etenkin organisaatioon ja hankkeen organisoimiseen liittyvät tekijät, kuten tarve käyttöönotolle ja etäkonsultaatioiden järjestäminen säännöllisiksi prosesseiksi, joissa on pysyvät työntekijät ja joissa teknologian saatavuudesta sekä toimivuudesta on huolehdittu. Terveyskeskustyöntekijät suhtautuvat pääasiassa myönteisesti etäterveydenhuollon käyttöönottoon, eikä kielteinen asenne ole ehdoton este käyttöönotolle. Terveyskeskustyöntekijät kokevat etäterveydenhuollosta olevan monenlaista hyötyä potilaille, työntekijöille ja yhteiskunnalle. Etäterveydenhuollon täytyy soveltua potilaille ja työntekijöille, terveydenhuollon kliinisiin prosesseihin ja organisaatiolle. Organisoinnilla ja teknologialla voidaan vaikuttaa soveltuvuuteen. Tutkimus on tuottanut tietoa etäterveydenhuollon käyttöönotosta suomalaisessa terveydenhuoltojärjestelmässä. Tätä tietoa voidaan hyödyntää suunniteltaessa uusia etäterveydenhuoltohankkeita.

Magister Public Health - MPH / Background: Optimal management of Type 2 diabetes requires that patients have a convenient method of collecting chronic medication. In the Western Cape Province, Type 2 diabetes patients can collect chronic medication from primary health care facilities including community health centres. The Chronic Dispensing Unit (CDU) was established to facilitate the dispensing of chronic medication by making medication collection more convenient for patients and was expected to improve medication collection. However, it has been observed that some Type 2 diabetes patients fail to collect pre-packed CDU parcels on the prescribed date and time which could result in poor treatment outcomes and secondary complications. This study therefore aims to explore the factors that influence collection of CDU chronic medication parcels by Type 2 diabetes patients from the Elsies River Community Health Centre (CHC), a primary health care facility in the Western Cape Province. Methodology: An exploratory qualitative research design was used to explore the personal-, social-, health system-related factors that affect collection of pre-packed CDU parcels. Semistructured interviews were conducted in English or Afrikaans with 18 purposefully selected Type 2 diabetes patients who are registered to collect pre-packed CDU parcels from the Elsies River CHC, and three key-informants from the Elsies River CHC. Data was recorded using a digital recorder. Interviews were transcribed and analysed using inductive content analysis. Results: The main factors that facilitate collection of pre-packed CDU parcels were support from family and social support. On the other hand, social factors that were reported as barriers to collection were the safety of the patients and collectors failing to collect on behalf of the patient. Patients' recognition of the value of their treatment and value of the service were the main personal factors which facilitated collection. Personal factors that were reported as a barrier to collection included forgetfulness, laziness and tiredness. Other personal factors that were reported by participants as barriers to collection were illness, transport problems, financial constraints and anticipating non-collection. Health service related factors reported as facilitating factors were reduced waiting time and mistrust of the off-site collection system. In addition, participation in the diabetes chronic club and pharmacy support were also reported as facilitating factors. Negative staff attitude and a limited collection time for pre-packed CDU parcels were reported as barriers to collection by Conclusion: Various personal-, social and health service related factors affect the collection of pre-packed CDU parcels by Type 2 diabetes patients from the Elsies River CHC. To improve collection among patients who fail to collect on their appointment date, the factors that have been found to facilitate collection should be extended to more patients. Recommendations: It is recommended that patients surround themselves with support structures including family, friends and community organisations to assist and motivate them in displaying adherent behaviour. Patients who make use of independent collectors should ensure that these individuals are reliable to avoid an undersupply of medication. Counselling and health promotion should be provided to patients by health service staff as a means of encouragement and empowerment. The diabetes club which serves as a source of information and support should be accessed by more patients. Open communications channels between health service staff and patients should be constructed to ensure that staff are aware of the barriers patients face.

Knowledge translation describes the process of getting knowledge into practice, leading to a healthy workforce and economy. Knowledge translation is particularly challenging at the primary healthcare level, which manifests as a research to practice gap. This research aimed to explore and describe knowledge translation from both a knowledge translation organisation’s and knowledge user’s point of view at the South African primary healthcare level. A qualitative dominant, mixed methods approach was used. Twelve semi-structured interviews were conducted with nine organisations to evaluate their knowledge translation strategies. An online survey collected responses from primary healthcare workers to assess their knowledge needs and preferences. Lastly, the Thinking Processes of Theory of Constraints were applied to the public sector to identify ways in which knowledge translation can be optimised within the Department of Health system. This research found that the organisations’ strategies were inextricably linked to the knowledge translation context. Barriers to knowledge translation in the public and private sector as well as urban and rural areas differed in many respects. Organisations were successful in overcoming many of these barriers, but barriers that reside at the Department of Health (DOH) policy level, remain difficult to address. The 82 survey respondents were mostly doctors from the urban private sector. They represented a distinct subset of practitioners who preferred using the internet to access knowledge and identified no significant barriers to staying up to date. The Thinking Processes identified possible solutions to getting new DOH guidelines into practice in a fast, reliable and coordinated manner. This requires increased collaboration between knowledge translation organisations and the DOH as well as the design of a system for updating the DOH guidelines on an annual basis. / Dissertation (MBA)--University of Pretoria, 2013. / ccgibs2014 / Gordon Institute of Business Science (GIBS) / MBA / Unrestricted