Orientador: Elen Rose Lodeiro Castanheira / Resumo: A Atenção Primária à Saúde (APS) possui papel essencial na promoção do envelhecimento ativo e gestão da saúde da pessoa idosa, conforme apontado na literatura nacional e internacional. Apesar do papel de destaque atribuído à APS, poucos trabalhos analisam como as ações que abordam o envelhecimento e a saúde dos idosos são desenvolvidas nesse nível de atenção. A presente pesquisa tem como objetivo geral avaliar a organização da atenção à saúde da pessoa idosa e ao envelhecimento em serviços de Atenção Primária à Saúde, e como objetivos específicos: avaliar a implementação e o desempenho de ações dirigidas à saúde da pessoa idosa e ao envelhecimento em serviços de APS de municípios do centro oeste paulista e verificar a associação entre o desempenho de serviços de APS na atenção à pessoa idosa e ao envelhecimento e indicadores de planejamento e avaliação em saúde. Trata-se de uma pesquisa avaliativa, quantitativa, transversal, de serviços de APS da Rede Regional de Atenção à Saúde 09, situada no centro-oeste paulista, a partir da aplicação do instrumento “Questionário de Avaliação da Qualidade de Serviços de Aten¬ção Básica” – QualiAB, em 2014. Baseado nas principais políticas públicas e diretrizes vigentes no país sobre atenção ao envelhecimento e à pessoa idosa foi construído um modelo teórico lógico operacional, que orienta a análise e discussão do material empírico. A partir do instrumento QualiAB foram definidos 155 indicadores relacionados a atenção à saúde da pessoa idos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Primary Health Care (PHC) plays an essential role in the promotion of active aging and in the health management of elderly, according to national and international literature. Despite the notable role attributed to the PHC, few studies have analyzed how the actions that approach the aging and health of the elderly are developed based on this type of healthcare. The general objective of this study is to evaluate the organization of elderly healthcare and aging in PHC services. The specific objectives are: to evaluate the implementation and development of actions directed to the health of elderly in PHC services in the central-west region of São Paulo state as well as to verify the association between the development of PHC services for the elderly and indicators of health planning and evaluation. This is an evaluative, quantitative and cross-sectional study, based on the 09 Healthcare Regional Network services, localized in the central-west of São Paulo state. The data were collected through the “Questionnaire for the Evaluation of Quality of Primary Health Care Services” – QualiAB, in 2014. Based on the main public policies and regulations in Brazil related to aging and healthcare of elderly, an operational, logical and theoretical model was developed in order to guide the analyses and discussion of the empirical material. Through the QualiAB instrument, 155 indicators were defined concerning the aging and healthcare of elderly, grouped into three domains: Healthcare for ... (Complete abstract click electronic access below) / Doutor

Bakgrund. Primärvården expanderar globalt och genomgår en förändring. Tillgänglighet prioriteras vilket har lett till en ökning av triage via telefonrådgivning och drop-in mottagningar.  Syftet med litteraturstudien var att undersöka för- och nackdelar med triage i primärvården relaterat till patientsäkerhet. Metod. En integrativ litteraturstudie med induktiv ansats. Mixad metod med både kvalitativa och kvantitativa artiklar användes och konvergent parallell design användes för att analysera artiklarna. Huvudresultat. Triage i primärvården bedömdes vara patientsäkert. Sjuksköterskor hade en god kommunikationsförmåga som bidrog till ökad patientsäkerhet. Däremot identifierades flertalet faktorer som riskerade att hota patientsäkerheten. Nackdelar vid triage via telefonrådgivning som uppmärksammades var bland annat beslutsstödsystemets brister och bristande kommunikationskunskaper hos sjuksköterskorna. Drop in-mottagningar behövde utvecklas men ansågs dock generellt främja patientsäkerheten. Vidare utbildning inom triage och kommunikation önskades för att säkerställa patientsäkerheten. Slutsats. Triage i primärvården via telefonrådgivning är fördelaktigt för patientsäkerheten. Litteraturstudiens resultat antyder även att triage vid drop in-mottagningar är fördelaktigt för patientsäkerheten, men ytterligare studier inom området krävs för att kunna undersöka om detta resultat reflekterar verkligheten. Sjuksköterskors kommunikationsförmåga kan utgöra både för- och nackdelar med triage i primärvården i förhållande till för patientsäkerheten, beroende på om kommunikationsförmågan är god eller bristande. Ett antal faktorer identifieras som riskerar att hota patientsäkerheten. / Background. Primary care is expanding globally and undergoing change. Accessibility is a priority, which has led to an increase in triage via telephone counseling and walk-in centres.  The purpose of this literature review was to examine advantages and disadvantages with triage in primary health care related to patient safety. The Design was an integrative literature review with an inductive approach. A mixed method with both qualitative and quantitative articles were used. Convergent parallel design was used to analyze the articles. Main findings. Triage in primary health care was judged to be safe for patients. Registered nurses had good communication skills that contributed to increased patient safety. However multiple factors that risked threatening patient safety were identified. Disadvantages identified in telephone triage were the flaws in the computerized decision support system and inadequacies in nurse’s communication skills among others. The walk-in centers needed to evolve but were considered to promote patient safety. Further education in triage and communication was requested to ensure patient safety. Conclusion. Triage in primary healthcare via telephone counseling is beneficial for patient safety. The results of the literature study also suggest that triage at walk-in centers is beneficial for patient safety, but further research is required to be able to investigate whether this result reflects reality. Registered nurses' communication skills can constitute both advantages and disadvantages of triage in primary health care in relation to patient safety, depending on whether the communication skills are good or lacking. Several factors are identified that risk threatening patient safety.

Magister Scientiae (Nutrition Management) - MSc(NM) / Globally, health workers play a critical role in the establishment and sustenance of breastfeeding due to their frequent contacts with mothers at the antenatal clinics, maternity/birthing units, Primary Health Care Centres (PHC) and postpartum clinics. Their knowledge and attitude regarding breastfeeding will affect the quality of information about infant and young child feeding practices passed along to mothers who visit their health facilities.

Master of Public Health - MPH / Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

Thesis (M.A. (Nursing)) -- University of Limpopo, 2021 / Background: The utilization of primary health care (PHC) facilities has declined as most patients are using the hospitals for minor ailments. The study aimed to investigate factors that contribute to non-utilization of PHC services by the community in Greater Tzaneen Municipality, Mopani District, Limpopo Province. Methodology: quantitative research method was used, and data was collected using self-designed questionnaire. Total of 101 respondents out of 135 population participated in the study. Simple random sampling was used. The questionnaire was piloted to ensure reliability in a different setting. Data was analyzed using SPSS version 24. The outcome of the analysis was presented as frequencies and percentages in tables, pie charts and bar graphs. Ethical standards were adhered to throughout the study. Results: Demographic results indicated that the most of the respondents were females, aged between 26-35 years, speak the Sepedi language unemployed, went up to secondary school level using public transport, and have used their local clinic before more than. Many indicated that they have visited the hospital for reasons other than maternal and child health, chronic diseases and medication and minor illnesses. 25 factors recorded and the respondents reported six major factors that contributed to non-utilizing their PHC services. Factors included long queues and waiting times, no drugs and essential medication, PHC not operating for 24 hours and not operating for 7 days per week and nurses’ negative attitudes toward the community. Conclusions: Demographic results did not impact on the non-utilization of PHC services, but community-related, administrative factors and health-related factors contributed to non-utilization of PHC services

Magister Scientiae (Medical Bioscience) - MSc(MBS) / The aim of this study was to determine and evaluate the prevalence of TB infection, active TB cases and the risk factors associated with TB infection in Macassar Camp in Macassar (about 40 km from Cape Town on the False Bay coast, with a population of 369). The study design of this epidemiological study was a cross sectional study with a descriptive and an analytic component A comparison between the Mantoux, TB ELISA and X-ray screening tests was performed first. A description of the origin, discovery, characteristics and pathology associated with Mycobacterium tuberculosis as well as the development of the TB epidemic on a global, national and local level, is given. TB was first described to give a South African perspective of the TB epidemic and both the "Virgin Soil" and "Non-Virgin Soil" theory of TB was reviewed. Secondly, ~he TB infection rate in Macassar Camp and the risk factors as well as the determinants of TB infection with regards to overcrowding, ventilation, primary food subsistence level rating (PFSL), social class and employment status were evaluated The third aspect of the study compares prevalence/incidence rates of TB to clinical diagnosis with regards to the symptomatology, radiographs, sputum microscopy, bacteriology and Mantoux test. Lastly the Mantoux test was compared with the TB ELISA test with regards to diagnosis of infection, in new and past confirmed TB cases. The first part of the survey involved the measurement of openable window area and the floor area of each Camp dwelling (to determine if ventilation was within required limits), during the administration of a household questionnaire which was designed to determine the number of occupants, rooms, income, food expenditure per household in the Camp. A personal questionnaire was administered to all Macassar Camp residents to elicit information on demography, knowledge and attitudes to TB, history of past TB, TB contacts, alcohol intake and smoking habits, occupation and BCG status. The Mantoux test were performed on consenting Camp residents in addition to the collection of 5 ml of blood for the TB ELISA tests. The Camp residents heights and weights were recorded prior to the miniature mass chest radiographs being taken. The 'TB suspects' sputa were collected for the microscopy and bacteriological examination. A review of the clinical records of TB patients in the Macassar/Stellenbosch area was also undertaken. The response rate to the household questionnaire was 60 from 63 (95,2%) dwelling units. Whereas the response rate to the personal questionnaire was 296 (80,2%). As for the Mantoux and TB ELISA tests the response rate was 209 (56,6%). Of the 60 dwelling units, 43 (71,7%) were calculated (according to . Batsons Index) to be crowded and 16 (26,7%) dwelling units had an overall ventilation of less than 5% (below the required regulation). There were significantly (p<0,005) more male than female smokers and only 78 (34,2%) of the residents regarded themselves as non-smokers. A similar trend was noted with regards to the alcohol intake of the residents, where only 86 (37,7%) regarded themselves as teetotallers, with significantly more (p=0,003) male than female alcohol consumers. Females sc6red significantly (p=0,002) better than the males with regards to TB knowledge and awareness. Only 199 (67,2%), residents indicated that they had had BeG vaccination. Of the 296 residents responding to the survey, there were 83 children aged 14 years or less. And only 74 of these children were confirmed to have been vaccinated with BeG, resulting in a 89,2% BeG coverage. Two (4,7%) of the 43 children aged 14 years or less were determined to be malnourished on the basis of Z-scores (below -2SD) taking into account height for age as well as weight for height.

Philosophiae Doctor - PhD / Sexually transmitted infections (STIs) are a problem for both developed and developing countries. Sub-Saharan Africa has the highest rates in the 15-49 years old group. The discovery that these infections playa vital role in the transmission of HIV raised their profile and made their control one of the central strategies of stopping the HIV/AIDS epidemic. In response to the challenge of improving the quality of care for people infected with STIs in the public health sector, the South African Ministry of Health adopted the syndromic management approach, recommended by the World Health Organisation as suitable for resource-poor settings, for use in primary health care clinics. In addition to providing guidelines on clinical management of STIs, the syndromic approach requires health providers to counsel and educate patients about STIs, encourage patients to complete treatment even if symptoms abate, promote condom use and the treatment of all sexual partners. While the management guidelines are clear and detailed around the diagnostic and medication issues, the processes of education and counseling are not as clearly outlined. Furthermore, although the syndromic approach is a viable way of providing good quality care to larger sections of the population than could be serviced through dedicated STI clinics, it requires health providers working in primary health care clinics, most of whom are professional nurses, to perform some tasks for which they may not be adequately trained. This study evaluated the quality of care for persons infected with ST!s by examining the extent to which the syndromic approach was being implemented in primary health care clinics. Interviews, using semi-structured interview schedules, were conducted with STI patients and health providers in twenty-four clinics located in four provinces. Indepth qualitative interviews were also conducted with a sub sample of the patients. For further triangulation the methods of participant observation, through the use of simulated patients, and focus group discussions with various community groups were used. The findings of the study indicate that although primary health care clinics in South Africa are well-resourced, the management of patients with STI's is inadequate. Adherence to the various aspects of syndromic management was poor. Similar to other studies in South Africa, the attitudes of health providers towards patients with ST!s were found to be problematic, a finding that has implications for health-seeking behaviours. The thesis argues that a large part of the problem is related to the multiple roles that nurses have to play in primary health care settings, as well as the content and methodology of the training of nurses who manage STI patients. It further argues for the constitution of the basic health team at primary health clinics to be multi-disciplinary, and for a multi-disciplinary input in the training of health providers.

Health care, and especially access to health care, has always been a critical metric for countries. In 2017, South Africa spent 9% of its GDP on health care. Despite the GDP health care allocation being 5% higher than recommended by the World Health Organisation for a country of its socio-economic status, South Africa's health status is poor compared to similar countries. In 1994, South Africa implemented a health care policy to make health care accessible to all South Africans. A primary health care facility within 5km of the place of residence is deemed accessible. There is still a significant gap between the actual and desired accessibility, especially for the lower-income communities. There is a need to improve access to public health care for all South Africans. Cost-effective and sustainable solutions are required to solve this problem. Therefore, an opportunity was identified to investigate the location of low-cost container clinics in lower-income communities. This report uses robust optimisation and goal programming to find robust sites for cost-effective container clinics over multiple years in an uncertain environment using multiple future city development scenarios. The study area of the report includes three metro municipalities (City of Tshwane, City of Johannesburg, and City of Ekurhuleni) in Gauteng, South Africa. Three future development scenarios were created for this study using a synthetic population and urban growth simulation model developed by the CSIR. The model provided the population distribution from 2018 to 2030 for all three of the scenarios. The simulation model provides household attribute tables as an output. Household attributes that have a causal relationship with health care demand were investigated during the literature review. Based on the literature and the available household attributes, four attributes were selected to forecast the health care demand. The four attributes are household income, the number of children in the household, the household size, and the nearest clinic's distance. Using associative forecasting, the primary health care demand was forecasted from 2018 to 2030. These forecasts were used as input into the facility location models. A p-median facility location model was developed and implemented in Python. Since facility location problems are classified as NP-hard problems, heuristics and metaheuristics were investigated to speed up the problem solving. A GA selected as the metaheuristic be used to determine a suitable configuration of facilities for each scenario. The model determined good locations of clinics from a set of candidate locations. A good year to open each clinic is also determined by the model. These decisions are made by minimising three variables: total distances travelled by the households to their nearest clinics, the total distance from the selected distribution centre to the open clinics and the total building cost. An accessibility target of 90% was added to the model to ensure that at least 90% of the households are within 5km of the nearest clinic within the first five years. In these models, operating costs were not included. Therefore all the results are skewed, with most of the clinics being opened in the first year when it is the cheapest since there is no penalty for opening a clinic before it is needed — the exclusion of operating costs is a shortcoming to address in future work. A goal programming model was developed with the variables of the individual scenarios as the goals. The goal programming model was implemented in Python and used to determine a robust configuration of where and in what year to open container clinics. A difference of 25% was set as the upper limit for the difference between the robust configuration variables and the good or acceptable variables for the individual scenarios as the scenarios investigated are very different. This ensured that the robust solution would perform well for any of the three scenarios. The model was able to find locations that provided a relatively good solution to all the scenarios. This came with a cost increase, but that is a trade-off that must be made when dealing with uncertainty. This model is a proof of concept to bridge the gap between urban planning with multiple development scenarios and facility location, more specifically robust facility location. The biggest rendement was achieved by constructing and placing the container clinics in the shortest space of time because the 90% accessibility requirement can be addressed cost-effectively without an operating cost penalty ― this is unfortunately not possible in reality due to budget constraints. An accessibility analysis was conducted to investigate the impact of the accessibility percentage on the variable values and to test the model in a scenario closer resembling the real world by adding a budget constraint. The time limit of the accessibility requirement was removed. In this case, a gradual improvement in the accessibility over the 12 years was observed due to the gradual opening of clinics over the years. Based on the analyses results, it was concluded that the model is sensitive to changes in parameters and that the model can be used for different scenarios. / Dissertation (MEng (Industrial Engineering))--University of Pretoria, 2021. / Industrial and Systems Engineering / MEng (Industrial Engineering) / Unrestricted

Under senare tid, säkerligen tack vare eller på grund av pågående Corona-pandemi har digitalisering inom sjukvården fått en extra skjuts, blivit mer legitim och utvecklats enormt. När patienten involveras mer i sin vård genom tillgång till digital journal, möjlighet till tidsbokning via nätet och kommunikation med sjukvårdspersonal via digitala chattfunktioner förbättras tillgängligheten. I yrkesrollen som sjuksköterska är det viktigt att man känner trygghet som yrkesutövare för att kunna bemöta patienten på ett professionellt sätt. En litteraturöversikt med syftet att sammanställa tidigare forskning kring sjuksköterskors upplevelser av att använda digitala verktyg i patientarbetet har genomförts. Tio vetenskapliga kvalitativa artiklar analyserades vilket resulterade i tre huvudkategorier och sex subkategorier. De tre huvudkategorierna är; Förtroende på avstånd, Stå på gemensam grund och Utveckla den professionella rollen. Sjuksköterskor upplever brist på utbildning och tid till att använda systemen optimalt. Det är flera system som används parallellt och som ska loggas in i vilka inte alltid är synkroniserade med varandra och inte alltid användarvänliga. De olika systemen skapar stress i arbetet som skulle kunna förhindras om sjuksköterskor gavs möjlighet att vara mer delaktiga i att utveckla och utforma vårdsystem utifrån sjuksköterskans behov. Resultatet i studien visar att användning av digitala verktyg inom sjukvården går framåt och att sjuksköterskor är positiva till att delta i den fortsatta digitala utvecklingen inom hälso- och sjukvården för att skapa en god och säker vårdmiljö.

Bakgrund: Hälsolitteracitet är ett komplext begrepp som rör både individ och samhälle samt speglar hur information från vårdpersonal tas emot och hanteras. Kommunikativ hälsolitteracitet beskriver hur patienter använder hälsoinformation i kommunikationen med vårdpersonal. Kommunikation skapar utmaningar för vårdpersonal i interaktionen, och för patienter i att kritiskt värdera information.Syfte: Att beskriva upplevelser av kommunikation i primärvården hos vuxna patienter.Metod: En systematisk litteraturstudie med deskriptiv och induktiv design. Studien baserades på kvalitativ forskning bestående av 19 artiklar.Resultat: Det patienter upplevde kring kommunikation i primärvården var att förberedelser inför besök, som att skriva ner frågor, underlättade kommunikationen. Patienter önskade att kommunikationen skulle individanpassas och ske på ett lättförståeligt sätt utan medicinska termer. Patienter upplevde att en ökad delaktighet i kommunikationen bidrog till större möjlighet att utföra egenvård. Och att anhörigstöd upplevdes öka delaktigheten i kommunikationen. Läkares kommunikation upplevdes tillförlitlig men kunde vara otydlig och bristande samt skapa en känsla av underställdhet. Patienter upplevde att sjuksköterskors kommunikation öppnade upp för samtal, skapade tillit och gjorde att patienter kände sig förstådda. Bristande kommunikation kunde skapa oro, rädsla och skam samt ledde till att patienter sökte kompletterande information på egen hand.Slutsats: Förberedelser upplevdes underlätta kommunikation. Individuell kommunikation var önskvärd. Läkares kommunikation upplevdes tillförlitlig men kunde vara otydlig, bristande och ge en känsla av underställdhet. Sjuksköterskors kommunikation skapade tillit och förståelse. Bristande kommunikation kunde skapa negativa känslor. Distriktssköterskan kan utveckla kommunikationen i primärvården till att bli mer hälsolitterat. / Background: Health literacy is a complex concept involving both the individual and the society and reflects on how information from health personnel is received and handled. Communicative health literacy describes how patients use health information in communication with health personnel. Communication creates challenges for health personnel in the interaction process and for patients in critically evaluating information.Aim: To describe experiences of communication in primary health care in adult patients.Method: A systematic literature study with a descriptive, inductive design based on 19 qualitative articles.Result: What patients experienced of communication in primary health care was that preparations before an appointment, such as written down questions made communication easier. Patients wished for communication to be individually adapted without medical terms. That an increased participation in communication could contribute to more opportunities of selfcare. And that support from family could increase participation in communication. The communication from physicians were trustworthy but inexplicit and deficient and caused a sense of subordination. Patients experienced that registered nurses opened up for communication, created trust and made them feel understood. Lack of communication could create feelings of concern, fear and shame and made patients search for additional information on their own.Conclusion: Preparations were perceived to facilitate communication. Individually adapted communication was desired. Physicians communication were thrustworthy but inexplicit and deficient and caused a sense of subordination. Registered nurses communication created trust and understanding. Deficient communication could create negative feelings. The district nurse can evolve communication in primary health care to become more health literate.