SUMMARY Management of Public Health Organization of help for children who experienced physical violence in the agencies of primary health care. Asta Norvile Sciential head doc. Hab. Dr. Apolinaras Zaborskis Kaunas University of Medicine, faculty of Public Health, department of Social Medicine. –Kaunas, 2005. –50p. Purpose of the work. To examine a potential of giving aid to the children who have experienced physical violence in the agencies of primary health care in Kaunas. Research tasks. 1. To compute the number of children who are suspected to have experienced a physical violence. 2. To examine giving aid for the children who have experienced physical violence organized by medics. 3. To rate the possibilities of improving facilities for children who have experienced physical violence. 4. to prepare recommendations of how to run a complex aid for the children who have experienced physical violence. Methodology. A questionnaire was made by giving questionnaires to the pediatricians and public caregivers working in BPG in the children clinic Kalnieciu, Dainavos, Centro, Sanciu and Silainiu subdivisions in Kaunas. Number of people working with children was 204, 159 took part in the questionnaire. An anonymic formal questionnaire was used. A questionnaire had 33 questions which were divided into 3 parts. Data was analyzed using a computer version of SPSS 10.0.7 and statistical methods of analyzing data: Chi Square criteria and Stjudent t criteria. Results. In latter years 47... [to full text]

För att primärvården ska kunna utvecklas är det viktigt att den har patienternas förtroende. Därför är det av stor betydelse att undersöka vad som påverkar om befolkningen känner att de har möjligheten att få den vård de behöver. Denna uppsats undersöker hur två faktorer påverkar andelen invånare som anser sig ha tillgång till den vård de behöver. De två faktorerna är primärvårdens nettokostnader, samt hur stor andel av dessa kostnader som kan hänföras till köpt vård från privata företag. Dessa samband undersöks genom att flera modeller formuleras. För att modellerna skall kunna skattas används paneldata över Sveriges landsting samt åren 2005 t.o.m. 2012. Modellerna skattas med ordinarie minsta kvadratmetoden. Studien kan inte fastställa något samband mellan de två undersökta variablerna och andelen invånare som anser sig ha tillgång till den vård de behöver. Däremot verkar det finnas ett samband mellan vårdval i primärvården och andelen invånare som anser sig ha tillgång till den vård de behöver. / In order to develop it is important for primary care to have the patients trust. Therefore, it is of great importance to investigate what influences if the population feel they have access to the health care they need. This paper examines the influence of two factors on the proportion of residents who feel they have access to the health care they need. The two factors are net cost of primary health care and the proportion of these costs that can be assigned to purchases of care from private companies. These relationships are examined by serval formulated models. To estimate the models, panel data of Swedish County Councils and the years 2005 to 2012 are used. The models are estimated with ordinary least squares method. The study cannot find a link between the two examined variables and the percentage of residents who feel they have access to the care they need. However, it seems to be a correlation between free choice of primary health care and the percentage of residents who feel they have access to the care they need.

The consultation is the GP’s form of work. How long a consultation should be, and what short/long consultations imply with regard to the satisfaction of patient and doctor has been much debated. The aim of this thesis was to study consultations with regard to content and time consumption in a short term and long term perspective. Three studies were carried out. 1. Consultations with the members of a group of GPs were investigated, where patients and doctors separately assessed different aspects of the consultation, and their ratings were related to the real length of the consultations. The following questions were posed: Was there time enough? Could the patient tell the doctor about her/his problems? Were the problems physical or psychological? 2. Nurses at the primary care health centres were interviewed about their considerations in booking short or long appointments for the patients. 3. Patients who frequently attended one health centre during one year and consumed much time were studied. Quantitative and qualitative methods were used. The results of the first study (Papers I-III) show that the average length of the consultations was 21 minutes; there was considerable variation (ranging from 3 to 60 minutes). (About 600 consultations with 7 male doctors were registered in two batches). The doctors’ mean consultation length also varied widely, from 13-28 minutes. Consultations dealing with psychological problems were longer than those dealing with physical problems. Older patients had longer consultations than younger patients, and female patients had somewhat longer consultations than male patients. The patients were generally more satisfied with the consultations than the doctors were, and there were no clear affinities between long consultations and high satisfaction. Male patients and patients with physical problems mainly received short consultations, whereas patients with ”mixed" problems and older patients received long consultations. The single factors most decisive for the length of a consultation were ‘the doctor factor’, the character of the problem and the age of the patient. "Good” consultations (operational definition) were associated primarily with ‘the doctor factor’, and the real length of the consultations was less important. The interviews with ten experienced primary care nurses (Paper IV) showed that the nurses worked in two perspectives: in the ”immediate” perspective, appointments were booked according to rules which directly impacted the length of the visit, and in the "reflective" perspective, appointments were booked with a view to the quality of the work at the health centre and the long-term time consumption. Other factors of importance were the patient’s age and problem(s), the doctor’s experience and working style, and the current situation at the health centre. Frequent attenders (FAs) at one health centre (Paper V) were compared with a contrast group of matched patients (CPs). The FAs represented 1.7% of the population of the catchment area and made 15% of the visits. The FAs were a heterogeneous group where small boys, women of working age and pensioners of both sexes were overrepresented. The FAs had higher consultation frequency than the CPs during the year of investigation, but few remained FAs for longer periods. The FAs had more problems and more complex problems than the CPs. Complaints regarding the musculo-skeletal organs, and psychosocial problems were common among these patients, often in combination. The present work thus shows that longer consultations do not naturally imply higher patient satisfaction. Other factors than the time factor, in particular ‘the doctor factor’ seem to be more important. ‘The doctor factor’, the characteristics of the patients, the type of problem and the situation at the health centre also have a bearing on consultation length and time consumption in a short-term as well as long-term perspective. The implications of these factors and their relative importance are discussed, but further studies of certain issues, such as ‘the doctor factor’, are necessary. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.</p> / digitalisering@umu

<p>Diss. Umeå : Umeå universitet, 1998, härtill 8 delarbeten.</p> / digitalisering@umu

At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes. The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected. Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered. Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration. Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1986, härtill 6 uppsatser.</p> / digitalisering@umu

Background: Social participation has been recognized as an important public health policy since the declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then, there have been many adaptations to the original policy recommendations, but participation in health is still seen as a means to make the health system more responsive to local health needs, and as a way to bring the health sector and the community closer together. Aim: To explore the role that social participation has in a municipal-level health system in Guatemala in order to inform future policies and programs. Methods: The fieldwork for this study was carried out over eight months and three field visits between early January of 2009 and late March of 2010. During this time, 38 indepth interviews with provincial and district-level health authorities, municipal authorities, community representatives and community health workers were conducted. Using an overall applied ethnographic approach, the main means of data collection were participant observation, in-depth interviews, group discussions and informal conversations. The data was analyzed in two different rounds. In the first one we used documentary analysis, role-ordered matrices and thematic analsis (see papers I-IV) and in the second round, thematic analysis was utilized. Results: We found four themes that frame what the role of social participation in the municipality of Palencia is. The first theme presents the historical, political and social context that has contributed to shaping the participation policies and practices in Guatemala as a whole. The second theme takes a deeper look at these policies and how they have been received in the municipality of Palencia. The third theme presents data regarding the three situated practices of participation, each occurring at a different level: municipal, community and the individual level. Finally, the last theme presents reflections on what it means to participate to the people that were involved in this study. Conclusion: In the process of social participation there are two different and complementary kinds of power that depend on the amount and the kind of resources available at each level of the participation structure. Stakeholders that have higher levels of power to formulate policies will have better access to financial, human and material resources while stakeholders that have higher levels of power to implement policies will have resources like community legitimacy, knowledge of local culture, values and mores, as well as a deep understanding of local social processes. The coordination of financial, human and material resources is just as important as the legitimacy that comes from having community leaders involved in more steps of the process. True collaboration can only be obtained through the promotion and creation of meaningful partnerships between institutional stakeholders and community leaders and other stakeholders that are working at the community level. For this to happen, more structured support for the participation process in the form of clear policies, funding and capacity building is needed.

Introduction: Despite Colombia having adopted a health system based on an insurance market, Bogota in 2004, as part of a left-wing government (elected for first time in the city), decided to implement a Primary Health Care (PHC) strategy to improve quality of life, level of population health and reduce health inequities. The PHC strategy has been implemented through the HomeHealth program by three consecutive governments over the last eight years in the context of continuous political tension stemming from differences between national and district health policies. This thesis is an attempt to provide a better understanding of the overall experience of implementing a PHC strategy in the context of a market-oriented health care system. The research aimed to evaluate results of the PHC strategy through the intervention of the Home Health program and to identify factors that have enabled or limited the on-going PHC implementation process in Bogota. Methods: This study used a combination of quantitative and qualitative methods. A descriptive analysis was performed to assess direct results of the PHC strategy in terms of progress in the Home Health program coverage and increases in health personnel ratios reaching out to poor and vulnerable groups in Bogota. A cross sectional analysis was carried out to evaluate qualities of the delivery of PHC services through the attainment of PHC essential dimensions in the network of first-level public health care facilities. An ecological analysis was performed to estimate the contribution of the PHC strategy, through the Home Health program, to improve child health outcomes and to reduce health inequalities. A qualitative multiple case study was conducted to identify contextual factors that have enabled or limited the on-going PHC implementation process in Bogota. Results: The descriptive analysis showed a notable initial increase and rapid expansion in the development of the PHC strategy between 2004 and 2007, followed by a period of slower growth and stagnation between 2007 and 2010. The cross-sectional analysis suggested that the Home Health program could be helping to improve the performance of first-level public health care facilities. Ratings assigned to PHC dimensions by different participants pointed out the need to strengthen family focus, community orientation, financial resources distribution, and accessibility. The ecological analysis showed that localities with high PHC coverage had a lower risk of under-five mortality, infant mortality and acute malnutrition as well as a higher probability of being vaccinated than low PHC coverage localities. The belonging to a high-coverage locality was significantly associated with risk reductions of under-five mortality (13.8%) and infant mortality by pneumonia (37.5%) as well as increases in the probability of being vaccinated for DPT (4.9%). Concentration curves and concentration indices indicated inequality reductions in all child indicators betwen 2003 and 2007. In 2007 (period after implementation), the PHC strategy was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-five mortality (24%), infant mortality rate (19%), acute malnutrition (7%) and DPT vaccination coverage (20%). The main facilitators of the results achieved so far by the PHC strategy were all related to the commitment and good will of actors at different levels. Longterm political commitment, support by local mayors and hospital managers, organized communities historically active in the process of social participation, as well as extramural work carried out by community health workers and health care teams were highly valued. Barriers to the implementation included the structure of the national health system itself, lack of a stable funding source, unsatisfactory working conditions, lack of competencies among health workers regarding family focus and community orientation, and limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. Conclusion: Despite adverse contextual conditions and limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has helped to improve the performance of first-level public health care facilities in the essential dimensions of PHC and has also contributed to improvement of child health outcomes and reduction of health inequalities associated with socioeconomic and living conditions. Significant efforts are required to overcome the market approach of the national health system. Structural changes to social policies at the national and district level are needed if the PHC strategy is expected to achieve its full potential. Specific interventions must be designed to have well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.

Primary health care represents a change from curative approach to preventive approach to rendering health care services. The study analyses the problems encountered in the administration of primary health care in South Africa with specific reference to the Emfuleni Local Authority. The study describes the role of international institutions in the administration of primary health care in South Africa. Furthermore, the historical development, the role of the National Department of Health in the administration of primary health care services is outlined. The study also investigates the role of the Gauteng Provincial Department of Health regarding the implementation of district health system, health promotion, the involvement of the private sector and NGO's in primary health care. Problems encountered by the Emfuleni Local Authority such as lack finance, personnel shartages, security, urbanisation, non-involvement of traditional healers and citizen apathy are investigated. Lastly, governmental relations for primary health care are described.

Primary health care (PHC) is the first component of the health system that provides patients with first-level care. PHC must be supported by a strong referral system whereby PHC nurses can refer patients with conditions beyond their capabilities to medical officers for further management using referral letters. The medical officers also using referral letters refer stable patients back to the PHC clinics for follow up and management. The aim of study was to determine factors related to patients bypassing primary health care facilities and accessing the district hospital as point of first contact in the Umuziwabantu health sub-district of KwaZulu-Natal. This research investigates the referral patterns of patients as well as the factors affecting the referral patterns of patients between PHC facilities and the district hospital. The study was conducted at the Gateway Clinic of St Andrew’s Hospital and its outpatient department. The following groups were excluded from the study: any patients who arrived at the clinic with a referral letter from another facility, any children who were brought there by another child, and any who were unwilling to take part in the study. The researcher made use of open-ended and structured questions to interview 720 patients over a period of six months. The overall findings show that a large part of the Umuziwabantu sub-district is still served by mobile clinics. Since mobile clinics do not visit each point daily, patients from mobile points often go to the hospital for any health-related problems. There is the widespread perception that a hospital provides better service than a PHC clinic. The Local Government (LG) clinic only sees a limited number of patients. The main reasons given by patients for bypassing their local PHC clinics are: 1. Mobile clinic unavailability on that day; 2. The hospital is closer. 3. Patients are used to coming to the hospital. 4. Patients are doing things in town and then decide to combine this visit with hospital visit. Three-hundred-and-sixty-one patients had only minor ailments and a further 95 required chronic treatment which could have been dispensed at PHC clinics. Only 264 of patients surveyed should have been seen at the Hospital. Conclusions from the study were that patients would use their local PHC clinics if there were enough fixed clinics and the LG clinic had more staff to attend to more patients than the number they are currently attending. The clinic-upgrading programme needs to be improved and fast-tracked. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

The focus of this study was on common psychiatric comorbidities of depression and anxiety in people with epilepsy (PWE). While international published data show that up to 60% of PWE suffer from depression and/or anxiety, most primary care (PHC) settings in developed countries display some oversight in this area. The study was conducted in Zambia, in three phases; which each culminated in submissions for publication in an internationally peer reviewed journal. Phase one involved chart review to establish the rate of detection of depression and/or anxiety in PWE at the outpatient clinic of Chainama Hills College Hospital. The detection rate was only 1%. This formed the basis for phase two where we developed a ten item screening tool for depression and/or anxiety for use by PHC workers in busy clinical settings. The tool was validated, its sensitivity and specificity were determined and the inter-rater reliability was also calculated. Phase three involved implementation of the tool validated screening tool. We measured the ability of PHC workers to use and interpret the screening tool in busy clinical settings. One month after training and implementing the use of the screening tool, a retrospective chart review was undertaken using the same tool that was employed in phase one chart review. There was a marked improvement when 120 files of PWE were reviewed as the percentage of screening for depression and anxiety increased from 1% to 49%. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2014.