<p>Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual&nbsp / TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death&nbsp / amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload&nbsp / due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may&nbsp / not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy.&nbsp / Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. </p>

Bakgrund Distriktssköterskors ansvarsområde innefattar att arbeta hälsofrämjande och förebyggande både på individ- och gruppnivå. För att åstadkomma ett effektivt hälsofrämjande arbete behöver distriktssköterskan kunskap och kompetens inom ett flertal områden. Få studier visar den kompetens distriktssköterskor besitter efter avslutad specialistutbildning och hur kompetensen kommer till användning inom primärvård. Syftet med denna studie var att beskriva distriktssköterskors upplevelse av hälsofrämjande arbete i primärvård. Metod Kvalitativa semistrukturerade intervjuer utfördes med tio distriktssköterskor som arbetade inom primärvård och hade avslutat sin specialistutbildning inom de senaste fem åren. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat Ett tema; En utmaning i det dagliga arbetet och fem kategorier framkom. Dessa kategorier var; Att hälsofrämjande arbete är centralt, Att se fram emot att arbeta hälsofrämjande, Att tillämpa sina kunskaper och använda lämpliga metoder, Att hinder finns i hälsofrämjande arbete och Att hälsofrämjande arbete genomsyrar arbetsplatsen. Slutsats Distriktssköterskor är motiverade till att arbeta hälsofrämjande, men det ses som en utmaning. En diskrepans finns mellan utbildningen och det dagliga arbetet. Distriktssköterskor önskar organisatoriska förändringar för det fortsatta hälsofrämjande arbetet.

Purpose: This study aimed to assess the feasibility of implementation of the Health Professions Council of South Africa's (HPCSA) clinic-based hearing screening subsection of its 2007 Position Statement on Early Hearing Detection and Intervention (EHDI) programmes in South Africa. Specific sub-aims included (a) establishing the prevalence of hearing screening conducted at Maternal Child Woman’s Health (MCWH) immunisation clinics; (b) determining the hearing screening procedures and protocols in use at MCWH immunisation clinics; (c) determining and exploring the possible concomitant personnel-associated factors which may influence the implementation of newborn and infant hearing screening programmes; (d) determining and exploring other factors that may have influenced implementation of newborn and infant hearing screening; and lastly, (e) comparing any hearing screening procedures and protocols in use to the HPCSA (2007) EHDI position statement clinic guidelines and associated clinic benchmarks Participants: Thirty primary healthcare immunisation clinic managers/acting managers were interviewed in two South African sample groups, in the North West province (NW) and Gauteng (GP). Design: An exploratory, non-experimental, qualitative research design was employed incorporating both quantitative and qualitative information within the two sample groups. Methods and Materials: An interview using a questionnaire was administered with primary health care (PHC) clinic nursing manager/acting manager, placed within the identified sites. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics. Data Analysis: Content analysis was used to code emergent themes into specific categories. Frequency calculations of the emergent themes were calculated and results described qualitatively. Results: No PHC clinics placed within the identified sites offered or provided formalised newborn/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with HPCSA (2007) clinic guidelines. Most respondents were willing to implement formalised hearing screening to coincide with their immunisation schedules. The immunisation context was considered favourable for implementation of formalised hearing screening. Other factors such as reduced parental awareness of the importance of hearing screening, and caregiver cultural issues were considered surmountable by respondents. Conclusions: HPCSA (2007) implementation of clinic hearing screening protocols at PHC immunization clinics (level one) does not appear to be feasible based on current evidence. Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA (2007) clinic guidelines for EHDI at immunisation clinics in South Africa. Future research implications include formal investigations of central directorate versus district differences in PHC Package Integrated Management of Childhood Illnesses (IMCI); Otitis Media, and Road to Health Chart (RtHC) protocols; provincial and district inequities in funding as they impinge on hearing health care service delivery; costing of rudimentary protocols in place versus formalised HPCSA (2007) EHDI service delivery; research into parental awareness, education and willingness in specific reference to certain procedures such as otoacoustic emissions; and replication of the current study throughout the country for quantitave data with increased ability to draw causal inferences and generalize findings.

Trata-se de um estudo de corte transversal realizado em uma Unidade Distrital de Saúde de Ribeirão Preto-SP que teve como objetivo geral analisar a satisfação profissional das equipes de enfermagem do Ambulatório de Especialidades e do Pronto-Atendimento (PA) e como objetivos específicos: analisar o grau de importância dado a cada componente da satisfação profissional (autonomia, interação, status profissional, requisitos do trabalho, normas organizacionais e remuneração) para as equipes estudadas; analisar a satisfação profissional das equipes de enfermagem de uma Unidade Distrital de Saúde, com base em seus componentes. A população do estudo foi constituída de 23 profissionais da equipe de enfermagem do Ambulatório (05 Enfermeiros,10 Técnicos de Enfermagem e 08 Auxiliares de Enfermagem) e 20 profissionais da equipe de enfermagem do PA ( 06 Enfermeiros, 06 Técnicos de Enfermagem e 08 Auxiliares de Enfermagem). A coleta de dados foi realizada com a utilização do instrumento Índice de Satisfação Profissional (ISP), constituído de 15 questões pareadas que mediram a importância dos componentes de satisfação profissional para as equipes e uma escala tipo Likert de 44 itens que mediram o nível de satisfação profissional. Os dados obtidos por meio do questionário foram organizados, categorizados, codificados e digitalizados em planilha eletrônica do Microsoft Office® Excel 2007, sob a forma de banco de dados, seguindo a técnica da dupla digitação. Posteriormente foram processados no programa estatísticos Statistical Analisys System® (SAS) versão 9.1. A estatística descritiva foi utilizada para a caracterização e análise dos dados sociodemográficos das equipes de enfermagem do Ambulatório e PA. O escore do ISP foi obtido segundo instruções específicas fornecidas pela autora Stamps (1997b) no instrumento original e por Lino (1999), responsável pela tradução para a língua portuguesa, adaptação e validação do mesmo. Os resultados mostraram predominância do sexo feminino, sendo a média de idade de 45 anos no Ambulatório e 41 anos no PA. Após a eliminação de seis itens da escala total identificados como inconsistentes, o coeficiente Alfa de Cronbach indicou uma confiabilidade de 0,78 no Ambulatório, 0,66 no PA, demonstrando ser um instrumento confiável. Quanto ao nível de importância atribuída aos componentes da satisfação profissional, verificou-se que a equipe de enfermagem do Ambulatório considerou o componente Interação como o mais importante, seguido dos componentes Status Profissional, Requisitos do Trabalho, Normas Organizacionais, Remuneração e Autonomia. A equipe do PA considerou o componente Interação também como o mais importante, seguido dos componentes Status Profissional, Normas Organizacionais, Autonomia, Requisitos do Trabalho e Remuneração. Em relação ao nível de satisfação profissional, verificou-se que a equipe de enfermagem do Ambulatório estava mais satisfeita com o componente Interação, seguido dos componentes Autonomia, Remuneração, Requisitos do Trabalho, Normas Organizacionais e Status Profissional. Já no PA estavam mais satisfeitos com o componente Autonomia, seguido dos componentes Interação, Remuneração, Requisitos do Trabalho, Status Profissional e Normas Organizacionais. Os valos de ISP encontrados foram 8,29 para o ambulatório e 7,64 para o PA, evidenciando a pouca satisfação no ambiente do trabalho. / This is a cross-sectional study conducted in a District Health Unit of Ribeirão Preto- SP, which aimed to analyze the professional satisfaction of the nursing team of the Specialty Outpatient Clinic and the Emergency Service (ES), with the specific aims: to analyze the degree of importance given to each professional satisfaction component (autonomy, interaction, professional status, work requirements, organizational policies and remuneration) by the teams studied; and to analyze the professional satisfaction of the nursing teams of a District Health Unit, based on the components. The study population consisted of 23 professionals of the Outpatient Clinic nursing team (05 Nurses, 10 Nursing Technicians and 08 Auxiliary Nurses) and 20 professional of the ES nursing team (06 Nurses, 06 Nursing Technicians and 08 Auxiliary Nurses). Data collection was performed using the Professional Satisfaction Index (PSI) instrument, consisting of 15 paired questions that measure the importance of the professional satisfaction components for the teams, and a Likert type scale of 44 items that measures the level of professional satisfaction. The data obtained through the questionnaire were organized, categorized, coded and digitalized into a Microsoft Excel® 2007 spreadsheet, in a database format, following the double entry technique. The statistical program Statistical Analysis System® (SAS) version 9.1 was subsequently used to process the data. Descriptive statistics were used for the characterization and analysis of the social-demographic data of the nursing teams of the Outpatient Clinic and the ES. The PSI score was obtained following specific instructions provided by the author Stamps (1997b) in the original instrument, and by Lino (1999), responsible for the Portuguese translation, adaptation and validation. The results showed a predominance of females, with a mean age of 45 years in the Outpatient Clinic and 41 years in the ES. After the elimination of six items from the total scale identified as inconsistent, the Cronbach\'s alpha coefficient indicated a reliability of 0.78 in the Outpatient Clinic and 0.66 in the ES, demonstrating the reliability of the instrument. Regarding the level of importance attached to the professional satisfaction components, it was found that the nursing team of the Outpatient Clinic considered the Interaction component to be the most important, followed by the Professional Status, Work Requirements, Organizational Standards, Remuneration and Autonomy components. The team of the ES also considered the Interaction component to be the most important, followed by the Professional Status, Organizational Standards, Autonomy, Work Requirements and Remuneration components. Regarding the level of professional satisfaction, it was found that the nursing team of the Outpatient Clinic was more satisfied with the interaction component, followed by the Autonomy, Remuneration, Work Requirements, Organizational Standards and Professional Status components. In the ES the team was more satisfied with the Autonomy component, followed by the Interaction, Remuneration, Work Requirements, Professional Status and Organizational Standards components. The PSI values found were 8.29 for the outpatient clinic and 7.64 to for the ES, evidencing the low satisfaction in the work environment.

This thesis contributes to the academic knowledge in the field of professional identity and organisational change. This thesis also has a practical implication as the findings helped to shape an organisational change within the co-funders organisation. The research was guided by the wish to explore the extent to which professional identity affects the willingness of those within Primary healthcare Units to accept fundamental changes in their working practices. Specifically, the aim was to establish the relationship of professional identity to processes of change. As the owners of small businesses who contract their services to the Health Board, the opinions of General Practitioners (GPs) were deemed to be of particular interest. The study was undertaken using a mixed method design, based upon a Constructivist grounded theory methodology. This was chosen as the ideal vehicle to examine the complex nature of identity within healthcare professionals and how they viewed organisational changes. Research started with unstructured interviews (n-14) and the analysis of the data obtained was fed into a questionnaire (n-97). The questionnaire offered validation of the initial findings. The findings of the research showed that professional identity has a bearing on the willingness of professionals to accept changes to their working environment. The resistance demonstrated by Healthcare staff, and specifically, GPs, to organisational change could be linked to feeling a perceived threat to their professional identity. Therefore, to undertake a successful organisational change, change managers must recognise that identity is vitally important and can affect the success or failure of an organisational change. Consideration of how any change may be perceived by professionals, within an identity context, must be built into the organisational change programme and revisited regularly during the change programme.

A busca de sintomáticos respiratórios (BSR) é uma ação programática para detecção precoce de casos de tuberculose. O Agente Comunitário de Saúde (ACS) favorece a ação na atenção básica (AB) pelas peculiaridades de seu trabalho na família e comunidade. O objetivo foi avaliar a BSR desempenhada pelo ACS nos serviços de AB, João Pessoa/PB. Estudo epidemiológico descritivo tipo inquérito, realizado nas 53 unidades de saúde da família que compõem o DSIII com uma população de 635 ACS. O cálculo amostral considerou uma variância (Sd2=1); diferença entre a média amostral simples e a média da população (B = 0,2); e probabilidade do erro tipo I igual a (Z? = 1,96) resultando em 108 ACS. Utilizou-se 3 fontes de coleta de dados: Check list (material, insumos e logística para a BSR); entrevista estruturada para os ACS e dados secundários (resultados das baciloscopias). O estudo obedeceu aos preceitos éticos envolvendo seres humanos. Os resultados do desempenho do ACS, relacionado aos componentes da avaliação dos serviços de saúde, revelaram Estrutura quantitativa de recursos humanos (ACS) e materiais suficientes; O Desempenho limitado e deficiente dos ACS que realizaram capacitação em TB foi atribuído à falta de envolvimento da gestão, supervisão e organização do serviço para BSR como trabalho em equipe e formação profissional; e no Resultado: laboratório, baixa cobertura de SR examinados e inexpressivo número de casos de TB identificados pela AB, 3(2009 ) e 1(2010). Ressalta-se que os resultados não são homogêneos, quando se analisam as unidades isoladamente. Sugere-se estudos individualizados considerando a micro-gestão das unidades e maiores investimentos na reorientação das práticas da AB para o controle da tuberculose aliado a um forte processo de educação permanente em saúde, que envolva profissionais e gestores. / The search for respiratory symptomatic people (RSS) is a programmatic action to detect early tuberculosis cases. The community health aid (CHA) promotes action in primary health care (PHC) through the peculiarities of his/her work with families and communities. The goal was to assess RSS performed by CHAs in PHC services in J Pessoa/Pb. Descriptive epidemiologic study, inquest-type, accomplished in the 53 family health units that make up Sanitary District (SD III) with a population of 635 CHAs. The sampling calculus considered a variance (Sd2=1); a difference between the simple sampling mean and population mean (B=0,2); and error probability I equal to (Z?= 1,96) totaling 108 CHAs. Three sources of data collecting were used: checklist (material, input and logistic to RSS); structured interview for CHAs as well as secondary data (bacilloscopy results). The study followed ethic principles involving human beings. The results of CHAs\' performance, related to health services evaluation components showed quantitative structure of human resources (CHA) as well as sufficient materials. Limited and defective performance, by CHAs qualified in TB, due to the lack of involvement in management, supervision and organization of RSS services as a teamwork and professional qualification; and the results: laboratory, poor cover of examined RS and inexpressive number of TB cases, identified by Primary care, 3 (2009) and 1 (2010). We point out that results are not homogeneous as units are individually analyzed. We suggest separate studies when considering units micro-management, as well as more investment in reorienting Primary care practices, with a view to control TB, associated to a major process of permanent Health education which should involve both professionals and managers.

Background The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. Methods/design In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. Discussion Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers. / <p>Funding Agencies|European Communitys Seventh Framework Program|259268|The Netherlands Organisation for Health Research and Development (ZonMW)|200310017|FP7 EC Grant||</p>

Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.

Primary health care (PHC) is a term used to refer to the parts of the health system that people interact with most of the time when health care is needed. It is considered the first point of contact for health services in Canada. Access to PHC services is an important issue regarding health care delivery in Canada today. There is a need to advance current understanding of access to PHC providers at local scales such as neighbourhoods. The primary objective of this study is to examine the variation in geographic (spatial) accessibility to permanently located primary care services in the Canadian urban environment. Furthermore, the analysis of spatial patterns of accessibility, both visually and statistically using GIS, is to provide a better understanding of among and between neighbourhood variations. This research took place in the 14 urban areas across Canada: Victoria and Vancouver, British Columbia; Calgary and Edmonton, Alberta; Saskatoon, Saskatchewan; Winnipeg, Manitoba; Hamilton, and Toronto, Ontario; Montréal and Québec, Quebec; Halifax, Nova Scotia; St. John’s, Newfoundland; Saint John, New Brunswick; and Ottawa–Gatineau, Ontario and Quebec. A GIS based method, the Three-Step Floating Catchment Area (3SFCA), was applied to determine the spatial accessibility to PHC services (accessibility score). First, for increasing geocoding match rates with reduced positional uncertainty, an integrated geocoding technique was developed after an empirical comparison of the geocoding results based on manually built and online geocoding services and subsequently applied to generate geographic coordinates of PHC practices which are an essential element for measuring potential access to health care. Next, the results of the Three-Step Floating Catchment Area (3SFCA) method was compared with simpler approachs to calculate the City level physician-to-population ratios and this research highlights the benefit of using the 3SFCA method over simpler approaches in urban areas by providing similar or comparable results of City level physician-to-population ratios with the advantage of intra-urban measurements. Further, the results point out that considerable spatial variation in geographical accessibility to PHC services exists within and across Canadian urban areas and indicate the existence of clusters of poorly served neighbourhoods in all urban areas. In order to investigate the low accessibility scores in relation to population health care needs, spatial statistical modeling techniques were applied that revealed variations in geographical accessibility to PHC services by comparing the accessibility scores to different socio-demographic characteristics across Canadian urban settings. In order to analyse how these relationships between accessibility and predictors vary at a local scale within an urban area, a local spatial regression technique (i.e., geographically weighted regression or GWR) was applied in two urban areas. The results of GWR modelling demonstrates intra-urban variations in the relationships between socio-demographic variables and the geographic accessibility to PHC services. In addition, the influences of “unit of analysis” on accessibility score were analyzed using spatial statistical modeling that emphasize the use of units of analysis that are pertinent to policy and planning purposes such as city defined neighbourhoods. Overall, this research shows the importance of measuring geographic accessibility of PHC services at local levels for decision makers, planners, researchers, and policy makers in the field of public health and health geography. This dissertation will advance current understanding of access to primary care in Canadian urban settings from the perspective of the neighbourhood.

<p>Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual&nbsp / TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death&nbsp / amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload&nbsp / due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may&nbsp / not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy.&nbsp / Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. </p>