Class of 2017 Abstract / Objectives: A chart will be used to assess the need for the asthma education program. The chart review aims to: analyze the refill history of asthma medications along with verifying adherence via electronic health record and assess if patients are getting appropriate asthma therapy per 2007 NHLBI asthma guidelines. Methods: The patient’s MHC Healthcare electronic record profile and pharmacy refill record will be accessed. The information that will be obtained from the electronic health record will be: ethnicity, age, sex, allergic rhinitis diagnosis, flu vaccine status, pneumonia vaccine status, GERD diagnosis, spirometry measure if available, use of prednisone for exacerbation, prescribed asthma therapy, and provider’s (MD, NP, PA, etc)’s notes that might indicate nonadherence. The information that will be obtained from the pharmacy record are controller and rescue medication refill history. The information will be recorded in paper data collection forms and electronic versions will be saved to the secure college of pharmacy workgroup. The raw physical information described above will be stored in a locked cabinet at MHC healthcare pharmacy inside the pharmacy director’s office and the de-identified information will be stored in the secure workgroup. Results: Conclusions:

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [237]-263).

Licentiatavhandling Växjö : Växjö universitet, 2007.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the second leading cause of death globally and the consequences on human and economic health are of major concern. The aim of this study was to determine and explore the participation restrictions experienced by stroke patients. The study populations were stroke patients living within the community in Western Cape, South Africa. A mixed methods approach was used to collect data in this study which consisted of two phases. For the first phase, the descriptive, observational cross sectional design was used to determine the participation restrictions of stroke patients living within the community and the factors associated with community with respect to integration. In this phase, an interviewer- administered questionnaire was used to collect data; the instrument for this study is the standard World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) for disability assessment which includes the International Classification of Functioning Health and Disability (ICF) concept in disability assessment which has been tested and found to be reliable and valid, to determine various participation restrictions among stroke patients living in the society. While in the second phase of this study, two focus group discussions were conducted at the selected community health centre; these participants were conveniently selected from those who participated in the first phase of the study. This was conducted to retrieve in-depth information on difficulties encountered in participating in daily life situations. The Statistical Package for Social Sciences (SPSS) was used for descriptive and inferential statistics. Chi square and Anova t-test was used to determine the association between the demographics statistic and participation restrictions. Alpha level was set at 0.05. For qualitative findings, audiotaped interviews and note taken were transcribed and translated into English; the expressed ideas were coded and reduced into subthemes, themes and categories. Ethical clearance and permission to conduct study was sought, consents from participants were sought, clearly stating the right to participate and withdraw from the study was respected and anonymity and confidentiality has been ensured. The result of the study showed that participants encountered difficulty with cognition, (23.3% of participants reported severe difficulty in learning a new task; 20% reported severe difficulty analyzing and finding solution to day to day activities), mobility (34% acknowledged difficulty walking a long distance like one kilometer after stroke), self-care ( 44% indicated difficulty staying alone for few days after stroke, while the majority, 61% complaints of difficulty with getting dressed by self), getting along with people with the majority of the difficulties (36%) are sexual activities, household activities with major complaints (46.6% and 31.4%, for severity and exemption respectively) in getting needed household work done, severe difficulty (51.7%) reported in relaxation and pleasure after stroke, 50.8% been financially restrained after stroke, 40% with difficulty in joining in the community activities, 39.2% severely affected by people perception towards them and 25.8% of the participants indicated extreme time spent on health; all difficulties investigated within the society 30 days after the incidence of stroke. However, the result of the qualitative phase reported the participation restrictions experienced by the participants. Difficulty in cognition was reported, which promotes indiscipline among family members. Limitation in activity level such as in mobility (walking for a long distance, standing from a sitting position), in self-care (washing the whole body, eating, staying alone after stroke), in getting along (maintaining friendship, sexual activities), in household activities and work activities was reported. Participants experienced difficulty in joining in community activities, emotional fluctuations, poor perception of attitudes of others after stroke, excessive use of time on health conditions, increased financial impact of health condition and burden impact on family was reported. Environmental barriers such as transportation and toilet facilities were reported. The current study findings suggest appropriate and specific programmes should be aimed at improving participation among stroke survivors in the community.

Established in 1965 as a part of President Johnson’s War on Poverty effort, the federal community health center (CHC) program is a primary source of federally-subsidized quality health care services for medically-vulnerable populations in the United States. Despite its current role as a medical safety-net for the nation’s health care system, the CHC program did not begin as a public health program, but rather as a social justice program. Since its formalization, the CHC program has enjoyed relatively consistent Congressional support as a cost-effective means of providing primary healthcare to indigent populations; however, the narrative of the program has shifted overtime from a focus of empowerment and lifting communities out of poverty, to the fortification of the national health care system as a cost-effective provider of quality healthcare care for all. In this manuscript, I argue that this transition from community empowerment and the mitigation of fundamental causes of disease to a more risk-based emphasis on the issue of access, has diminished the urgency around the engagement of the structural effects of poverty on health in favor of a “one size fits all” approach to the provision of basic health care. In an effort to objectively quantify the effects of geographic access on health as a means for evaluating the success of the contemporary program, this research project explores the extent to which proximal access to a CHC is significantly associated with various self-reported indicators of positive health outcomes. My primary research method is multivariable regression utilizing secondary data from the 2012 Southeastern Pennsylvania Household Health Survey, the 2008-2012 5-year American Community Survey Estimate, and the Health Resources and Services Administration Data Warehouse. Using statistical modeling, I test the effect of CHC access on three distinct measures of individual health: (1) self-reported health status, (2) the likelihood of having pain lasting 6 months or more, and (3) the likelihood of having a usual source of health care. Within each model, I also test a series of interaction terms through nested sub-models to uncover any conditional effects of access for selected social groups. This statistical design offers the opportunity to explore whether the main association between access to a CHC and health varies based on the social characteristics and/or social environment of the individual. The findings of my analysis suggest that the effect of CHC access varies for different social groups, with less disadvantaged groups, such as poor non-Hispanic whites with high social capital, and poor individuals living in areas of low disadvantage, receiving the greatest benefit from proximal CHC access. However, individuals at the extremes of social disadvantage benefit least from CHC access alone. I argue that while the provision of CHC access is a noble and necessary tactic for fighting the persistence of health disparities in our medically-vulnerable communities, focusing on access alone is insufficient to solve the problem. The pendulum must switch back to community empowerment and the eradication of structural threats to health to initiate real change for medically-vulnerable populations. / Sociology

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Class of 2010 Abstract / OBJECTIVES: Describe the characteristics and research interests of Community Health Centers (CHC) pharmacists and pharmacies in a pharmacy based practice based research network (PBRN). METHODS: Pharmacy directors of eight Arizona CHC pharmacies were initially contacted by telephone and asked to participate in a survey. The survey was then sent to these directors via email and a second telephone conversation was set up to re-­‐administer the survey and gather the answers to the questionnaire. The questionnaire consisted of demographic, clinical and practice related questions targeted at identifying areas of interest for research in developing a community pharmacy practice based research network (PBRN). RESULTS: The data regarding the demographics and characteristics of the Arizona CHC pharmacies, pharmacists, and patients showed that only two pharmacies served more than 300 patients per day and dispensed more than 400 prescriptions per day. The data found that an average of 46% of the patients that went to these pharmacies did not consider English as their primary language and that an average of 49% of the patients were Hispanic/Latino. The data collected regarding the clinical interests of these pharmacies showed that asthma had the highest level of clinical interest among the eight CHC pharmacies (average rank = 3.1). For the public health interests of the CHC pharmacies, patient adherence/compliance was ranked the most important (average rank = 3.1). In regards to internal practice site interests job satisfaction was the most highly ranked interests among these CHC pharmacies (average rank = 3.1). CONCLUSIONS: The data suggests asthma, job satisfaction and patient compliance/adherence are the top areas of interest in the clinical, internal worksite, and public health sectors. The data collected from this study will help to establish a pharmacy based PBRN in Arizona and provide a starting point in terms of research topics that will be explored. The establishment of an Arizona pharmacy based PBRN is very important since it will provide cohesiveness between research and community based practice of Community Health Centers in Arizona and is a step in the right direction in terms of growth of these centers.

Thesis (M.P.H.)--University of Michigan, 1944.

Thesis (M.P.H.)--University of Michigan, 1944.