Trata-se de estudo seccional, cujo objetivo foi avaliar a adesão ao tratamento e o controle metabólico em pessoas com diabetes mellitus, em Passos, MG. A amostra foi constituída por 423 pessoas com diabetes mellitus tipo 2, cadastradas em 17 unidades de saúde da família, por meio da técnica de amostragem aleatória estratificada. A coleta de dados foi realizada por pesquisadores de campo, mediante entrevista dirigida, em domicílio, utilizando quatro instrumentos: questionário contendo variáveis sociodemográficas, clínicas e terapêuticas, medida de adesão aos tratamentos - MAT, questionário de frequência de consumo alimentar - QFCA e questionário internacional de atividade física - IPAQ. Para a análise, utilizou-se estatística descritiva e teste exato de Fisher para as associações. Os resultados mostraram que houve predomínio do sexo feminino, média de 62,4 anos, 4,3 anos de estudo e 3,2 salários mínimos. A maioria possuía menos de dez anos de diagnóstico, encontrava-se com excesso de peso; valores de circunferência abdominal acima do recomendado e valores alterados de pressão arterial. Quanto aos exames laboratoriais, com exceção do colesterol total, os resultados obtidos mostraram-se acima dos valores de normalidade e a média de HbA1c foi de 8,1%. Segundo a prevalência da adesão ao tratamento do DM, vê-se que 357 (84,4%) dos sujeitos apresentaram adesão ao tratamento medicamentoso, 248 (58,6%) à prática de atividade física e apenas 13 (3,1%) ao plano alimentar. Ao analisar, simultaneamente, os três elementos investigados, obteve-se que apenas 1,4% apresentou adesão total ao tratamento. No que se refere ao tratamento medicamentoso, para o controle do DM, a prevalência da adesão foi maior entre os homens (85,8%), nos sujeitos com idade superior a 60 anos (87,0%), escolaridade entre quatro e oito anos de estudo (85%) e tempo de doença maior ou igual a dez anos (86,9%). Quanto ao plano alimentar, as mulheres (3,2%), os sujeitos com idade inferior a 60 anos (4,3%), com mais de oito anos de estudo (6,5%), renda familiar menor que três salários mínimos (3,7%) e mais de dez anos de doença (4%) apresentaram maior prevalência à adesão ao tratamento. A prevalência da adesão à atividade física foi maior também entre as mulheres (61%), nas pessoas com idade inferior a 60 anos (59,3%), com menos de quatro anos de estudo (60,4%), com renda familiar inferior a três salários mínimos (59,6%) e com tempo de doença maior ou igual a dez anos (59,7%). Ao adotar o nível mínimo de significância de 5% (p-valor<0,05), não foi verificada diferença estatisticamente significativa entre as variáveis estudadas e a prevalência da adesão ao tratamento do DM, com exceção do colesterol total que apresentou associação estatisticamente significativa com a adesão ao plano alimentar (p=0,036), e os valores de hemoglobina glicada com a atividade física (p=0,006). Frente aos resultados obtidos, recomenda-se a implantação urgente de estratégias de educação efetiva no município de Passos, MG, com vistas à integralidade da atenção em diabetes, tendo como indicador de resultado a adesão dos usuários ao tratamento. / This sectional study aimed to evaluate treatment adherence and metabolic control in people with diabetes mellitus from the city of Passos, state of Minas Gerais, Brazil. Sample was comprised of 423 people with type 2 diabetes mellitus who were enrolled in 17 Family Health Units and were selected through stratified random sampling technique. Data collection was conducted by field researchers, through directed interviews at home, using four instruments: questionnaire containing sociodemographic, clinical and therapeutic variables; Measure of Treatment Adherence; Questionnaire of Food Consumption Frequency; and International Questionnaire of Physical Activity. Descriptive statistics and Fisher\'s exact test for associations were used for analysis. Results showed that subjects were predominantly female; aged an average of 62.4 years and 4.3 years of study; and received an average of 3.2 Brazilian minimum wages. Majority had less than ten years after diagnosis; were overweight; values for abdominal circumference above of recommended levels; and had altered values of blood pressure. With regard to laboratory tests, excepted regarding the total cholesterol, results showed abnormal values, and the average for HbA1c was of 8.1 %. Related to the prevalence of treatment adherence in patients with DM, 357 (84.4%) of them had adherence to drug treatment, 248 (58.6%) to physical activity and only 13 (3.1%) to diet. By analyzing simultaneously the three elements investigated, it was found that only 1.4% showed full adherence to DM treatment. Regarding drug treatment to control diabetes, the prevalence of adherence was higher for males (85.8%), for subjects aged over 60 years (87.0%), with educational level between four and eight years of study (85%), and disease duration greater than or equal to ten years (86.9%). Regarding diet, women (3.2%), subjects under the age of 60 years (4.3%), with more than eight years of study (6.5%), with family income less than three Brazilian minimum wages (3.7%) and more than ten years of disease (4%) had a higher prevalence of treatment adherence. Prevalence of adherence to physical activity was also higher among women (61%), in people aged less than 60 years (59.3%), with less than four years of study (60.4%), with family income less than three minimum wages (59.6%) , and with disease duration greater than or equal to ten years (59.7%). By adopting the minimum level of significance of 5% (p<0.05), there was no statistically significant difference between researched variables and prevalence of adherence to DM treatment, excepted regarding the total cholesterol which presented an associated statistically significant with adherence to diet (p=0.036) and glycated hemoglobin values with physical activity (p=0.006). The chance of subjects with the recommended value for cholesterol make adherence to diet is nearly five times the chance of people in poor lipid control. The chance of subjects with poor glycemic control make adherence to physical activity is almost twice the chance of those with adequate glycemic control. Considering results, urgent implementation of strategies for effective education in the city of Passos is recommend, being in view the comprehensive care in diabetes, with the result indicator users\' adherence to treatment.

The aim of this study was to explore the Health Service Utilization (HSU) of homeless people in Dublin. In particular, it sought to identify a critical realist explanatory model for why the HSU of homeless people differs from that of the general population. Critical realist (CR) ethnography was used as the research methodology and was supplemented with forty-seven semi-structured interviews and two focus groups. The HSU of homeless participants in Dublin is described. When compared to the domiciled population, homeless people were found to have a tendency to present late on in their illness, to have higher utilization of primary care services and lower utilization of secondary care services and to avoid psychiatric services. The factors that influenced participants HSU tendency are identified as external or internal influences on HSU. External factors are described as physical, administrative or attitudinal barriers or deterrents; or external promoters of health service usage. Internalised inhibitors and promoters are illustrated as either cognitions or emotions that are developed in reaction to external circumstances and which either negatively or positively impact on health service usage. Interactions between health professionals and participants that resulted in exclusion (by the health professional or self-exclusion) are described as Conversations of Exclusion. A critical realist model was outlined that offers an explanation for why homeless people’s HSU differs from that of the general population in Dublin. This model included a description of the generative mechanisms identified as producing the HSU tendencies in the study population. The implications of this new model are discussed in the light of the literature and previous models that seek to explain the HSU of homeless people.

Barnavårdscentralen (BVC) är en frivillig men väl socialt accepterad del av barnhälsovården i Sverige. Behovet av stöd på BVC har förändrats över tid och nu dominerar de psykosociala behoven. Barn är beroende av vuxnas omsorg. Eftersom en stor andel av förskolebarnen träffar en BVC-sjuksköterska har hon en viktig roll i att identifiera och hjälpa barn som är utsatta för omsorgssvikt. Syftet med studien är att undersöka BVC-sjuksköterskors erfarenheter av att möta familjer där de misstänker att barn kan vara utsatta för omsorgssvikt och hur de upplever de resurser de har till sitt förfogande för att hjälpa barn och familj.En kvalitativ metod med induktiv ansats valdes och åtta BVC-sjuksköterskor intervjuades. Intervjuerna är analyserades med kvalitativ innehållsanalys. I resultatet framkommer att känslan av utsatthet och ensamhet i beslut och bedömning kring utsatta barn är tydlig, likaså frustration och maktlöshet i förhållande till samarbetet med socialtjänsten. Reflektion och tankeutbyte får BVC-sjuksköterskorna med sina kollegor, men också med barnhälsovårdspsykolog och socionom på familjecentral, där sådan finns. Den egna kunskapen och intuitiva känslan används i mötet med familjerna. Det svåraste är att formulera sin oro för familjerna. Mycket energi och kraft går åt till processen att fundera kring utsatta barn.De som arbetar i någon typ av team, upplever att de har bäst stöd och störst möjlighet att hjälpa familjer. Familjecentraler, eller liknande på fler platser, handledning och utbildning i samtalsmetodik är önskvärda förbättringar som författarna föreslår. I framtida forskning är det intressant att undersöka familjers upplevelse av stöd på BVC med eller utan familjecentral. Mer kunskap behövs om hur BVC-sjuksköterskans utsatthet påverkar henne. / Program: Fristående kurs

Considerando as recomendações do modelo de cuidado pautado na atenção psicossocial e as dificuldades relacionadas ao núcleo de cada profissão no campo da saúde mental, neste estudo propôs-se analisar a percepção de enfermeiros e demais membros da equipe multiprofissional sobre as ações de enfermagem no cuidado em saúde mental. Como referencial teórico foram utilizadas as concepções de \"campo\" e \"núcleo\", propostas por Campos (2000), com a intenção de diferenciar o conjunto de saberes e práticas comuns de todos os profissionais da equipe daqueles específicos da enfermagem. Trata-se de estudo qualitativo, descritivo, transversal, sendo a população do estudo os profissionais de todos os Centros de Atenção Psicossocial e Ambulatório de Saúde Mental do município de Bauru, SP. Foram utilizadas três diferentes técnicas de coleta de dados, a saber, entrevista semiestruturada, questionário com perguntas fechadas e grupo focal. A entrevista foi realizada com todos os enfermeiros e analisada segundo procedimentos metodológicos da análise de conteúdo. O questionário foi aplicado a todos os profissionais das equipes e foi analisado utilizando estatística descritiva. E o grupo focal contou com pelo menos um participante de cada categoria profissional, exceto terapeuta ocupacional, médico e fonoaudiólogo.Os resultados foram divididos em dois grandes temas: atuação da equipe nos serviços de saúde mental e dificuldades do enfermeiro na execução das ações de saúde mental. Notou-se que a percepção de toda a equipe multiprofissional, inclusive a do enfermeiro, enfatizou proximidade com \"o corpo físico\" dos usuários e os procedimentos técnicos relacionados. Ações de campo foram mencionadas como atribuição do enfermeiro também, porém, desafios para tal desempenho foram ressaltados, entre eles: formação deficitária, dificuldades pessoais, estereótipos profissionais, infraestrutura do serviço e falta de delimitação do núcleo das profissões pelos próprios profissionais.O presente estudo pode subsidiar a construçãode processos de trabalho interdisciplinares e auxiliar na delimitação das ações específicas da enfermagem no cuidado em saúde mental, agregando contribuições singulares aos serviços e à identidade profissional dos enfermeiros / Considering the recommendations of the care model based on psychosocial care and the difficulties related to the core of each profession in the field of mental health, this study proposed to analyze the perception of nurses and other members of the multiprofessional team on the actions of nursing in mental health care. As a theoretical reference, the field and core conceptions proposed by Campos (2000) were used with the intention of differentiating the set of common knowledge and practices of all the professionals of the team from those specific to nursing. This is a qualitative, descriptive and transversal study, which subjects were the professionals of all Psychosocial Attention Centers and Mental Health Ambulatory of Bauru city, in São Paulo, Brazil. Three different data collection techniques were used: a semi-structured interview, a questionnaire with closed questions and a focus group. The interview was performed with all the nurses and analyzed according to the methods of content analysis. The questionnaire was applied to all the professionals of the teams and was analyzed using descriptive statistics. And the focus group had at least one participant from each professional category, except occupational therapist, doctor and speech therapist. The results were divided into two main themes: the team\'s performance in mental health services and the nurse\'s difficulties in performing mental health actions. It was noted that the perception of the entire multiprofessional team, including the nurse, emphasized proximity to the \"physical body\" of users and technical procedures associated. Field actions were also mentioned as a nursing attribution, but some challenges for such performance were highlighted, among them: lack of training, personal difficulties, professional stereotypes, infrastructure and lack of delimitation of the professions core by the professionals themselves. The present study may support the construction of interdisciplinary work processes and assist in the delimitation of specific actions of nursing in mental health care by adding singular contributions to services and the professional identity of nurses

The shift from traditional models of public service design to public-driven ones has been slow in the health service and particularly in the General Practice Consultation in the UK. This hesitation about fully adapting these design methods has been found to be motivated by a lack of evidence regarding the successful implementations of public involvement activities and the use of its tools, partial coverage of these tools, and failures to report on the use of alternative tools, among other reasons. This research therefore aimed to propose Human-Centred Design (HCD) as an underlying philosophy and a pragmatic set of methodologies to better understand the challenges related to the application of customer involvement activities and the use typical methods when deployed in the investigation of issues and opportunities for the design of healthcare settings. This research consisted of three stages. An exploration stage, in which it was identified and confirmed several research gaps as well as a specific case for study with a degree of complexity and known for supporting customer involvement approaches. These activities involved a literature review about customer involvement processes and a qualitative interview study (with 30 participants) in which it was identified that, a suitable case for study to perform a large ethnographic investigation using representative Human-Centred Design tools could be 'Communication and relationship between GPs and patients'. A development stage, in which it was investigated the design of public involvement activities as well as the identification and selection process of some ideal HCD tools (Focus Groups, Future Workshops / Rich Pictures. Love & Break-up Letters, and Crowdsourcing) to work with the selected case. For these activities, a total of 72 participants were recruited (n=18 per activity). Lastly, an evaluation and proposal phase, analysed these tools through a comparative study to identify several of their strengths and weakness in order to identify the best tool or combination of tools. The outcome from this comparison suggested that among the tools used for this research there was not a most optimal option or combination of options and that the success of an involvement activity relies in the careful and thorough preparation of such processes. This research concludes, that the most optimal form of helping health researchers to undertake public involvement research and to better understand the process of identifying and selecting ideal engagement tools, could be by providing a best practice informative guide containing a simplified and comprehensive version of the most commonly found steps embedded in this kind of design practices.

O controle orçamentário é apontado como um mecanismo gerencial adequado para redução, controle de custos e avaliação do desempenho de uma instituição hospitalar. No ambiente da Saúde, onde se inserem os hospitais, o orçamento atua como um instrumento de alocação de recursos, coordenação, controle e comunicação das estratégias da instituição, já que há crescente busca pela redução de custos e eficiência devido à escassez de recursos presente nesse setor. O processo orçamentário nesse ambiente pode ser influenciado por características peculiares desta área, como complexidade, frequência e incerteza da tarefa, e também da tensão existente entre as áreas clínica e administrativa do hospital no estabelecimento de metas. A pesquisa observará o fenômeno do processo orçamentário sob a ótica da área clínica, dos profissionais do Serviço de Saúde, predominantemente do Serviço de Enfermagem, cujo objetivo é investigar a relação das características do processo orçamentário no Serviço de Saúde sobre a efetividade da Execução Orçamentária. O modelo teórico da pesquisa e a definição das cinco hipóteses analisadas são alicerçados na literatura e apresentam a relação de cada característica do processo orçamentário - Participação Orçamentária, Feedback Orçamentário, Avaliação Orçamentária, Clareza e Dificuldade da meta orçamentária - com o Indicador de Execução Orçamentária Meeting the budget. Para o desenvolvimento da pesquisa, o questionário desenvolvido foi aplicado aos gestores do Serviço de Saúde, selecionados pela técnica de amostragem não probabilística snowball. As técnicas utilizadas para tratamento e análise dos dados foram de estatística descritiva e Modelagem em Equações Estruturais. Após a coleta e organização das respostas dos 33 questionários respondidos, as hipóteses foram testadas utilizando o software SmartPls, cujos resultados dessa análise do modelo foram: somente a Hipótese 3 foi suportada estatisticamente, afirmando que há uma relação positiva e significante da característica Avaliação Orçamentária sobre a performance da Execução Orçamentária, cujo coeficiente de caminho dessa relação foi de 0,487, o qual explica aproximadamente 50% da variação do efeito da Avaliação Orçamento sobre a efetividade do orçamento; as hipóteses H1 e H5 foram rejeitadas, mas verificou-se uma relação positiva com o Indicador de Execução Orçamentária; as hipóteses H2 e H4 não foram testadas devido à retirada dos construtos Dificuldade da meta orçamentária e Feeback Orçamentário. O achado dessa pesquisa foi uma constatação relevante para esse ambiente do setor de Saúde, no que se refere à amostra estudada, pois se constatou que mesmo havendo Participação Orçamentária e Clareza das Metas, esses gestores se orientam pela questão da Avaliação Orçamentária, ou seja, o quanto as variações orçamentárias ocorridas são reportadas aos responsáveis e utilizadas na avaliação de desempenho desses gestores. Nesse ambiente, com características peculiares, as decisões desses gestores se orientam para a prestação do serviço de assistência ao paciente, mas se importam com a alocação dos recursos escassos, expressa nas metas orçamentárias traçadas, cuja Avaliação Orçamentária dessa alocação interfere diretamente na execução orçamentária do seu setor/unidade. / Budget control is indicated as a management tool suitable to reduce and control costs and valuate a hospital performance. In the health services field, where the hospitals fit in, the budget works as an instrument to allocate resources, coordinate, control and communicate the institution strategies, aiming costs reduction e efficiency, taking in consideration the scarce resources available in the area. The budget process in this area could be influenced by peculiar characteristics, such as complexity, frequency, the task uncertainty and also the tension between the clinical and management departments of a hospital concerning establishment of goals. The research will show the budgetary process from the clinical department, health providers and specially from the Nursing Service perspective. Its goal is to investigate the relation between characteristics of the budgetary process in the health service and the budgetary execution. The theoretical framework of the research and also the definition of the five hypotheses analyzed are based on the literature and present the relationship between each budgetary process characteristic - Budgetary Participation, Budgetary Feedback, Budgetary Evaluation, Budget Goal Difficulty and Budget Goal Clarity - and the Budgetary Execution Indicator Meeting the budget. For the research, the questionnaire was applied to the health service managers selected by the non-probability sampling snowball. For the treatment and analysis of data we used descriptive statistics and Structural Equation modeling. After the data collection and organization that came from 33 questionnaires, the hypothesis were tested using SmartPls that showed the following results: only hypothesis H3 was supported statistically, stating that there is a positive and significant relation between budgetary evaluation and the Budgetary Execution performance, whose coefficient was 0,487. This figure explains the approximately 50% variation in effect of budgetary evaluation over the efficacy of the budget. The hypotheses H1and H5 were rejected. It was, however, observed that they both presented a positive relation with the Budgetary Execution Indicator. The hypotheses H2 and H4 were not tested due the removal of the constructs budget goal difficulty and budgetary feedback. The research finding was a relevant realization for the health area, concerning the samples analyzed as we observed that even when the budgetary participation and the budget goal clarity happened, these managers were guided by the budgetary evaluation. In other words, the budgetary variations are reported depending on their use for the managers\' performance evaluation. In this field, which presents peculiar characteristics, these managers\' decisions are towards the patient and their needs, considering, however, how to allocate the scarce resources they have as determined in the budgetary goals. Also, the budgetary evaluation impacts directly the department/unity budget execution.

Destaca o papel dos hospitais, no contexto dos princípios e diretrizes do sistema nacional e regional de saúde, observando, entretanto, as transformações ocorridas nos modelos de gestão, em função dos propósitos preconizados pela reforma do aparelho do Estado brasileiro. Para tanto, resgata a política de gestão do trabalho e educação em saúde proposta e implementada pelo Ministério da Saúde, bem como, o processo histórico e conceitual sobre gestão e desenvolvimento de recursos humanos nas organizações. Objetivos - Identificar o modelo adotado de gestão do trabalho e educação em saúde pelas instituições hospitalares públicas e privadas da região metropolitana de São Paulo, a partir da percepção dos profissionais de saúde, e suas implicações na valorização e na motivação para o trabalho em saúde. Procedimentos Metodológicos - Revisão bibliográfica; experiência do autor como gestor de recursos humanos da Secretaria de Estado da Saúde; e pesquisa qualitativa, com profissionais médicos e equipe de enfermagem, de hospitais: públicos, públicos com fundação de apoio, organização social da saúde e privados, da região metropolitana de São Paulo, utilizando-se da técnica de Grupo Focal. Resultados Os entrevistados demonstraram desconhecimento sobre as políticas de gestão do trabalho adotadas pelas instituições hospitalares, porém, com relação à educação em saúde, destacam a existência de ações isoladas, pontuais e fragmentadas de treinamento, desenvolvimento e formação de recursos humanos. Conclusões - o modelo de gestão do trabalho e educação em saúde adotado pelos hospitais públicos e privados não é percebido pelos colaboradores como fator de interferência no processo motivacional dos mesmos / This work is focused on the role of the hospitals, in the context of the principles and guidelines of the National and Regional Health Systems, considering the changes in their work management model to conform to the purposes established by the reformulation of the Brazilian State. In addition, the policies for work management and health education proposed and implemented by the Ministry of Health as well as the historical process and conception on the management development of human resources are also discussed. Objectives To identify the models of management and health education in public and private hospitals in the metropolitan region of the City of São Paulo city, through the perception of health professionals and the influence exerted on their motivation to work. Method Literature search; the authors experience as a human resource manager in the Department of Health of State of São Paulo; a qualitative research, conducting groups with physicians and nursing teams of different types of hospitals: public, public with partner Foundations, social health organizations and private hospitals. Results The interviewed professionals had the policies of management adopted by the hospitals, but they identified the existence of isolated and fragmented actions for training and development of human resources in the process of health education. Conclusions The model of work management and health education adopted by public and private hospitals is not perceived by their professional contributors as an interfering factor for their motivation to work

O problema da violência contra a mulher é um fenômeno mundial. O movimento feminista, no final dos anos 60, se fortaleça e começa a denunciar alguns casos, dando corpo e visibilidade a esta questão, que até então permanecia no campo do privado. O objetivo dessa pesquisa foi identificar situações de violência doméstica entre as usuárias das várias clínicas do Centro de Referência da Saúde da Mulher e de Nutrição, Alimentação e Desenvolvimento Infantil (CRSMNADI) do Hospital Pérola Byington. Os dados coletados foram obtidos por meio da utilização de Metodologia Qualitativa, denominada grupo focal, onde 164 mulheres reunidas em 12 grupos falaram sobre as formas e conseqüências da violência doméstica em suas vidas. O estudo permitiu compreender os significados e o sentido que as mulheres em situação de violência atribuíram as suas experiências. As informações foram organizadas em categorias construídas durante o próprio processo de análise, procurando assim contextualizar as multifaces e multicausas da violência doméstica vivenciada pelas usuárias do serviço. Os resultados obtidos revelaram que a maioria das usuárias vivem em situação de violência doméstica, tendo como conseqüência agravos de saúde e, portanto necessitam de atendimento em serviços de saúde / Violence against women is a global phenomenon. The Feminist Movement has strengthened in the late sixties and since then it has began to report some facts that so far we did not know. The aim of this research was identify the violence at home. This research was made at Nutricional Health Women Reference Center and Food Children Development at Pérola Byington Hospital. Data was collected through qualitative methodology called focal group, where 164 women were gathered in twelve groups in order to talk about different form and consequences of domestic violence in their lives. This survey allowed us to understand the meanings that women suffering from domestic violence attributed to their experiences. The information was organized into categories constructed during the process of analysis, aiming to contextualize the multi faceted of domestic violence experienced by the women users of this service. This results revealed that most women live in a situation of domestic violence which compromise their health and, therefore, in need of attending specialized health services.

Medication-related problems (MRPs) are a common issue that lead to suboptimal healthcare outcomes and increased healthcare cost. Overall, older adults have a high risk of experiencing MRPs due to large medication consumption and recession of biological functions. One approach to reduce such a risk is for elderly patients to use comprehensive medication reviews (CMRs), the fundamental service of Medication Therapy Management (MTM). The Centers of Medicare and Medicaid (CMS) has been promoting CMRs among Medicare Part D beneficiaries since 2009, such as offering of an annual free CMR to eligible MTM beneficiaries and making “CMR completion rate” a quality rating (Star) measurement for Part D plans. However, statistics from the report of CMS 2017 Star rating measures showed that the CMR completion rate among MTM eligible was still low. Even though Medicare Part D beneficiaries ultimately make the decision, there are insufficient U.S. studies examining patient perceived factors affecting their use of CMRs. Thus, there is critical need to better understand decision making for using CMRs from a consumer perspective. This dissertation project aimed to explore Medicare Part D beneficiaries’ perceptions on using a CMR, using a conceptual framework adapted from consumer decision making, which consisted of internal need, external influence, perceived risks of using CMRs, and alternative comparison. The dissertation project also aimed to describe how CMR recipients and non-recipients were different and to identify main factors associated with Medicare Part D beneficiaries’ decision making for using CMRs. To achieve these objectives, this study used an exploratory sequential mixed-method approach in a cross-sectional setting. Semi-structured personal interviews were conducted as the qualitative phase followed by self-administered mailed survey as the quantitative phase. Both interview questions and survey items were developed based on the conceptual framework, though findings from qualitative phase informed the survey item generation as well. Survey items and administration were further refined using a panel of expert review and pilot study. A convenient sample consisted of older adults recruited from one pharmacy in Iowa and a senior registry maintained by University of Iowa was used for the qualitative phase (n = 13). The quantitative study sample were randomly selected from each sampling frame: 1) elderly residents of the States of Florida (n = 320), Washington (n = 320), Wisconsin (n = 320), and Pennsylvania (n = 320) covered in a commercial mailing list; and 2) older adults included in the same senior registry used for the qualitative phase (n = 460). The study inclusion criteria were: 1) must be at least 65 years old in 2016, 2) must be taking at least one prescription currently, and 3) must be a Medicare Part D beneficiary. A thematic analysis was conducted for qualitative data, using MaxQDA version 12. Descriptive analysis and multiple logistic regression modeling were used to analyze data of the quantitative phase, using SAS version 9.4. A total of 13 study participants were included in the qualitative analysis, of which 5 were CMR recipients. The thematic analysis yielded five themes, which supported the use of the conceptual framework (i.e. internal need, external influences, perceived risks of using CMRs, and alternative comparison) to understand Medicare Part D beneficiaries’ decision making for using CMRs. Plus, consumers who received a CMR expressed a positive attitude towards them. Safety worriers or knowledge seekers appeared more likely to use CMRs while physician believers or privacy worriers are more likely to not use CMRs. Meanwhile, awareness of CMRs remains low after being available for 7 years, possibly due to an infrequent marketing activity. An overall usable response rate of 26.8% and an overall completion rate of 89.4% were obtained in the mailed survey phase. Of the study sample, 381 respondents who were Medicare Part D beneficiaries, were using at least one prescription, and returned a complete survey were included for analysis. There were 27.56% respondents (n = 105) reported that they had a CMR in 2016 or before, which was consistent with the low CMR completion rate nationwide. Meanwhile, about two thirds of respondents never heard of CMRs, supporting findings from the qualitative phase. CMR recipients and non-recipients had several characteristics differences in the domain of internal need, external influences, and perceived risks of using CMRs. Compared to CMR non-recipients, CMR recipients took slightly more prescription medications (p = 0.0299), were self-reported less healthy (p = 0.0009), had better provider communication in previous pharmacy encounters (p < 0.0001), had higher overall satisfaction in previous pharmacy encounters (p = 0.0053), perceived more seriousness of MRPs (p = 0.0016), perceived more susceptibility of MRPs (p < 0.0001), expected more positive outcome from suing CMRs (p < 0.0001), were more likely influence by a physician’s opinion (p = 0.0184) or a pharmacist’s opinion (p < 0.0001) when considering the use of CMRs, were more likely received a physician recommendation (p < 0.0001) or a pharmacist recommendation (p < 0.0001), had less concern of psychological risk (p = 0.0170), functional risk (p < 0.0001), and social risk (p = 0.0016). The regression modeling further determined that a pharmacist or a physician recommendation, pharmacist’s communication in previous pharmacy encounters, perceived susceptibility of MRPs, and positive outcome expectancy were positively associated with Medicare Part D beneficiaries’ decision making for using CMRs at a significant level of .05, when holding other variables fixed. Meanwhile, perceived functional risk, access to general counseling in previous experiences, and family/friends influence were negatively associated with Medicare Part D beneficiaries’ decision making for suing CMRs at a significant level of .05, when holding other variables fixed. This study is the first to adapt consumer behavior frameworks to explore factors affecting Medicare Part D beneficiaries’ decision making for using CMRs. Unfortunately, it was found that CMR awareness among older population was still low after years’ of promotion efforts among Medicare Part D beneficiaries. Findings of this dissertation suggested that policy makers should not entirely focus on promoting CMRs through Part D plan sponsors, but seek for collaborations from healthcare professionals, particularly community pharmacists and physicians. Meanwhile, addressing key components and benefits of CMRs in an understandable way to general older population could help them establish a link between benefit expectation and their demand. Furthermore, using short surveys or phone interviews to obtain self-perceived internal need among older population could be used by Part D plans or other stakeholders to target potential CMR users more effectively.

Bakgrund: Depression är lika vanligt som demens hos äldre, men ofta inte lika studerat eller diskuterat. I dagsläget finns det flertalet olika bedömningsformulär för att finna dessa patienter men depression hos äldre är ofta odiagnostiserat. Konsekvenserna med en depression i sen ålder kan vara mycket ogynnsamma, både för individen och samhället. Allt eftersom den äldre befolkningen kommer att öka så kommer även depression att öka.Syfte: Syftet med denna studie är att undersöka olika metoder för att lindra depressiva symtom hos den äldre befolkningen. Metod: Beskrivande design med litteraturöversikt med systematisk ansats som metod.Resultat: Tolv originalartiklar med kvantitativ experimentell metod inkluderades. Fyra artiklar tog upp självhjälp och hjälp till självhjälp av olika slag som intervention, fyra tog upp fysisk aktivitet som intervention, två tog upp KBT som intervention, en använde samtalsterapi som intervention och två artiklar hamnade under mer än en underrubrik. Nio av artiklarna hade interventioner som visade sig fungera för att lindra depressiva symtom. Slutsats: Att kombinera motion med socialt umgänge, rätt kost och en aktiv vardag kan lindra depressiva symtom i stor utsträckning. Det viktigaste arbetet borde vara att upptäcka och börja sätta in åtgärder i ett tidigt skede, för att förhindra att en depression utvecklas. Detta kan leda till minskat lidande för patienten och minskade kostnader för samhället. / Introduction: Depression is as common as dementia in the elderly, but often not as well studied or discussed. At present, there are several different assessment forms for finding these patients, but depression in the elderly is often undiagnosed. The consequences of a late-age depression can be vary unfavorable, both for the individual and society. As the older population increases, so will depression. Aim: The purpose of this study is to investigate various methods to relieve depressive symptoms in the elderly population. Methods: Descriptive design with literature review with systematic approach as method. Results: Twelve original articles with a quantitative experimental method were included. Four articles addressed self-help and self-help of various kinds as intervention, four took up physical activity as intervention, two took up KBT as intervention, one used conversational therapy as intervention and two articles ended up with more than one sub-heading. Nine of the articles had interventions that were found to work to relieve depressive symptoms. Conclusion: Combining exercise with social interaction, the right diet and an active everyday life can greatly alleviate depressive symptoms. However, the most important work should be to discover and take measures at an early stage, to prevent a depression to develop. This can lead to reduced suffering for the patient and reduced costs for society.