Introdução: A legislação brasileira prioriza a atenção às crianças, aos portadores de deficiência, às gestantes, lactantes, pessoas acompanhadas por crianças de colo e pessoas idosas em serviços públicos e privados. No entanto, não é claro o que diferencia a priorização entre esses grupos ou dentro do mesmo grupo. Com o progressivo aumento da população idosa, faz-se necessária a adequação das políticas públicas de forma a atender as novas e crescentes demandas econômicas, sociais e de saúde. Em situações nas quais os recursos assistenciais existentes podem não ser suficientes para o atendimento global, torna-se necessária a hierarquização dos mesmos a partir de critérios objetivos e claros que reorganizem o fluxo assistencial dos serviços de acordo com as suas reais necessidades e demandas. Objetivo: Identificar os critérios relacionados à priorização de atendimento em saúde de pessoas idosas, considerando aspectos biomédicos/clínicos, epidemiológicos, etários e bioéticos. Método: Trata-se de um estudo de revisão bibliográfica realizada nas bases de dados CINAHL, EMBASE, LILACS e PubMed. Foram encontrados 1.973 artigos e, após análises, mantiveram-se 11 artigos. Resultados: Os trabalhos encontrados apresentaram-se de forma bem diversa em relação aos objetivos e metodologias utilizadas diante de diferentes formas de classificação, hierarquização e seleção de idosos de acordo com os riscos de gravidade, declínio ou morte. De acordo com os estudos, foram selecionados pacientes com maior necessidade ou risco de acordo com instrumentos ou por avaliação dos profissionais. Os principais motivos foram: idosos acima de 85 anos, homens, uso de polifarmácia, isolamento social, necessidade de ajuda para realizar as atividades cotidianas, comprometimento cognitivo e problema respiratório. Conclusão: A priorização dos cuidados de saúde dos idosos deve ser embasada em fatores que mais impactam essa população e em critérios que destaquem casos mais susceptíveis a riscos, mediante escolhas hierarquizadas entre alternativas de cuidados e recursos disponíveis. É necessário garantir o acesso aos idosos nos diferentes níveis de atenção à saúde de forma eficiente, permitindo o efetivo monitoramento e gerenciamento de sua condição clínica. / Introduction: Brazilian law prioritizes care for children, people with disabilities, pregnant women, nursing women, people carrying infants and elderly people in several public and private services. However, it is not clear what differentiates the prioritization between these groups or within each group. With the progressive increasing of the elderly population, it is necessary to adapt public policy in a way that suits the new and growing economic, social and health demands. In situations which the available care resources may not be sufficient to provide medical attention globally, it is necessary to hierarchize care through objective and clear criteria that allows a reorganization of the care flux according to the actual needs and demands of each case. Objective: To identify criteria related to the prioritization of health care for elderly people, considering biomedic/clinic, epidemiologic, age-related and bioethical aspects. Method: The following is a bibliography review study. The bibliographical search was done on the CINAHL, EMBASE, LILACS and PubMed databases. 1973 articles were identified and, after multiple analysis, 11 articles were kept. Results: The papers identified presented diverse objectives and methodologies, which were utilized to identify diferente forms of classification, hierarchization and elderly selection, accordingly to risks related to severity, decline or death. According to these studies, patients with more needs or in more risk were selected either through instruments or through professional evaluation. The main causes were: elderly over the age of 85, male, polypharmacy, social isolation, needing help to perform daily activities, cognitive impairment and respiratory issues. Conclusion: The prioritization of health care for the elderly must be based in the factors that cause the most impact on this population and in criteria that highlights cases more susceptible to risks, through hierarchized choices between care alternatives and the available resources. It is necessary to ensure access to elderly people on every different level of health care in an efficient way, allowing the effective monitoring and management of their clinical condition.

Thesis (M.A. (Clinical psychology)) --University of Limpopo, 2012 / A number of studies have indicated that help-seeking pathways followed by individuals suffering from mental disorders and other conditions of ill-health are not random, but are structured by a range of psychosocial and cultural factors. The quality and seriousness of the distress provide the impetus to the pathway, but its direction and duration is shaped by the convergence of psychosocial and cultural factors. This study explored the help-seeking pathways followed by patients receiving mental health care services in Polokwane-Mankweng Hospital Complex (PMHC) in Limpopo Province (South Africa). A qualitative approach was followed and participants were selected through purposive sampling. Ten participants (5 males and 5 females) who are receiving mental health care services at PMHC and were apsychotic at the time were recruited to the study. Data were collected using semi-structured interviews and analyzed using content analysis. The following psychological themes emerged from the study: participants’ subjective notions of the events or factors that could have led to their mental illness; their explanations of mental illness; the reasons for entering the mental health care system; the pathways they followed before receiving mental health services in the hospital; concurrent use of hospital mental health services and other services; their experiences of living with mental illness; and, the role of significant others in this regard. The study revealed that various agencies and providers of health care are visited by individuals suffering from mental illness and that there is also some evidence of concurrent use of these services, i.e., Western and African. The findings emphasize that help-seeking pathways are mainly determined by the perceived causes of the illness, which are derived from cultural ideologies.

Thesis Summary COMMUNITY-BASED EVIDENCE ABOUT THE HEALTH CARE SYSTEM IN RURAL VIETNAM This thesis contributes further evidence for policy-making on health care system reform in Vietnam. The author aims to provide insights into the provincial rural health system ten years after health sector reform was launched, through assessing availability of health care services, patterns of access of health care services when people are ill, and the costs of care and the performance of public and private providers. The following questions are addressed: 1. Which health care providers, i.e., public or private, are dominant in providing curative services to rural people when they are ill? 2. How much inequality exists between the poor and the non-poor in access to health care services in general, and public health care services in particular, when they are ill? Which factors explain the gap in use of services between the poor and the non-poor? 3. What policy and strategies should Vietnam consider implementing in order to reach the goals of better equity and quality of care for rural populations? These research questions were addressed using community-based survey data collected in 2001 from Hung Yen province, in which three components of the system -- user, provider, and community context -- are described and linked together in analysis. In addition, a supplementary health care provider survey collected in 1999 in three other provinces (Thai Binh, Binh Thuan, An Giang) is used to provide evidence about the availability of healthcare services in general and of private health care providers. The thesis is divided into two parts with a total of 9 chapters. Part A (chapters 1-4) provides background for the research questions raised about the commune health care system in rural Vietnam, the framework used in evaluating this health care system, and the data sources used in this thesis. Part B consists of five chapters (chapters 5-9) that presents research results on various dimensions of the rural health care system. It also provides conclusions on the health care system in rural Vietnam, and proposes policies and strategies for strengthening this system toward equity and efficiency. Chapter 1 presents the research rationale and objectives. It examine the international context of health sytem research, the Vietnamese context of health sector reform since the ?Doi Moi?, and the current trend of health sector reform, and the previous research done so far related to health system reform in Vietnam. The research questions addressed by the thesis are presented at the end of this chapter. Chapter 2 describes the historical development of rural health care system in Vietnam. It startes with an overview of social changes in the rural Vietnam including revolution and wars and both the positive and negative impacts on the health of rural populations. The evolution of the rural health care system is then outlined, from the single national provider system (public) to the reforms of 1989 where a public-private model for rural health care was introduced. Chapter 3 provides frameworks for analysis of availability, health accessibility, quality and efficiency of the rural health care system, and inequality of healthcare service utilization. It starts with a statement about the concept of health care system used in this thesis. Then five theoretical models for assessing the health care systems (health service utilization model, triangular model, model for improve quality of care, health care services as an open system, and the World Bank?s framework for assessing the performance of the health sector in serving the poor) are presented. The strategy of using these frameworks to assess the rural health system in Vietnam is explained. The link between the research questions and methodology used was described. Chapter 4 provides detailed descriptions of the two data sources and analysis strategies used to address the thesis research questions. The design and data collection methods of the health care provider surveys and household surveys in the four provinces are presented, followed by the specific strategy of using information from each database for the thesis objectives. The chapter ends with a presentation of the overall strategy of data analysis. Chapter 5 assesses availability of the commune health care system in rural areas of Vietnam with empirical data from all the four provinces. The findings show that both public and private health care providers are available in rural Vietnam, with a slight dominance of private services. There were commune health centers (CHCs) in all communes with at least one private physician in the majority of the communes. The average number of private providers ranged from 2.7 to 7.7 per 10,000 population in the four provinces. Many of them practiced without formal registration and under limited government supervision. Chapter 6 estimates perceived need of care by measuring the burden of non-fatal health problems with data from 3,498 people of 900 households randomly selected in Hung Yen province. Compared to the better off, the poor suffered significantly more long-term health ailments (an excess of 78 cases per thousand population) and more short-term morbidity (an excess of 112 cases per thousand population). The study found that the gap in household wealth index contributed approximately 55% of the explained gap in prevalence of long-term health conditions, equivalent to the gap of 60 cases per thousand population, and also 55% of the explained gap in short-term morbidity, equivalent to the gap of 38 cases per thousand population between the two groups based on the Oaxaca decomposition (D=0). Gaps in education, gender, health insurance, and occupation played a minor role in explaining the wealth-related inequalities in non-fatal health burden. Chapter 7 describes patterns of use of health care services when people are ill by type of providers, by type of illnesses, and by poverty ranking level. Findings in this chapter reveal a high level of self-medication, greater access to private than public services, and less use of public services or any health care services by the poor in comparison to the better off. Self-funded purchases of drugs for self-medication and use of private curative services were even common in those with health insurance. A single private provider contact for treatment of illness costs on average 2.6% of the total annual expenditure per capita, and self-medication with drugs purchased at private health care facilities costs 1.0% of total annual expenditure per capita, similarly these at district hospitals and commune heath centers were similar. Finally, the percentage of ill people with no access to any health care providers during their illness episode was high, regardless of their wealth or health insurance status. Chapter 8 compares the quality of private and public health services using a framework proposed by the World Bank for evaluating the quality of health care in developing countries. Results from this chapter show that technical quality of care was poorer in the private sector than among public providers while costs for patients were similar in private and public facilities, and client satisfaction was similar in public and private facilities. Chapter 9 summarizes the results from Chapters 5-8 to identify the main characteristics of the rural health system with a view to system sustainability and proposes policies and strategies for strengthening the quality of the public health care sector and improving its equity and efficiency. The main features of the current rural health care system in Vietnam identified from the community-based evidence found in this research are: (1) primary health care services are available and there is equality in physical access; (2) financial resources for the CHC system are diversified with Government resources the key contributors; (3) private health care providers for outpatient services, public providers for inpatient services; (4) quality of treatment services is below the national standard; (5) public services are available but under utilized; (6) the rural health care system is not a pro-poor system; (7) direct payment is the main component of total health care expenditure; and (8) the economic relationship of the rural health care system is a user-provider model rather than a health care triangular model. Nine recommendations to strengthen the rural health care system were then developed based on a critical view of the objectives of the Vietnam health sector reform for the period 2001-2010 supported by evidence found in this research. This chapter ends with a section to remind readers about the limitations of this study and then proposes future research with specific questions covering three main dimensions of health care system reform in Vietnam (accessibility, quality of care, and overall management). A study with a sentinel site approach to follow-up the impact of the social and health sector reform policies is also proposed to help the government make timely adjustments to their policies to protect the poor. / PhD Doctorate

The purpose of this study was to explore the challenges parents of children with mental health disabilities and disorders in Namibia face when attempting to access mental healthcare resources. The study used a qualitative exploratory approach. Purposive sampling was used to include parents, caregivers and relatives of children with metal health disabilities and disorders. The sample also included key informants. Data was collected through focus group discussions with the participants and individual interviews with the key informants. Overall, a total of 41 people provided information for this study. Thematic data analysis was used to assess the data. The results suggest that parents/caregivers and relatives of children with mental health disabilities and disorders do experience barriers accessing mental health care. The challenges go beyond commonly-reported problems in the literature such as stigma and discrimination and include basic challenges such as a lack of transportation to healthcare services and a lack of acceptance of the mental health disorders by the parents. The study offers recommendations for how service provision can be improved and how parents of children with mental health challenges can have better access to services.

The purpose of this study was to explore the challenges parents of children with mental health disabilities and disorders in Namibia face when attempting to access mental healthcare resources. The study used a qualitative exploratory approach. Purposive sampling was used to include parents, caregivers and relatives of children with metal health disabilities and disorders. The sample also included key informants. Data was collected through focus group discussions with the participants and individual interviews with the key informants. Overall, a total of 41 people provided information for this study. Thematic data analysis was used to assess the data. The results suggest that parents/caregivers and relatives of children with mental health disabilities and disorders do experience barriers accessing mental health care. The challenges go beyond commonly-reported problems in the literature such as stigma and discrimination and include basic challenges such as a lack of transportation to healthcare services and a lack of acceptance of the mental health disorders by the parents. The study offers recommendations for how service provision can be improved and how parents of children with mental health challenges can have better access to services.

The Department of Health adopted the District Health System as a means to unify South Africa's fragmented health services into a comprehensive, integrated National Health System (NHS). The Primary Health Care (PHC) approach is the driving force in promoting equity and accessibility to essential PHC services. Successful implementation of the PHC approach is in part, dependent on the availability of essential drugs, which impacts on patient quality of care and well-being. According to a report compiled by Pillay, McCoy and Asia in 2001 , the pharmaceutical component of the health sector reflected deficiencies in terms of the lack of equity in access to essential drugs, irrational use of drugs, poor security and cost-ineffective procurement and logistic practices. This study utilised a case study approach to examine the suitability, acceptability and feasibility of implementing a Public-Private Partnership (PPP) between the KwaZulu-Natal Department of Health (KZNDOH) the private provider, to improve pharmaceutical service delivery at provincial PHC clinics in the Ethekwini South Sub-District (ESSD). Participative observations and semistructured interviews conducted at PHC clinics in the target area provided valuable insight into problems of drug management supply, adherence to effective and rational prescribing and dispensing practices and additional training needs of the nurses. This study found the proposed PPP complementary to the mission and objectives of the Provincial DOH and suitable within the socio-political environment, in which the private provider operates. Recommendations were made to improve upon weaknesses inherent in the value chain and address deficient resources, capabilities and competences necessary to attain the PPP's critical success factors. The implementation of the proposed PPP rests on the ability of the private provider, to prove to the Provincial DOH and the National Treasury that the PPP is affordable, represents value for money and is in keeping with the goals of the NHS. Therefore, recommendations for management of these and other key stakeholders were made. On completion of all necessary modifications to the proposed model, the revised PPP to improve pharmaceutical service delivery at PHC clinics in the ESSD was found to be suitable, acceptable and feasible to both the KZN DOH and the private provider. / Thesis (MBA)-University of KwaZulu-Natal, 2006.

Darbo tikslas - įvertinti Kauno miesto ir Kauno rajono šeimos gydytojų nuomonę apie skatinamųjų paslaugų teikimo tvarką, vykdant profilaktines programas, sistemines bei įstaigų, teikiančių šias paslaugas, organizavimo problemas. Darbo uždaviniai: 1. Įvertinti Kauno miesto ir Kauno rajono pirminės asmens sveikatos priežiūros įstaigose dirbančių šeimos gydytojų nuomonę apie skatinamųjų paslaugų teikimo tvarką ir organizavimą jų įstaigoje. 2. Nustatyti, kaip motyvuojami Kauno miesto ir Kauno rajono šeimos gydytojai teikti skatinamąsias paslaugas. 3. Palyginti skirtingos priklausomybės Kauno miesto ir Kauno rajono pirminės asmens sveikatos priežiūros įstaigose skatinamųjų paslaugų organizavimo tvarką ir jų skatinimą. Tyrimo metodika. Anoniminės anketos pagalba 2010m. spalio – 2011m. kovo mėn. buvo apklausti skirtingos priklausomybės (privati ar priklausanti savivaldybei) Kauno miesto ir Kauno rajono pirminės asmens sveikatos sveikatos priežiūros įstaigų šeimos gydytojai (n=130). Duomenų analizė atlikta „MS Excel“ ir „SPSS Windows 14,0“ versijos kompiuterinėmis programomis. Rezultatai. Visi respondentai pažymėjo, kad jų PASP įstaigose yra vykdomos profilaktinės programos ir teikiamos kitos skatinamosios paslaugos. Pacientai dažniausiai kviečiami dalyvauti programose spontaniškai. Atsakomybė už pacientų kvietimą tenka šeimos gydytojams (74,1proc.). Informavimo paslaugų iš viso neregistruoja 31,8 proc. visų tyrime dalyvavusių PASP įstaigų darbuotojų. Tyrimo metu buvo nustatyta... [toliau žr. visą tekstą] / Aim of study – to evaluate the opinion of family physicians practicing in Kaunas city and district about organizating and providing the promotive health care services in prevention programmes as well as system-specific and setting-specific problems related with promotive services. Objectives: 1) to evaluate the opinion of family physicians practicing in Kaunas city and district about organization and provision of promotive health care services in prevention programmes at their health care settings; 2) to evaluate the motivation ways for family physicians to provide the promotive services at Kaunas city and district; 3) to compare the organization and motivation of promotive services between primary health care settings of different subordination at Kaunas city and district. Material and methods. From October 2010 to March 2011 anonymous questonnaire survey was conducted aimed at family physicians (n=130) working at public and private primary health care settings at Kaunas city and district. Data analyses were done using „MS Excel“ software and „SPSS Windows 14.0“ statistical package. Results. All study participants stated that at their health care setting the prevention programmes are running together with promotive services. Patients are asked to participate in programmes spontaneously. Main responsibility for patients invitation to participate is regarded for family physicians (74.1%). Of all study participants, 31.8% do not have a practice of registering the informative... [to full text]

Darbo tikslas. Įvertinti Šiaulių centro poliklinikos teikiamų pirminės sveikatos priežiūros paslaugų kokybę pacientų bei gydytojų požiūriu. Uždaviniai. 1. Atskleisti sveikatos priežiūros paslaugų kokybės sampratą ir esmę, teorines vertinimo prieigas. 2. Parengti teorinį pirminės sveikatos priežiūros paslaugų kokybės vertinimo modelį. 3. Įvertinti Šiaulių centro poliklinikos teikiamų paslaugų kokybę pacientų požiūriu. 4. Išanalizuoti gydytojų nuomonę apie pirminės sveikatos priežiūros paslaugų kokybę. Tyrimo metodika. Sveikatos priežiūros paslaugų kokybės įvertinimui taikytas anketinės apklausos metodas. Empiriniame tyrime dalyvavo 33 Šiaulių centro poliklinikos gydytojai ir 296 pacientai. Rezultatai. Atlikto Šiaulių centro poliklinikos teikiamų paslaugų kokybės tyrimo pacientų požiūriu rezultatai parodė, kad pirminės sveikatos priežiūros paslaugų kokybė labai gerai įvertinta pacientų lūkesčių, įstaigos veiklos bei gydytojų konsultacijų aspektais. Aukštą kokybę gydytojų etinės elgsenos aspektu riboja dalies gydytojų nenoras diskutuoti apie pacientų nepasitenkinimą paskirtu gydymu. Šiaulių centro poliklinikos teikiamų paslaugų kokybės įvertinimas gydytojų požiūriu parodė, gydytojai finansinėmis pajamomis už papildomas veiklas yra motyvuojami teikti kokybiškas sveikatos priežiūros paslaugas. Aukštą sveikatos priežiūros paslaugų kokybę gydytojai stengiasi užtikrinti per nenutrūkstamą paslaugų teikimą: sudarant galimybę pacientams kreiptis į šeimos ar budintį gydytoją bet kuriuo... [toliau žr. visą tekstą] / Aim of the study. To evaluate quality of primary health care services in Siauliu centro poliklinika from patients’ and doctors’ point of view. Objectives. 1. To reveal concept and essence of health care quality, theoretical approaches to its evaluation. 2. To prepare theoretical model for evaluation of primary health care quality. 3. To evaluate quality of primary health care services in Siauliu centro poliklinika from patients’ point of view. 4. To analyse doctors’ attitudes to quality of primary health care services. Methods. A questionnaire survey was applied for the evaluation of quality of health care services. 33 doctors of Siauliu centro poliklinika and 296 patients took part in empirical survey. Results. The accomplished survey of quality of health care services in Siauliu centro poliklinika from customers point of view presented that quality of primary health care services was evaluated as high through expectations of patients, activity of institution and doctors’ consultations. Quality of services is limited due to doctors’ avoidance to discuss patients’ lack of satisfaction with given treatment. Evaluation of quality of health care services in Siauliu centro poliklinika from doctors’ point of view indicate that doctors are motivated to render high quality services through income received due to complementary activity. Doctors seek to make high quality services certain through continuous provision of services as patients can apply to family doctor at any time of... [to full text]

Thesis (M.Sc.(Pharmacy)) - Rhodes University, 2007.

This thesis focused on the situation of family members of persons with psychotic illness, particular on their experience of the approach of the healthcare professionals and of their feelings of alienation regarding the professional care of their family member. A further aim was to explore how siblings who have participated in a support group for siblings experienced their situation. A questionnaire was developed that enabled the aims of this thesis to be investigated (I). Seventy family members from various parts of Sweden participated, and data were collected via the questionnaire developed in study I (II-III). Thirteen siblings who previously had participated in a support group participated in follow-up focus groups interviews (IV). The questionnaire developed was shown to be reliable and valid in these studies (I). In many cases, the participants had experienced an approach from professionals that indicated that they did not experience openness, confirmation and cooperation, and that they felt powerless and socially isolated in relation to the care. There was also found to be a certain degree of association between how the participants experienced the approach and whether they felt alienation (II). The majority of the participants considered openness, confirmation, and cooperation to be important aspects of professional’s approach. The result also identified a low level of agreement between the participants’ experience and what they considered to be significant in the professional’s approach (III). The findings revealed the complexity of being a sibling of an individual with psychotic illness. Participating in a support group for siblings can be of importance in gaining knowledge and minimizing feelings of being alone (IV). Although the psychiatric care services in Sweden have been aware of the importance of cooperating with family members, the results indicated that there is a need for further research in this area.