Population health is concerned with analyzing the factors that determine the uneven distribution of health in a population and it also proposes interventions to narrow health inequalities. Kindig has proposed a population health management strategy that would engage the health and other sectors on population health improvement through a financial incentive linked to health outcomes. Proposed elements of a population health approach in health care at the patient encounter level include paying attention to health determinants for the patient and ensuring interprofessional collaboration; at the system level the approach includes developing and advocating for interventions that address health inequalities, such as delivering services to under-serviced areas and vulnerable populations. There has been virtually no research among frontline clinicians on the awareness and salience of a population health approach. In order to address this gap an exploratory study was conducted among family physicians in Primary Care Networks (PCNs) in Alberta, Canada. PCNs include capitation funding that is used to purchase services such as nursing, pharmacy and dietetics. The physicians were able to describe their patient populations in terms of a full range of social determinants and the health status inequalities they produce. They emphasized the importance of preventive screening and counseling in contributing to the health of their patients, and cited the key contributions of other team members to these activities, as well as the electronic medical record (EMR). They reported ambivalence toward the effectiveness of financial incentives for population health improvement, and while there was some collaboration with schools, inter-sectoral collaboration has yet to develop outside the health sector. This thesis has demonstrated the potential for primary care physicians to adopt a population health approach. However, there is a considerable distance to go in introducing an incentive approach for outcome-based population health management, as envisioned by Kindig.

Population health is concerned with analyzing the factors that determine the uneven distribution of health in a population and it also proposes interventions to narrow health inequalities. Kindig has proposed a population health management strategy that would engage the health and other sectors on population health improvement through a financial incentive linked to health outcomes. Proposed elements of a population health approach in health care at the patient encounter level include paying attention to health determinants for the patient and ensuring interprofessional collaboration; at the system level the approach includes developing and advocating for interventions that address health inequalities, such as delivering services to under-serviced areas and vulnerable populations. There has been virtually no research among frontline clinicians on the awareness and salience of a population health approach. In order to address this gap an exploratory study was conducted among family physicians in Primary Care Networks (PCNs) in Alberta, Canada. PCNs include capitation funding that is used to purchase services such as nursing, pharmacy and dietetics. The physicians were able to describe their patient populations in terms of a full range of social determinants and the health status inequalities they produce. They emphasized the importance of preventive screening and counseling in contributing to the health of their patients, and cited the key contributions of other team members to these activities, as well as the electronic medical record (EMR). They reported ambivalence toward the effectiveness of financial incentives for population health improvement, and while there was some collaboration with schools, inter-sectoral collaboration has yet to develop outside the health sector. This thesis has demonstrated the potential for primary care physicians to adopt a population health approach. However, there is a considerable distance to go in introducing an incentive approach for outcome-based population health management, as envisioned by Kindig.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-07T14:44:21Z No. of bitstreams: 1 Josue Souza Gleriano.pdf: 2299806 bytes, checksum: 46cc3937b0e1b2301d90df1d031803e4 (MD5) / Made available in DSpace on 2015-04-07T14:44:23Z (GMT). No. of bitstreams: 1 Josue Souza Gleriano.pdf: 2299806 bytes, checksum: 46cc3937b0e1b2301d90df1d031803e4 (MD5) Previous issue date: 2014-11-03 / Introduction: The intersection between health, education and work permeates the institutionalization of the NHS since its proposed construction. The professional health education leads to permanent health education and the centrality of care practices and technologies. The axis training to practice and practice to the service becomes the object of this study. Objective: To characterize the profile of doctors and nurses working in health units belonging to the Primary Care of Guarujá SP Method: This was a study approved by the Ethics and Research Committee No. 452 727 / CEP UNAERP / 2013 prepared by A cross-sectional study. Participating physicians and nurses in health centers were to link the level of Primary Health, who were not on vacation or away for health reasons, answering a self-administered structured questionnaire developed by Brazil Telehealth and was drafted by a complementary conducted a descriptive analysis of all variables of the study. A descriptive analysis of all variables of the study was conducted. Qualitative variables were presented in terms of their absolute and relative values. Quantitative variables in terms of their values of central tendency and dispersion. To evaluate the association between categories of health professionals (doctors, nurses) and qualitative variables the Chi-square and Fisher's exact test was used. For quantitative variables, the normality and homogeneity of variances were assessed using Kolmogorov-Smirnov and Levene tests, respectively. As these two variables were not satisfied principles, the nonparametric Mann-Whitney U test was used. The significance level was 5%. Statistical package used was SPSS for Windows 17.0. Results: In relation to the research subjects shows that the professionals linked to units of family health were more accepted to participate. Regarding age, one realizes that professional family health (USAFA) are younger than those of basic health units (BHU) (p <0.05) sequence that also references the type of employment in the city. Regarding the type of employment shows that the higher prevalence in the APS will occur by CLT (p <0.05). The satisfaction expressed by health professionals when analyzed in the context of increased prevalence is a good level, highlighting only with respect to the health service system of the municipality which is rated as fair (p <0.05). Regarding the light for the job-analysis technologies in general feels empowered to play a familiar approach, community, the multidisciplinary work group activities and home visits (p <0.05). Conclusion: The knowledge of the profile of professional members of the body of human resources in health services points need qualification, first exposed in continuing education scenario and lack of introductory courses and approaches to the labor process in APS. The scenario might propose in relation to working technologies then requested the validation of professional a weakness in what is expected for the level of attention. The stability of the employment relationship must be worked with professionals especially in relation to the supervision of labor and production for the attention, remembering that the spaces of care are not just specific to a pathological clinical look. The reflection of the expanded clinic should be treated, in question, as a human resources policy not only to UBS. / Introdução: A interseção entre saúde, educação e trabalho permeia a institucionalização do SUS desde a sua proposta de construção. A educação profissional em saúde conduz a formação permanente em saúde e a centralidade das práticas e nas tecnologias do cuidado. O eixo formação para a prática e prática para o serviço torna-se objeto desse estudo. Objetivo: Caracterizar o perfil de médicos e enfermeiros que trabalham nas unidades de saúde pertencentes à Atenção Primária do município de Guarujá S.P. Método: Tratou-se de uma pesquisa aprovada pelo Comitê de Ética e Pesquisa nº 452.727/CEP- UNAERP/2013 elaborada mediante a um estudo transversal. Participaram médicos e enfermeiros das Unidades de Saúde que estavam com vínculo no nível de Atenção Primária a Saúde, que não estavam de férias ou afastados por motivos de saúde, respondendo um questionário estruturado auto-aplicado, desenvolvido pelo Telessaúde Brasil e um complementar elaborado pelos Foi realizada a análise descritiva de todas as variáveis do estudo. As variáveis qualitativa foram apresentadas em termos de seus valores absolutos e relativos. As variáveis quantitativas em termos de seus valores de tendência central e de dispersão. Para se avaliar a associação entre as categorias de profissionais de saúde (médicos, enfermeiros) e as variáveis qualitativas foi utilizado o teste de Qui-quadrado e o teste exato de Fisher. Para as variáveis quantitativas a normalidade e homogeneidade das variâncias foram avaliadas através de Kolmogorov-smirnov e Levene respectivamente. Como as variáveis não apresentaram esses dois princípios satisfeitos, foi utilizado o teste não paramétrico U Mann-Whitney. O nível de significância foi de 5 %. Pacote estatístico utilizado foi SPSS for Windows 17.0. Resultados: Em relação aos sujeitos da pesquisa exibe que os profissionais vinculados às unidades de saúde da família tiveram maior aceite em participar. Em relação à faixa etária percebe-se que os profissionais de saúde da família (USAFA) são mais novos que os das unidades básicas de saúde (UBS) (p<0,05) sequência que também faz referência ao vínculo de trabalho no município. Em relação ao vínculo de trabalho apresenta que a maior prevalência na APS dar-se-á por CLT (p<0,05). A satisfação expressa pelos profissionais de saúde quando analisadas em âmbito de maior prevalência é de um nível bom, destacando apenas com relação ao sistema de serviço de saúde do município que é avaliado como regular (p<0,05). Em relação às tecnologias leves para o trabalho em análise geral sente-se capacitados em desempenhar a abordagem familiar, comunitárias, o trabalho multiprofissional, as atividades de grupo e visitas domiciliares (p<0,05). Conclusão: O conhecimento do perfil desses profissionais integrantes do corpo de recursos humanos dos serviços de saúde aponta necessidade de qualificação, primeiramente exposto no cenário de educação continuada e pela falta de cursos introdutórios e de abordagens para o processo de trabalho na APS. O cenário pode propor em relação às tecnologias de trabalho então solicitadas na validação dos profissionais uma fragilidade no que se espera para o nível de atenção. A estabilidade do vínculo empregatício deve ser trabalhada com os profissionais principalmente em relação à supervisão do trabalho e da produção para com a atenção, lembrando que os espaços de atendimento não são apenas específicos de um olhar clínico patológico. A reflexão da clínica ampliada deve ser tratada, em questão, como uma política de recursos humanos não somente para a UBS.

Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment.

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 using the Administrative Claims Data in Chronic Condition Warehouse (CCW). The results for the first research question revealed that an increase in the number of primary care physicians was correlated with a decrease in ED visits; thus, persons living in areas with higher PCPs also had lower ED visits therefore the first null hypothesis was rejected (Ï?2 = 3.85, p=.05) . The results for the second research question revealed that ED visits had no significant relationship with death in a given year; thus, patients may be diverted to less expensive care sites to minimize cost and ED overcrowding, therefore the second null hypothesis was not rejected (Ï?2 = 0, p=.98). In both cases, the confounding variables of gender, age, and race had significant effects upon the relationship. Health Professionals and policy makers may use the findings to develop strategies to increase supply of PCPs, adapt patient centered interventions and modify existing chronic disease care strategies to minimize or prevent lifestyle and environmental factors that affect chronic disease outcomes. Such improvements could contribute to positive social change by eliminating or reducing the overcrowding that occurs in emergency departments in Maryland and other states.

The purpose of this study was to examine the practicing characteristics of graduates of a college of medicine with a rural primary care mission, including influences on graduates' specialty choices and practice locations. Secondary data analyses were conducted on student records and AMA Physician Masterfile data. Fewer graduates were practicing primary care than had entered primary care training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended other primary care programs. Women and rural track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Primary care physicians (PCPs) were practicing in more rural locales than non-PCPs. Family physicians tended to practice in the most rural locales. FMDRL_ID: 4822

Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment.

The prevalence of chronic Lyme disease (CLD) remains relatively unknown in Connecticut because there is not an agreement on what CLD is and how it should be diagnosed in addition to which pathological agent causes CLD. The aim of this quantitative study was to assess whether there were significant differences between two groups of primary care physicians (PCP) working in Connecticut from two different points in time regarding their knowledge in the diagnosis, treatment, and management of CLD. A knowledge, attitude, and practice model was used as the underlying theoretical framework for this study. A random cross-sectional survey was mailed out to the 1,726 PCPs found in the list of certified medical doctors in Connecticut of 2015. One hundred and forty-five PCPs responses (11.9% response rate) were received and compared to responses from previous data (a 2010 study) of 285 PCPs (39.1% response rate) from the list of certified medical doctors in 2006. The PCP estimated mean number of patients diagnosed and treated for CLD was not significantly different between 2006 and 2015. However, a significantly higher number of PCPs in 2015 reported knowing Lyme disease (LD) symptoms but not feeling comfortable diagnosing LD (χ� = 536.83, p < 0.001), and significantly more PCPs in 2015 reported knowing LD symptoms and feeling comfortable diagnosing CLD (χ� = 265.41, p < 0.001). This study can promote social change by encouraging Connecticut PCPs to recognize CLD as a diagnosis to enable the development of registries and case-control assessments. The findings of this study may also inspire future studies.

Nearly 11 million deaths in 2012 can be attributed to ischemic and hypertensive heart disease, stroke, and diabetes. Yet, these diseases are highly preventable and even treatable via improvement in nutritional intake and physical activity. From a public health perspective, primary care providers have promising and population-wide potential for modifying patient behavior to reduce dietary risk factors. However substantial socio-structural barriers prevent physicians from applying nutrition to improve patient outcomes. In my thesis, I first examine the epidemiological context in both the populations of United States and Switzerland. I then elucidate the importance and context of the application of nutrition knowledge in primary care based on the ideologies of holistic, patient-centered health. Then, I identify and analyze the obstacles physicians face in applying nutrition in patient care, as well as the sociological structures in which these barriers arise. Lastly, I set forth models of progress to improve patient outcome via reformed and restructured application of nutrition in primary care, using studies of exemplary strategies for addressing these barriers to nutrition counseling.

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