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Results for “Primary Health Care--changes”

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At least 19 recordsLinked to original sources
PubMedDate not supplied

The Appalachian Rural Health Project in Chautauqua County, N.Y., 1973-78.

The Appalachian Regional Commission awarded a 5-year grant to the Chautauqua County Department of Health to establish primary health care services to medically underserved rural areas of the county. Four clinics were opened at various stages as the project grew.What began as an open system multidisciplinary approach to the delivery of primary health care changed abruptly to a closed system in March 1976, when the county medical society members voiced a strong objection to the rural health project. Among other assertions, the medical society claimed that the clinics of the project were "too costly and unnecessary as they now exist." Equally strong voices of community people demanded that the project be allowed to operate. An unprecedented public hearing was held and, as a result, a compromise plan was developed that permitted the medical services of the clinics to be continued, but most of the multidisciplinary components devoted to social development were eventually dropped.By September 30, 1978, when the project grant ended, three of the four clinics had been taken over on a private basis by physicians who had previously been assigned to the clinics and supported by the project.The effects of grassroots support and power of the people in a community in determining their health rights and needs were demonstrated and documented in this pioneer program. It is anticipated that the Chautauqua County experience may be a helpful model in planning other projects that attempt to institute change in the health care delivery system in underserved rural areas.

Appalachian Region↗
PubMed1995

The Americanization of the British National Health Service.

The core reform of the British National Health Service (NHS) was the establishment of a quasi market with a split between purchasers and providers. Health authorities and general practitioner (GP) fundholders were to be discriminating purchasers seeking more efficient and responsive services. This market orientation was embedded in a larger context of managerial, allocational, public health, and primary care changes. This paper reviews the background and dynamics of these modifications and offers an early assessment. There is evidence that the reforms have unleashed much energy, activity, and thoughtfulness about future health care, but it remains unclear whether the gains justify the increased administrative and other transaction costs and potential threats to equal access.

Family Practice↗
PubMed1992

WHO commends India.

Explore the source record for details and available documents.

Developing Countries↗
PubMed1995

A model curriculum for mental disorders and behavioral problems in primary care.

Changes in the health care delivery system will increasingly emphasize the role of the primary care physician in diagnosing and treating mental disorders and behavioral problems. This increasing emphasis points to the need for more systematic definition of the knowledge and skills that future primary care physicians will need for effective delivery of mental health services. The model curriculum described in this paper represents the efforts of a multidisciplinary Task Force to describe basic training objectives for the psychiatric education of future primary care physicians.

Clinical Competence↗
PubMed1996

Evaluating the workload of practice nurses: a study.

In 1990 and 1991, 67 practice nurses with a total of 12,725 consultations took part in a before and after study of health board attached and practice-employed nurse workload. The intervention of the New General Practitioner Contract (DoH 1989) and other primary care changes in April 1990 provided an opportunity to examine the process of care, and identify and changes in workload or differences in working patterns of attached and practice-employed nurses, as a result of these modifications. Practice-employed nurses initiated more of their own appointments following implementation of the New Contract and saw fewer GP referrals. Routing treatment room work had decreased for both groups of nurses in the second year. Both groups of nurses had also increased their level of therapeutic listening in the second year, but practice-employed nurses reported higher levels of therapeutic listening than their attached colleagues during both recording periods.

Adult↗
PubMed1993

[Differences in mortality in the Dogon of Boni].

Mortality has been analyzed at the level of a small population of approximately 5000 persons, part of the Dogon of Mali. They are separated into four distinct groups, each composed of from three to four villages. Adjusted life tables are estimated for two periods of five years: 1977-81 and 1982-86. First these tables were calculated for the entire population and then for two of the most densely populated massifs. Mortality is very high. However, it is different in the two areas. This difference, already notable in 1977-81, increased during the period 1982-86. Possible causal factors could be linked to the presence of primary health care in the Tabi region. Although very limited, the care changed elementary rules of hygiene. Moreover, comparison between villages point to the important role of the quality and quantity of available water in relation to child mortality levels.

Adolescent↗
PubMed1984

The family as a resource unit in health care: changing patterns.

Medicine has long asserted that the family is one of the principal units of medical care. Concurrent with a resurgence of interest in holistic medicine, there has been a major increase in attention being paid to the role of the family unit in health care. There are, however, very few examples of how this interest has been put into practice, nor is it evident that it is reflected in teaching or graduate training programs. This paradox persists in spite of the growth of family medicine as a primary care discipline, especially in North America. The results of three studies are summarized to support the impression that, in general, these 'family specialists', along with other primary care practitioners (e.g. pediatricians), know relatively little about the structure or functioning of the families of patients they treat. The findings also suggest that there is little relationship between such knowledge and various indicators of the processes or outcomes of medical care. The question then arises whether such knowledge is lacking because it is truly of little value clinically, or whether these findings reflect methodological limitations in research of this kind. Intuitively it is reasonable to suppose that such a relationship does exist, and there is an extensive body of well-documented theory to support this view. How relevant such knowledge could or should be in practice, is an issue of particular importance in the context of the rapid changes taking place in the nature of the family itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Back pain in primary care. Outcomes at 1 year.

Outcomes of primary care back pain patients (N = 1128) were studied at 1 year after seeking care. Changes in depression depending on outcome, and predictors of poor outcome were evaluated. Less than one back pain patient in five reported recent onset (first onset within the previous 6 months). One year after seeking care, the large majority of both recent and nonrecent-onset patients reported having back pain in the previous month (69% vs. 82%). A significant minority of both recent and nonrecent-onset patients had either a poor functional outcome (14% vs. 21%) or continuing high intensity pain without appreciable disability (10% vs. 16%). Predictors of poor outcome included pain-related disability, days in pain, lower educational attainment, and female gender. Among initially dysfunctional patients with persistent pain, one half were improved and one third had a good outcome at the 1-year follow-up. Among initially dysfunctional patients who experienced a good outcome, elevated depressive symptoms improved to normal levels at follow-up. The outcome of back pain was predicted by pain-related disability and days in pain rather than by recency of onset, so it may be more meaningful to distinguish characteristic levels of pain intensity, pain-related disability, and pain persistence than to classify patients as acute or chronic.

Adult↗
PubMed1991

One year later: evaluating a changing delivery system.

One year after the introduction of primary nursing on four medical and surgical units in the tertiary hospital, a 23-item survey was distributed to primary and associate nurses on these units to evaluate the nurses' perceptions of the status of this change in nursing care delivery. Lewin's theory of change provided direction for evaluation of the change. The survey assessed improvements in patient care, changes in nursing practice, and interactions with other disciplines. The majority of nurses surveyed reported that patient care had improved under primary nursing; 100% of the primary nurses agreed that care had improved. The nurses identified continuity of care, communications, and awareness of patient problems as specific areas of improvement. They also identified improved interactions with many members of the healthcare team; the greatest were with dietitians, social workers, and physicians. The authors reported both positive and negative perceptions of how practice had changed under primary nursing. Results from the survey provided suggestions for continued support for staff nurses in this change in nursing care delivery within the studied facility, and suggested the need for future assessment and further evaluation.

Attitude of Health Personnel↗
PubMed1985

Probable future funding priorities in maternal and child health: a modified Delphi National Survey.

Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact of such a change on categorical programs in maternal and child health (MCH). This study first presents predictions about the future of 23 specific MCH services, derived from a modified Delphi Survey of MCH experts, and then examines the implications of these predictions for future public health.

Adult↗
PubMed1991

General theory of paradigms in health.

In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.

Adult↗
PubMed1978

Depression in primary care: changes in pattern of patient visits and complaints during a developing depression.

The purpose of this study was to characterize changes in patient behavior associated with a developing depression. The records of 154 depressed patients from a solo family practice were examined for type and number of complaints, number of visits, and amount of hospitalization during two periods of time. In addition, 154 patients were used as controls and matched to the depressive patients by age, sex, and season of year seen. Two similar time periods were examined in the controls. The depressed group in comparisons both with itself and with the control group showed, in the seven months prior to the diagnosis of depression, these changes: (1) increase in number of patient-initiated office and home visits; (2) increased incidence of hospitalization; and (3) increased number of presenting complaints of three types: ill-defined "functional" complaints; pain of undetermined etiology in a wide variety of sites: head, chest, abdomen, and extremities; and "nervous" complaints, mainly increased tension and feelings of anxiety. The study results indicate that increased number of office visits and "functional" somatic complaints or anxiety-tension feelings should suggest depression.

Adolescent↗
PubMed1980

A new direction for public health care: changing cafeteria eating habits.

A "Food for Thought" game, an eight-week, media-based nutrition program designed to influence food choices in a cafeteria setting, was conducted in a National Institutes of Health employee cafeteria. Its purpose was to encourage customers to select lower-caloric food during lunch. The effects of the program on food choices and total calories of food purchased each day were measured by time series analyses. During the eight-week intervention period, skim milk purchases increased, and dessert and bread sales, as well as average number of calories purchased per day per person, declined significantly. Some evidence for a maintenance effect over a ten-week follow-up period was obtained. The "Food for Thought" game delivered nutrition education in an upbeat but unobtrusive way. Although people patronize cafeterias to eat, socialize, and relax and not to be educated, this program had only minimal requirements for participation. The result was a high level of interest and involvement. People can "learn while they eat," if careful attention is paid to customer needs and principles of effective communication.

Diet↗