Suchergebnisse

BY ANISH KOKA Filling in the holes of recent stories in the New York Times, and Propublica on the outpatient care of patients with peripheral arterial disease Most have gotten used toContinue reading...

Nurses is one of profession who have high risk to suffered of job stress. Public hospital Surabaya is hospital which is teaching hospital type and as a reference hospital healths program from government of National Health Insurance in Surabaya city. The effect of this conditions are increase number of patients and nurse's workload. This case also increasing the opportunity of risk nurse to job stress. This study aims to assess the prevalence of job stress among nurse in outpatient unit and to investigate the correlation between job stress with individual factors and workload. This study is quantitative research with cross- sectional design, study was conducted during January 2017 and the respondents were recruited by using a total population were 26 nurses. Technique of data collection was based on questionnaire and callorimeter to measure a physical workload. To know the level of influence of each risk factor on the job stress at nurse in outpatient unit then conducted with frequency distribution, and crosstab, then analyzed with the test of logistic regression. The results of the analysis showed no influence significant between the age, gender, physical workload with job stress. The result of logistic regression showed that there is significant relation of mental workload. Based on result showed mental workload is the dominant factor that influence the job stress. The odds of which is 39,539 times higher at nurses who have major mental workload. Based on these results need efforts to increase cooperation among a nurse with others unit which is related units to work system becomes an effective and efficient, to improve the social support among the co-worker, and to improve the commitment of all staff in the hospital to be more punctual on performing their duty.

In Italy the 1978 Reform Law established that all psychiatric admissions had to take place in the General Hospital Psychiatric Wards (GHPW). In 1984 a national survey found a national rate of 0.05 GHPW beds per thousand population. However, for several reasons, in Italy very few studies have been carried out on the inpatient popula tion. In this paper we analyse all the patients admitted to the two GHPWs in Cremona, Lombardy Region, during 1986. Males were generally younger than females. The large majority of patients studied lived with relatives and had completed only elemen tary education; 1/3 of all the inpatients were employed, 1/3 retired or with social security disability and ¼ housewives. About 25% of them were at the first ever psychiatric admission, and a significant difference was found for the age of the first admission, being higher in females. Concerning the diagnosis, a significant sex difference was found only for depressive neurosis and alcohol related disorders. The need for a better understanding of the role and the functions of the new GHPWs in the Italian psychiatric scene is emphasized.

Background: As many patients with severe mental illness (SMI) who have complex needs are difficult to engage, outreach mental health services are needed to engage them into treatment. The extent to which these services exist in large European cities is unknown. Methods: Experts in 29 European countries were sent a structured questionnaire containing two case vignettes of difficult-to-engage patients (a first-episode psychosis patient and a homeless chronic schizophrenia patient). The type and quality of outpatient care was assessed and related to several national indices. Results: The questionnaire was returned by experts from 22 countries (76%) representing 92% of the EU population. Six countries (21%) had a systematic method for detecting difficult-to-engage patients. The most important route whereby such patients entered the mental health system was through informal care; the most important reasons for entering it were the level of psychiatric symptoms, nuisance and violence. Assertive outreach was available in nine countries (41%), with coverage ranging from a few teams (sometimes for a specific target group) to most of the country. The case vignettes showed that outpatient care for these difficult-to-engage patients varied widely. In seven (30%) of the 22 countries, a hospital would take no action if such patients who had been admitted voluntarily discharged themselves prematurely. On a scale of 0–10, the experts' mean scores regarding the quality of outpatient care for patients with SMI in general were 5.2 (SD = 1.9) and 3.2 (SD = 2.2) in difficult-to-engage ones. Explorative analyses showed that the quality of outpatient care for difficult-to-engage patients was associated with gross national income and the number of psychiatrists per capita. Conclusions: Outpatient mental health services for difficult-to-engage SMI patients varied widely among European countries; experts judged their overall quality to be poor. It is now important to achieve consensus on a minimum European standard for the quality of care for such patients.

Context: meso level organizations are intended to link different actors to organize care for a defined population. They act between the macro level of care policies and the micro level of interaction with the patient. The establishment of Territorial Professionnal Health Communities (CPTS) in France is an opportunity for health professionals to participate in structuring primary care (PC) delivery. Objective: to query the Belgian health system to identify meso level organizations and describe them by completing data with a documentary search. Method: qualitative descriptive study conducted by semi-structured videoconference interviews with Belgian professionals considered as experts. The interview guide covered 4 clinical vignettes and 6 PC themes. Data were analyzed and discussed collectively within the research group. Results: 7 interviews were conducted. 5 main organizations illustrate the two "meso-clinical" and "meso-organizational" levels of the meso level. The Circle of General Practitioners (GPs) represent the GPs of a geographical area to organize out of hours care, health promotion, multidisciplinary collaboration, partnerships with hospitals, meeting with local politics. The reform of the Flemish front-line areas offer support to professionals and gives them a responsibility towards the population. Conclusion: the projects of CPTS could be based on some experiences led in Belgium. ; Contexte : les organisations de niveau meso sont destinées à mettre en lien différents acteurs afin d'organiser les soins pour une population définie. Elles se situent entre le niveau macro des politiques de santé et le niveau micro d'interaction avec le patient. L'instauration des Communautés Professionnelles Territoriales de Santé (CPTS) en France est l'occasion pour les professionnels de santé de participer à la structuration de l'offre en soins primaires (SP). Objectif : interroger le système de santé belge pour identifier des organisations de niveau meso et les décrire en complétant les données par une recherche documentaire. Méthode : étude qualitative descriptive menée par entretiens semi-structurés en visioconférence auprès de professionnels belges, experts. Le guide d'entretien abordait 4 vignettes cliniques et 6 thèmes des SP. Les données ont été analysées puis discutées collectivement au sein du groupe de recherche. Résultats : 7 entretiens ont été réalisés, 5 organisations principales illustrent les deux strates « meso-clinique » et « meso-organisationnelle » du niveau meso. Le Cercle des médecins généralistes (MG) représente les MG d'une aire géographique pour organiser la garde et favoriser la promotion de la santé, la collaboration multidisciplinaire, les partenariats avec l'hôpital, la rencontre avec la politique locale. La réforme des zones de première ligne en Flandre offre un support aux professionnels et leur confère une responsabilité vis-à-vis de la population. Conclusion : les projets de CPTS pourraient s'appuyer sur certaines expériences menées en Belgique.

Context: meso level organizations are intended to link different actors to organize care for a defined population. They act between the macro level of care policies and the micro level of interaction with the patient. The establishment of Territorial Professionnal Health Communities (CPTS) in France is an opportunity for health professionals to participate in structuring primary care (PC) delivery. Objective: to query the Belgian health system to identify meso level organizations and describe them by completing data with a documentary search. Method: qualitative descriptive study conducted by semi-structured videoconference interviews with Belgian professionals considered as experts. The interview guide covered 4 clinical vignettes and 6 PC themes. Data were analyzed and discussed collectively within the research group. Results: 7 interviews were conducted. 5 main organizations illustrate the two "meso-clinical" and "meso-organizational" levels of the meso level. The Circle of General Practitioners (GPs) represent the GPs of a geographical area to organize out of hours care, health promotion, multidisciplinary collaboration, partnerships with hospitals, meeting with local politics. The reform of the Flemish front-line areas offer support to professionals and gives them a responsibility towards the population. Conclusion: the projects of CPTS could be based on some experiences led in Belgium. ; Contexte : les organisations de niveau meso sont destinées à mettre en lien différents acteurs afin d'organiser les soins pour une population définie. Elles se situent entre le niveau macro des politiques de santé et le niveau micro d'interaction avec le patient. L'instauration des Communautés Professionnelles Territoriales de Santé (CPTS) en France est l'occasion pour les professionnels de santé de participer à la structuration de l'offre en soins primaires (SP). Objectif : interroger le système de santé belge pour identifier des organisations de niveau meso et les décrire en complétant les données par une recherche documentaire. Méthode : étude qualitative descriptive menée par entretiens semi-structurés en visioconférence auprès de professionnels belges, experts. Le guide d'entretien abordait 4 vignettes cliniques et 6 thèmes des SP. Les données ont été analysées puis discutées collectivement au sein du groupe de recherche. Résultats : 7 entretiens ont été réalisés, 5 organisations principales illustrent les deux strates « meso-clinique » et « meso-organisationnelle » du niveau meso. Le Cercle des médecins généralistes (MG) représente les MG d'une aire géographique pour organiser la garde et favoriser la promotion de la santé, la collaboration multidisciplinaire, les partenariats avec l'hôpital, la rencontre avec la politique locale. La réforme des zones de première ligne en Flandre offre un support aux professionnels et leur confère une responsabilité vis-à-vis de la population. Conclusion : les projets de CPTS pourraient s'appuyer sur certaines expériences menées en Belgique.

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) spent about $3.0 billion on its outpatient pharmacy benefit in fiscal year 2001. After VA implemented the Veterans' Health Care Eligibility Reform Act in 1999, more veterans could use VA outpatient care, including the pharmacy benefit, than before. Increased eligibility contributed to a doubling of the number of Priority 7 veterans using VA health care. Priority 7 veterans are primarily veterans with higher incomes and no service-connected disability. GAO was asked to report on Priority 7 veterans' use of the outpatient pharmacy benefit and VA's expenditures to provide this benefit. To do this, GAO reviewed VA pharmacy data on use and costs from fiscal years 1999 through 2001."

It is estimated that around 8 % of the Indian population is driven into poverty by high health care costs every year. Despite this, financial protection in the form of health insurance coverage remains low at around 25 % among the Indian population. Health Microinsurance (HMI) schemes have emerged throughout the country to protect the low-income population from catastrophic health care expenditures and to improve their access to care. HMI are based on the same insurance principles as conventional insurance but due to targeted and limited portfolios, they can offer their products at lower prices. Because of an underdeveloped public health care sector, private Non-Degree Allopathic Practitioners (NDAPs) are the most important source of care for acute illness episodes in rural areas in India. These providers lack a formal qualification in Western medicine, but practice it anyway. Their inclusion into insurance arrangements could be a chance to improve financial access to care. Therefore, in 2010, three newly established HMI schemes in rural northern India integrated NDAPs into their portfolio. According to our knowledge, they were the first HMI scheme in India to have done so, which makes it particularly valuable to study the effect on access to outpatient care. The present thesis consists of various independent publications which together address the question whether the inclusion of NDAPs in HMI schemes can improve access to quality outpatient health care in rural India. The focus lies on the subjective experiences of the insured themselves and how they perceive the effect of being insured on their access to outpatient care from NDAPs. I make use of an analytical framework which differentiates between three dimensions of access: physical access (availability), financial access (affordability) and cultural access (acceptability). A cross-cutting issue is quality of care, defined within this framework as the perceived technical ability of health services to affect people's health. The thesis follows a qualitative, exploratory research approach as the research questions address how the insured themselves perceive the effect of insurance to access and what facilitators or barriers they experience. This information is important for understanding dynamics in place when insured make or not make use of insurance-related health care services and for improving accessibility of these. Ultimately, the insureds' subjective perception of the impact of being insured is also fundamental for understanding their decision to (re-)enroll into a scheme or not. Each independent study follows its own qualitative, exploratory research approach, adapted to the specific sub-question under study. These approaches comprise a systematic review (analyzed by applying a thematic synthesis), a cross-sectional study based on focus-group discussions (analyzed using a directed qualitative content analysis) as well as longitudinal case study with insured and non-insured households based on in-depth interviews (and analyzed by applying case description and analysis and explanation of themes and patterns, both within and across cases). The systematic review of existing qualitative studies on access to care through HMI shows that a lack of physical access to care provided under HMI and dissatisfaction with its quality are among the most frequently identified problems with access to care through HMI. This confirms the relevance of my research question for different countries and schemes, as the integration of local providers such as NDAPs in combination with an involvement of insurance clients into the selection of these providers tackles just these shortcomings. Second, the review also reveals the limitations of this approach. Given that health system-related barriers to accessing care can compromise the schemes' efforts, it makes clear that complementing measures addressing system-related shortcomings are indispensable. With regard to the initial health care seeking behavior for acute illness episodes among the HMI's target population and the popularity of NDAPs, the thesis presents evidence that because of their proximity, flexible payment options and familiarity with patients' belief systems, among other things, local NDAPs are physically, financially and culturally accessible. They have a "high degree of fit" with their patients. Usually, they are the first contact points for patients before turning to qualified practitioners, and treat minor illnesses, provide first relief, refer patients to other providers and administer formally prescribed treatments. These findings again confirm specifically for the Indian case the relevance of our HMI schemes' decision to include NDAPs into their portfolio for the provision of outpatient care. Finally, the thesis shows what effect on access to outpatient care is perceived by the HMI-clients under study, how they utilize the services offered and what factors facilitate or hamper their access to services. It shows that households appreciate to have immediate access to outpatient care from NDAPs without co-payment. Perceived low quality of care and limited physical access are important barriers experienced by the insured. Both factors are partly caused by how HMI-associated NDAPs are integrated into the insurance schemes. While some households do not consult them due to the barriers perceived, others integrate them and their services into their health care seeking behavior or even use them exclusively. Based on the evidence presented, it is concluded that HMI has the potential to improve access to quality outpatient care services in India from the point of view of the insured by including popular providers such as NDAPs into their portfolio and making use of their physical and social embeddedness. However, their inclusion needs to be designed carefully to not let external regulation of NDAP-patient-relationships restrict already existing access as it had happened in some cases in the insurance scheme under study. At the same time, it is necessary to also implement measures within the health care system itself, mainly addressing the quality of health care provision by NDAPs through qualification and formalization efforts by the Indian government. A close monitoring of the effect of these measures on accessibility of NDAPs would be necessary. This should also include the perspective of the NDAPs themselves on HMIs and its effect on their relations with their patients. Although the findings are not easily generalizable to other regions or countries, they can serve as valuable input for HMI schemes which aim to improve access to outpatient care while confronted with a similar significance of NDAPs.

ABSTRAKIndonesia has entered an aging population as showed by the number of elderly population which has reached more than 7% of the population. Basically, the increase in the elderly population will also increase the number of illnesses, because the more a person ages, the physical condition will decrease and be more susceptible to disease. This research is a quantitative study that aims to determine the determinants of outpatient health service use for Indonesian elderly in 2017. This research used secondary data from the 2017 National Socio-Economic Survey (Susenas) results with the unit of analysis is people aged ≥ 60 years who had health complaints. The analytical method used is logit regression analysis. The results showed that gender, education, employment status, residential area, health insurance ownership, economic status, and disruption of activity due to illness had a p-value of 0,000 < 0,05 which means that it was significantly associated with the utilization of outpatient health services. The most dominant variable is the disruption of activity due to illness. The government can issue policies related to efforts to register each elderly person into health insurance through optimizing a healthy Indonesian program with a family approach. The government is expected to be more assertive in monitoring and evaluating elderly health services by considering factors that support the elderly in utilizing health services to achieve healthy aging and active aging. ABSTRAKIndonesia telah memasuki populasi menua yang ditunjukkan dengan angka populasi lansia yang sudah mencapai angka lebih dari 7% jumlah penduduk. Pada dasarnya kenaikan populasi lansia juga akan meningkatkan angka keluhan kesehatan dan kesakitan, karena semakin bertambah usia seseorang maka kondisi fisiknya akan menurun dan lebih rentan terhadap penyakit. Penelitian ini merupakan penelitian kuantitatif yang bertujuan untuk mengetahui determinan pemanfaatan pelayanan kesehatan rawat jalan pada lansia sakit di Indonesia tahun 2017. Data yang digunakan adalah data sekunder dari hasil Survei Sosial Ekonomi Nasional (Susenas) tahun 2017 dengan unit analisis yaitu individu dengan usia ≥ 60 tahun yang mempunyai keluhan kesehatan. Metode analisis yang digunakan adalah analisis regresi logit. Hasil penelitian menunjukkan bahwa jenis kelamin, pendidikan, status pekerjaan, wilayah tinggal, kepemilikan jaminan kesehatan, status ekonomi, dan gangguan aktivitas akibat sakit mempunyai nilai P-value 0,000 < 0,05 yang berarti berhubungan secara signifikan dengan pemanfaatan pelayanan kesehatan rawat jalan. Pemerintah diharapkan dapat lebih tegas dalam memonitoring serta mengevaluasi pelayanan kesehatan lansia dengan mempertimbangkan faktor yang mendukung lansia dalam memanfaatkan pelayanan kesehatan agar tercapainya healthy ageing dan active ageing.

Ziel des Beitrags ist die Untersuchung und Bewertung der Erreichbarkeit der Bevölkerung durch ambulante Pflegedienste in Unterfranken unter Einbeziehung der räumlich differenzierten Bevölkerungsstruktur für das Jahr 2017 sowie der voraussichtlichen demographischen Entwicklung bis 2025. Die Erreichbarkeiten werden sowohl rasterbasiert als auch vektorbasiert in einer GIS-Software modelliert. Darüber hinaus werden demographische Entwicklungen in der Altersgruppe "80 Jahre und älter" eingebunden. Die Ergebnisse der rasterbasierten Fahrzeitenmodellierung zeigen flächenhaft relativ gute Erreichbarkeiten, mit Ausnahme weniger peripherer Gebiete. Mittels vektorbasierter Fahrzeitenmodellierung werden Einzugsgebiete, welche auf Personalkosten und Anfahrtspauschalen nach SGB V und SGB XI als Berechnungsgrundlagen basieren, für ambulante Pflegedienste berechnet. Es zeigt sich, dass in Teilen Unterfrankens keine ausreichende Kostendeckung gegeben ist. Hinsichtlich der skizzierten Bevölkerungsentwicklung sowie unzureichender Fahrtkostendeckung im Bereich der Mittelgebirge und abseits der Verdichtungsräume wird eine Flexibilisierung der Anfahrtsvergütung sowie eine Aufstockung des Pflegepersonals empfohlen.

The support of professional interpreters is an essential component of adequate mental health care for migrants with limited language proficiency. Nevertheless, for varied reasons, only a small proportion of outpatient psychotherapists provide interpreter-mediated psychotherapy for migrants. This study explored the perspectives of psychotherapists who have not worked with professional interpreters in outpatient mental health care to identify factors that may prevent the use of interpreters in outpatient care and explore possible incentives to provide interpreter-mediated psychotherapy for migrants with limited language proficiency. Semi-structured interviews were conducted with 13 outpatient psychotherapists in Northern Germany who had not yet worked with professional interpreters in outpatient care. The interviews were audio recorded, transcribed and analysed using a structured content analysis approach. The psychotherapists named structural as well as subjective barriers and concerns. Findings suggest that improving structural factors, such as secure funding, minimal additional work, better preparation and training could facilitate the integration of professional interpreters into everyday treatment. Psychotherapists also mentioned concerns about their own confidence (e.g., insecurities regarding the triadic situation), the patient (e.g., reduced openness), the interpreter (e.g., doubts about suitability, motivation and empathy), as well as the therapeutic process (e.g., unclear allocation of roles). However, positive aspects and opportunities of interpreter-mediated psychotherapy were also described. These could be enhanced by the presence of conducive factors, such as existing trust between all parties and professional cooperation between interpreter and psychotherapist.