scholarly journals Patients and Health System-Related Factors Impacting on Tuberculosis Program Implementation in Resource-Constrained Settings: Experience from Multi-TB Facilities in Oyo State, South-West of Nigeria

2018 ◽  
Author(s):  
Olanrewaju Oladimeji ◽  
Joyce Tsoka-Gwegweni ◽  
Lungelo Mlangeni ◽  
Lehlogonolo Makola ◽  
Olusegun Awolaran
Keyword(s):  
Health System ◽  
Program Implementation ◽  
Resource Constrained ◽  
Related Factors ◽  
South West

Implementation of a positive youth development program by class teachers in a Chinese context

2012 ◽  
Vol 24 (3) ◽  
pp. 273-280
Author(s):  
Daniel T.L. Shek ◽  
Daniel W.M. Lung ◽  
Yammy L.Y. Chak
Keyword(s):  
Youth Development ◽  
Positive Youth Development ◽  
Program Implementation ◽  
Development Program ◽  
Related Factors ◽  
Chinese Context ◽  
Youth Development Program ◽  
The People ◽  
Study Results

Abstract This paper reports the findings of a case study in which a curriculum-based positive youth development program (Project P.A.T.H.S.) was implemented by the class teachers in a school. School-related factors which contributed to the success of program implementation were identified in the study. Results showed that factors facilitating the program implementation were closely related to the “5Ps” model (i.e., program, people, process, policy and place). While all the above factors contributed to the success of program implementation, the “people” factor was identified as the most crucial factor. Overall, both the students and program implementers perceived the program to be effective in promoting holistic development in the program participants.

scholarly journals Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system

2021 ◽  
Vol 2 ◽  
pp. 263348952110437
Author(s):  
Ana M Progovac ◽  
Miriam C Tepper ◽  
H. Stephen Leff ◽  
Dharma E Cortés ◽  
Alexander (Cohen) Colts ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Behavioral Health ◽  
Program Implementation ◽  
Health Management ◽  
Safety Net ◽  
Clinical Settings ◽  
Urban Safety ◽  
Core Components ◽  
Health Home

Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees’ transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6–7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6–7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.

scholarly journals Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Neusa BAY ◽  
Edna JUGA ◽  
Carlos MACUACUA ◽  
José JOÃO ◽  
Maria COSTA ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Health System ◽  
Health Facility ◽  
Essential Medicines ◽  
World Health ◽  
Diagnostic Tools ◽  
Clinical Protocols ◽  
Double Burden ◽  
Related Factors

Abstract Background Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods During a pragmatic and prospective 30-day snapshot study (with 24 h surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral de Mavalane, Maputo, we assessed patient’s flow and care, as well as health facility’s infrastructure and resources through direct observation. Reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results The 1911 hypertensive patients included in the study had several stops during their journey inside the health facility and followed a non-standardized care flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

2019 ◽  
Vol 34 (8) ◽  
pp. 618-624
Author(s):  
Anatole Manzi ◽  
Alyssa Ierardo ◽  
Jean Claude Mugunga ◽  
Cate Oswald ◽  
Patrick Ulysse ◽  
...  
Keyword(s):  
Global Health ◽  
Health System ◽  
Low Income ◽  
Program Implementation ◽  
Quality Care ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Global Movement ◽  
Active Implementation

Abstract The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

scholarly journals Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria

2015 ◽  
Vol 8 ◽  
pp. HSI.S27177 ◽  
Author(s):  
Ugochukwu U. Onyeonoro ◽  
Joseph N. Chukwu ◽  
Charles C. Nwafor ◽  
Anthony O. Meka ◽  
Babatunde I. Omotowo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Health System ◽  
Access To Care ◽  
Care Facility ◽  
Related Factors ◽  
Staff Attitude ◽  
Patients Satisfaction ◽  
Multilinear Regression Analysis ◽  
Southern Nigeria ◽  
Adherence Counseling

Objective Knowing tuberculosis (TB) patients’ satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients’ satisfaction with TB services in southern Nigeria. Materials and Methods A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. Results Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. Conclusion Patient- and health system–related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing.

scholarly journals Evolution of Vascular Access among Incident Hemodialysis Patients during the First Year: A National Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006842020
Author(s):  
Wael F. Hussein ◽  
Gasim Ahmed ◽  
Leonard D. Browne ◽  
William D. Plant ◽  
Austin G. Stack
Keyword(s):  
Health System ◽  
Vascular Access ◽  
Cox Regression ◽  
National Study ◽  
First Year ◽  
Related Factors ◽  
Clinical Patient ◽  
Predominant Type ◽  
Conversion Rates ◽  
Using Data

Background: Although the arteriovenous fistula (AVF) confers superior benefits over central venous catheters (CVC), utilisation rates remain low among prevalent haemodialysis (HD) patients. The goal of this study was to determine the evolution of vascular access type in the first year of dialysis and identify factors associated with conversion from CVC to a functioning AVF. Methods: We studied adult patients (n=610) who began HD between the 01/01/2015 and 31/12/2016 and were treated for at least 90 days using data from the National Kidney Disease Clinical Patient Management System in the Irish Health System. Prevalence of vascular access type was determined at day 90 and 360 following dialysis initiation and at 30-day intervals. Multivariable logistic regression explored factors association with CVC at day 90, and Cox regression evaluated predictors of conversion from CVC to AVF on day 360. Results: CVC use was present in 77% of incident patients at day 90 with significant variation across HD centres (from 63 % to 91%, P<0.001) that persisted following case-mix adjustment. From day 90 to day 360, AVF use increased modestly from 23% to 41%. Conversion from CVC to AVF increased over time but the likelihood was lower for older patients [adjusted hazard ratio (HR) 0.43, 95% CI 0.19-0.96 for age >77yrs vs referent], for patients with lower BMI [HR 0.95, (0.93- 0.98) per unit decrease in BMI], and varied significantly across HD centres [from HR 0.25, (0.08-0.74) to 2.09 (1.04-4.18)]. Conclusion: CVC are the predominant type of vascular access observed during the first year of dialysis with low conversion rates from CVC to AVF. Substantial centre variation exists in the Irish health system that is not explained by patient-related factors alone.

Gender and key population disparities in tuberculosis programs in Cambodia: findings from a national assessment

2020 ◽  
Author(s):  
Siyan Yi ◽  
Alvin Kuo Jing Teo ◽  
Say Sok ◽  
Sovannary Tuot ◽  
Sivanna Tieng ◽  
...  
Keyword(s):  
Health System ◽  
Program Implementation ◽  
Service Providers ◽  
Guideline Implementation ◽  
National Health System ◽  
Data Availability ◽  
Key Populations ◽  
National Assessment ◽  
Key Population ◽  
Multi Stakeholder

Abstract Background Globally, the successes in tuberculosis (TB) programs are hampered by the challenges in new case identification, particularly in key and vulnerable populations. Identification of gaps in the programs in response to gender and key population sensitivity is crucial in reaching the un-identified cases. This study aims to define TB key populations, assess gender- and key population-specific issues, and identify successes and gaps in the national TB response in Cambodia.Methods This national assessment was conducted in 2018 through a consultative workshop and a validation workshop with representatives of multi-stakeholder groups, a desk review of documents from all levels of the national health system, and 19 in-depth interviews and 30 focus group discussions with policymakers, service providers, and representatives of key populations. Content analysis was conducted for qualitative interviews.Results We identified seven TB key populations to be prioritized for the national TB programs in Cambodia. Key themes that inhibit access to TB services included the lack of knowledge and awareness, distance to TB clinics, lack of time and financial means, and other systemic barriers such as inconsistencies in policy and guideline implementation at different levels of the health system and lack of financial and human resources required for effective program implementation. We did not find any indications of discriminatory practices against women and key populations. In general, community participation in the national TB response was encouraging. However, there were significant gaps in data and reporting system at all levels, which are required to understand the burden of TB and risk behaviors in genders and key populations.Conclusions Disparities in gender and key populations are well-recognized in Cambodia. Barriers to TB services faced by key populations ought to be addressed through consistent engagements with different stakeholders. Data availability is vital for enhancing the understanding of gender and key population gaps, and the existing data should be duly utilized. Mechanisms to ensure equality and inclusivity are necessary to end TB in Cambodia.

scholarly journals Adherence to statin treatment and associated factors in female users from the Unified Health System (SUS)

2014 ◽  
Vol 48 (3) ◽  
pp. 477-483
Author(s):  
Mariana Rotta Bonfim ◽  
Arina Hansen ◽  
Bruna Camilo Turi ◽  
Gabriel de Souza Zanini ◽  
Acary Souza Bulle Oliveira ◽  
...  
Keyword(s):  
Health System ◽  
Associated Factors ◽  
Statin Treatment ◽  
Self Report ◽  
Adherence Rate ◽  
Medical Prescription ◽  
Related Factors ◽  
Unified Health System ◽  
System Method ◽  
Chi Squared

Objective: To identify the adherence rate of a statin treatment and possible related factors in female users from the Unified Health System. Method: Seventy-one women were evaluated (64.2 ± 11.0 years) regarding the socio-economic level, comorbidities, current medications, level of physical activity, self-report of muscular pain, adherence to the medical prescription, body composition and biochemical profile. The data were analyzed as frequencies, Chi-Squared test, and Mann Whitney test (p<0.05). Results: 15.5% of women did not adhere to the medical prescription for the statin treatment, whose had less comorbidities (p=0.01), consumed less quantities of medications (p=0.00), and tended to be younger (p=0.06). Those patients also presented higher values of lipid profile (CT: p=0.01; LDL-c: p=0.02). Musculoskeletal complains were not associated to the adherence rate to the medication. Conclusion: The associated factors to adherence of dyslipidemic women to statin medical prescription were age, quantity of comorbidities and quantity of current medication.


scholarly journals Factors Affecting Adherence to Antihypertensive Medication: Results from a Rural Population Study in East of Iran

2016 ◽  
Vol 9 (5) ◽  
pp. 286 ◽  
Author(s):  
Reza Esmaeili ◽  
Mohammad Matlabi ◽  
Abduljavad Khajavi ◽  
Ehsan Aliasghari ◽  
Moosa Sajjadi
Keyword(s):  
Medication Adherence ◽  
Health System ◽  
Rural Population ◽  
Antihypertensive Medication ◽  
Cross Sectional Study ◽  
Time Interval ◽  
Chi Square ◽  
Related Factors ◽  
Cross Sectional ◽  
Medication Therapy

<p><strong>INTRODUCTION: </strong>Medication therapy is one of the most important interventions for the control of hypertension and its complications, but patient nonadherence to prescribed antihypertensive medication is a challenge. This study was conducted to measure medication adherence and examine its determinants in patients with hypertension in a rural population of Iran.</p><p><strong>METHODS: </strong>This cross-sectional study was conducted on 422 patients with hypertension covered by the healthcare network of Bajestan, Razavi Khorasan Province, Iran. Medication adherence was measured by using the Persian version of the 8 items Morisky Medication Adherence Scale (MMAS-8). The Chi-square test and Spearman’s correlation coefficient were used to examine the relationship between the determinants of medication adherence in SPSS.</p><p><strong>RESULTS: </strong>The mean age of the patients was 65.02±8.88 years. Of the total of 422 patients, 299 (70.9%) were female. Based on the MMAS-8, medication adherence was high in 39.6% of the patients, moderate in 10.9% and low in 49.5%. The variables that correlated significantly with the level of medication adherence included age (P=0.032), education (P=0.022), income (P=0.001), the satisfaction of patients-physician communication (P=0.006), physician based education (P= 0.003), occupation, time interval of physician’s consultation (P=0.001), medication regime complexity (P=0.001), medications meals frequency (P=0.001), side effects (P=0.081) duration of the disease (P=0.015), comorbidities (P=0.001), smoking (P=0.047), patient’s ability to read medication instruction (P=0.011), the patient’s beliefs about the effectiveness of medications (P=0.001) and the patient’s beliefs about the effectiveness of health system (P=0.001). The variables of gender (P=0.147), marital status (P=0.054), and distance problems to the health center (P=0.181) were not significantly correlated with the level of medication adherence.</p><p><strong>CONCLUSION:</strong> The results of the present study revealed a low medication adherence in half of the patients with hypertension due to various personal and socioeconomic determinants as well as factors associated with the health system, therapy-related factors, disease-related factors and patient-related factors. Purposeful interventions therefore appear essential to improving medication adherence in rural populations with a focus on the effect of each determinant of medication adherence.</p>

Sign in / Sign up

Export Citation Format

Share Document