PP95 Engagement Of Local Policymakers In HTA With Positive Results

2018 ◽  
Vol 34 (S1) ◽  
pp. 101-102
Author(s):  
Flavia Elias ◽  
Luciana Gallo ◽  
Ana Carolina Pereira ◽  
Erica Silva ◽  
Juliana Girardi ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Pulmonary Tuberculosis ◽  
Homeless People ◽  
Control Program ◽  
Professional Staff ◽  
Surveillance Program ◽  
Overview Of Systematic Reviews ◽  
Surveillance Programs ◽  
Positive Results

Introduction:São Paulo city in Brazil has implemented social and health care for homeless people with pulmonary tuberculosis since 2007. We conducted a health technology assessment (HTA) of the interventions provided based on a national theoretical model using 2015 data and an overview of systematic reviews. The HTA was requested by national policymakers. The results demonstrated that the interventions for pulmonary tuberculosis were satisfactory. The municipal secretariat implemented actions to improve the national treatment recommendations and adopted incentives to increase adherence to treatments. Our objective was to describe the feedback process for the Health Secretariat.Methods:The feedback was categorized as: (i) an executive abstract with key messages (i.e. ninety-seven percent of notified cases underwent sputum smears, nineteen percent were hospitalized, and fifty-nine percent were cured) reported to policymakers involved in the surveillance program; and (ii) three meetings were organized jointly by the research group and local policymakers.Results:In 2016 we conducted a meeting to present the results. Thirty-nine professionals involved in the primary care team working on the streets (thirty-five percent) and the Tuberculosis Surveillance and Control Program (five percent) were present. The main barriers presented by the professionals were issues of human resources (i.e. suboptimal professional staff and having two different social organizations responsible for health care). The main facilitators presented by professionals were: (i) using homeless-peers as healthcare workers; (ii) having a network linking the primary care and surveillance programs; and (iii) periodic training.Conclusions:In addition to the positive results, the HTA presented an opportunity to discuss the sustainability of incentives for adhering to treatments adopted by the policymakers, such as meal allowances and housing support, to improve social conditions among the homeless.

scholarly journals Improving Health Care Management in Primary Care for Homeless People: A Literature Review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Jego ◽  
J Abcaya ◽  
C Calvet-montredon ◽  
S Gentile
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
General Population ◽  
Literature Review ◽  
Care Management ◽  
Multidisciplinary Approach ◽  
Homeless People ◽  
Primary Health

Abstract Background Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. However, they face multiple difficulties in accessing primary health care and receive less preventive health care than the general population. Methods We performed a literature review that included articles which described and evaluated primary care programs for homeless people. We searched into the MEDLINE, PsycINFO, COCHRANE library, and Cairn.info databases primary articles published between 1 January 2012 and 15 December 2016. We also performed a grey literature search, and we added relative articles as we read the references of the selected articles. We described the main characteristics of the primary care programs presented in the selected articles. Then we classified these characteristics in main categories, as a descriptive thematic analysis. Secondarily, we synthetized the main results about the evaluation of each intervention or organization. Results Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. Key messages To improve the health care management of homeless people it seems necessary to priorize multidisciplinary approach, integrated care, involve community health and answer their specific needs. It is necessary to evaluate more non-tailored primary care programs that collaborate with tailored structures.

scholarly journals A Cost-Effective Method for Identifying Enterobacterales with OXA-181

2019 ◽  
Vol 57 (11) ◽  
Author(s):  
Gisele Peirano ◽  
Yasufumi Matsumura ◽  
Diego Nobrega ◽  
Johann D. D. Pitout
Keyword(s):  
Indian Subcontinent ◽  
Cost Effective ◽  
Accurate Information ◽  
Surveillance Program ◽  
Molecular Surveillance ◽  
Specific Pcr ◽  
Cost Effective Method ◽  
Molecular Studies ◽  
Surveillance Programs ◽  
Positive Results

ABSTRACT OXA-181 is the second most common global OXA-48-like carbapenemase and is endemic in the Indian subcontinent. Molecular studies have shown that Enterobacterales with OXA-181 are often introduced into regions of nonendemicity. Distinguishing OXA-181 from other OXA-48-like enzymes often requires sequencing, which is rather expensive and time-consuming. A specific PCR (i.e., OXA181PCR) for the detection of blaOXA-181 was validated using a global collection (n = 315) of bacteria with well-characterized carbapenemases and showed 100% sensitivity and specificity (95% confidence interval [CI], 94.1 to 100 and 98.6 to 100, respectively) for detecting bacteria with OXA-181. The OXA181PCR subsequently gave positive results on 58/160 (36%) Enterobacterales with OXA-48-like carbapenemases from the 2015 INFORM surveillance program. The blaOXA-181-positive Enterobacterales were present in 9 countries spanning 5 continents, illustrating the global distribution of OXA-181. This methodology can easily be incorporated into molecular surveillance programs to provide accurate information about the prevalence of OXA-181. A loop-mediated isothermal amplification (LAMP)-OXA48 assay overall performed well for detecting OXA-48-like enzymes but showed poor specificity due to false-positive results with non-OXA carbapenemases.

scholarly journals What Results Should Be Returned from Opportunistic Screening in Translational Research?

2020 ◽  
Vol 10 (1) ◽  
pp. 13 ◽  
Author(s):  
Colin M. E. Halverson ◽  
Sarah H. Jones ◽  
Laurie Novak ◽  
Christopher Simpson ◽  
Digna R. Velez Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Primary Care Physicians ◽  
Ethical Issues ◽  
Opportunistic Screening ◽  
Test Results ◽  
Undue Burden ◽  
Positive Results

Increasingly, patients without clinical indications are undergoing genomic tests. The purpose of this study was to assess their appreciation and comprehension of their test results and their clinicians’ reactions. We conducted 675 surveys with participants from the Vanderbilt Electronic Medical Records and Genomics (eMERGE) cohort. We interviewed 36 participants: 19 had received positive results, and 17 were self-identified racial minorities. Eleven clinicians who had patients who had participated in eMERGE were interviewed. A further 21 of these clinicians completed surveys. Participants spontaneously admitted to understanding little or none of the information returned to them from the eMERGE study. However, they simultaneously said that they generally found testing to be “helpful,” even when it did not inform their health care. Primary care physicians expressed discomfort in being asked to interpret the results for their patients and described it as an undue burden. Providing genetic testing to otherwise healthy patients raises a number of ethical issues that warrant serious consideration. Although our participants were enthusiastic about enrolling and receiving their results, they express a limited understanding of what the results mean for their health care. This fact, coupled the clinicians’ concern, urges greater caution when educating and enrolling participants in clinically non-indicated testing.

PP81 Engagement Of Healthcare Professionals In Health Technology Assessment With Negative Results

2018 ◽  
Vol 34 (S1) ◽  
pp. 97-97
Author(s):  
Luciana Gallo ◽  
Flavia Elias ◽  
Ana Carolina Pereira ◽  
Wildo Araujo
Keyword(s):  
Surveillance System ◽  
Healthcare Professionals ◽  
Homeless People ◽  
Secondary Data ◽  
Control Program ◽  
Federal District ◽  
Health Technology ◽  
Professional Staff ◽  
Homeless Population ◽  
Structured Interviews

Introduction:We conducted health technology assessments (HTAs) of the interventions used between 2012 and 2014 to improve the treatment of homeless people with pulmonary tuberculosis in the Federal District of Brazil. The HTA, which was not ordered by policymakers, was based on the evidence-based national theoretical model compared with local interventions indicated in focus groups, semi-structured interviews, and secondary data produced by the Health Secretariat. The results demonstrated that the implementation of the interventions was unsatisfactory. Our objective was to present the feedback process for policymakers and the Health Secretariat, particularly its challenges.Methods:The feedback was categorized as: (i) an executive abstract with key messages (i.e. underreporting of cases in the surveillance system, lack of primary care, and underestimation of the health problem) reported to policymakers involved in the surveillance and healthcare systems; and (ii) oral presentations in eight meetings organized by the research group and local policymakers.Results:Between 2016 and 2017 we conducted eight feedback meetings. All of the professionals (n = 8) involved in the Tuberculosis Surveillance and Control Program were present in at least one of the meetings, but healthcare professionals and the Secretary of Health did not participate. The barriers presented by the professionals were: (i) lack of material resources (i.e. cars and gas, phones, diagnostic tests, medications); (ii) lack of human resources (i.e. suboptimal professional staff); and (iii) feeling insecure when performing extramural activities due to the potentially unsafe work environment.Conclusions:Gathering feedback on a HTA that was not ordered by policy makers can be a challenge. Mainly we demonstrated a negative result on research done in a vulnerable population with a neglected disease, in this case tuberculosis. However, this provided an opportunity for professionals in the surveillance system to discuss the challenges of implementing tuberculosis control among the homeless population.

scholarly journals Exploring the Experiences of Changes to Support Access to Primary Health Care Services and the Impact on the Quality and Safety of Care for Homeless People During the COVID-19 Pandemic: A Study Protocol for A Qualitative Mixed Methods Approach.

2020 ◽  
Author(s):  
Kelly Howells ◽  
Martin Burrows ◽  
Mat Amp ◽  
Rachel Brennan ◽  
Wan-Ley Yeung ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Lived Experience ◽  
Health Care Services ◽  
Homeless People ◽  
Health Care Need ◽  
Seek Health Care ◽  
Care Services ◽  
High Level ◽  
The Impact

Abstract Background: Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this back drop, there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes. Methods: An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. Interviews with health professionals and stakeholders exploring their experiences of delivering and facilitating care for homeless people during the pandemic will also be explored.Discussion: It is important to explore whether recent changes to the delivery of primary care in in response to the COVID-19 pandemic compromise the safety of homeless people and exacerbate existing health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.

scholarly journals Improving Health Care Management in Primary Care for Homeless People: A Literature Review

2018 ◽  
Vol 15 (2) ◽  
pp. 309 ◽  
Author(s):  
Maeva Jego ◽  
Julien Abcaya ◽  
Diana-Elena Ștefan ◽  
Céline Calvet-Montredon ◽  
Stéphanie Gentile
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Literature Review ◽  
Care Management ◽  
Health Care Management ◽  
Homeless People ◽  
Improving Health Care

scholarly journals Exploring the experiences of changes to support access to primary health care services and the impact on the quality and safety of care for homeless people during the COVID-19 pandemic: a study protocol for a qualitative mixed methods approach

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kelly Howells ◽  
Martin Burrows ◽  
Mat Amp ◽  
Rachel Brennan ◽  
Wan-Ley Yeung ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Lived Experience ◽  
Health Care Services ◽  
Homeless People ◽  
Health Care Need ◽  
Seek Health Care ◽  
Care Services ◽  
High Level ◽  
The Impact

Abstract Background Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this backdrop there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes. Methods An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. The experiences of health professionals and stakeholders delivering and facilitating care for people experiencing homelessness during the pandemic will also be explored. Discussion It is important to explore whether recent changes to the delivery of primary care in response to the COVID-19 pandemic compromise the safety of people experiencing homelessness and exacerbate health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.

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