scholarly journals A piece of the jigsaw of primary care: health professional perceptions of an integrated care model of hepatitis C management in the community

2014 ◽  
Vol 6 (2) ◽  
pp. 129 ◽  
Author(s):  
Carla Treloar ◽  
Rebecca Gray ◽  
Loren Brener
Keyword(s):  
Health Care ◽  
Hepatitis C ◽  
Integrated Care ◽  
Health Care Services ◽  
Service Providers ◽  
Health Resources ◽  
Opinion Leader ◽  
Interprofessional Relations ◽  
Hcv Treatment ◽  
Care Clinic

INTRODUCTION: There is growing interest in increasing uptake of hepatitis C (HCV) treatment. HCV is strongly associated with injecting drug use and is a stigmatised illness. People with HCV may be reluctant to engage with health care services. A community-based, nurse-led integrated care clinic was established in Christchurch, New Zealand with the intention of bridging the health care gap for those unwilling or unable to access mainstream health care. This paper explores the experiences and perceptions of health professionals regarding the implementation of this clinic, with particular attention paid to the interprofessional relationships relevant to the clinic. METHODS: Qualitative, in-depth interviews were conducted with 24 stakeholders, including four staff of the clinic and other service providers with varying relationships to the clinic. FINDINGS: Participants generally endorsed the clinic model and described its operation as easy to access, non-judgmental and non-threatening, and, therefore, able to attract and engage ‘hard-to-reach’ clients. The clinic model was also thought to support more effective use of health resources. Some participants expressed concerns regarding the potential ‘poaching’ of patients from other services (particularly general practice) and indicated a preference for HCV treatment services to be restricted to hospital settings. CONCLUSION: The findings of this study suggest the need to address concerns of general practitioners regarding patient poaching. Key information to disseminate is the clinic’s success in engaging with complex clients and contribution to more efficacious use of health service resources. These activities may require the advocacy of a key local opinion leader acting as ‘knowledge broker’. KEYWORDS: Community health services; hepatitis C; interprofessional relations; primary health care; qualitative research

scholarly journals Barriers to Hepatitis C Virus Treatment in a Canadian HIV-Hepatitis C Virus Coinfection Tertiary Care Clinic

2008 ◽  
Vol 22 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Meaghan McLaren ◽  
Gary Garber ◽  
Curtis Cooper
Keyword(s):  
Health Care ◽  
Substance Abuse ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Care Delivery ◽  
Tertiary Care ◽  
Hcv Treatment ◽  
Care Clinic ◽  
Hcv Therapy

BACKGROUND: Despite demonstrated efficacy in HIV-hepatitis C virus (HCV) coinfection, not all patients initiate, complete or achieve success with HCV antiviral therapy.PATIENTS AND METHODS: All HIV-HCV coinfected patient consults received at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) between June 2000 and September 2006 were identified using a clinical database. A descriptive analysis of primary and contributing factors accounting for why patients did not initiate HCV therapy, as well as the therapeutic outcomes of treated patients, was conducted.RESULTS: One hundred two consults were received. Sixty-seven per cent of patients did not initiate HCV therapy. The key primary reasons included: HIV therapy was more urgently needed (22%), loss to follow-up (12%), patients were deemed unlikely to progress to advanced liver disease (18%) and patient refusal (12%). Many patients had secondary factors contributing to the decision not to treat, including substance abuse (23%) and psychiatric illness (14%). Overall, 59% of untreated patients (40 of 68) were eventually lost to follow-up. Thirty-three per cent of referred patients started HCV therapy. Twenty-seven of 42 courses (64%) were interrupted prematurely for reasons such as virological nonresponse (48%), psychiatric complications (10%) and physical side effects (7%). Of all treatment recipients, 12 of 42 full courses of therapy were completed and three remained on HCV medication. Overall, eight of the 102 coinfected patients studied (8%) achieved a sustained virological response.DISCUSSION: Not all HIV-HCV coinfected patients who are deemed to be in need of HCV treatment are initiating therapy. Only a minority of patients who do receive treatment achieve success. Implementation of HIV treatment, patient retention, attention to substance abuse and mental health care should be the focus of efforts designed to increase HCV treatment uptake and success. This can be best achieved within a multidisciplinary model of health care delivery.

Perceptions of Health Education of Selected Health and Social Service Providers in the Bahamas

1982 ◽  
Vol 3 (3) ◽  
pp. 279-290
Author(s):  
Audrey Marie Deveaux ◽  
William A. Darity
Keyword(s):  
Health Care ◽  
Health Education ◽  
Social Service ◽  
Health Care Services ◽  
Service Providers ◽  
Care Delivery ◽  
Future Research ◽  
The Bahamas ◽  
Social Service Providers ◽  
Education And Health

Health education is a new component of the health care delivery system in the Bahamas. In the past, confusion and uncertainty was expressed regarding the contribution of health education to the health care services. The intention of this study was to investigate the perceptions of selected health and social service providers to health problems, their most likely solutions, and to health education and health education related issues in the Bahamas. A questionnaire was either mailed or hand delivered to 412 selected health and social service providers in New Providence and the Family Islands in the Bahamas. Of these 127 (31%) usable questionnaires were returned. A discussion of the study findings, study limitations, implications for health education and suggestions for future research are presented. The survey results showed that a majority of respondents indicated consistent support for health education and health education related issues. This support was evident even when responses were crosstabulated with such variables as age, profession, and years of experience in present occupation.

scholarly journals Alcohol and other drug treatment experiences of hepatitis C-positive and negative clients: implications for hepatitis C treatment

2009 ◽  
Vol 33 (1) ◽  
pp. 100 ◽  
Author(s):  
Loren Brener ◽  
Carla J Treloar
Keyword(s):  
Health Care ◽  
Hepatitis C ◽  
Drug Treatment ◽  
Health Care Workers ◽  
Differential Treatment ◽  
Treatment Facility ◽  
Hcv Treatment ◽  
Treatment Uptake ◽  
Care Workers ◽  
Treatment Facilities

To assess whether HCV-positive clients perceive that alcohol and other drug (AOD) staff discriminate against them, this study compared the treatment experiences of 120 HCV-positive clients with those of 120 HCV-negative clients attending the same AOD treatment facility. Despite the overall findings of favourable attitudes of HCV-positive clients toward their health care workers, these attitudes were less positive than those of their HCV-negative counterparts. Clients with HCV also rated their interpersonal treatment by their health care workers less favourably. These findings suggest that HCV-positive clients? attitudes towards their health care workers and their experiences of differential treatment by these health care workers might be a barrier to HCV treatment uptake in AOD treatment facilities.

scholarly journals Strategie allocative per la persona nella economia sanitaria

2005 ◽  
Vol 54 (1) ◽  
Author(s):  
Carlo Hanau
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Mental Disease ◽  
Health Maintenance Organization ◽  
Health Resources ◽  
Clinical Severity ◽  
Ethical Perspective ◽  
Health Maintenance ◽  
Personalized Care ◽  
Use Of Resources

L’autore affronta il tema della allocazione delle risorse sanitarie adottando una prospettiva etico-politica di tipo solidale. In particolare, viene messo in risalto come la sanità pubblica italiana comporti una spesa a carico del cittadino sempre maggiore, soprattutto per determinate categorie di soggetti quali i malati cronici non autosufficienti. Una indagine condotta per conto dell’OMS rileva infatti che in Italia i malati affetti da patologie più gravi ricevono in proporzione meno cure dei pazienti con patologie di grado lieve/moderato. Si tratta, dunque, del cosiddetto “effetto Matteo” - mutuato dalla espressione evangelica - secondo cui “a chi ha sarà dato e a chi non ha sarà tolto anche quello che ha”. Traslato alla realtà sanitaria ciò esita nel deprecabile superamento del criterio di severità clinica quale caposaldo dell’assistenza socio-sanitaria a vantaggio di criteri economicistici rappresentati da un uso improprio del sistema di remunerazione delle prestazioni sanitarie secondo DRG, che penalizza il produttore il quale sfori il limite di budget fissato dalle autorità sanitarie, magari a motivo di una maggiore attenzione all’assistenza dei malati cronici e/o disabili. Va peraltro considerato che la medicina attuale sconta altri limiti oltre a quelli relativi alle risorse, in particolare il limite rappresentato dalla finitezza umana, di cui occorrerebbe prendere serenamente atto. L'articolo considera peraltro in modo analitico alcuni strumenti utilizzati per la valutazione dell’efficacia e dell’efficienza degli interventi sanitari (QALYs, EQALYs, UVG, UVH, ROSES), mettendone in risalto punti di forza e criticità. In definitiva, occorre riferirsi sempre ad un criterio solidaristico, adottando peraltro una rigorosa logica di cura ed assistenza personalizzate, il che consentirebbe un utilizzo ottimale di risorse. ---------- The Author faces the issue of the allocation of the health resources adopting a solidarity ethical perspective. Particularly, it is underlined that Italian health care system involve an expense more and more in charge of the citizen, above all for subjects with chronic pathologies. In fact, a survey by WHO highlights that in Italy the sick affected by serious pathologies (disability, mental disease) receive less care than patients with slight/moderate diseases: therefore, the so called “Matthew effect”. In this perspective, the “clinical severity” criterion is overcome by the economical one, the perspective payment system of health care services is utilized in improper way and penalizes the health maintenance organization that dedicate great attention to chronic sick. On the other hand, the medicine has indubitable limits: resources, but above all, the probabilistic nature of outcomes and the finite nature of man. The article considers some tools used for the evaluation of effectiveness and the efficiency of health interventions (QALYs, EQALYs, UVG, UVH, ROSES), bringing out strengths and weaknesses. Finally, it is always necessary to refer to a solidarity criterion, adopting a rigorous logics of care and personalized care: this approach would allow a better use of resources.

scholarly journals From risk to care: the hepatitis C screening and diagnostic cascade in a primary health care clinic in Karachi, Pakistan—a cohort study

2018 ◽  
Vol 12 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Gul Ghuttai Khalid ◽  
Khine Wut Yee Kyaw ◽  
Christine Bousquet ◽  
Rosa Auat ◽  
Dmytro Donchuk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Primary Health Care ◽  
Hepatitis C ◽  
Early Stage ◽  
Informal Settlement ◽  
Cohort Analysis ◽  
Care Clinic ◽  
Primary Health Care Clinic ◽  
Primary Health

Abstract Background In the high-prevalence setting of Pakistan, screening, diagnosis and treatment services for chronic hepatitis C (CHC) patients are commonly offered in specialized facilities. We aimed to describe the cascade of care in a Médecins Sans Frontières primary health care clinic offering CHC care in an informal settlement in Karachi, Pakistan. Methods This was a retrospective cohort analysis using routinely collected data. Three different screening algorithms were assessed among patients with one or more CHC risk factors. Results Among the 87 348 patients attending the outpatient clinic, 5003 (6%) presented with one or more risk factors. Rapid diagnostic test (RDT) positivity was 38% overall. Approximately 60% of the CHC patients across all risk categories were in the early stage of the disease, with an aspartate aminotransferase:platelet ratio index score <1. The sequential delays in the cascade differed between the three groups, with the interval between screening and treatment initiation being the shortest in the cohort tested with GeneXpert onsite. Conclusions Delays between screening and treatment can be reduced by putting in place more patient-centric testing algorithms. New strategies, to better identify and treat the hidden at-risk populations, should be developed and implemented.

Reevaluating Funding Mechanisms for UK Primary Care Trusts: A New Model of Secondary Care Usage Incorporating Lifestyle Data

10.1068/c0427 ◽  
2005 ◽  
Vol 23 (3) ◽  
pp. 317-336 ◽  
Author(s):  
Mark Birkin ◽  
Graham Clarke ◽  
Phil Gibson ◽  
Roger Dewhurst ◽  
Jacqui Bobby
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Goodness Of Fit ◽  
Service Providers ◽  
Social Economic ◽  
Explanatory Variables ◽  
Care Services ◽  
Funding Mechanisms ◽  
The City ◽  
Use Of Health Care

This paper is concerned with modelling variations in the use of health-care services between small geographic areas. A range of potential explanatory variables are identified from a review of previous literature, ranging from social, economic, and demographic factors through access to services, and practitioner characteristics, to new measures of behaviour and lifestyle. Real admissions data for the city of Leeds relating to a variety of services over a three-year period are introduced to calibrate a series of utilisation models. It is argued that the strength of the goodness of fit makes these models potentially useful in the evaluation of resource allocation between service providers. By providing better global models of usage it is possible to examine small-area outliers to highlight areas where revealed demand, or usage, is not reflecting need as much as it should. In particular, this paper demonstrates the importance of lifestyle preferences in modelling the utilisation of health-care services.

scholarly journals Insights and decision support for home health care services in times of disasters

2021 ◽  
Author(s):  
Klaus-Dieter Rest ◽  
Patrick Hirsch
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Home Health Care ◽  
Health Care Services ◽  
Service Providers ◽  
Home Health ◽  
Assessment Tools ◽  
Real World Data ◽  
Cascading Effects ◽  
Care Services

AbstractHome health care (HHC) services are of vital importance for the health care system of many countries. Further increases in their demand must be expected and with it grows the need to sustain these services in times of disasters. Existing risk assessment tools and guides support HHC service providers to secure their services. However, they do not provide insights on interdependencies of complex systems like HHC. Causal-Loop-Diagrams (CLDs) are generated to visualize the impacts of epidemics, blackouts, heatwaves, and floods on the HHC system. CLDs help to understand the system design as well as cascading effects. Additionally, they simplify the process of identifying points of action in order to mitigate the impacts of disasters. In a case study, the course of the COVID-19 pandemic and its effects on HHC in Austria in spring 2020 are shown. A decision support system (DSS) to support the daily scheduling of HHC nurses is presented and applied to numerically analyze the impacts of the COVID-19 pandemic, using real-world data from a HHC service provider in Vienna. The DSS is based on a Tabu Search metaheuristic that specifically aims to deal with the peculiarities of urban regions. Various transport modes are considered, including time-dependent public transport.

Hepatitis C and Racial Disparity in Liver Transplant Waitlist Additions

2020 ◽  
Vol 86 (8) ◽  
pp. 985-990
Author(s):  
Chloe Q. Wang ◽  
Jacentha Buggs ◽  
Ebonie Rogers ◽  
Ashley Boyd ◽  
Ambuj Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Hepatitis C ◽  
Health Care Disparities ◽  
Organ Procurement ◽  
Ethnic Disparities ◽  
Racial Groups ◽  
Hcv Treatment ◽  
Treatment Disparities ◽  
Rate Of Decline ◽  
Direct Acting

Background In 2014, direct-acting antivirals (DAAs) became available for hepatitis C virus (HCV) with successful results. Since their implementation, the rate of HCV waitlist (WL) for liver transplantation (LT) has decreased, but significant ethnic disparities exist. We hypothesized that the rate of decline for HCV WL for LT is different across the various racial groups. Methods We conducted a retrospective cohort study using Organ Procurement and Transplantation Network data reports of adult LT candidates from 2014 to 2018. Results Overall, there was a decline in HCV WL rates for all ethnic groups (Caucasians, African Americans [AA], and Hispanics). However, the WL rates were significantly higher in AA compared with Caucasians each year, and this trend was continuous across the 5-year period. There were no differences in WL rates between Caucasians and Hispanics. Discussion The results show that health care disparities related to HCV disproportionately affect AA. The factors associated with this disparity need to be explored further to develop mechanisms to address these differences. By understanding the HCV treatment disparities across racial groups, modifications to HCV treatment nationwide can be adopted. Additional emphasis should be placed on AA to help reduce their WL rate, as well as redistributing resources to promote health care equity.

scholarly journals How to get away with COVID-19: endoscopy during post-peak pandemic. A perspective review

2020 ◽  
Vol 13 ◽  
pp. 175628482096507
Author(s):  
Giuseppe Vanella ◽  
Gabriele Capurso ◽  
Ivo Boškoski ◽  
Eleonora Bossi ◽  
Carlo Signorelli ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Service Providers ◽  
Protective Equipment ◽  
Care Services ◽  
Routine Work ◽  
Potential Risks ◽  
Free Environment ◽  
Second Wave ◽  
Work And Health

The SARS-CoV-2 pandemic has changed the way we work, and health care services have to adapt. The use of personal protective equipment (PPE) and the delay of non-urgent procedures were the immediate measures adopted by Gastrointestinal (GI) Endoscopy Units at the time of crisis. As the peak has now passed in most countries, GI facilities are facing the next challenge of this pandemic: service providers must adapt their routine work to a ‘new normal’. Routine casework must resume, and waiting lists must be addressed: all in the awareness of the ongoing potential risks of COVID-19, and the threat of a second wave. In this review, we discuss strategies to manage the workload by improving procedure appropriateness and prioritization, whilst maintaining a ‘COVID-free’ environment. This includes monitoring of an adequate stock of PPE and the implications for the staff’s workload, and the GI trainees’ need of training.

Sign in / Sign up

Export Citation Format

Share Document