scholarly journals How primary care and public health interact in local health contracts in France?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M s Kendir ◽  
Mr Le Bodo ◽  
M r Breton ◽  
M r Bourgueil
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Access To Care ◽  
Health Care Services ◽  
Local Level ◽  
Rapid Decline ◽  
Local Health ◽  
Epidemiological Changes ◽  
The Impact ◽  
Primary Care Professionals

Abstract The demographic and epidemiological changes orient health care services towards communities with a focus on prevention and health promotion. Moreover, in France, the rapid decline of General Practitioners affect access to care in certain areas. Thus, it has made a call for interaction of primary care (PC) services and public health which can be strengthened by the actions at the local level. In 2009, the local health contracts (Contract local de santé; CLS) were developed to foster collaborative actions on the social determinants of health and to improve access to care. Considering the critical contribution of PC in these issues, one may ask how CLS mobilized PC and facilitate linkages between actions oriented toward population and primary care. The objective of this ancillary study (part of the CloterreS project), is to explore how often and how CLS involve PC in access to care and public health related actions. A mixed-method study based on document analysis, with a random sample of 17 CLSs (N = 165) from all French regions, was developed. A quantitative analysis of the 440 forms identified in 17 CLS computed frequency of involvement of PC actors and/or PC organizations and a qualitative analysis defined typology of interactions. All CLS and 20.1% (n = 86) of the forms involved PC actors and 43.2% (n = 185) concerned access to care. Of the access to care forms, 35.7% (n = 66) concerned PC. The most common strategies related to actions on the health workforce and on planning of services. The role of primary care professionals was as the target of the action and rarely as leader and partner. PC, mostly GP’s involvement, had a big place and access to care was at the core of local health contracts. The impact of CLS as an instrument to invite interaction public health and healthcare at the local level should be further assessed. Key messages Many of the local access to care actions involved primary care professionals. The local level appears strategic to integrate public health and health services yet more evidence is needed on its role.

scholarly journals Influenza H1N1 2009 in Canterbury: a case study in pandemic response co-ordination

2010 ◽  
Vol 2 (4) ◽  
pp. 323 ◽  
Author(s):  
Daniel Williams ◽  
Annabel Begg ◽  
Kim Burgess ◽  
Michele Hider ◽  
Lance Jennings ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Influenza A ◽  
Health Care Services ◽  
Call Centre ◽  
Care Services ◽  
Influenza A H1n1 ◽  
Civil Defence ◽  
The Impact

BACKGROUND AND CONTEXT: Reviews of overseas pandemic responses have suggested that stronger links between primary care and other parts of the health sector are required. The influenza A (H1N1) 2009 (‘H1N1 09’) pandemic was the first real test of New Zealand’s pandemic preparedness. ASSESSMENT OF PROBLEM: In the six months from May to October 2009, there were 595 confirmed cases of H1N1 09 in Canterbury, with 187 hospitalisations and three deaths. This paper describes the way a range of Canterbury agencies worked together in a co-ordinated health-led response aimed at minimising the impact of H1N1 09 in the community and maintaining effective health care services for both influenza and non-influenza patients. STRATEGIES FOR IMPROVEMENT: Key strategies included sector-wide response co-ordination, intelligence and communications, a combined public health/primary care response during the ‘containment’ phase, and universal red/green streaming supported by dedicated ’flu centres and an 0800 call centre during the ‘manage it’ phase. LESSONS: Despite the considerable impact of the H1N1 09 virus in Canterbury, health care services were not overwhelmed. The key lesson learned from the Canterbury H1N1 09 response has been the importance of preparing and working together across the sector. KEYWORDS: Influenza, human; pandemic; primary health care; public health; mass media; civil defence

scholarly journals Collaboration of primary care and public health at the local level: observational descriptive study of French local health contracts

2020 ◽  
Vol 21 ◽  
Author(s):  
Candan Kendir ◽  
Eric Breton ◽  
Yann Le Bodo ◽  
Yann Bourgueil
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Local Level ◽  
Primary Care Providers ◽  
Local Health ◽  
Action Plans ◽  
Care Providers ◽  
Level Of Involvement ◽  
Main Driver ◽  
French Region

Abstract Aim: In this paper, we report on a study investigating the involvement of primary care providers in French local health contracts. Background: Worldwide actions are carried out to improve collaboration between primary care and public health to strengthen primary healthcare and consequently community health. In France, the local health contract is an instrument mobilising local stakeholders from different sectors to join in their actions to improve the health of the population. Methods: We developed an instrument to analyse the frequency and nature of involvement of primary care providers in 428 action plans extracted from a sample of 17 contracts (one per French region). The number of primary care actions were counted, and thematic analyses were conducted to identify the nature and level of involvement of the professionals. Findings: Primary care providers were involved in 20.1% (n = 86) of the action plans and were mostly described as a target of the action rather than leaders or partners. Within those action plans, 76.7% (n = 66) of these action plans aimed to improve access to care for local communities; an issue that appears as the main driver of collaboration between public health and primary care actors.

scholarly journals The Association of Residence Permits on Utilization of Health Care Services by Migrant Workers in China

2021 ◽  
Vol 18 (18) ◽  
pp. 9623
Author(s):  
Haochuan Xu ◽  
Han Yang ◽  
Hui Wang ◽  
Xuefeng Li
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Access ◽  
Migrant Workers ◽  
Health Care Services ◽  
Public Health Care ◽  
Chinese Government ◽  
Care Access ◽  
Care Services ◽  
The Impact

Due to the limitations in the verifiability of individual identity, migrant workers have encountered some obstacles in access to public health care services. Residence permits issued by the Chinese government are a solution to address the health care access inequality faced by migrant workers. In principle, migrant workers with residence permits have similar rights as urban locals. However, the validity of residence permits is still controversial. This study aimed to examine the impact of residence permits on public health care services. Data were taken from the China Migrants Dynamic Survey (CMDS). Our results showed that the utilization of health care services of migrant workers with residence permits was significantly better than others. However, although statistically significant, the substantive significance is modest. In addition, megacities had significant negative moderating effects between residence permits and health care services utilization. Our research results emphasized that reforms of the household registration system, taking the residence permit system as a breakthrough, cannot wholly address the health care access inequality in China. For developing countries with uneven regional development, the health care access inequality faced by migrant workers is a structural issue.

scholarly journals The prevalence of scabies in Monrovia, Liberia: a population-based survey

2020 ◽  
Author(s):  
Shelui Collinson ◽  
Joseph Timothy ◽  
Samuel K Zayay ◽  
Karsor K Kollie ◽  
Eglantine Lebas ◽  
...  
Keyword(s):  
Public Health ◽  
Quality Of Life ◽  
Health Problem ◽  
Public Health Problem ◽  
Sub Saharan Africa ◽  
Quality Data ◽  
Local Health ◽  
Sub Saharan ◽  
The Impact

AbstractBackgroundScabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-Urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking.MethodsWe conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate dermatology life quality indices (DLQIs). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression.Results1,318 participants from 477 households were surveyed. The prevalence of scabies prevalence was 9.3% (95% CI: 6.5-13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4-1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies.ConclusionsOur study indicates a substantial burden of scabies in this peri-Urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life.Plain English summaryScabies is an infestation with a microscopic mite which affects many people living in low-resource tropical countries. It causes intense itching, which can lead to complications through bacterial infection and poor quality of life. To help develop global scabies control programmes, we need a better understanding of how common it is across different tropical settings. We conducted a survey to assess the burden of scabies and bacterial skin infection in a random sample of people living in a community in Monrovia, Liberia. Information about participants and their household were collected and their skin was examined; those with skin conditions were asked about its impact on quality of life.We examined 1,318 participants and found that almost 10% of people had scanies. Scabies was more common in young children, and was more common in male children than female children. We found that there was a large impact on quality of life due mostly to the itching that scabies causes and to people feeling embarrassed or sad because of their skin condition. This scabies survey is one of the first conducted across all age groups in recent years in sub-Saharan Africa and indicates a substantial burden and impact on quality of life. More work is needed to understand how common scabies is in different settings and the impact that different treatment strategies may have.

scholarly journals Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248339
Author(s):  
Megan A. Lewis ◽  
Laura K. Wagner ◽  
Lisa G. Rosas ◽  
Nan Lv ◽  
Elizabeth M. Venditti ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Collaborative Care ◽  
Health Impact ◽  
Public Health Impact ◽  
Integrative Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Care Intervention ◽  
The Impact

Background An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential. Methods The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance. Conclusions RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.

scholarly journals Mangroves, garbage, fishing: Bringing everyday ecology to Sydney’s industrial Georges River

2010 ◽  
Vol 5 (1) ◽  
Author(s):  
Heather Goodall ◽  
Allison Cadzow ◽  
Denis Byrne
Keyword(s):  
Public Health ◽  
Waste Disposal ◽  
Environmental Science ◽  
Local Level ◽  
The United States ◽  
City Development ◽  
Local Data ◽  
Local Public Health ◽  
Post War ◽  
The Impact

Post war problems of rising urban, industrial pollution and intractable waste disposal are usually considered as technical and economic problems only, solutions to which were led by experts at State level, and filtered into Australia from the ferments occurring in the United States and Britain in the 1960s and 70s. This paper investigates the change which arose from the localities in which the impact of those effects of modern city development were occurring. In particular, this study looks at a working class, industrial area, the Georges River near Bankstown Municipality, which was severely affected by Sydney’s post-war expansion. Here, action to address urgent environmental problems was initiated first at the local level, and only later were professional engineers and public health officials involved in seeking remedies. It was even later that these local experts turned from engineering strategies to environmental science, embracing the newly developed ecological analyses to craft changing approaches to local problems. This paper centres on the perspective of one local public health surveyor, employed by a local municipal council to oversee waste disposal, to identify the motives for his decisions to intervene dramatically in river health and waste disposal programs. Rather than being prompted to act by influences from higher political levels or overseas, this officer drew his motivation from careful local data collection, from local political agitation and from his own recreational knowledge of the river. It was his involvement with the living environments of the area – the ways in which he knew the river - through personal and recreational experiences, which prompted him to seek out the new science and investigate emerging waste disposal technologies.

Evaluating models of working at the interface between mental health services and primary care

1997 ◽  
Vol 170 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Linda Gask ◽  
Bonnie Sibbald ◽  
Francis Creed
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Care Services ◽  
Service Providers ◽  
Psychiatric Nurses ◽  
Local Health ◽  
Care Services ◽  
Secondary Health Care

BackgroundThis paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.MethodMethodological problems relevant to evaluation of innovative models of working at the interface are discussed.ResultsAlthough there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the ‘shifted out-patient’ model have eased this problem. By contrast the ‘consultation-liaison’ (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.ConclusionStudies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

scholarly journals Rapid urban health security assessment tool: a new resource for evaluating local-level public health preparedness

2020 ◽  
Vol 5 (6) ◽  
pp. e002606 ◽  
Author(s):  
Matthew R Boyce ◽  
Rebecca Katz
Keyword(s):  
Public Health ◽  
Urban Health ◽  
Assessment Tool ◽  
Local Level ◽  
Local Health ◽  
Security Assessment ◽  
Direct Function ◽  
Health Security ◽  
Public Health Emergencies ◽  
Sustainable Capacity

Urbanisation will be one of the defining demographic trends of the 21st century—creating unique opportunities for sustainable capacity development, as well as substantial risks and challenges for managing public health and health emergencies. Plans and policies for responding to public health emergencies are generally framed at higher levels of governance, but developing, improving and sustaining the capacities necessary for implementing these policies is a direct function of local-level authorities. Evaluating local-level public health capacities is an important process for identifying strengths and weaknesses that can impact the preparedness for, detection of and response to health security threats. However, while various evaluations and assessments exist for evaluating capacities at other levels, currently, there are no readily available health security assessments for the local-level. In this paper, we describe a tool—the Rapid Urban Health Security Assessment (RUHSA) Tool—that is based on a variety of other relevant assessments and guidance documents. Assessing capacities allow for local-level authorities to identify the strengths and weaknesses of their local health security systems, create multiyear action plans and prioritise opportunities for improving capacities, effectively engage with development partners to target resources effectively and develop compelling narratives and a legacy of leadership. While the RUHSA Tool was not designed to be used in the midst of a public health emergency, such as the ongoing COVID-19 pandemic, it may also be adapted to inform a checklist for prioritising what capacities and activities a city needs to rapidly develop or to help focus requests for assistance.

scholarly journals How to engage French professionals to undertake social responsibility at a local level?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Gautier ◽  
Y Bourgueil
Keyword(s):  
Primary Care ◽  
Access To Care ◽  
Health Professionals ◽  
Local Level ◽  
Radical Change ◽  
Team Work ◽  
Professional Commitment ◽  
Fee For Service ◽  
Structured Interviews ◽  
Integration Of Care

Abstract Background In France, primary care is organised according to the principles of private practice: independent providers, payment by fee for service, freedom of settlement... Successive reforms have introduced more regulation i.e. gatekeeping role for GPs, better recognition of professional groups, new forms of payment and promotion of team work and multi-professional practices. Today, the concept of Health Territorial and Professional Communities (HTPC) is becoming a key element of health care reform encouraging primary care professionals to meet with specialists and social workers at a larger level than practice. HTPC should address issues such as access to services, coordination of care and promoting of preventive actions toward populations. This implies change in the roles, skills, methods and resources needed on both professional and regulatory sides. This study explores levers of the professional commitment in the HTPC and resources necessary for it. Methods We conducted a qualitative multiple case study in three French regions. Data was collected from thirty semi-structured interviews with key national informants, regional regulators and health professionals themselves. Results Professional commitment emerges at a local level on a territory defined by the collaboration practices and habits following a bottom-up process. The integration of care relies on the size of the HTPC which allows them to know each other and to work together to improve access to care and patient’s disease management. In order to achieve that, professionals claim to have access to administrative health data and to be able to analyze it. They need to develop news skills in management and group animation. The function and training of coordination professionals appear to be essential. Conclusions The professional commitment in HTPC relies on professional empowerment toward collective activities. This requires autonomy, skills and new roles both for professionals and regulatory authorities. Key messages French government relies on professionals’ investment at the territorial level by implementing HTPC to guarantee access to care and respond to population needs in primary care. HTPC implementation implies radical change for the professionals to undertake social and populational responsibility for which public health professionals should help to meet the challenge.

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