Constructing Normalcy in Dementia Care: Carers’ Perceptions of Their Roles and the Supports They Need

2019 ◽  
Vol 60 (5) ◽  
pp. 905-915 ◽  
Author(s):  
Leigh Hale ◽  
Elizabeth Mayland ◽  
Matthew Jenkins ◽  
Yvette Buttery ◽  
Pauline Norris ◽  
...  
Keyword(s):  
Health Care ◽  
Social Services ◽  
Care Delivery ◽  
Theory Development ◽  
Social Contact ◽  
People With Dementia ◽  
Semistructured Interviews ◽  
The Cost ◽  
Design And Methods

Abstract Background and Objectives: People with dementia are critically dependent on their carers when accessing and utilizing health care. To inform health care development and delivery, we aimed to explore carers’ perceptions of their role in caring for a family member with dementia and to identify carers’ skills and attributes and factors impacting on care. Research Design and Methods: We used semistructured interviews to collect data from 25 carers supporting older adults with dementia. Data were thematically analyzed and the paradigm model was used to guide theory development. Results: “Constructing normalcy” was central to all carers did, impacted by stage of life and relationship status and driven by a holistic focus on their care-recipient’s quality of life. Goals guiding care were: keeping the peace; facilitating participation, happiness and independence; and ensuring safety. Enablers included: social contact; knowledge; and quality social services. Barriers included health and legal issues; symptoms of dementia; and reduced knowledge. These goals kept the peace and reduced stress for the cared-for person, but often at the cost of unrelenting responsibility and loss of carers’ original roles. Discussion and Implications: As carers are so critical to the access and uptake of health care of those with dementia, health professionals and services need to support carers in their quest to construct normalcy. Our findings provide guidance to assist in ensuring appropriate support and understanding of carers work in order to optimize dementia health care delivery.

Changes in Cuban Health Care: An Argument against Technological Pessimism

1977 ◽  
Vol 7 (3) ◽  
pp. 383-400 ◽  
Author(s):  
Sally Guttmacher ◽  
Ross Danielson
Keyword(s):  
Health Care ◽  
Social Services ◽  
Health Care System ◽  
Health Workers ◽  
Care Delivery ◽  
Social Changes ◽  
The Past ◽  
Political Economic ◽  
Care System

Since the popular revolution in 1959, alterations in the organization and delivery of health care in Cuba have paralleled the country's broader political, economic, and social changes. This paper discusses the evolution of the Cuban health care system during the past seventeen years within the wider context of societal development. The authors compare three “snapshots” of Cuba, the first in 1959, the second in 1970, and the last in 1976, and touch upon such issues as the organization of health care delivery, the recruitment and socialization of health workers, and aspects of the process of receiving health care. They point out that the Cuban experience should be of particular interest to the developing world. For though it is true that a larger portion of Cuban national resources has been directed to the health and social services than in other developing countries, nonetheless, it was largely through the reorganization and equalization of the prerevolutionary health care system that improvement in the health status of the population was achieved. It appears that Cuba could well serve as an example for those who are skeptical about the possibility of combining technical development with improvement in the humane quality of care.

A conceptual model for a geriatric syllabus for podiatric medicine

2000 ◽  
Vol 90 (5) ◽  
pp. 258-267 ◽  
Author(s):  
AE Helfand
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Chronic Disease ◽  
Care Delivery ◽  
Foot Care ◽  
Older Patient ◽  
Care Services ◽  
Cost Of Health Care ◽  
The Cost

Foot disorders and the complications of chronic disease in the older population have a significant effect on society, the cost of health care, and individuals' quality of life. Given podiatric medicine's role in the management of problems of the aging, it is critical that the profession's educational system produce practitioners who understand the process of aging and the needs of the older patient and who are prepared to serve on the health-care-delivery team as the primary providers of foot-care services. The geriatric syllabus presented here is one approach to attaining that goal.

Patient Response Toward a Change in the System of Health Care Delivery

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 289-293
Author(s):  
Kathleen J. Motil ◽  
W. John Siar
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Poor Quality ◽  
Emergency Rooms ◽  
Patient Response ◽  
Number Of Patients ◽  
Comprehensive Health ◽  
Crisis Care

With the emphasis being placed on comprehensive health care, outpatient clinics in major city hospitals have found it necessary to reevaluate their methods of health care delivery. An increasing number of patients who fail to schedule or keep medical appointments appear for crisis care, resulting in a higher cost of hospital operation due to unnecessary utilization of emergency rooms and the wasting of time of clerical and professional personnel, as well as poor quality of health care due to See the Table in PDF File sporadic clinic attendance. When comparing behavior patterns and attitudes of clinic patients under different methods of health care delivery, patient preferences become apparent.

Avarice, Inefficiency, and Inequality: An International Health Care Tale

1977 ◽  
Vol 7 (2) ◽  
pp. 179-190
Author(s):  
Alan Maynard
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Care Delivery ◽  
Medical Profession ◽  
International Health ◽  
West Germany ◽  
Health Care Outcomes ◽  
Care Outcomes ◽  
Health Care Delivery Systems ◽  
The Cost

The paper is concerned with impact of a medical profession, physicians, on the delivery of health care. The basic economic motivation of self-interest and avarice has led this profession to produce health care outcomes which are inequitable and inefficient. In the first section of the paper the regional geographical distribution of physicians in four disparate health systems—England, Ireland, France, and West Germany-is analyzed and found to be highly unequal. The next section is concerned with the efficacy of therapies and the cost-effectiveness of health care delivery systems in a variety of countries. The final section discusses how health care can be more equitably and more efficiently delivered. It is argued that both markets and bureaucracies are likely to be inadequate unless carefully monitored. In particular, there is a great need to investigate the cost-effectiveness of therapies and then persuade physicians, via pecuniary and nonpecuniary incentives, to behave in a manner which leads to more equitable and efficient health care outcomes.

PP048 Quality Of Health Care Through Integration: Experience Of Cochlear Implantation

2017 ◽  
Vol 33 (S1) ◽  
pp. 93-94
Author(s):  
Lyazzat Kosherbayeva ◽  
Aigul Medeulova ◽  
Abdulla Alzhanov
Keyword(s):  
Health Care ◽  
Healthcare System ◽  
Cochlear Implantation ◽  
Cost Utility ◽  
Economic Research ◽  
Rehabilitation Programs ◽  
Life Years ◽  
The Republic ◽  
The Cost

INTRODUCTION:The State Program for Health Development of the Republic of Kazakhstan (RK) “Densaulyk” for 2016–2019 initiated the modernization of primary health care with the introduction of family practice in order to ensure the availability, completeness and quality of health services on the basis of an integrated healthcare system focused on the needs of the population. The aim of this study was to determine the effectiveness of the cochlear implantation (CI) programs.METHODS:A literature search was conducted for all clinical trials, randomized controlled trials, and reviews in the PubMed, Cochrane, and Center for Reviews and Dissemination databases. Two reviewers independently evaluated all publications for selection. The analysis included the cost-effectiveness and benefit from the CI program.RESULTS:We analyzed the effectiveness of the services for CI in the RK and other countries (1). In our analysis, we identified that there is no research on Quality-adjusted Life Years (QALYs) and Cost-Utility Analysis (CUA) in RK. We found that, in general, the cost of CI and pre-surgical procedures are comparable with other countries. The length of stay in Kazakhstan was much higher (an average of 8 days) compared with other countries (3 days). Also in RK, there were significantly lower prices per hospital day and cost of various consultations. Postoperative costs of other countries consisted of one-third to two-thirds of the total costs for preoperative and implantation stages (2, 3). There was a little information on the effectiveness of rehabilitation programs in RK.CONCLUSIONS:Economic research like QALYs and CUA are new directions in the healthcare system in the RK. Lack of integration between primary care, rehabilitation and other services leads to difficulties in assessing the effectiveness of CI programs (for example, in our case, there was the restriction of assessment in only postoperative costs).

scholarly journals The impact of the use of health information and communication technology on health care delivery in Manitoba, Canada

2014 ◽  
Vol 3 (6) ◽  
pp. 8 ◽  
Author(s):  
Israel R Kabashiki ◽  
Ngozi I Moneke
Keyword(s):  
Health Care ◽  
Health Information ◽  
Information And Communication Technology ◽  
Health Care Delivery ◽  
Communication Technology ◽  
Quality Of Health Care ◽  
Care Delivery ◽  
Wait Times ◽  
Information And Communication

Background: Health Information and Communication Technology (HICT) has the potential to reduce patient wait time and improves patient satisfaction. The Long wait times for patients to receive medical services are a big issue in Canada. The Canadian government has invested in Information and Communication Technology (ICT) to shorten patient referral wait times for medical services. Little was known about the association between ICT investments and the quality of health care delivery, and particularly between the use of ICT and referral wait times in the Manitoba Health System (MHS). Methods: The purpose of this quantitative correlational study was to determine if a relationship existed between the use of HICT and the quality of health care delivery in the MHS. The quality of health care delivery was measured in terms of referral wait time, health information sharing effectiveness, physicians’ satisfaction, and patients’ satisfaction. Conclusion: Findings indicated the absence of a significant association between HICT use and referral wait times. Significant correlations were found to exist between (1) HICT use and health information sharing effectiveness, (2) HICT use and physician’s satisfaction, and (3) HICT use and patient’s satisfaction. Four recommendations emerged from this study: First, patient satisfaction should be used as an indicator of the quality of health care delivery. Second, health knowledge repository and expert systems should be integrated into health ICT systems to minimize unnecessary referrals. Third, a mixed health system should be implemented to shorten wait times. Fourth, the portability of the Canadian Medicare should be enhanced to allow Manitobans in particular and Canadians in general to seek medical services abroad. This study was intended to contribute to the existing body of knowledge associated with ICT investments’ outcomes and health care delivery in the MHS.  

scholarly journals Female insertion in neurosurgery: Evolution of a stigma break

2021 ◽  
Vol 12 ◽  
pp. 76
Author(s):  
Luiz Severo Bem Junior ◽  
Nilson Batista Lemos ◽  
Júlia de Araújo Vianna ◽  
Juliana Garcia Silva ◽  
Luana Moury Fernandes Sanchez ◽  
...  
Keyword(s):  
Health Care ◽  
Gender Differences ◽  
Literature Review ◽  
Gender Inequality ◽  
Care Delivery ◽  
Electronic Library ◽  
Participation Of Women ◽  
The World ◽  
The Usa

Background: Utilizing the Brazilian Medical Demography analysis and a literature review, we evaluated how women choose to become neurosurgeons in Brazil and around the world, specifically citing the Europe, the USA, India, and Japan. Methods: We utilized the Brazilian Medical Demography prepared by the Federal Council of Medicine and the Regional Council of Medicine of the State of São Paulo (2011, 2013, 2015, and 2018). We also included an evaluation of 20 articles from PubMed, the Scientific Electronic Library Online, and National Health Library databases (e.g., using descriptors “Women in neurosurgery” and “Career”). Results: In Brazil in 2017, women comprised 45.6% of active doctors, but only 8.6% of all neurosurgeons. Of 20 articles identified in the literature, 50% analyzed the factors that influenced how women choose neurosurgery, 40% dealt with gender differences, while just 10% included an analysis of what it is like to be a female neurosurgeon in different countries/continents. Conclusion: The participation of women in neurosurgery has increased in recent years despite the persistence of gender inequality and prejudice. More women need to be enabled to become neurosurgeons as their capabilities, manual dexterity, and judgment should be valued to improve the quality of neurosurgical health-care delivery.

scholarly journals Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

2020 ◽  
Author(s):  
Bénédicte Razafinjato ◽  
Luc Rakotonirina ◽  
Jafeta Benony Andriantahina ◽  
Laura F. Cordier ◽  
Randrianambinina Andriamihaja ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Community Health ◽  
Access To Health Care ◽  
Care Delivery ◽  
Local Level ◽  
Scale Up ◽  
P Value ◽  
The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

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