scholarly journals Understanding competing discourses as a basis for promoting equity in primary health care

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amélie Blanchet Garneau ◽  
Annette J. Browne ◽  
Colleen Varcoe
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Equity ◽  
Point Of Care ◽  
Health Inequities ◽  
Care Staff ◽  
Healthcare Organizations ◽  
Primary Health ◽  
Structural Inequities ◽  
Multiple Discourses

Abstract Background Globally, health inequities persist with effects on whole populations and the most profound effects on populations marginalized by poverty, discrimination and other forms of disadvantage. In the current neoliberal political-economic context, health inequities are produced and sustained by the inequitable distribution of social determinants of health and structural inequities such as discrimination and institutional racism. Even in the context of healthcare organizations with an explicit commitment to health equity, multiple intersecting discourses, such as ongoing efficiency discourses, and culturalist and racialized discourses, are in constant interaction with healthcare practices at the point of care and the organizational level, limiting providers’ and organizations’ capacities to address structural inequities. Attention to discourses that sustain inequities in health care is required to mitigate health inequities and related power differentials. In this paper, we present findings from a critical analysis of the relations among multiple discourses and healthcare practices within four Canadian primary health care clinics that have an explicit commitment to health equity. Methods Informed by critical theoretical perspectives and critical discourse analysis principles, we conducted an analysis of 31 in-depth interviews with clinic staff members. The analysis focused on the relations among discourses and healthcare practices, the ways in which competing discourses influence, reinforce, and challenge current practices, and how understanding these dynamics can be enlisted to promote health equity. Results We articulate the findings through three interrelated themes: equity-mandated organizations are positioned as the “other” in the health care system; discourses align with structures and policies to position equity at the margins of health care; staff and organizations navigate competing discourses through hybrid approaches to care. Conclusions This study points to the ways in which multiple discourses interact with healthcare organizations’ and providers’ practices and highlights the importance of structural changes at the systemic level to foster health equity at the point of care.

scholarly journals Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

2014 ◽  
Vol 32 (4) ◽  
pp. 241-247 ◽  
Author(s):  
Staffan Nilsson ◽  
Agneta Andersson ◽  
Magnus Janzon ◽  
Jan-Erik Karlsson ◽  
Lars-Åke Levin
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Setting ◽  
Troponin T ◽  
Point Of Care ◽  
Health Care Setting ◽  
Primary Health Care Setting ◽  
Primary Health

Primary Health Care Models Addressing Health Equity for Immigrants: A Systematic Scoping Review

2016 ◽  
Vol 20 (1) ◽  
pp. 214-230 ◽  
Author(s):  
Ricardo Batista ◽  
Kevin Pottie ◽  
Louise Bouchard ◽  
Edward Ng ◽  
Peter Tanuseputro ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Equity ◽  
Scoping Review ◽  
Primary Health ◽  
Health Care Models ◽  
Care Models

scholarly journals Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

2019 ◽  
Vol 11 (13) ◽  
pp. 158
Author(s):  
Nkosinothando Chamane ◽  
Tivani Phosa Mashamba-Thompson
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Experiential Learning ◽  
Service Delivery ◽  
Point Of Care ◽  
Service Improvement ◽  
Quality Service ◽  
Resource Limited Settings ◽  
Primary Health ◽  
Resource Limited

BACKGROUND: Despite impressive progress that has been made in the provision of health care services to all, the issue of quality service delivery still remains a challenge particularly for point-of-care (POC) diagnostics in resource-limited-settings. Poor competency of primary health care workers in these settings has been shown to be amongst the main contributors to poor quality service delivery. FINDINGS: Participatory-based continuous professional development (CPD) strategies to support technology advancements in health care are recommended. Experiential learning approaches have been shown to be efficient in supplementing traditional teaching methods for both health care students and professionals. These approaches have been shown to further contribute towards continuous skills development and lifelong learning. CONCLUSION: This review therefore provided an overview of literature on experiential learning as one of CPD approaches in relation to health care service improvement in resource-limited setting. In addition, this review has recommended a mobile-based experiential learning approach to help deliver a quality POC technology curriculum to Primary health care-based workers in resource-limited settings.

scholarly journals The Future of Health Care: Protocol for Measuring the Potential of Task Automation Grounded in the National Health Service Primary Care System (Preprint)

2018 ◽  
Author(s):  
Matthew Willis ◽  
Paul Duckworth ◽  
Angela Coulter ◽  
Eric T Meyer ◽  
Michael Osborne
Keyword(s):  
Machine Learning ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Care Staff ◽  
Primary Health ◽  
The Future

BACKGROUND Recent advances in technology have reopened an old debate on which sectors will be most affected by automation. This debate is ill served by the current lack of detailed data on the exact capabilities of new machines and how they are influencing work. Although recent debates about the future of jobs have focused on whether they are at risk of automation, our research focuses on a more fine-grained and transparent method to model task automation and specifically focus on the domain of primary health care. OBJECTIVE This protocol describes a new wave of intelligent automation, focusing on the specific pressures faced by primary care within the National Health Service (NHS) in England. These pressures include staff shortages, increased service demand, and reduced budgets. A critical part of the problem we propose to address is a formal framework for measuring automation, which is lacking in the literature. The health care domain offers a further challenge in measuring automation because of a general lack of detailed, health care–specific occupation and task observational data to provide good insights on this misunderstood topic. METHODS This project utilizes a multimethod research design comprising two phases: a qualitative observational phase and a quantitative data analysis phase; each phase addresses one of the two project aims. Our first aim is to address the lack of task data by collecting high-quality, detailed task-specific data from UK primary health care practices. This phase employs ethnography, observation, interviews, document collection, and focus groups. The second aim is to propose a formal machine learning approach for probabilistic inference of task- and occupation-level automation to gain valuable insights. Sensitivity analysis is then used to present the occupational attributes that increase/decrease automatability most, which is vital for establishing effective training and staffing policy. RESULTS Our detailed fieldwork includes observing and documenting 16 unique occupations and performing over 130 tasks across six primary care centers. Preliminary results on the current state of automation and the potential for further automation in primary care are discussed. Our initial findings are that tasks are often shared amongst staff and can include convoluted workflows that often vary between practices. The single most used technology in primary health care is the desktop computer. In addition, we have conducted a large-scale survey of over 156 machine learning and robotics experts to assess what tasks are susceptible to automation, given the state-of-the-art technology available today. Further results and detailed analysis will be published toward the end of the project in early 2019. CONCLUSIONS We believe our analysis will identify many tasks currently performed manually within primary care that can be automated using currently available technology. Given the proper implementation of such automating technologies, we expect considerable staff resources to be saved, alleviating some pressures on the NHS primary care staff. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11232

scholarly journals P0619POINT OF CARE CREATININE FOR EARLY DIAGNOSIS OF COMMUNITY ACQUIRED ACUTE KIDNEY INJURY IN NIGERIA. TECHNOLOGY EVALUATION AND DESIGN OF QUALITY IMPROVEMENT PROJECT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Dimitrios Poulikakos ◽  
Ibi Erekosima ◽  
Pedro Emem-Chioma ◽  
Prelador Fakrogha ◽  
R I Oko-Jaja ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Primary Health Care ◽  
Early Diagnosis ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Kidney Injury ◽  
Improvement Project ◽  
Primary Health ◽  
Port Harcourt

Abstract Background and Aims Acute Kidney Injury (AKI) in low- and middle-income countries is mostly a community-acquired potentially reversible syndrome and has high morbidity and mortality. Due to limited laboratory infrastructure diagnosis of AKI is often delayed until life threatening complications have developed and dialysis treatment is largely unavailable. Decisions for hospital referral from primary health care centers and triage decisions for hospital admission are not based on laboratory results in Port Harcourt Nigeria. To address the need for early diagnosis and treatment of AKI we established a collaboration between the Renal Unit of the University of Port Harcourt Teaching Hospital, Primary Health Care Board Rivers State and the Renal Department of Salford Royal NHS Foundation Trust, aiming at the evaluation of the use of point of care (POC) Creatinine (Cr) for early detection and management of community acquired AKI. Method The first stage of the project evaluated the accuracy of POC Cr technology. Following informed consent patients underwent concurrent measurement of Cr using the central laboratory (Lab) assay (Jaffe) from a venous sample and a point of care Cr measurement using a capillary sample (fingerstick) with the NOVA Stasensor Xpress Cr analyser. Pearson Correlation and Bland-Altman plots were used to assess correlation and agreement between the two methods. During the second stage, the results were discussed at a focused AKI workshop and guidance for the use of POC Cr was developed. Results During the first phase 96 concurrent POC Cr capillary and venous Lab Cr samples were analysed. Mean age was 49±14 years and 66 subjects were females. POC Cr values were 127±122 umol/l and Lab Cr values were 100 ±85 umol/L, mean positive bias of 27.2±47.94 umol/L. Overall, correlation between POC Cr and Lab Cr was very good, with Pearson correlation r=0.956) Figure 1A. All 4 out of 96 values that were outside the limits of agreement (set at mean ±2 standard deviations) were for Lab Cr values >200 umol/L. A Bland-Altman Plot is presented for paired samples with Lab Cr values <200 umol/L (Figure 1B).

A Well Woman Clinic in Bangalore: one strategy to attempt to decrease the transmission of HIV infection

1998 ◽  
Vol 9 (7) ◽  
pp. 418-423 ◽  
Author(s):  
C M Baksi ◽  
I Harper ◽  
Margaret Raj
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Hiv Infection ◽  
Sex Workers ◽  
Pilot Project ◽  
Care Staff ◽  
Vulnerable Groups ◽  
Health Care Staff ◽  
Governmental Organization ◽  
Primary Health

Samraksha, a non governmental organization NGO in Bangalore, South India, was established in 1993 to take steps to control the spread of HIV infection. As a result of their interactions the Samraksha team recognized the urgent need for management of sexually transmitted diseases STDs as a crucial component of their work. Samraksha approached Action Health, a UK based charity, for assistance. This paper outlines the needs assessment and the process of setting up a Well Woman Clinic for commercial sex workers CSWs and other vulnerable groups in Bangalore. The pilot project has been running for over a year and has gained credibility both with vulnerable women and with professionals. Furthermore it has officially become a government resource centre for the training of doctors and health care staff in the management of STDs, and provides formal training sessions for the staff at each of the primary health care centres in Bangalore. Thus STD management is being integrated with the current primary health care provision for women throughout Bangalore. Factors influencing the successful development of such a service are considered.

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