Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings

AbstractBackgroundDespite the assurance of free medical access through the universal health insurance system, over the past three decades Japanese youth have experienced an increase in developmental and behavioral problems, psychosomatic disorders, and psychiatric illnesses.ObjectivesTo identify the challenges in promoting comprehensive preventive health services to adolescents in Japan, specifically in Tokyo.MethodsA cross-sectional online survey was conducted of physicians who are members of the Tokyo Pediatric Association. The questionnaire assessed primary care pediatricians’ practice settings and their attitudes toward outpatient services to adolescent patients.ResultsOut of 617 member pediatricians, 69 valid responses were obtained. Majority were private pediatricians. 52% indicated that they had specialties in addition to general pediatrics; however, no one reported specializing in adolescent medicine. Approximately 70% answered the optimal patient encounter time would be under 10 min. More than 90% of respondents reported challenges providing health services to adolescent patients. Nearly half indicated that they did not routinely evaluate height, heart rate or blood pressure. Few providers asked about reproductive health, violence, or smoking/alcohol use.ConclusionThis survey is the first exploration of adolescent health care in an urban area of Japan. While the sample is small, the magnitude of challenges was great with limited training in adolescent medicine, severe time constraints and limited appreciation for the value of health screening at each encounter. Developing a standardized practical assessment tool for adolescent patients may help guide primary care pediatricians to better meet the needs of their adolescent patients.

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Preventive Health Care and Payment Systems

Topics in Economic Analysis & Policy ◽

10.2202/1538-0653.1115 ◽

2003 ◽

Vol 3 (1) ◽

Cited By ~ 3

Author(s):

Pedro P Barros ◽

Xavier Martinez-Giralt

Keyword(s):

Primary Care ◽

Health Care ◽

Integrated Management ◽

Care Center ◽

Preventive Health Care ◽

Preventive Health ◽

Primary Care Center ◽

Care Providers ◽

Referral Decisions ◽

Payment Schemes

Abstract Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care. The analysis is performed through a series of examples combining different payment schemes at the primary care center and hospital. When hospitals are reimbursed according to costs, prevention efforts are unlikely to occur. However, under a capitation payment for the primary care center and prospective budget for the hospital, prevention efforts increase when shifting from an independent to an integrated management. Also, from a normative standpoint, optimal payment schemes are simpler under joint management.

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Yarning about health checks: barriers and enablers in an urban Aboriginal medical service

Australian Journal of Primary Health ◽

10.1071/py12138 ◽

2014 ◽

Vol 20 (2) ◽

pp. 151 ◽

Cited By ~ 12

Author(s):

Warren Jennings ◽

Geoffrey K. Spurling ◽

Deborah A. Askew

Keyword(s):

Health Care ◽

Torres Strait Islander ◽

Medical Service ◽

Care Delivery ◽

Preventive Health Care ◽

Health Check ◽

Audit And Feedback ◽

Barriers And Enablers ◽

Health Checks ◽

Torres Strait

The annual health check for Aboriginal and Torres Strait Islander People has been welcomed as a means of conducting a comprehensive assessment to address preventive health care delivery, identify new diagnoses and initiate new treatments. Rates of health check uptake across Australia have been poor with less than 12% of the eligible population receiving one during 2009/10. This qualitative study sought to identify barriers and enablers to undertaking health checks in an urban Aboriginal Medical Service through semistructured interviews with 25 clinical staff (doctors, nurses and Aboriginal and Torres Strait Islander health workers). Clinical systems for conducting health checks were unclear to staff, with barriers relating to time pressures for both patients and clinic staff, and lack of clarity about staff responsibilities for initiating and conducting the health check. Additionally some staff perceived some content as sensitive, invasive, culturally inappropriate and of questionable value. Other barriers included concerns about community health literacy, disengagement with preventative health care, and suspicion about confidentiality and privacy. The development of clear service-wide systems that support the conduct of health checks are required to increase uptake, combined with supportive local clinical leadership and audit and feedback systems. Staff training, consideration of culture and roles, and critical review of health check content may improve staff confidence and community acceptance. Community-based health education and promotion is strongly supported by staff to increase client engagement, knowledge and acceptance of the health check.

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