Indigenous participation in primary care services in Brazil

2018 ◽  
Vol 8 (1) ◽  
pp. 54-76
Author(s):  
Eliana Elisabeth Diehl ◽  
Esther Jean Langdon
Keyword(s):  
Primary Care ◽  
Indigenous Health ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Services ◽  
Unified Health System ◽  
Primary Care Services ◽  
El Sistema ◽  
Indigenous Participation ◽  
The Government

English abstract:In 1990, the Brazilian Unified Health System institutionalized new relationships between the government and society. In recognition of the inequalities and inequities inflicted upon Indigenous Peoples, the Indigenous Health Subsystem was established in 1999. Roles were created for the democratic exercise of Indigenous participation and prominence in three border spaces: Indigenous health agents as members of health teams; Indigenous representatives on health councils; and Indigenous organizations as primary care providers. This article explores these spaces based on ethnographic research from southern Brazil. It concludes that the roles created for Indigenous participation and governance are ambiguous and contradictory. When participating in new opportunities created by the government, Indigenous actors are subjected to a centralized and bureaucratized system that offers little possibility of autonomous decision- making or action.Spanish abstract:En 1990, el Sistema Único de Salud institucionalizó nuevas relaciones entre el gobierno y la sociedad, estableciendo en 1999 el Subsistema de Salud Indígena. Se crearon nuevos roles para el ejercicio democrático de la participación indígena con prominencia en tres espacios de frontera: agentes indígenas de salud como miembros de los equipos de salud; representantes indígenas en los consejos de salud; y organizaciones indígenas como proveedores de atención primaria. Este artículo explora estos espacios basado en investigación etnográfi ca del sur de Brasil. Se concluye que los roles creados para la participación y gobernanza indígena son ambiguos y contradictorios. Cuando se participa en nuevas oportunidades creadas por el gobierno, los actores indígenas son sometidos a un sistema que ofrece poca posibilidad de tomar decisiones autónomas o actuar.French abstract:1990 le système unique de santé brésilien, le SUS (Sistema Único de Saúde) institutionnalisait de nouvelles relations entre le gouvernement et la société en donnant aux usagers un rôle central et en leur att ribuant une large participation dans tous les secteurs des soins. En reconnaissance des inégalités et iniquités historiques infl igées aux peuples indigènes, le sous-système de soin indigène fut établi en 1999. De nouveaux rôles furent créés pour l’exercice démocratique de la participation indigène et sa reconnaissance dans trois zones d’action et de communication délimitées. Cet article explore ces espaces sur la base de recherches ethnographiques réalisées au Sud du Brésil et conclut que les rôles créés pour la participation indigène et la notion associée de gouvernance sont souvent ambigus et contradictoires.

scholarly journals An Agent-Based Model for Addressing the Impact of a Disaster on Access to Primary Care Services

2016 ◽  
Vol 10 (3) ◽  
pp. 386-393 ◽  
Author(s):  
Hasan Guclu ◽  
Supriya Kumar ◽  
David Galloway ◽  
Mary Krauland ◽  
Rishi Sood ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Hurricane Sandy ◽  
Care Providers ◽  
Agent Based Model ◽  
Agent Based ◽  
Primary Care Access ◽  
Care Access ◽  
Care Services ◽  
Primary Care Services

AbstractObjectiveHurricane Sandy in the Rockaways, Queens, forced residents to evacuate and primary care providers to close or curtail operations. A large deficit in primary care access was apparent in the immediate aftermath of the storm. Our objective was to build a computational model to aid responders in planning to situate primary care services in a disaster-affected area.MethodsUsing an agent-based modeling platform, HAZEL, we simulated the Rockaways population, its evacuation behavior, and primary care providers’ availability in the aftermath of Hurricane Sandy. Data sources for this model included post-storm and community health surveys from New York City, a survey of the Rockaways primary care providers, and research literature. The model then tested geospatially specific interventions to address storm-related access deficits.ResultsThe model revealed that areas of high primary care access deficit were concentrated in the eastern part of the Rockaways. Placing mobile health clinics in the most populous census tracts reduced the access deficit significantly, whereas increasing providers’ capacity by 50% reduced the deficit to a lesser degree.ConclusionsAn agent-based model may be a useful tool to have in place so that policy makers can conduct scenario-based analyses to plan interventions optimally in the event of a disaster. (Disaster Med Public Health Preparedness. 2016;10:386–393)

scholarly journals LO087: Emergency department patients’ connection to primary care providers: reasons for lack of connection

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S60-S60
Author(s):  
L. Krebs ◽  
S.W. Kirkland ◽  
K. Crick ◽  
C. Villa-Roel ◽  
A. Davidson ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Family Physician ◽  
Patient Characteristics ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Access ◽  
Care Services ◽  
Primary Care Services ◽  
Access To Primary Care

Introduction: Some non-urgent/low-acuity Emergency Department (ED) presentations are considered convenience visits and potentially avoidable with improved access to primary care services. This study surveyed patients who presented to the ED and explored their self-reported reasons and barriers for not being connected to a primary care provider (PCP). Methods: Patients aged 17 years and older were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada. Following initial triage, stabilization, and verbal informed consent, patients completed a 47-item questionnaire. Data from the survey were cross-referenced to a minimal patient dataset consisting of ED and demographic information. The questionnaire collected information on patient characteristics, their connection to a PCP, and patients' reasons for not having a PCP. Results: Of the 2144 eligible patients, 1408 (65.7%) surveys were returned and 1402 (65.4%) were completed. The majority of patients (74.4%) presenting to the ED reported having a family physician; however, the ‘closeness’ of the connection to their family physician varied greatly among ED patients with the most recent family physician visit ranging from 1 hour before ED presentation to 45 years prior. Approximately 25% of low acuity ED patients reported no connection with a family physician. Reasons for a lack of PCP connection included: prior physician retired, left, or died (19.8%), they had never tried to find one (19.2%), they had recently moved to Alberta (18.0%), and they were unable to find one (16.5%). Conclusion: A surprisingly high proportion of ED patients (25.6%) have no identified PCP. Patients had a variety of reasons for not having a family physician. These need to be understood and addressed in order for primary care access to successfully contribute to diverting non-urgent, low acuity presentations from the ED.

The evolving role of the primary care provider in the comprehensive cancer care paradigm: Knowledge, attitudes, beliefs, and practices of primary care clinicians.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 28-28 ◽  
Author(s):  
G J. Van Londen ◽  
Jill Weiskopf Brufsky ◽  
Ira Russell Parker
Keyword(s):  
Primary Care ◽  
Cancer Care ◽  
Primary Care Providers ◽  
Survivorship Care Plan ◽  
Care Providers ◽  
Data Set ◽  
Beliefs And Practices ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Clinicians

28 Background: Due to increasing numbers of individuals diagnosed with cancer, a burgeoning cohort of cancer survivors with significant medical co-morbidities, and oncology workforce challenges, the optimal integration of Primary Care Providers (PCPs) into the comprehensive cancer care paradigm is of timely importance. The goal of this investigation is to determine the knowledge, attitudes, beliefs, and practices of primary care clinicians -- pertaining to their existing and potential roles in cancer care. Methods: 1,069 clinical affiliates of the University of Pittsburgh Medical Center, who provide primary care services (e.g. Cardiology, Family Medicine, Geriatric Medicine, Gynecology, and Internal Medicine), were invited to participate in a 77-question, IRB-approved, online survey questionnaire [Qualtrics (Provo, Utah)]. Three “reminder emails” were generated. Results: Note: These results reflect the analysis of an initial, preliminary subset of survey responders (N=90). The full data set will be utilized for the final poster presentation. Eighty percent of the responders are physicians. Seventy-one percent reported that 50%+ of their time is spent providing primary care services and 66% have been in-practice for 15+ years. 73%, 63% and 59% respectively have participated in “cancer surveillance”, “cancer treatment/disease-related adverse event (AE) monitoring”, and “AE management” activities. Cardiotoxicity (42%), lymphedema (61%), and vasomotor flushing (63%) represented those AEs that the responders felt least comfortable monitoring independently. Twelve percent were aware of the PCP-targeted December/2015 “ACS-ASCO Breast Cancer Guideline” and 24% of the term “Survivorship Care Plan”. Twenty-two percent were “very confident” with regard to conducting a “low dose CT” lung cancer screening decision-making patient conversation. Twenty-one percent felt that their formal training did not adequately prepare them and that their present educational opportunities are inadequate pertaining to PCP-Cancer Survivorship issues. “Communication between the Oncology Team and PCP” was noted as the most stated “major issue”. Conclusions: To fully optimize the interface between Oncologists and PCPs with regard to best practices cancer care, strategies targeting competency training, enhanced information/guideline dissemination, and the development of collaborative-based delivery models will likely be necessary.

Ray’s Theory of Bureaucratic Caring: A Conceptual Framework for APRN Primary Care Providers and the Homebound Population

2015 ◽  
Vol 19 (2) ◽  
pp. 41-48
Author(s):  
Pamela V. Johnson,
Keyword(s):  
Primary Care ◽  
Conceptual Framework ◽  
Systems Of Care ◽  
Primary Care Providers ◽  
Advanced Practice ◽  
Care Providers ◽  
Multiple Systems ◽  
House Calls ◽  
Care Services ◽  
Primary Care Services

More advanced practice registered nurses (APRN) are making primary care house calls to homebound patients. Coordinating primary care services for people confined to their place of residence is complex and requires multiple systems working in congruence to assure basic health needs of patients are met. Marilyn Ray’s theory of bureaucratic caring (Alligood & Tomey, 2010; Ray, 1998; Turkel, 2007) is being used as a conceptual framework for APRN primary care providers’ operating systems of care.

scholarly journals Exploring the implementation and delivery of primary care services for transgender individuals in Ontario: case study protocol

2020 ◽  
Vol 21 ◽  
Author(s):  
Erin Ziegler ◽  
Ruta Valaitis ◽  
Nancy Carter ◽  
Cathy Risdon ◽  
Jennifer Yost
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Access To Health Care ◽  
Care Providers ◽  
Case Study Methodology ◽  
Care Services ◽  
Services Delivery ◽  
Primary Care Services ◽  
Care Models

Abstract Background: Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care. Methods: Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases. Discussion: Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population.

scholarly journals Trends in hospitalization due to cardiovascular conditions sensitive to primary health care

2015 ◽  
Vol 18 (2) ◽  
pp. 372-384 ◽  
Author(s):  
Maicon Henrique Lentsck ◽  
Maria do Rosário Dias de Oliveira Latorre ◽  
Thais Aidar de Freitas Mathias
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Polynomial Regression ◽  
The State ◽  
Main Diagnosis ◽  
Care Services ◽  
Unified Health System ◽  
Primary Health ◽  
Primary Care Services ◽  
Males And Females

OBJECTIVE: To analyze the trend in hospitalizations for primary care-sensitive cardiovascular conditions for residents of the state of Paraná, Brazil, from 2000 to 2011. METHODS: Ecological, time series study of the rates of hospitalization for cardiovascular diseases in residents aged 35-74 years old by sex, age and main diagnosis for hospitalization. Data from the Hospital Information System of the Unified Health System (SIH-SUS) and polynomial regression models for trend analyses were used. RESULTS: Hospitalization rates for cardiovascular conditions decreased during the period (r2 = 0.96; p < 0.001), with similar decreasing patterns for males and females, in all age ranges, although always higher for males. Although hospitalization trends for hypertension, heart failure and cerebrovascular disease decreased, angina remained stable for males and females. CONCLUSION: A downward trend in hospital admissions due to primary care-sensitive cardiovascular conditions in the state of Paraná between 2000 and 2011 may have resulted from the expansion of the health network of and the access to primary health attention, as well as other factors that influence this set of diseases, such as improved socioeconomic conditions of the population, organization of primary care services for higher age ranges and women and decrease in risk factors.

Methods and Measurement of Primary, Secondary and Tertiary Healthcare Expenditures in India During 2013–2014 to 2016–2017

2021 ◽  
pp. 097370302110470
Author(s):  
Charu C. Garg ◽  
Pratheeba John ◽  
Tushar Mokashi
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Private Sector ◽  
Health Care Providers ◽  
National Health ◽  
Tertiary Care ◽  
Health Coverage ◽  
Care Providers ◽  
Care Services ◽  
The Government

Improving investments in primary health care has become a mounting priority in the context of Universal Health Coverage and India’s National Health Policy 2017 goal to provide cost-effective care. The paper uses the India National Health Accounts, health care providers and health care functions classifications, to allocate current health expenditures (CHE) to primary, secondary and tertiary (PST) care and analyse the trends and composition of PST expenditures between 2013–2014 and 2016–2017. Findings reveal that 45.2% of CHE was spent on primary care in 2016–2017. The government spends 52% of its CHE for primary care. Private spending on primary care has declined from 44% to 41% during the study period. Disaggregate analysis shows that 41% of primary care expenditures were on medicines, 29% on curative care and 15% on preventive care services. About 32% of primary care expenditures were spent at government facilities/providers as compared to 10% at private facilities/doctors. Private sector share of secondary care (38%) and tertiary care (75%) reinforces the role of private sector in providing secondary and tertiary care services. In cognisance of national and international goals, an additional investment of 0.7% of gross domestic product or additional US$11 (₹754) per capita would be required in primary care.

“Why Should I Tell My Business?”: An Emerging Theory of Coping and Disclosure in Teens

2016 ◽  
Vol 30 (2) ◽  
pp. 124-142 ◽  
Author(s):  
Daniela T. DeFrino ◽  
Monika Marko-Holguin ◽  
Stephanie Cordel ◽  
Lauren Anker ◽  
Melishia Bansa ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Services ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Services ◽  
Constant Comparative Analysis ◽  
To Receive

Disclosing predepression feelings of sadness is difficult for teens. Primary care providers are a potential avenue for teens to disclose these feelings and a bridge to mental health care before becoming more seriously ill. To explore how to more effectively recruit teens into a primary care-based, online depression prevention study, we held 5 focus groups with African American and Latino teens (n = 43) from a large Midwestern city. We conducted constant comparative analysis of the data and a theoretical conceptualization of coping and disclosure emerged. Our analysis revealed an internal coping continuum in reaction to sadness and pivotal elements of trust and judgment that either lead teens to disclose or not disclose these feelings. The teens’ perspectives show the necessary characteristics of a relationship and comfortable community and virtual settings that can best allow for teens to take the step of disclosing to receive mental health care services.

Sign in / Sign up

Export Citation Format

Share Document