Adoption,Reach, Implementation,and Maintenance of a Behavioral and Mental Health Assessment in Primary Care

PURPOSE

Guidelines recommend screening patients for unhealthy behaviors and mental health concerns. Health risk assessments can systematically identify patient needs and trigger care. This study seeks to evaluate whether primary care practices can routinely implement such assessments into routine care.

METHODS

As part of a cluster-randomized pragmatic trial, 9 diverse primary care practices implemented My Own Health Report (MOHR)—an electronic or paper-based health behavior and mental health assessment and feedback system paired with counseling and goal setting. We observed how practices integrated MOHR into their workflows, what additional practice staff time it required, and what percentage of patients completed a MOHR assessment (Reach).

RESULTS

Most practices approached (60%) agreed to adopt MOHR. How they implemented MOHR depended on practice resources, informatics capacity, and patient characteristics. Three practices mailed patients invitations to complete MOHR on the Web, 1 called patients and completed MOHR over the telephone, 1 had patients complete MOHR on paper in the office, and 4 had staff help patients complete MOHR on the Web in the office. Overall, 3,591 patients were approached and 1,782 completed MOHR (Reach = 49.6%). Reach varied by implementation strategy with higher reach when MOHR was completed by staff than by patients (71.2% vs 30.2%, P <.001). No practices were able to sustain the complete MOHR assessment without adaptations after study completion. Fielding MOHR increased staff and clinician time an average of 28 minutes per visit.

CONCLUSIONS

Primary care practices can implement health behavior and mental health assessments, but counseling patients effectively requires effort. Practices will need more support to implement and sustain assessments.     

货币时间当量、潜在卫生资金与卫生事业大发展

我国由政府组织筹集的潜在卫生资金数量巨大,潜在卫生资金具有随时失去、不可存储,指向未来、可以计划,外部转化、等同货币等特点。将潜在卫生资金转化为卫生资金,可解决卫生事业大发展问题,对此,需要坚持政府主导、市场运作、银行参与、保医密接、供需同补等原则。     

对基本医疗服务和特需医疗服务界定的探讨

健康是人类生存和发展的基本要素,享有卫生保健是每一个公民的权利。为了保证医疗服务的公平性,在推行“特需医疗服务”政策时,必须首先对基本医疗服务和特需医疗服务加以界定。指出,基本医疗服务和特需医疗服务的界定,不能背离医学宗旨,应正确理解卫生事业的性质。在运作中要加强管理,根据当地卫生资源配置情况,使特需医疗服务限定在一定时间和空间中进行。     

Future Directions for Violence Against Women and Reproductive Health: Science,Prevention, and Action

Despite the recognition that violence may be associated with serious consequences for women's reproductive health, the understanding of the relationship between the two remains limited, as does our understanding of the most effective role for reproductive health care providers and services. This paper briefly summarizes the history of the nexus of public health, health care, and violence against women in the United States. In addition, we present some considerations for future directions for research, health care practice, and policy that will advance the understanding of the complex relationship between violence and reproductive health.     

An exploration of the feasibility,acceptability, and effectiveness of professional,multitasked community health workers in Tanzania

Despite four decades of global experience with community-based primary health care, the strategic details of community health worker (CHW) recruitment, training, compensation, and deployment remain the subject of continuing discussion and debate. Responsibilities and levels of clinical expertise also vary greatly, as well as contrasting roles of public- versus private-sector organisations as organisers of CHW effort. This paper describes a programme of implementation research in Tanzania, known as the Connect Project, which aims to guide national policies with evidence on the impact and process of deploying of paid, professional CHWs. Connect is a randomised-controlled trial of community exposure to CHW integrated primary health-care services. A qualitative appraisal of reactions to CHW implementation of community stakeholders, frontline workers, supervisors, and local managers is reviewed. Results highlight the imperative to plan and implement CHW programmes as a component of a broader, integrated effort to strengthen the health system. Specifically, the introduction of a CHW programme in Tanzania should draw upon community structures and institutions and strengthen mechanisms to sustain their participation in primary health care. This should be coordinated with efforts to address poorly functioning logistics and supervisory systems and human resource and management challenges.     

Women's health, men's health, and gender and health: implications of intersectionality

Although intersectionality is now recognized in the context of women's health, men's health, and gender and health, its full implications for research, policy, and practice have not yet been interrogated. This paper investigates, from an intersectionality perspective, the common struggles within each field to confront the complex interplay of factors that shape health inequities. Drawing on developments within intersectionality scholarship and various sources of research and policy evidence (including examples from the field of HIV/AIDS), the paper demonstrates the methodological feasibility of intersectionality and in particular, the wide-ranging benefits of de-centering gender through intersectional analyses.     

The Conceptual and Empirical Link Between Health Behaviors,Self Reported Health,and the Use of Home Health Care in Later Life

ABSTRACT

The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.     

Subjective well-being, sociodemographic factors, mental and physical health of rural residents

Objective: To ascertain the relationship between subjective well‐being and sociodemographic factors, mental and physical health of a sample of rural residents. Design: Cross‐sectional survey with stratified random sampling of persons based on the 2000 State Electoral Role. Questionnaire was forwarded to 23 000 residents throughout a rural area. Setting: Households within Gippsland. Participants: Five thousand three hundred and ninety‐one adults aged 18 years and above. Main outcome measures: Residents completed a self‐reported questionnaire assessing life satisfaction/subjective well‐being, psychological distress, sociodemographic factors, physical and mental health problems. Results: Completed survey indicated that participants with lower levels of psychological distress, physical disability and mental disability had higher odds of being satisfied with their life. Participants with severe mental disability had the lowest odds of being satisfied with life. On average, participants were satisfied with their life (mean score of 21, SD = 5.9), are within the normal range of the Kessler‐10 (mean score = 16.31, SD = 5.85), had no mental disability (mean score = 51.8, SD = 7.36) on the mental component of the Short Form‐12 Health Survey, but are mildly physically disabled (mean score = 48.9, SD = 7.74). Conclusions: The results of this study indicate that sociodemographic factors, psychological distress, physical health and mental health contribute to subjective well‐being. Compared with other age groups, those aged 66 years and above had the highest level of life satisfaction. Those living with partner/spouse without children, with no mental or physical disability and no psychological distress had highest level of life satisfaction. Women also had higher levels of life satisfaction compared with men.     

上海市卢湾区三种行业农民工健康相关知信行调查

目的了解上海市卢湾区不同行业农民工的健康知识、信念、行为（KAP）以及影响农民工健康状况的主要因素，为今后开展有针对性的健康服务提供依据．方法采用统一的“上海市农民工健康需求调查问卷”对调查对象进行现场调查，现场发放调查问卷、现场填写、现场回收的方法，除必要的解释外，调查员不给予任何提示。结果调查对象慢性病知识的知晓率较低，传染病和食品卫生知识的知晓率较高，仪有41．9％的调查对象测量过血压，30．4％的调查对象参加过健康教育活动，健康相关KAP的综合评价结果表明，餐饮服务业农民工的健康状况最好，建筑工地农民工次之，农贸市场农民工最差。结论农民工的健康知识相甘缺乏，大部分人对自己的健康状况不太关注，存在较多的不良行为，经济收入、环境污染、食品卫生和工作压力等成为影响农民工健康的主要因素。     

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.