People with diabetes mellitus: their care and treatment choices

Study based on qualitative research, from an interpretative perspective. Its objective was to understand the therapeutic itinerary of people with Diabetes Mellitus who search for different care and treatments within the different subsystems of health care. The data was collected through in-depth interviews and focus groups. As a result of the data analysis therapeutic modalities were identified, the evaluation of the care process and health treatment and the therapeutic journey in the three subsystems. The person with Diabetes Mellitus needs to reevaluate their process of living. Thus, the person circulates through various therapeutic modalities until they perceive that (or those) which are most convenient for them. This also applies to how said care or treatment becomes integrated into their day-to-day.     

Kritische Thesen zu patientenbezogenen Anwendungen der Gesundheitstelematik

Telematics applications in health care improve patient care in many ways. Especially the improvements through electronic communication, documentation and cooperation between the different providers have high potential for a qualitative and effective health care. Immaterialization of patient records enables their availability as health records across all health care institutions that are involved in the treatment of a patient. However, the realization of a telematic platform in health care raises new questions concerning ethical and technical issues. These questions must be answered in consideration of the interests of citizens, patients, health care providers and insurance companies. Against this background ten critical theses regarding patient-oriented applications in health telematics are presented and discussed. Special attention is paid to the changes in the relationship between patients and physicians and the necessity to establish a new cooperative medical documentation culture, based on controlled vocabularies and where patients and physicians together decide, which information should be added to the central health record, as well as the creation of the necessary trustworthiness and the balance of effective benefit of health telematics and the informational self determination of the patient.     

Living groups: contributions for an educational proposal for tuberculosis

This study is a report on care practice. Its objective was to develop a proposal for education in health care from a group of people with tuberculosis, seeking to increase the effectiveness of their treatment. The data was obtained through a proposal for education in health care, developed through a living group. Two interrelated themes resulted from the process of analyzing the data: the perception of tuberculosis and its care and treatment, and social isolation. These represent the elements that influence education in health care for people with tuberculosis, as well as the meaning that such a situation has to these people.     

Third party purchasing of health services: patient choice and agency

Health care provision is almost universally characterised by third party purchasing in which the provider of health services is reimbursed by an agency (public or private insurer), rather than the patient. We show how a purchaser can manage the incentives that patient choice gives rise to by its own choice of monitoring arrangement. Even though patients are ignorant about their exact medical conditions and insulated from the costs of health care, they can help alleviate incentive problems due to asymmetric information through the choices that they make about whether to be treated. We show that if patients are responsive to variations in treatment, it can be worthwhile to base payment on the health outcome achieved rather than upon the treatment delivered. Outcomes-based payments may also be preferable where services are supplied by not-for-profit agencies who are intrinsically concerned with patient welfare.     

Therapeutic itinerary of the family and adolescent with type I mellitus diabetes

This is a qualitative assistential convergent study. Its main objective is to understand the therapeutic itinerary of adolescents with type 1 mellitus diabetes, as well as that of their families. The sample was composed of adolescents, between 15 and 25 years old, involved with a health institution in Florianópolis through the Health Care model that includes professional, family, and popular subsystems. Data were obtained through in-depth interviews and field observation of 20 people (relatives and adolescents with diabetes). The data analysis included data codification and categorization. Two categories were constructed: Decisions and negotiations about health, care and treatment; and the journey through the three subsystems of health care. The study permitted to understand that the treatment and care within the professional subsystem are not the only ones available. There are different practices in health performed from the evaluation each family makes, of what they believe adequate for their adolescent with diabetes.     

The redistributive effect of health care finance in twelve OECD countries.

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.     

‘Makes you wanna do treatment’: Benefits of a hepatitis C specialist clinic to clients in Christchurch,New Zealand

People with hepatitis C virus (HCV) are a marginalised population that may experience discrimination in everyday contexts, including health‐care, due to the association of HCV with injecting drug use. Stigma and discrimination are known to have a range of negative effects on people with HCV, including diminished quality of life and avoidance of health‐care. The Hepatitis C Community Clinic is an integrated care service established in 2008 in Christchurch, New Zealand to provide alternative access to health‐care that is non‐judgemental and supportive. As an integrated care service, the clinic aims to improve health outcomes and quality of life through a holistic approach to health‐care for people with HCV and people who inject drugs. This qualitative study forms part of a broader mixed‐methods evaluation of the clinic, and aims to assess the role of the clinic in improving health outcomes, knowledge, lifestyle practices and psychosocial functioning of the target population. Interviews were conducted with 24 health professionals and 24 clients of the clinic between April and November 2010. Findings illustrate that the clinic is a novel model of care that is effective in accessing a hard‐to‐reach and marginalised population in part due to the non‐judgemental, caring and supportive environment that engenders trust with clients. Based on participant reports, the clinic assists clients in managing their HCV and other health concerns and in increasing their readiness for HCV treatment. Given the benefits of this community clinic to clients, it is proposed that future research investigate the feasibility and benefits of administering HCV treatment through community‐based integrated care networks.     

Improving intergenerational health care communication

The relationship between health care providers and their older adult patients may suffer from miscommunication problems stemming from agist stereotyping. Stereotypes of older adults by younger adults may be revealed through patronizing speech--or elder-speak, which is the overaccommodation of speech interaction. Over- and underaccommodation strategies based on these stereotypes are often used by young health care providers when communicating with older adults. As the population ages and the demand for health care services increases, health care providers must improve their communicative effectiveness with their older patients. Attention to the individual needs of health care consumers, cognizance of age or role stereotyping, and proper training of health care providers would increase communicative effectiveness and enhance the patient-provider relationship.     

The case for educating health care students in professionalism as the core content of interprofessional education

BACKGROUND: Professional teams are becoming more central to health care as evidence emerges that effective teamwork enhances the quality of patient care. Currently, health care professionals are poorly prepared by their education for their roles on the team. In parallel, there are increasing demands from consumers for health care professionals to serve the interests of society and patients through engaging in effective professional partnerships. Professionalism for health care providers is now being defined as a commitment to standards of excellence in the practice of the profession that are designed primarily to serve the interests of the patient and to be responsive to the health needs of society. Yet, there are multiple barriers impeding the development of professionalism beyond a uni-professional frame of reference. METHOD: Incorporating teamwork and professionalism into health care professional curricula at pre-registration level is proving to be challenging. These 2 areas of learning are brought together in this paper through a discussion of the role of interprofessional education in preparing all health care professional students for the workforce. CONCLUSION: Interprofessionalism is presented as a pre-registration curriculum framework that includes values shared by all health care professionals, which should be learned in order to more adequately prepare students for working in health care teams. It will be argued that interprofessional education provides appropriate methods by which to learn interprofessionalism, and that this will ultimately contribute to overcoming uni-professional exclusivity.     

Aren't health services already promoting health?

Abstract: Smoke–free health care environments are now the norm in Australia and exemplify the way in which environments for health care can become more health promoting. Community health services that assist people with chronic illnesses and disabilities to increase control over their lives, hospitals that provide nutritious food choices for staff and patients, and general practices that encourage routine preventive care throughout the life span are other examples of health–promoting environments. In their roles as providers of services, employers, community corporations and citizens, health care organisations have a wide range of opportunities for developing their capacity for health promotion. These include transforming the principles and values on which service delivery models are based, developing an organisational capacity for health promotion through staff training and designing programs, services and facilities to promote health. While some industry accreditation programs are evolving to embody specific elements that are health promoting, significant barriers to this area of organisational development continue to exist. These include disincentives linked with health care financing and the values, priorities and skills of health care workers who must turn rhetoric into practice. Just as the introduction of smoke–free environments success on research findings and a supportive political and social milieu to be successful, the further development of environments for health care which are health promoting in other ways will need to be driven by evidence and advocacy.     

On-site primary care and mental health services in outpatient drug abuse treatment units

Providing health services to drug abuse treatment clients improves their outcomes. Using data from a 1995 national survey of 597 outpatient drug abuse treatment units, this article examines the relationship between these units' organizational features and the degree to which they provided onsite primary care and mental health services. In two-stage models, Joint Commission on Accreditation of Healthcare Organizations-certified and methadone programs delivered more on-site primary care services. Units affiliated with mental health centers provided more on-site mental health services but less direct medical care. Units with more dual-diagnosis clients provided more on-site mental health but fewer on-site HIV/AIDS treatment services. Organizational features appear to influence the degree to which health services are incorporated into drug abuse treatment. Fully integrated care might be an unattainable ideal for many such organizations, but quality improvement across the treatment system might increase the reliability of clients' access to health services.     

Can ??Giving Preference to My Patients?? be Explained as a Role Related Duty in Public Health Care Systems?

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the ??right?? to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to ??their clients?? is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to ??your?? patients in certain circumstances.     

Isomorphic pressures, institutional strategies, and knowledge creation in the health care sector

BACKGROUND: Health care organizations are facing surprisingly complex challenges, including new treatment and diagnostic technologies, ongoing pressures for health care institutional reform, the emergence of new organizational governance structures, and knowledge creation for the health care system. To maintain legitimacy in demanding environments, organizations tend to copy practices of similar organizations, which lead to isomorphism, and to use internal strategies to accommodate changes. A concern is that a poor fit between isomorphic pressures and internal strategies can interfere with developmental processes, such as knowledge creation. PURPOSES: The purposes of this article are to, first, develop a set of propositions, based on institutional theory, as a theoretical framework that might explain the influence of isomorphic pressures on institutional processes through which knowledge is created within the health care sector and, second, propose that a good fit between isomorphic pressures factors and health care organizations' institutional strategic choices will enhance the health care organizations' ability to create knowledge. METHOD: To develop a theoretical framework, we developed a set of propositions based on literature pertaining to the institutional theory perspective of isomorphic pressures and the response of health care organizations to isomorphic pressures. FINDINGS: Institutional theory perspectives of isomorphic pressures and institutional strategies may provide a new understanding for health care organizations seeking effective knowledge creation strategies within institutional environment of health care sector. PRACTICE IMPLICATIONS: First, the ability to identify three forces for isomorphic change is critical for managers. Second, the importance of a contingency approach by health care managers can lead to strategies tailoring to cope with uncertainties facing their organizations.     

Restoring control: empowering older patients and their families during health crisis.

Acute health crises and the care provided within the health care system often reduce control for older patients and their families. Drawing on the authors' research with hip fracture patients and work with home health teams, the discussion focuses specifically on older patients who require home health care following a hip fracture and who have family support. Successful recovery and rehabilitation of the older patient is contingent upon restoring the patients' perception of control over their recovery. Empowerment is achieved both through the content of interventions, and through the process by which health professionals work with patients and their families.     

Religion,Spirituality and Health Care Treatment Decisions: The Role of Chaplains in the Australian Clinical Context

This paper summarizes the views of Australian health care chaplains concerning their role and involvement in patient/family health care treatment decisions. In general terms the findings indicated that the majority of chaplains surveyed believed that it was part of their pastoral role to help patients and their families make decisions about their health care treatment. Differences in involvement of volunteer and staff chaplains, Catholic and Protestant, male and female chaplains are noted, as are the perspectives of chaplaincy informants regarding their role in relation to health care treatment decisions. Some implications of this study with respect to quality patient centered care, chaplaincy utility, and training are noted.     

Teenagers educating teenagers about reproductive health and their rights to confidential care

This paper focuses on the efforts of the Teen Health Initiative (THI) to meet the needs of teenagers for an accurate understanding of their rights to health care in New York. In particular, THI makes the state's laws understandable and explains the legal rights of minors to health care. In addition to the extensive training for professionals who work with adolescents, THI runs a peer education program. The program provides teenagers the opportunity to discuss their rights to confidential health care and gives them the tools to present that information to other adolescents around the state. An important aspect of the THI program is that it focuses on teenagers educating teenagers. Its workshop covers areas of health care to which minors can give informed consent and that they can receive confidentiality such as mental health care, drug and alcohol counseling, as well as areas of reproductive health such as birth control, pregnancy testing, prenatal care and counseling, testing and treatment for sexually transmitted diseases, HIV/AIDS testing and treatment, and abortion. The group believes that, when fully educated and treated respectfully, most teenagers are willing and able to make responsible choices about their health and their lives.     

Communication Between HIV Patients and Their Providers: A Qualitative Preference Match Analysis

Since the introduction of cART (combination antiretroviral therapy), HIV has evolved into a chronic disease such that it requires lifelong medical treatment to which patients must adhere. Communication with health care providers is pivotal in supporting patients to adapt to having HIV and adhering to treatment, in order to maintain health and quality of life. Previous research indicates that communication is optimal when it matches patient preferences for information exchange, relationship establishment, and involvement in treatment decisions. The aim of the present study is to explore HIV patient communication preferences as well as patient experiences with their providers (not) matching their preferences. A second aim is to explore provider beliefs about patient preferences and provider views on optimal communication. Data were collected through interviews with 28 patients and 11 providers from two academic hospitals. Results indicate that patient preferences reflect their cognitive, emotional, and practical needs such that patients look to increase their sense of control over their HIV. Patients aim to further increase their sense of control (by proxy) through their relationship with their providers and through their decisional involvement preferences. Providers are well aware of patient communication preferences but do not explicate underlying control needs. Implications for clinical practice are discussed.     

Effective internal marketing: the challenge of the 1990s

Results of a recent public opinion study suggest that health care provider organizations are not taking advantage of several important public relations and internal marketing channels to educate the public through their employees. As increasing pressures on health care providers from other segments of the health care industry result in reduced revenues, lower margins, and downsizing, health care marketers and public relations managers should reassess their internal marketing efforts.