Local public health system partnerships

OBJECTIVES: Interorganizational collaboration aimed at community health improvement is an expectation of local public health systems. This study assessed the extent to which such collaboration occurred within one state (Wisconsin), described the characteristics of existing partnerships, and identified factors associated with partnership effectiveness. METHODS: In Stage 1, local health department (LHD) directors in Wisconsin were surveyed (93% response rate). In Stage 2, LHDs completed self-administered mailed surveys for each partnership identified in Stage 1 (85% response rate). Two-level hierarchical logit regression methods were used to model relationships between partnership and LHD variables and partnership outcomes. Data from 924 partnerships associated with 74 LHDs were included in the analysis. RESULTS: Partnerships most frequently addressed tobacco prevention and control, maternal and child health, emergency planning, community assessment and planning, and immunizations. Partnering was most frequent with other government agencies, hospitals, medical practices or clinics, community-based organizations, and schools. Partnership effectiveness was predicted by having a budget, having more partners contributing financially, having a broader array of organizations involved, and having been in existence for a longer period of time. A government mandate to start the partnership was inversely related to successful outcomes. Characteristics of LHDs did not predict partnership effectiveness. CONCLUSIONS: Financial support, having a broader array of partners, and allowing sufficient time for partnerships to succeed contribute to partnership effectiveness. Further study-using objective outcome measures-is needed to examine the effects of organizational and community characteristics on the effectiveness of local public health system partnerships.     

Emergency preparedness training for public health nurses: a pilot study

The Columbia Center for Public Health Preparedness, in partnership with the New York City Department of Health, recently developed an emergency preparedness training program for public health workers. A pilot training program was conducted for a group of school health nurses and evaluated using a pre/posttest design. A surprising finding was that 90% of the nurses reported at least one barrier to their ability to report to duty in the event of a public health emergency. The most frequently cited barriers included child/elder care responsibilities, lack of transportation, and personal health issues. These findings suggest that it may be prudent to identify and address potential barriers to public health workforce responsiveness to ensure the availability of the workforce during emergencies.     

Open-access community child health clinics: the everyday experience of parents and child health nurses

In Australia, Community Child Health Services (CCHS) is the primary health care service which seeks to strengthen and support families, prevent illness and manage risks. Several nursing models of care exist within CCHS, and limited research has investigated which is the best way to provide child health surveillance and parenting support during the early years. This study qualitatively explored the everyday lived experience of parents and child health nurses involved with an open-access (appointment-free, parent-led) group child health surveillance clinic. Findings showed that participants considered the open-access clinic provided a helpful and supportive way of delivering child health surveillance and parental support to families with infants aged 0-18 months, without identified risk factors. The perspectives of multiple parents, nurses and other health workers found it effective, flexible and parent-directed, which may be in contrast to some traditional individual appointment child health surveillance methods.     

Public health in hospitals: the missing link in health improvement

Traditionally, public health professionals have scorned hospitals as the antithesis of community health. Secondary care remains notably distant from public health practice and policy. Yet hospitals consume over 50 per cent of the health budget and over a quarter of the population have contact with hospital services every year. There is an important public health agenda in hospitals for promoting health and an environment that encourages community partnership and a healthy place to work and be. Public health skills have a key role in ensuring high-quality, safe and evidence-based health care. Epidemiological support for hospitals can promote a much-needed culture of monitoring and evaluation of health services. A public health approach to planning of secondary care services can encourage a more objective and strategic assessment of health needs and how these are best met. We argue that public health hospitals should not be an oxymoron, but an essential component of public health strategy. Different approaches to putting public health into hospitals are discussed.     

Difference between consciousness of intervention for improving lifestyle by public health nurses and recipients of a company health check

Improving an unhealthy lifestyle decreases risk of incidence and death of lifestyle-related diseases. Consultation about a healthy lifestyle to recipients of health checkups conducted by public health nurses is one method for such improvement. The objective in the present study was to investigate the difference between consciousness of intervention by (1) the public health nurses who conducted consultations with recipients of health checkups and (2) the recipients who were consulted by the public health nurses. Data on 1,370 male white collar workers who underwent health checks were analyzed. When public health nurses determined that recipients required health consultation regarding lifestyle from the health checkup, they consulted with the recipients regarding improvement of lifestyle. The consultation regarding lifestyle included abstinence from smoking, drinking in moderation, exercise, and eating. The results of the analysis regarding difference in consciousness of the intervention by the public health nurses and the recipients show that (1) most drinkers did not think they were being discouraged to drink despite intervention by the public health nurses and (2) the smokers and the subjects with no habitual physical exercise tend to think that they were being consulted even though the public health nurses did not intervene regarding smoking and exercise.     

深圳市社区儿童保健医生中医药服务能力现状分析

目的了解深圳市社区儿童保健医生中医药服务能力现状,为提高社区儿童保健医生水平提供科学依据。方法采用随机抽样的方法抽取深圳市两个行政区,对所有社区健康服务中心工作时间满1年的儿童保健医生进行调查。结果共调查142名儿童保健医生。临床医生、社区护士及公卫医师常用养生保健内容与方法知晓率比较差异有统计学意义(P<0. 05)。女性养生保健理念及体质养生保健知晓率显著高于男性(均P<0. 05)。临床医生、社区护士及公卫医师养生保健理念及饮食养生保健知晓率比较差异均有统计学意义(均P<0. 05)。142名调查对象中,在对儿童家长进行中医保健指导时,内容正确性平均得分为(8. 31±1. 04)分,手法正确性平均得分为(5. 83±2. 50)分,指导针对性平均得分为(7. 04±1. 82)分。结论深圳市儿童保健医生中医健康素养及中医保健技术水平偏低,应加强儿童保健医生的中医药科普水平及具体操作技能培训。     

A manual for community mental health activities for a public health center in Japan]

A system for treatment of persons with chronic mental disease such as schizophrenics in the present structure of the Japanese public Health Center is proposed. Presently, while cases are handled by responsible staff members, incorporation into the health center system with full utilization of its personnel and resources is seldom accomplished. There is a necessity for a systems approach in order to organize essential programs that would provide care for the mentally diseased. Health centers would have three main roles in this system: as a coordinator of mental health resources in the community, as a specialized agency for case management, and responsibility for public relations in its service area. For proper administration of its system, health centers should follow a team concept. The team would consist of a director of health centers, physicians, part-time psychiatrists, public health nurses, psychiatric social workers and clerical staff. At case conferences discussion of whether a prospective case should be registered, assessment of the needs, and development of management plans for all of the registered cases would be conducted. The files and documents of each case would be deleted or re-registered 5 years after initial registration. Cases would have a case-manager to coordinate public health care, including home visits, family care, psycho-educational consultation and crisis intervention. Health centers would be responsible for bringing together available social resources such as sheltered workshops and transient residential programs. The goal of health centers' mental health activities would be to facilitate the normalization of the mentally diseased within the community.     

The reinvigoration of public health nursing: methods and innovations.

Los Angeles County (LAC) restructured and reinvigorated public health in response to nationwide concern over the adequacy of all public health infrastructures and functions. LAC's reorganization into geographically defined service planning areas (SPAs) has facilitated the integration of core public health functions into local practice. Public health nurses practicing as generalists within their SPA identified three initial objectives to address in population-based care: (1) expanding practice beyond disease control to a more holistic approach, (2) providing consultation using the Ask-the-Nurse innovation, and (3) developing a community assessment database for interdisciplinary SPA health planning. Additional innovative objectives are planned for the future.     

Building a new health system: implications for public health management and practice.

Changes in the health care system should encourage private-sector health care providers and the public health system to work in partnership to improve the public health of all citizens. Minnesota, with its recent comprehensive health reform efforts, has made a strong commitment to strengthen the public health system in performing those functions that are critical to protecting the health of the public and meeting public health goals that are identified by the state and local communities.     

Environmental assessment of the Indian health service

The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, was responsible for providing federal health services to 1.51 million American Indian and Alaska Natives in 2000. Several opportunities related to health care exist for the IHS: potential public and private collaborations, continuation of the Clinton Administration's legacy of meaningful tribal consultation, and increasing the numbers of American Indian physicians, nurses, and other health related professionals. Modifications in federal programs such as Medicare and Medicaid pose a serious threat to the IHS because the IHS relies on these programs to offset the overall lack of funding. This article provides a framework for identifying the ways in which the external environment affects and determines the IHS' strategic responses to ensure competitiveness within the U.S. health care market. Value chain analysis will be used to evaluate the competitive advantages and disadvantages of the current IHS internal environment.     

Home alone: unmet need for formal support services among home health clients

In order to remain in the home without family or other informal support, home health clients must have access to essential formal services such as nutritional support and homemaking chores to supplement medical and nursing care. In this study, we looked at client-related factors associated with the need for formal support services, and factors associated with whether those needs are adequately met. Data were collected from 2,013 home health clients in Massachusetts. According to the assessment of the skilled nurses treating them, 85 percent of the clients needed one or more support services; some or all needs were not adequately met in nearly half. Significant factors contributing to unmet need included: being non-white, having Medicaid as payer, being in a health maintenance organization, having AIDS, receiving maternal/child health services, and having an acute condition. This research suggests that even clients receiving skilled nursing care may not have many or most of their supportive needs met, and that there are identifiable factors which decrease the likelihood of having adequate care provided.     

Child public health: A new basis for child health workers

To treat and alleviate diseases in children is an importanttask that demands extensive knowledge, skills and training.It forms the basis of our understanding of sick children andtheir needs, and its quality is a measure of the efforts ofsociety to care for its citizens. With the health of children,however, a much broader view must be taken, including otheraspects of children's well-being than their diseases and theirmedical care. To reach the goals set by international organizationsand national governments for the populations' health, policiesbased on public health ideas and functions must be vigorouslypursued. Although these actions are valid for the whole population,there are major reasons why children should be seen as particularlyimportant. Merging the broad aspects of health and public healthfunctions with children's special needs creates child publichealth, which aims to place the health of children and adolescentsin its full social, economic and political context. It is nota new speciality; rather it is a counterbalance towards thefullness of health. Its activities - in teaching, research andservice - should be practical and relevant and include knowledgeand experience from many professions and sciences. With sucha broad competence, child public health is fit to take on awide range of child health issues, be it healthy public policyfor children and adolescents, support for vulnerable groups,education and training or creating centres of relevance forresearch and surveillance of children's and adolescents' health.     

Approach to sustainable primary health care service delivery for rural and remote South Australia

ABSTRACT: We describe the operation of four University Teaching Practices established by the South Australian Centre for Rural and Remote Health (SACRRH) and the Adelaide University Department of General Practice. These practices were established in response to the acknowledged difficulty in recruiting and retaining GPs in rural South Australia. The practices are co-located with a hospital or accident and emergency service and community based nurses and allied health professionals. They provide integrated health care and multidisciplinary health care student placements in a learning environment where students experience rural multidisciplinary practice and country life. The study found that although the sites differed in significant ways, they all provided integrated care and effective placements for students. This style of health care delivery is flexible and broadly applicable. Sustainability is achieved through financially viability, attracting and retaining health care professionals and the development of electronic information systems, to support integrated practice.     

The public health workforce

Defining the public health workforce and specifying its performance requirements present equal challenges as the nation anticipates public health needs for the twenty-first century. The core group of professionals employed by government public health agencies works in close partnership with a wide range of public, private, and voluntary organizations. The wider circle includes almost all physicians, dentists, and nurses, plus many other health, environmental, and public safety professionals. The task of ensuring that this workforce is prepared with skills and knowledge to face both identified and emerging public health challenges is immense.     

Pediatric nurse associates in a large official health agency: their education, training, productivity, and cost.

During 1974, 29 pediatric nurse associates and 15 pediatric nurse associate trainees worked in the child health care system of the New York City Department of Health. All of these nurse associates, formerly public health nurses from the Department of Health, were trained in a one-year, intensive, closely supervised didactic and clinical course. Within the child health units the nurse associates assumed clinical roles in the care of well and sick preschool children according to the written guidelines and protocols of the Department. In addition, they continued to function in the traditional role of the public health nurse for their own patients, rendering counseling, referral, and follow-up services as indicated. Physicians acted as consultants to the pediatric nurse associates. Comparisons are made between pediatric nurse associate-physician staff versus public health nurse-physician staff in terms of productivity and cost.     

Evaluation of practices and knowledge among primary health care professionals in relation to child development surveillance

In the present study, the practices and knowledge of 40 physicians and 40 nurses from municipal health care units (UMS) and 40 physicians and 40 nurses from the Family Health Program (FHP) in Belém, Pará State, Brazil, all of whom working in primary health care, were evaluated in relation to child development surveillance. Measures of knowledge of child development showed an average of 63.7% correct answers for UMS physicians, 57.3% for FHP physicians, 62.1% for FHP nurses, and 54.3% for UMS nurses. Only 21.8% of mothers attending appointments mentioned that the health care professional had asked about their children s development, 27.6% of mothers reported that the health care professional had asked about or observed the child s development, and 14.4% mothers reported having received instructions on how to stimulate their children s development. According to this study, primary health care physicians and nurses in the municipality of Belém showed gaps in their knowledge of child development. Child development surveillance is not being conducted satisfactorily in primary health care in the municipality of Belém. It is thus necessary to raise the awareness of health care professionals concerning the problem and provide them with appropriate training.     

从公共财政角度看公共卫生与医疗的伙伴关系

从公共财政角度分析了公共财政平台建设、分级财政、以及公立医疗机构管办分离改革等方面对公共卫生与医疗的伙伴关系建设的影响,并提出推进伙伴关系建设的关联财政制度设计。     

Use and sources of payment for health and community services for children with impaired mobility

A survey was made of the parents of 380 children whose mobility impairments require the use of a wheelchair, walker, or braces. They were asked about equipment, health services, related services, and family support services used during the previous year. There was extensive use of equipment and traditional medical and health services, such as visits to primary care and specialist physicians; there was moderate use of related health services, such as physical or occupational therapy and child counseling; and there was very little use of community-based family support services, such as respite care, after-school care, homemaker services, and summer camp. The cost of health care, particularly medical specialty care, was defrayed in large part by private insurance and public programs, such as Medicaid and Title V Programs for children with special health care needs, while financial support for related services, such as physical therapy and speech therapy, came largely through the schools. Compared to funding for health and related services, financial aid for community-based family support services is largely lacking.     

Child Care Health Consultation Programs: Barriers and Recommendations

Objectives: While many studies describe the need for health services in early care and education (ECE) settings and the role of child care health consultants (CCHCs), little information exists about the challenges to developing health consultation programs. The goal of this paper is to provide insight for the development of current and future child care health consultation programs by describing the barriers identified by CCHCs related to program implementation in 20 California counties. Methods: Forty-four child care health consultants participated in nine focus groups during their health consultation training at the California Training Institute. Participants were asked to discuss the barriers they encountered while establishing new county-wide child care health consultation programs. Themes were assigned to each response, and frequency and percentage of each theme were documented and trends were identified. Results: The four general themes describing barriers to program implementation were: Program Management, Child Care Culture, Geography and Community Services. Twenty additional sub-themes, including Multi-agency involvement, Chaos, Travel time, and Fragmentation, were assigned to each response. The most frequent general theme was Program Management. The most frequent sub-theme was Professional Support. Conclusions: The barriers identified by the child care health consultants can be valuable for administrators and clinicians establishing or developing child care health consultation programs. Program managers should be prepared for the unique challenges of child care health consultation and provide flexibility and support for child care health consultants.