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21.
Julian Brunner Cindy L. Cain Elizabeth M. Yano Alison B. Hamilton 《Women's health issues》2019,29(1):64-71
Background
The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy.Methods
We conducted semistructured interviews with 86 local and regional women's health leaders at 12 VHA medical centers across four regions. At the conclusion of interviews about women's primary care, participants were asked to imagine “ideal care” for women veterans. Interviews were transcribed and coded using a hybrid inductive/deductive approach.Results
In describing ideal care, participants commonly touched on whether women veterans should have separate primary care services from men; the need for childcare, expanded reproductive health services, resources, and staffing; geographic accessibility; the value of input from women veterans; the physical appearance of facilities; fostering active interest in women's health across providers and staff; and the relative priority of women's health at the VHA.Conclusions
Policy and practice changes to care for women veterans must be mindful of key stakeholders' vision for that care. Specific features of that vision include clinic construction that anticipates a growing patient population, providing childcare and expanded reproductive health services, ensuring adequate support staff, expanding mechanisms to incorporate women veterans' input, and fostering a culture oriented towards women's health at the organizational level. 相似文献22.
ObjectivesTo identify peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services.DesignReview of qualitative and quantitative studies.Data sourcesA comprehensive electronic database search was conducted between October 2014 and December 2015 in PubMed, CINAHL, Web of Science, The Cochrane Library, and PsycARTICLES. Additional articles were identified through handsearch.Review methodsAll articles were assessed on quality. A thematic analysis informed by a multi-level approach was adopted to identify and discuss the main themes in the individual studies. Reporting was in line with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ statement.ResultsEighteen articles met the inclusion criteria. All studies adopted qualitative research methods, of which three studies used additional quantitative methods. Peer workers’ perceptions and experiences cover a range of themes including the lack of credibility of peer worker roles, professionals’ negative attitudes, tensions with service users, struggles with identity construction, cultural impediments, poor organizational arrangements, and inadequate overarching social and mental health policies.ConclusionsThis review can inform policy, practice and research from the unique perspective of peer workers. Mental health professionals and peer workers should enter into an alliance to address barriers in the integration of peer workers and to enhance quality of service delivery. Longitudinal research is needed to determine how to address barriers in the implementation of peer worker roles. 相似文献
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分析“两票制”对药品流通行业的影响及药品批发企业执行“两票制”过程中的问题与困难,为企业顺利应对政策要求、长期健康发展提供参考。调研江苏省药品批发企业“两票制”执行情况,针对企业遇到的困难和问题,分析对应的解决办法。“两票制”对于药品批发企业既是挑战也是机遇,企业要进一步发展壮大,必须积极应对政策调整所带来的问题和困难,提高自身管理水平,调整经营思路。要使“两票制”政策落实到位,充分发挥效力,促进行业长期健康发展,并从立法、市场、监管等多个层面共同发力。 相似文献
25.
ObjectiveBuilding federated data sharing architectures requires supporting a range of data owners, effective and validated semantic alignment between data resources, and consistent focus on end-users. Establishing these resources requires development methodologies that support internal validation of data extraction and translation processes, sustaining meaningful partnerships, and delivering clear and measurable system utility. We describe findings from two federated data sharing case examples that detail critical factors, shared outcomes, and production environment results.MethodsTwo federated data sharing pilot architectures developed to support network-based research associated with the University of Washington’s Institute of Translational Health Sciences provided the basis for the findings. A spiral model for implementation and evaluation was used to structure iterations of development and support knowledge share between the two network development teams, which cross collaborated to support and manage common stages.ResultsWe found that using a spiral model of software development and multiple cycles of iteration was effective in achieving early network design goals. Both networks required time and resource intensive efforts to establish a trusted environment to create the data sharing architectures. Both networks were challenged by the need for adaptive use cases to define and test utility.ConclusionAn iterative cyclical model of development provided a process for developing trust with data partners and refining the design, and supported measureable success in the development of new federated data sharing architectures. 相似文献
26.
《Research in social & administrative pharmacy》2019,15(12):1453-1463
BackgroundThe purpose of this study was to assess the impact of the We Immunize Program on structures, processes, and outcomes of pneumococcal and herpes zoster pharmacy-based immunization services.MethodsPharmacy-technician pairs from 62 Alabama and California community pharmacies participated in a 6-month randomized controlled trial (intervention = 30/control = 32). All received immunization update training; intervention participants also received practical strategies training and monthly telephonic expert feedback. Completion of immunization service structure and process activities were analyzed using Fisher's Exact and one-way Mann-Whitney U tests. The primary outcome, change in number of pneumococcal, herpes zoster, and total vaccine doses administered, was assessed using one-way Wilcoxon signed rank and Mann-Whitney U tests. Associations between program and vaccine doses across time were explored using generalized estimating equations (GEE).ResultsIntervention pharmacies completed more structure (median 12.00 versus 9.00, p = 0.200) and process activities (median 8.00 versus 7.00, p = 0.048) compared to control. Statistically significant increases in the median number of pneumococcal vaccine doses (7.50–12.00 doses, p = 0.007), and total vaccine doses (12.50–28.00 doses, p = 0.014) were seen from baseline to post-intervention within the intervention group. However, these changes were not statistically significant when compared to the control group (pneumococcal p = 0.136, total p = 0.202). Changes in median herpes zoster vaccine doses did not reach significance among intervention (8.50–9.00, p = 0.307) or control (9.00–13.00, p = 0.127) pharmacies.ConclusionsPractical strategies training combined with tailored expert feedback enhanced existing pneumococcal immunization services in community pharmacies.Clinical trial registrationClinicalTrials.gov identifier: NCT02615470. 相似文献
27.
《Journal of the Academy of Nutrition and Dietetics》2022,122(1):49-63
BackgroundThe Community Eligibility Provision (CEP) allows high-poverty schools participating in US Department of Agriculture meal programs to offer universal free school meals. Emerging evidence suggests benefits of CEP for student meal participation, behavior, and academic performance. Although CEP became available nationwide in 2014, in school year 2019–2020, one third of eligible schools were not participating.ObjectiveThis study evaluates which school, district, and state factors are associated with CEP participation.DesignCross-sectional study comparing CEP-participating with eligible nonparticipating schools to assess the relationship between CEP participation and school, district, and state factors.ParticipantsUS public schools eligible for CEP in school year 2017–2018 (n = 42,813).Main Outcome MeasuresCEP participation.Statistical Analyses PerformedPenalized regression variable selection methods to determine which factors contribute information to the model. Generalized logistic regression to predict odds of CEP participation unadjusted and adjusted for each factor in the full sample and in stratified analyses by whether a state was part of the CEP phase-in period (early vs late implementing states).ResultsIn the full sample, adjusted odds of CEP participation were greater in states where CEP had been available longer (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.34, 1.67). In late implementing states, adjusted odds of CEP participation were higher in schools with more students directly certified for free meals (OR in schools with 80%–89% vs 30%–39% directly certified: 19.32; 95% CI, 12.98, 28.76), Title I schools (OR, 1.85; 95% CI, 1.55, 2.21), and urban schools (OR suburban vs urban, 0.46; 95% CI, 0.36, 0.59). Differences by school level, enrollment, district size, student race/ethnicity, and geographic region also existed.ConclusionsFindings may help advocates, state agencies, and policymakers understand potential barriers to adoption and guide research exploring effective strategies to promote uptake. Future research should use qualitative and longitudinal designs to explore barriers to adoption, including cost and state and local policies. 相似文献
28.
魏冬华 《安徽卫生职业技术学院学报》2014,(6):81-82
探讨优质护理服务在神经外科护理管理中的应用效果。方法:2010年1~12月随机抽取100名住院患者为对照组,自从实施优质护理服务后,2011年1~12月随机抽取100名住院患者为研究组,两组都采用自制的满意度调查表和健康教育知晓率调查表进行调查。结果:研究组满意度为95%,健康教育知晓率94%,对照组满意度为76%,健康教育知晓率为74%。结论:优质护理服务在神经外科护理中得到了患者的普遍认同。进一步强化了护士对优质护理内容的了解,使住院患者满意度明显提高。 相似文献
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30.
《Journal of the American Dental Association (1939)》2014,145(5):443-451
BackgroundStaff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past.MethodsIn a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM.ResultsIn 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period.ConclusionsFluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation.Practical ImplicationsFluoride use reduces the need for future restorations in adults at high risk of experiencing caries. 相似文献