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Architectural and Management Strategies for The Design, Construction and Operation of Energy Efficient and Intelligent Primary Care Centers in Chile. SUSTAINABILITY 2019. [DOI: 10.3390/su11020464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary care centers are establishments with elevated social relevance and high operational energy consumption. In Chile, there more than 628 family healthcare centers (CESFAM) have been built in the last two decades and with plans for hundreds more in the next few years. We revised the architecture, construction management and energy performance of five CESFAM centers to determine possible instances of overall improvement. Staff was interviewed, and state documents reviewed, which allowed the conceptualization of the architectonic and energy structure of the centers, as well as the process of implementation. At the same time, energy simulations were done for each one of the centers, controlling for different climates, construction solutions and orientations. Our study revealed that strategies employed by the primary healthcare centers in Chile have aided a progressive implementation of establishments with elevated costs and materialization times, as well as neglect for climatic conditions. These energy evaluations show relevant and consistent impacts of the architectural form and material conditions, especially in southern zones, demonstrating the need to work with shared knowledge resources such as BIM. There is a clear necessity to define technological, morphological and construction strategies specific to each climate zone in order to achieve energetically efficient and intelligent healthcare establishments.
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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Shah M, Orton E, Tata L, Gomes C, Kendrick D. Risk factors for scald injury in children under 5 years of age: A case–control study using routinely collected data. Burns 2013; 39:1474-8. [DOI: 10.1016/j.burns.2013.03.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 11/28/2012] [Accepted: 03/29/2013] [Indexed: 01/07/2023]
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Calderón C, Balagué L, Cortada JM, Sánchez A. Health promotion in primary care: how should we intervene? A qualitative study involving both physicians and patients. BMC Health Serv Res 2011; 11:62. [PMID: 21426590 PMCID: PMC3070625 DOI: 10.1186/1472-6963-11-62] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 03/23/2011] [Indexed: 12/04/2022] Open
Abstract
Background The effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions. Methods Qualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers. Results GPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere. Conclusions HPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.
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Affiliation(s)
- Carlos Calderón
- Centro de Salud de Alza, Comarca Ekialde, Servicio Vasco de Salud-Osakidetza, San Sebastián, Spain.
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Peckham S, Hann A. General practice and public health: Assessing the impact of the new GMS contract. CRITICAL PUBLIC HEALTH 2008. [DOI: 10.1080/09581590802178028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scott C, Hofmeyer A. Networks and social capital: a relational approach to primary healthcare reform. Health Res Policy Syst 2007; 5:9. [PMID: 17894868 PMCID: PMC2048492 DOI: 10.1186/1478-4505-5-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 09/25/2007] [Indexed: 11/10/2022] Open
Abstract
Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform.
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Affiliation(s)
- Catherine Scott
- Knowledge into Action Department, Calgary Health Region, 10101 Southport Road, Calgary, Alberta, T2W 3N2, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, T2N 4N1, Canada
| | - Anne Hofmeyer
- Faculty of Nursing, University of Alberta 3Floor, Clinical Sciences Building, Edmonton, Alberta, T6G 2G3 Canada
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Mallinson S, Popay J, Kowarzik U. Collaborative work in public health? Reflections on the experience of public health networks. CRITICAL PUBLIC HEALTH 2006. [DOI: 10.1080/09581590600986481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Plochg T, Delnoij DMJ, Hogervorst WVG, van Dijk P, Belleman S, Klazinga NS. Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam. Eur J Public Health 2006; 16:559-64. [PMID: 16469757 DOI: 10.1093/eurpub/ckl010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. METHODS In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. RESULTS Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. CONCLUSION The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.
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Affiliation(s)
- T Plochg
- Department of Social Medicine, Academic Medical Center/University of Amsterdam, The Netherlands.
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Greasley P, Small N. Establishing a welfare advice service in family practices: views of advice workers and primary care staff. Fam Pract 2005; 22:513-9. [PMID: 15964868 DOI: 10.1093/fampra/cmi047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The placement of welfare advice services in family practice to assist patients with health-related social and economic issues (e.g. disability benefits) has gathered momentum over the last decade in the UK. This expansion of primary care raises a number of issues for practices hosting these services. OBJECTIVES To gain the views of advice workers and primary care staff about the issues raised in hosting a welfare advice service across 30 practices in inner city Bradford. METHODS Views were obtained through focus groups with six advice workers, and primary care staff in 14 practices. A questionnaire was also posted to all practice managers asking their opinions about the service. RESULTS The focus groups highlighted a number of advantages for patients, including improvements in health and quality of life through increased income and reduced stress from social and economic issues. For practice staff, the service provided a resource to refer patients for welfare advice, reducing the time spent dealing with welfare issues, thereby reducing workload. This was confirmed in the questionnaire to practice managers where 72% said the service had saved time for GPs and reception/office staff. The advice workers raised concerns about the perceived level of commitment to the service from some staff at some practices. Practice staff were particularly concerned about the need for feedback about referrals. CONCLUSION Providing welfare advice in family practice can act as a valuable resource for primary care staff helping to address their patients health-related social and economic needs.
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Affiliation(s)
- Peter Greasley
- Department of Community & Primary Care, School of Health Studies, University of Bradford, UK.
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Abstract
Recent policy guidance has recommended that community nurses address public health issues, suggesting that they play a role in assessing and addressing poverty, and ensuring patients claim the welfare benefits to which they are entitled. This article reports an evaluation of a welfare advice service catering for 30 general practices in inner-city Bradford. Community nurses, along with other members of the primary care team, were able to refer patients for advice about welfare issues, including benefits, housing, debt etc. A retrospective study was conducted of all patients referred for advice during 24 months of the project. The advice workers saw 2484 patients, dealt with over 4000 welfare advice issues, and raised over pounds 2 million in welfare benefit claims for patients, primarily through disability-related benefits. The contribution of community nurses is examined in terms of referrals and outcomes for patients.
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Affiliation(s)
- Peter Greasley
- Department of Community and Primary Care, Graduate School, University of Bradford.
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Greasley P, Small N. Providing welfare advice in general practice: referrals, issues and outcomes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:249-258. [PMID: 15819746 DOI: 10.1111/j.1365-2524.2005.00557.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
General practices in the UK are increasingly hosting welfare advice services on their premises to address patients' social and economic needs. In this paper, the authors present the outcomes of a service providing welfare advice across 30 general practices in inner-city Bradford. A retrospective study of all patients referred for advice during the initial 24 months of the project was conducted. The following information was collected: patient demographics, source of referrals, advice issues raised and income generated through benefit claims. The advice workers saw 2484 patients dealing with over 4000 welfare advice issues. Demand for the service varied widely across practices, reflecting practice list size and engagement with the service by practice staff. The main source of referrals was general practitioners (28%), and disability-related welfare benefits constituted the largest category of advice issues. Sixty-nine per cent of patients seen for advice were of south Asian ethnic origin. The advice workers raised pound sterling 2,389,255 in welfare benefit claims for patients, primarily through disability-related benefits. Approximately one in four patients referred for advice benefited financially. It is concluded that the service is an excellent strategy by which primary care organisations address the social, economic and environmental influences on the health of their population.
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Affiliation(s)
- Peter Greasley
- Department of Community and Primary Care, School of Health Studies, University of Bradford, Bradford, UK.
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Watterson A. Introduction. PUBLIC HEALTH IN PRACTICE 2003. [DOI: 10.1007/978-0-230-21421-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gillam S, Schamroth A. The community-oriented primary care experience in the United kingdom. Am J Public Health 2002; 92:1721-5. [PMID: 12406792 PMCID: PMC1447317 DOI: 10.2105/ajph.92.11.1721] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The UK National Health Service has long delivered public health programs through primary care. However, attempts to promote Sidney Kark's model of community-oriented primary care (COPC), based on general practice populations, have made only limited headway. Recent policy developments give COPC new resonance. Currently, primary care trusts are assuming responsibility for improving the health of the populations they serve, and personal medical service pilots are tailoring primary care to local needs under local contracts. COPC has yielded training packages and frameworks that can assist these new organizations in developing public health skills and understanding among a wide range of primary care professionals.
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Wilkin D. Primary care budget holding in the United Kingdom National Health Service: learning from a decade of health service reform. Med J Aust 2002; 176:539-42. [PMID: 12064986 DOI: 10.5694/j.1326-5377.2002.tb04498.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2001] [Accepted: 12/21/2001] [Indexed: 11/17/2022]
Abstract
1. The United Kingdom National Health Service (NHS) has experienced 10 years of primary care budget holding in a variety of forms. 2. Half of all general practitioners had joined the GP fundholding scheme by 1997, and many others had joined broader GP commissioning groups, but fundholders controlled only about 20% of the budget for hospital and community health services. 3. Research on fundholding and commissioning groups suggests that delegation of budgets produced some gains in the range and effectiveness of services, but also had significant management costs and inequities. 4. From 1999, all primary care professionals joined Primary Care Groups, which are now becoming Primary Care Trusts (PCTs). PCTs will control three-quarters of the healthcare budget and provide all primary and community services as well as commissioning hospital care. 5. Control of a unified healthcare budget presents opportunities to improve quality, increase integration of services, reduce inequities and improve health. However, PCTs are threatened by a growing gap between capacity and expectations, and by continuing tension between devolution of power and increasingly prescriptive management by central government.
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Affiliation(s)
- David Wilkin
- National Primary Care Research and Development Centre, University of Manchester, 5th Floor, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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Stange KC. The best of times and worst of times. Br J Gen Pract 2001; 51:963-6. [PMID: 11766867 PMCID: PMC1314187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Glendinning C, Coleman A, Shipman C, Malbon G. Progress in partnerships. BMJ (CLINICAL RESEARCH ED.) 2001; 323:28-31. [PMID: 11440941 PMCID: PMC34330 DOI: 10.1136/bmj.323.7303.28] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C Glendinning
- National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL.
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