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O agente comunitário de saúde e a saúde mental: percepções e ações na atenção às pessoas em sofrimento mental; The community health agent and mental health: perceptions and actions in mental health people attention

Sousa, Gianne Carvalho de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: dissertação de mestrado Formato: application/pdf
Publicado em 22/05/2007 Português
Relevância na Pesquisa
66.01%
A inserção de ações da Saúde Mental no Programa Saúde da Família (PSF) é recente e está restrita a alguns locais. O conhecimento existente acerca das atividades das Equipes de Saúde Mental no PSF é escasso, assim como sobre a atuação dos Agentes Comunitários de Saúde (ACS) no âmbito da Saúde Mental. Nessa perspectiva, a presente investigação, de natureza qualitativa, teve como objetivo verificar as concepções do ACS a respeito do sofrimento mental e identificar as ações que realiza após detectar pessoas com este tipo de sofrimento no território em que desenvolve suas atividades. O estudo foi norteado pelos pressupostos da estratégia do Programa Saúde da Família, da Reforma Psiquiátrica e da Vulnerabilidade. Os dados foram coletados através de entrevistas individuais e semi-estruturadas, com doze ACS de Unidades de Saúde da Família (USF) da região sudeste do município de São Paulo. Na análise temática dos dados foram definidos dois núcleos temáticos: a compreensão do sofrimento mental e as práticas dos ACS na atenção em saúde mental do PSF. As concepções sobre sofrimento mental estão relacionadas às formas de identificação, suas causas e tratamentos. O ACS identifica as situações de sofrimento mental através de solicitações dos usuários...

Controle da tuberculose na atenção básica de saúde de Natal / RN: visão do agente comunitário; Tuberculosis control in primary health care in Natal / RN: community health agent's view

Pinto, Erika Simone Galvão
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 18/07/2011 Português
Relevância na Pesquisa
66.18%
O agente comunitário de saúde (ACS) é um ator social fundamental nas ações de controle da tuberculose (TB). Nesse estudo considerou-se à micro política voltada para prática do ACS. Objetivo do estudo: analisar segundo a visão do ACS a Busca de Sintomático Respiratório (BSR). Estudo descritivo do tipo inquérito, de forma transversal realizado em Natal, junho a setembro de 2009. População: 646 ACS do Programa de Agentes Comunitário de Saúde (PACS) / Estratégia Saúde da Família (ESF). Critérios de seleção: ACS trabalhando no período de coleta. Foram excluídos aqueles que estavam de férias, licença ou com atestados médicos. Utilizou-se amostragem de múltiplas etapas: cálculo da amostra baseado na população, partilha proporcional de acordo com a quantidade de ACS por distrito sanitário (DS) e amostragem casual simples. Prevendo-se uma taxa de não resposta de 10%, calculouse um n=108. Para coleta de dados utilizou-se um formulário aplicado aos ACS. Este compreendeu um total de 28 questões, divididas em três seções: caracterização dos ACS (08 questões), dados sobre a Estrutura das unidades de saúde (07 questões), dados sobre o Processo de atenção (13 questões). Os ACS responderam cada pergunta segundo diferentes escalas variadas de respostas: dicotômicas...

The substitutability of outpatient primary care in rural community health centers for inpatient hospital care.

Deprez, R D; Pennell, B E; Libby, M A
Tipo: text
Publicado em /06/1987 Português
Relevância na Pesquisa
66.02%
To determine whether outpatient medical care obtained at federally funded rural community health centers (CHCs) in Maine acts primarily as a substitute or as a complement to inpatient care, a study of 36 communities served by CHCs was conducted. The hospital use of CHC users (age- and sex-adjusted admissions, days, and length of stay) was compared with that of nonusers from the same communities in 1980. Statistically lower rates of hospital admissions and days were observed for all CHC patients and for selected groups based on their age, sex, and insurance status (specifically Medicaid or Medicare). Hospital use of CHC community populations was then compared with that of 24 comparison communities without access to CHCs, using multiple linear regression in a pre/post design. The model tested, which included rates of health center use, insurance penetration, poverty, and hospital availability, among other factors, did not detect any differences in hospital use between CHC community and comparison populations. These results and additional data presented on selected hospital diagnoses and insurance coverage suggest that treatment, and hospitalization incentives, of CHC providers may reduce hospitalization. Clinic providers lack the economic...

Quality of diabetes care in community health centers.

Chin, M H; Auerbach, S B; Cook, S; Harrison, J F; Koppert, J; Jin, L; Thiel, F; Karrison, T G; Harrand, A G; Schaefer, C T; Takashima, H T; Egbert, N; Chiu, S C; McNabb, W L
Tipo: text
Publicado em /03/2000 Português
Relevância na Pesquisa
66.19%
OBJECTIVES: This study assessed the quality of diabetes care in community health centers. METHODS: In 55 midwestern community health centers, we reviewed the charts of 2865 diabetic adults for American Diabetes Association measures of quality. RESULTS: On average, 70% of the patients in each community health center had measurements of glycosylated hemoglobin, 26% had dilated eye examinations, 66% had diet intervention, and 51% received foot care. The average glycosylated hemoglobin value per community health center was 8.6%. Practice guidelines were independently associated with higher quality of care. CONCLUSIONS: Rates of adherence to process measures of quality were relatively low among community health centers, compared with the targets established by the American Diabetes Association.

Challenges to Research in Urban Community Health Centers

Lemon, Stephenie C.; Zapka, Jane G.; Estabrook, Barbara; Benjamin, Evan
Fonte: © American Journal of Public Health 2006 Publicador: © American Journal of Public Health 2006
Tipo: text
Publicado em /04/2006 Português
Relevância na Pesquisa
75.97%
Community health centers (CHCs) are important settings for research aimed at reducing health disparities. However, CHCs pose many challenges to research at patient, provider, and system levels.

Trends in Mental Health and Substance Abuse Services at the Nation’s Community Health Centers: 1998–2003

Druss, Benjamin G.; Bornemann, Thomas; Fry-Johnson, Yvonne W.; McCombs, Harriet G.; Politzer, Robert M.; Rust, George
Fonte: © American Journal of Public Health 2006 Publicador: © American Journal of Public Health 2006
Tipo: text
Publicado em /10/2006 Português
Relevância na Pesquisa
75.98%
Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers.

The Perceived Financial Impact of Quality Improvement Efforts in Community Health Centers

Cheung, Karen; Moiduddin, Adil; Chin, Marshall H.; Drum, Melinda L.; Brown, Sydney E. S.; Graber, Jessica E.; Heuer, Loretta; Quinn, Michael T.; Schaefer, Cynthia T.; Schlotthauer, Amy E.; Huang, Elbert S.
Tipo: text
Publicado em //2008 Português
Relevância na Pesquisa
66.02%
We administered surveys to 100 chief executive officers (CEOs) of community health centers to determine their perceptions of the financial impact of the Health Disparities Collaboratives, a national quality improvement initiative. One third of the CEOs believed that the HDC had a negative financial impact on their health center, and this perception was significantly correlated with centers having a higher proportion of uninsured patients. Performance-based payment incentives may improve care but may also add new financial burdens to facilities that treat the uninsured population. As such, a provider’s payer mix may need to be considered in the design of QI programs if they are to be sustainable.

Trends in Mental Health and Substance Abuse Services at the Nation’s Community Health Centers: 1998–2003

Druss, Benjamin G.; Bornemann, Thomas; Fry-Johnson, Yvonne W.; McCombs, Harriet G.; Politzer, Robert M.; Rust, George
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: text
Publicado em /09/2008 Português
Relevância na Pesquisa
85.99%
Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers.

Sustaining Quality Improvement in Community Health Centers: Perceptions of Leaders and Staff

Chin, Marshall H.; Kirchhoff, Anne C.; Schlotthauer, Amy E.; Graber, Jessica E.; Brown, Sydney E.S.; Rimington, Ann; Drum, Melinda L.; Schaefer, Cynthia T.; Heuer, Loretta J.; Huang, Elbert S.; Shook, Morgan E.; Tang, Hui; Casalino, Lawrence P.
Tipo: text
Publicado em //2008 Português
Relevância na Pesquisa
66%
The Health Disparities Collaboratives (HDC) are the largest national quality improvement (QI) initiative in community health centers. This paper identifies the incentives and assistance personnel believe are necessary to sustain QI. In 2004, 1006 survey respondents (response rate 67%) at 165 centers cited lack of resources, time, and staff burnout as common barriers. Release time was the most desired personal incentive. The highest funding priorities were direct patient care services (44% ranked #1), data entry (34%), and staff time for QI (26%). Participants also needed help with patient self-management (73%), information systems (77%), and getting providers to follow guidelines (64%).

Insurance Status and Quality of Diabetes Care in Community Health Centers

Zhang, James X.; Huang, Elbert S.; Drum, Melinda L.; Kirchhoff, Anne C.; Schlichting, Jennifer A.; Schaefer, Cynthia T.; Heuer, Loretta J.; Chin, Marshall H.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: text
Publicado em /04/2009 Português
Relevância na Pesquisa
75.95%
Objectives. We sought to compare quality of diabetes care by insurance type in federally funded community health centers.

Use of Enabling Services by Asian American, Native Hawaiian, and Other Pacific Islander Patients at 4 Community Health Centers

Weir, Rosy Chang; Emerson, Heidi P.; Tseng, Winston; Chin, Marshall H.; Caballero, Jeffrey; Song, Hui; Drum, Melinda
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: text
Publicado em /11/2010 Português
Relevância na Pesquisa
75.95%
Objectives. We sought to examine the utilization and impact of enabling services, such as interpretation and eligibility assistance, among underserved Asian American, Native Hawaiian, and other Pacific Islander (AANHOPI) patients served at 4 community health centers.

Higher Yet Suboptimal Chlamydia Testing Rates at Community Health Centers and Outpatient Clinics Compared With Physician Offices

Eugene, Jeffrey M.; Hoover, Karen W.; Tao, Guoyu; Kent, Charlotte K.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: text
Português
Relevância na Pesquisa
76.11%
To assess chlamydia testing in women in community health centers, we analyzed data from national surveys of ambulatory health care. Women with chlamydial symptoms were tested at 16% of visits, and 65% of symptomatic women were tested if another reproductive health care service (pelvic examination, Papanicolaou test, or urinalysis) was performed. Community health centers serve populations with high sexually transmitted disease rates and fill gaps in the provision of sexual and reproductive health care services as health departments face budget cuts that threaten support of sexually transmitted disease clinics.

Methodological Challenges of Measuring Primary Care Delivery to Pediatric Medicaid Beneficiaries Who Use Community Health Centers

Tyo, Karen R.; Gurewich, Deborah; Shepard, Donald S.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: text
Português
Relevância na Pesquisa
75.95%
Efforts to measure quality of care have focused on ambulatory care providers. We examined the performance of community health centers serving children on Medicaid in 3 states. Descriptive analysis showed considerable patient population heterogeneity, and regression analysis demonstrated that variation explained by the assigned provider was small (mean R2?=?4.3%) compared with the variation explained by patient demographic variables (mean R2?=?29.9%). The results reinforce the need for caution when one is attributing quality differences to provider performance.

Combating Obesity at Community Health Centers (COACH): A Quality Improvement Collaborative for Weight Management Programs

Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.
Tipo: text
Publicado em //2013 Português
Relevância na Pesquisa
66%
Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs.

Ethical Considerations for Conducting Health Disparities Research in Community Health Centers: A Social-Ecological Perspective

Boutin-Foster, Carla; Scott, Ebony; Melendez, Jennifer; Rodriguez, Anna; Ramos, Rosio; Kanna, Balavenkatesh; Michelen, Walid
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: text
Português
Relevância na Pesquisa
85.98%
Community health centers (CHCs) provide optimal research settings. They serve a high-risk, medically underserved population in the greatest need of intervention. Low socioeconomic status renders this population particularly vulnerable to research misconduct.

Medicaid Managed Care: How Do Community Health Centers Fit?

Henderson, Tim; Markus, Anne Rossier
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: text
Publicado em //1996 Português
Relevância na Pesquisa
76.08%
Managed care has brought about important changes in how the health care system is financed and services delivered. The authors describe the approaches adopted by community health centers to participate in Medicaid managed care and argue that these providers, commonly referred to as providers of last resort, have a role to play in this system. Many challenges lie ahead for these centers, such as the potential imposition of Medicaid block grants, the increasing number of uninsured persons, and cuts in both Federal grants and State budgets. These various forces may adversely impact health centers, leaving them with more uninsured patients and fewer resources.

Provision of Telemedicine Services by Community Health Centers

Shin, Peter; Sharac, Jessica; Jacobs, Feygele
Fonte: University of Illinois at Chicago Library Publicador: University of Illinois at Chicago Library
Tipo: text
Publicado em 16/10/2014 Português
Relevância na Pesquisa
66.2%
The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good blood sugar control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers.

Recruitment and retention of participants in a pragmatic randomized intervention trial at three community health clinics: Results and lessons learned

Warner, Erica; Glasgow, Russell E; Emmons, Karen Maria; Bennett, Gary G; Askew, Sandy; Rosner, Bernard Alfred; Colditz, Graham A.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
66.07%
Background: Obesity and hypertension and their associated health complications disproportionately affect communities of color and people of lower socioeconomic status. Recruitment and retention of these populations in research trials, and retention in weight loss trials has been an ongoing challenge. Methods: Be Fit, Be Well was a pragmatic randomized weight loss and hypertension management trial of patients attending one of three community health centers in Boston, Massachusetts. Participants were asked to complete follow-up assessments every 6-months for two years. We describe challenges encountered and strategies implemented to recruit and retain trial participants over the 24-month intervention. We also identify baseline participant characteristics associated with retention status. Retention strategies included financial incentives, contact between assessment visits, building relationships with health center primary care providers (PCPs) and staff, and putting participant convenience first. Results: Active refusal rates were low with 130 of 2,631 patients refusing participation (4.9%). Of 474 eligible persons completing telephone screening, 365 (77.0%) completed their baseline visit and were randomized into the study. The study population was predominantly non-Hispanic Black (71.2%)...

The ADVANCE network: accelerating data value across a national community health center network

DeVoe, Jennifer E; Gold, Rachel; Cottrell, Erika; Bauer, Vance; Brickman, Andrew; Puro, Jon; Nelson, Christine; Mayer, Kenneth H; Sears, Abigail; Burdick, Tim; Merrell, Jonathan; Matthews, Paul; Fields, Scott
Fonte: BMJ Publishing Group Publicador: BMJ Publishing Group
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
66.02%
The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network (CDRN) is led by the OCHIN Community Health Information Network in partnership with Health Choice Network and Fenway Health. The ADVANCE CDRN will ‘horizontally’ integrate outpatient electronic health record data for over one million federally qualified health center patients, and ‘vertically’ integrate hospital, health plan, and community data for these patients, often under-represented in research studies. Patient investigators, community investigators, and academic investigators with diverse expertise will work together to meet project goals related to data integration, patient engagement and recruitment, and the development of streamlined regulatory policies. By enhancing the data and research infrastructure of participating organizations, the ADVANCE CDRN will serve as a ‘community laboratory’ for including disadvantaged and vulnerable patients in patient-centered outcomes research that is aligned with the priorities of patients, clinics, and communities in our network.

Comparing the implementation of team approaches for improving diabetes care in community health centers

Van der Wees, Philip J; Friedberg, Mark W; Guzman, Elena Alcala; Ayanian, John Z; Rodriguez, Hector P
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
96.19%
Background: Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. Methods: Mixed methods study with interviews and surveys of clinicians and staff participating in a study comparing the effectiveness of MA and CHW health coaching for improving diabetes care. Participants included 24 key informants in five role categories and 249 clinicians and staff survey respondents from 14 participating practices. We conducted thematic analyses of key informant interview transcripts to clarify implementation processes and describe barriers to integrating the new roles into practice. We surveyed clinicians and staff to assess differences in practice culture among intervention and control groups. We triangulated findings to identify concordant and disparate results across data sources. Results: Implementation processes and experiences varied considerably among the practices implementing CHW and MA team-based approaches...