Health service planning
Discuss about the Health Service And Intervention Program.
Purpose of the work: The objective of this paper is to detect the effectiveness of the hospital based care interventions in the improvement of the quality of care for the children with disabilities or with special health care needs.
The main intervention program that has been evaluated in this paper were mainly hospital based, community based. 17 programs involved multidisciplinary teams, 15 programs were education based providing awareness for a particular disease or health maintenance information, parenting skills. The outcomes were then evaluated. (1% of the programs evaluated the effectiveness of the health care provided to the patient. For example a program that focused n sickle cell anemia found that the respondents in the intervention group faced less adverse crisis.
73 % of the programs evaluated the efficacy of care and found that health programs brought about reduced hospital stay, reduction of cost and lesser hospital readmissions.
48 % of the programs contributed to the increase of the family centeredness by giving education regarding the parenting issues, their ability to care for their child. three programs were found to be associated with the increase of the patient safety and un-delayed referrals. In a word most of the studies indicated towards the positive outcome in child care.
There are several limitations of this review that is the studies were heterogeneous having varied definitions interventions, designs and outcome measures. Many of the studies had no comparison groups making the chance of the confounding bias high. Another limitation is the confinement of the search strategy to the English language studies.
The implication of this study is that, in spite of the presence of a large number of literary sources very little can be known about the comprehensive system of care that provides the scope of more research. Other areas to be focused on are reduction of the health care costs and introduction of the new technologies.
Purpose of the work: Purpose of the work: The purpose of this paper is to report and evaluate the short term outcomes of a program supporting the chronic disease management in the remote community. One in the Top end Northern Territory and two aboriginal medical services in Western Australia. The paper also aims to discuss the implications of the findings after the chronic disease management program.
Summary: Programs were mainly centered round the health care worker and involved regular screening of the adults for the presence of any chronic diseases. Rigorous documentations were made regarding the rates of the hypertension, diabetes and renal diseases. The program was done mainly for the middle age adults. Adherence to the protocols improved after the health care program. Individuals were motivated to take part in the screening procedures. Interventions brought about better outcomes in the hypertensive patients.
Analysis of hospital and community-based intervention programs
In the NT communities the rates of diabetes hypertension and renal diseases were calculated. It was found that the hypertension and the renal diseases were common in younger age while diabetes was seen to be appearing in the age old adults. Diabetes was found to be 3 to 8 times higher in the aboriginals, 2.5 to 5.3 fold increases in proteinuria and 10 fold increases in diabetes.
In the NT communities the compliance with the protocol was found to be increased with time. The intervention program was associated with the proper diagnosis of the chronic condition, adherence to the treatment and awareness to the self management of the disease.
The implication for this program is that it could show that most of the aboriginals in the remote areas actually need attention by the early or the mid-adult life and that regular screening is extremely necessary to check the chronic conditions such as diabetes. The program also indicated towards the physical, mental and the economical burden caused by the chronic disease.
Some of the limitations of the program were limited resources and lack of funding. The overpowering barrier to the productivity was found to be due to absenteeism in the workers. Only 40 % of the work was achieved. The follow up visits, the confirmation of the diagnosis and up titrating of the treatment were severely delayed due to the lack of work force.
Purpose of the work: This paper aims to define the type of core services required by the population of the remote Australia that can be provided by a resident health care professional along with the possible implementation issues related to that.
Summary: The health status of the rural Australia is mainly due to the disparities in the health care facilities as compared to the other developed regions of Australia. In order to address what core services are required for a remote Australia, a Delphi method was constructed with primary care expertise in rural health. The study helped to find out the percentage of population or the particular areas that required PHC. The main recommendations included consideration of the social determinants of health, equity in health care, reduction of the health care costs prioritization of the services as per the needs.
Analysis: The Delphi study brought forward some of the core primary health care services such as the 24 hour care including evacuation, immunization, pathology, radiology services, provision for the essential drugs, patient advocacy, alcohol and substances abuse treatment, maternal and child health, sexual and reproductive health, palliative care, psychiatry and proper advocacy for family planning.
Short-term outcomes of chronic disease management program
It was found that the population threshold for the requirements of the primary health care services was more in the remote areas of Australia than the rural areas. For example the population for the mental health in the remote communities were found to be between 101- 500 and that of the rural part was between 500- 1000. The policy makers face difficulties in ensuring the equal access of the health care to the communities due to insufficient workforce, lack of local community services, inadequate infrastructure, distance and high costs. Importantly the population threshold for all the PHC was found to be higher in the rural communities compared to that of the remote communities.
Some of the limitations involving the Delphi study were the selection bias, the low response rates and the iterations. The validity of the results cannot be guaranteed as there were no rules for the number of panelists.
The main implication of this study is that the research can be helpful for the policy makers and the service planners for determining the population threshold at which the primary care services should be provided more equably at all the strata of the community.
Purpose of the work: The paper provides an insight of the advance care planning program, known as Respecting Patient Choices programs. This paper will focus on the lessons learnt from the implementations and identify the strategies for fostering sustainability of the advanced care planning.
Summary: An advanced care planning program was introduced in 17 residential aged care facilities, situated in the metropolitan Melbourne, Australia. The programmed aimed at educating the aged care staffs and adopted policies and provisions for a systematic organizational change. The main objective of this health care program is to ensure that the aged clients get the comprehensive care and have opportunities for future health care.
The main implementation guidelines of the health care program involved organizational support, development of the implementation plan, documentation of the medical records, staff handover, on transfer to the hospitals, staff support and education, promotion evaluation and sustainability.
The key lessons that were learnt from this acute care programs are that good governance is extremely important for a successful ACP. There should be someone looking after the day to day running of the organization. Another factor is the accumulation of certain mass of people who actually understand the ACP. In order to achieve this first step that was taken was to provide appropriate education to the staff and clients and the general population about the importance of the ACP. Variety of education strategies should be used for staff teaching including the role play, case studies and problem solving scenarios. Choice and decision making should be the core part of the ACP. The aged clients should be educated by various means.
Defining core services for remote Australia
The major implication of this program is that an acute care program has helped the residents to enhance their decision making skills for their future health care. The program had been successful in determining some of the essential steps that needs to be incorporated in such kinds of health care programs, such as the governmental structure, the educational process, the residence documentation, quality of the audit and intercommunication between the organizations. If these factors are not addressed then any ACP are bound to fail.
Purpose of the work- The main purpose of this paper is to evaluate the population based employment program and its clinical outcomes in managing the Type 2 diabetes mellitus in the primary care settings
Summary- A random sample of 1,141 patients suffering from T2DM was enrolled to participate in the PEP between March 2010 and September 2010, from a general outpatient clinic, inpatient admissions and emergency department. The impact the PEP was then measured by using the generalized estimation models. It was found that the PEP groups were successful in improving the quality of the diabetic care in clinical settings.
Analysis- It was found that PEP made a significant reduction of HbA1c level in the patient. The study have shown that the effect of the PEP on the health service utilization can be complex, such as patients participating in PEP will get more aware of the complications in diabetes, leading to high demands of the specialized care. Some of the strategies taken up by the education program were- coupling of the diabetic management strategies with the behavioral strategies, addressing the social, medical and the emotional requirements of the patient. PEP improved the, LDL-C control although much benefit in the control of the blood pressure was not found.
The implication of this study is that ha study could identify the impact of the PEP in the real world setting. The strength of the study is that a large number of participants were involved in the study. PEP program could prove that it is possible to integrate NGO services in the community for providing a community based care to the individual.
The limitations of this study are that the patient who participated in the study might be those people who were motivated from the beginning in seeking the support. Secondly some of the participants might have been receiving the co interventions like the multi0disciplinary risk assessment and management program. Thirdly the controls may not match with all the potential confounders.Purpose of the work- This report is to understand the effectiveness of a new modeling approach to assess the cost effectiveness of the obesity project and its implication in the obesity prevention interventions in adolescents and children.
Lessons learnt from advanced care planning program
Summary- Nontraditional epidemiological study designs were taken for determining the health benefits of the obesity project n the body mass index, the disability adjusted life years. Different health benefits were considered but the greatest health benefit that was identified was likely to be achieved by the reduction of the TV advertising of sweetened beverages to children and school based multifaceted program.
Analysis- 22 potential interventions were taken in to consideration from the government programs, literature and current initiatives. DALYs, disability adjusted life years saved over the lifetime of a child was taken as the measure of the health gain for the project. The change in the BMI after the interventions was measured to identify the effectiveness of the interventions. The ACE obesity modeling helps in painting a broader picture of the priorities for the interventions. It is expected that the modeling will be improved and sophisticated for including the attributable burden and the risk factors.
The ACE obesity approach aims to provide the information to the decision makers and the paper provides a key methodological approach and the potential health benefits related to the standard.
The greatest limitation is the assumption that 100 % of the BMI benefit is maintained over the life time. Another limitation is that the effects of the disease in the adolescent and child hood were not included.
References
Blackford, J., Strickland, E. and Morris, B., 2007. Advance care planning in residential aged care facilities. Contemporary Nurse, 27(1), pp.141-151.
Cohen, E., Jovcevska, V., Kuo, D.Z. and Mahant, S., 2011. Hospital-based comprehensive care programs for children with special health care needs: a systematic review. Archives of pediatrics & adolescent medicine, 165(6), pp.554-561.
Haby, M.M., Vos, T., Carter, R., Moodie, M., Markwick, A., Magnus, A., Tay-Teo, K.S. and Swinburn, B., 2006. A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project. International journal of obesity, 30(10), p.1463.
Hoy, W.E., Davey, R.L., Sharma, S., Hoy, P.W., Smith, J.M. and Kondalsamy?Chennakesavan, S., 2010. Chronic disease profiles in remote Aboriginal settings and implications for health services planning. Australian and New Zealand journal of public health, 34(1), pp.11-18.
Thomas, S.L., Wakerman, J. and Humphreys, J.S., 2015. Ensuring equity of access to primary health care in rural and remote Australia-what core services should be locally available?. International journal for equity in health, 14(1), p.111.
Wong, C.K., Wong, W.C., Lam, C.L., Wan, Y.F., Wong, W.H., Chung, K.L., Dai, D., Tsui, E.L. and Fong, D.Y., 2014. Effects of Patient Empowerment Programme (PEP) on clinical outcomes and health service utilization in type 2 diabetes mellitus in primary care: an observational matched cohort study. PLoS One, 9(5), p.e95328.
In the NT communities the rates of diabetes h
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