Working in public health services in Brazil: The relationship between different rationalities

Success in a public health system is related to its ability to change its production process and to deal with general principles of the health system, such as universality and equity. The frameworks proposed by service marketing scholars have been developed primarily for private services; they focus on acceptance by the targeted client-users, and on the technical specifications of the new service delivery processes. Little attention has been given to the employees` point of view and their activities to maintain service operations modulated by innovation. In a public health system, workers make decisions in real time related to users` needs and the technical specifications of the process; therefore, it is very important to understand how the changes impact on employees` activities and on the quality delivered for citizens. This article discusses how changes implemented in Sao Paulo, Brazil impact the organizational parameters and working activities for front-line workers. (C) 2008 Elsevier Ltd. All rights reserved.

STD syndrome packets: Improving syndromic management of sexually transmitted diseases in developing countries

Objective: To design, introduce, and evaluate STD syndrome packets containing recommended drugs for each syndrome, four condoms, a partner treatment card, and a patient information leaflet, with the goal of improving sexually transmitted disease (STD) case management. Methods: Packet design evolved around available packaging technology, informed by pilot testing with nurses working in primary care clinics, doctors in private medical practices, and patients with an STD, in Hlabisa, South Africa. Evaluation 1 year later included analysis of distribution records and interviews with 16 nurses and 61 patients. Results: A cheap packet (2 U, S, cents each, excluding contents) compatible with current legislation was designed and introduced to six public sector clinics and as a short pilot to five private medical practices, Four thousand eighty-five packets were distributed to the clinics, equivalent to approximately 115% of the STDs reported over that period. All 16 nurses reported using the packets, but only 63% did so all the time because of occasional supply problems, All believed the packets improved treatment by saving time (75%), improving supply of condoms and partner cards (44%), and making treatment easier (56%), Patients also responded positively, and most said they would buy a packet (up to $5) at a pharmacy (84%) or store (63%) if available. Conclusions: The STD syndrome packets have the potential to improve STD syndromic management by standardizing therapy and improving the supply of condoms, partner cards, and information leaflets. Packets are popular with practitioners and patients, but consistent supply is essential for maximal impact, There may be scope for social marketing of the packets, which could further increase use.

Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations

There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright (C) 2002 John Wiley Sons, Ltd.

A qualitative study of Australian GPs' attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD)

Background. The importance of general practice involvement in the care of attention-deficit/hyperactivity disorder (ADHD) is increasing due to the rising numbers of patients who present with the disorder. It has been suggested by consensus bodies that GPs should be identifying and referring patients at the severe end of the ADHD spectrum and managing those with less severe symptoms. However, GPs' views of their role in ADHD care are unknown. Objective. Our aim was to explore the attitudes and practices of Australian GPs towards the diagnosis and management of ADHD. Methods. We conducted a series of focus groups to explore GPs' beliefs regarding the causes of ADHD, their perceived role in ADHD diagnosis and management and their views on the role of behaviour therapies and pharmacotherapies in ADHD management. The subjects were 28 GPs in six focus groups. Results. GPs in this study did not want to be the primary providers of care for patients with ADHD. Participants indicated a preference to refer the patient to medical specialists for diagnosis and treatment of ADHD, and expressed low levels of interest in becoming highly involved in ADHD care. Concerns about overdiagnosis and misdiagnosis of the disorder, diagnostic complexity, time constraints, insufficient education and training about the disorder, and concerns regarding misuse and diversion of stimulant medications were the reasons cited for their lack of willingness. Conclusions. The Australian GPs in this study identify a role for themselves in ADHD care which is largely supportive in nature, and involves close liaison with specialist services.

Management are aliens! Rumours during organisational change

Rumors collected from a large public hospital undergoing change were content analyzed, and a typology comprising the following five broad types of change-related rumors was developed: rumors about changes to job and working conditions, nature of organizational change, poor change management, consequences of the change for organizational performance, and gossip-rumors. Rumors were also classified as positive or negative on the basis of their content. As predicted, negative rumors were more prevalent than positive rumors. Finally, employees reporting negative rumors also reported more change-related stress as compared to those who reported positive rumors and those who did not report any rumors. The authors propose that rumors be treated as verbal symbols and expressions of employee concerns during organizational change.

Production efficiency and financing of public health: an analysis of small municipalities in the state of Sao Paulo - Brazil

This paper measured the variations in performance of small municipalities in the State of Sao Paulo, Brazil, regarding the technical efficiency in the use of public funds in public primary health care actions concerning the funding profile, in a scenario of fiscal federalism. Technical efficiency is one of the parameters of evaluation of public sector performance and was measured by means of Data Envelopment Analysis (DEA). The correlation analysis of DEA score was used to verify possible associations between technical efficiency and the funding profile of expenses with health care. The results showed that 6.41% of the municipalities were considered efficient. They also showed that the level of municipality dependence to inter-governmental general purpose grants and the national health funding specific purpose grants have negative correlation with efficiency scores.

Management Innovation at the Brazilian Superior Tribunal of Justice

We describe administrative reform involving management innovation undertaken at the Superior Tribunal of Justice, Brazil`s highest appellate court for infra-constitutional cases. The innovation is the introduction of a new management model based on strategic planning and a process management approach to work processes. Introduction of the new model has been supported by the use of information technology and project management techniques. Qualitative methods were used for data collection and analysis. Findings reveal that the innovation is contributing to the development of a systemic overview of key processes, reducing the fragmenting effects of the division of work activities within the Tribunal. At least three new organizational routines or capabilities have been developed as a result of the innovation studied: Electronic Court Management, Project Management, and Process Management. The paper contributes to knowledge about court management, a field that has received little research attention in the public administration literature.

Management of Patients With Rheumatoid Arthritis in Latin America A Consensus Position Paper From Pan-American League of Associations of Rheumatology and Grupo Latino Americano De Estudio de Artritis Reumatoide

Objective: A consensus meeting of representatives of 18 Latin-American and Caribbean countries gathered in Renaca, Chile, for 2 days to identify problems and provide recommendations for the care of patients with rheumatoid arthritis (RA) in Latin America, a region where poverty and other health priorities make the efforts to provide effective and high quality care difficult. This report includes recommendations for health professionals, patients, and health authorities in Latin America, with an emphasis oil education and therapeutic issues. Methods: Fifty-one rheumatologists (list available only online on the JCR website) from 18 Latin-American and Caribbean countries with a special interest in RA participated in the consensus meeting. Participants were experts identified and appointed by the National Societies of Rheumatology affiliated with the Pan-American League of Associations for Rheumatology (PANLAR) and by the Grupo Latino Americano De Estudio de Artritis Reumatoide (GLADAR)-an independent group of Latin American rheumatologist researchers were also invited to the meeting. Eight topics were identified as priorities: patient, community and allied health professional education, health policy and decision making, programs for early detection and appropriate treatment of RA, role of classic disease modifying antirheumatic drugs (DMARDs), role of biologic therapy, and drug safety surveillance. To reach consensus, a survey with questions relevant to the topic of interest was sent to all participants before the meeting. During a 2 day meeting, the answers of the survey were reviewed and discussed by each group, with final recommendations on action items. Results: The specific topic of the survey was answered by 86% of the participants and 68% of them answered the entire survey. It was agreed that RA and rheumatic diseases which are currently not but should be public health priorities in Latin America, because of their prevalence and impact on quality of life. Conclusions: Strategic areas identified as priorities for our region included: early diagnosis and access to care by multidisciplinary teams, creation of databases to identify infections with the use of biologic agents in RA which are relevant to Latin America, and overall efforts to improve the care of RA patients in accordance with international standards. Implementation of educational programs aimed to improve self-management for patients with RA was also considered crucial.

Improved case management and continued government investment are needed for malaria eradication in Henan Province, China

A two-year study of malaria control began in Henan Province following cuts in government malaria spending in 1993. Cost data were collected from all government levels and on treatment-seeking (diagnosis, treatment) from 12,325 suspected malaria cases in two endemic counties. The cost burden was found to fall mainly on patients, but using government infrastructure. Good stewardship requires continuing government investment, to at least current levels, along with improved case management. In mainland China, vivax malaria is a significant factor in poverty and economic underdevelopment.

Public attitudes to the use of wildlife by Aboriginal Australians: Marketing of wildlife and its conservation

Indigenous Australians have socioeconomic attributes similar to those of residents in some developing countries. Their utilisation of wildlife could add to their economic opportunities. Attitudes of a sample of the Australian public towards the subsistence use of wildlife by Indigenous Australians and whether or not they should be allowed to sell wildlife and wildlife products are examined. Allowing such possibilities could provide economic incentives for nature conservation among local people. We explore whether those sampled believe that Indigenous Australians should do more than other groups and institutions to conserve Australia's tropical species, and whether or not they should be allowed to take common as well as endangered wildlife species for food. Attitudes of the sampled public towards Indigenous Australians earning income from trophy hunting and from the harvesting of northern long-necked turtles for the pet trade are canvassed. The possible conservation consequences of sale of wildlife by Indigenous Australians are discussed.