Analyse de l'implantation d'une innovation en prévention du VIH: le dépistage rapide en milieu communautaire gai

Une équipe multidisciplinaire et intersectorielle a implanté en 2009 une recherche-intervention novatrice : Spot, un service de dépistage rapide du VIH en milieu communautaire offert aux hommes ayant des relations sexuelles avec d’autres hommes de Montréal. Une étude de cas a été menée afin de décrire le processus d’implantation de Spot et les facteurs contextuels qui l’ont affecté. L’analyse par théorisation ancrée des entrevues, l’observation participante et l’analyse documentaire ont permis d’identifier un processus d’implantation dynamique en plusieurs phases. Elles sont modulées par des facteurs liés aux motivations des acteurs à s’engager dans le projet, à la complexité des dynamiques partenariales et aux défis de la coordination en contexte d’équipe multidisciplinaire et intersectorielle et à d’autres facteurs ayant affecté l’organisation de l’équipe terrain et leurs pratiques au quotidien. Des motivations telles l’occasion unique de contribuer à la mise en place d’un projet de prévention novateur et pertinent, ont eu une influence favorable constante, ralliant les acteurs autour du projet et maintenant leur implication malgré les difficultés rencontrées. Sur le plan des dynamiques partenariales, une définition floue des rôles et tâches a ralenti l’implantation du projet, alors qu’une fois clarifiée, chacun a pu se sentir légitime et participer activement à la réussite de l’implantation. Des difficultés à la coordination du projet, entre autres concernant la gestion des fonds interinstitutionnels, sont un facteur ayant ralenti le processus d’implantation. Cette étude a permis de tirer des leçons sur l’implantation et la pérennisation d’un service de dépistage rapide du VIH en milieu communautaire gai.

Evaluation der Langzeitcompliance lebertransplantierter Patienten mit der immunsuppressiven Therapie und eines Betreuungsmodells zur intersektoralen kooperativen pharmazeutischen Betreuung durch eine Krankenhausapotheke und öffentliche Apotheken

Ein wichtiger Baustein für den langfristigen Erfolg einer Lebertransplantation ist die Compliance mit der lebenslang einzunehmenden immunsuppressiven Therapie. Im Rahmen der vorliegenden Arbeit wurde erstmals mittels MEMS® die Compliance bei lebertransplantierten Patienten untersucht, deren Transplantation einige Jahre zurücklag. Rekrutiert wurden Patienten, die vor 2, 5, 7 oder 10 Jahren (Gruppe 2 y.p.t., 5 y.p.t., 7 y.p.t., 10 y.p.t.) in der Universitätsmedizin Mainz lebertransplantiert wurden. 39 Patienten nahmen an der prospektiven Anwendungsbeobachtung teil. Die Compliance wurde mittels MEMS® über eine Beobachtungszeit von 6 Monaten erfasst. Bei der MEMS®-Auswertung war zu vermuten, dass 10 Patienten diese nicht wie vorgesehen verwendet hatten. Folglich konnten die mittels MEMS® gemessenen Compliance-Parameter nur für 29 Patienten valide ermittelt werden. Die mittlere Dosing Compliance betrug 81 ± 21 %, wobei die Gruppe 2 y.p.t. mit 86 ± 14 % bessere Werte zu verzeichnen hatte als die Gruppe 5 y.p.t. (75 ± 27 %) und 7 y.p.t. (74 ± 28 %). Die Ergebnisse waren jedoch nicht signifikant unterschiedlich (p=0,335, Kruskal-Wallis-Test). Unter Einbeziehung aller mittels MEMS® gemessenen Compliance-Parameter wurden 19 von 29 Patienten (66 %) als compliant eingestuft. Bei der Analyse der Gesamtcompliance basierend auf den subjektiven Compliance-Messmethoden (Morisky-Fragebogen, MESI-Fragebogen, Selbsteinschätzung), der Arzneimittel-Blutspiegel und der Anzahl an Abstoßungsreaktionen, in der alle 39 Patienten einbezogen werden konnten, wurden 35 Patienten (90 %) als compliant eingestuft. rnIm zweiten Teil der Arbeit wurde die Etablierung und Bewertung eines intersektoralen Pharmazeutischen Betreuungskonzepts für lebertransplantierte Patienten untersucht. Erstmals wurden anhand eines entwickelten schnittstellenübergreifenden, integrierten Betreuungskonzepts niedergelassene Apotheker in die Pharmazeutische Betreuung lebertransplantierter Patienten eingebunden. 20 Patienten wurden rekrutiert und während ihres stationären Aufenthaltes nach Transplantation pharmazeutisch betreut. Die Betreuung umfasste eine intensive Patientenschulung mit drei bis vier Gesprächen durch einen Krankenhausapotheker. Während des stationären Aufenthaltes wurden arzneimittelbezogene Probleme erkannt, gelöst und dokumentiert. Bei Entlassung stellte der Krankenhausapotheker einen Medikationsplan für den Hausarzt sowie für den niedergelassenen Apotheker aus und führte mit den Patienten ein ausführliches Entlassungsgespräch. Darüber hinaus wurden den Patienten Arzneimitteleinnahmepläne und eine Patienteninformation über ihr immunsuppressives Arzneimittel übergeben. 15 Patienten konnten daraufhin ambulant von niedergelassenen Apothekern pharmazeutisch weiterbetreut werden. Das kooperierende pharmazeutische Personal wurde durch ein eigens für die Studie erstelltes Manual zur Pharmazeutischen Betreuung lebertransplantierter Patienten geschult und unterstützt. Die niedergelassenen Apotheker sollten die Patienten in ihrer Arzneimitteltherapie begleiten, indem Beratungsgespräche geführt und arzneimittelbezogene Probleme erkannt und gelöst wurden. Die Nutzeffekte der intensiven Pharmazeutischen Betreuung konnte anhand verschiedener Erhebungsinstrumente dargelegt werden. Im Ergebnis resultierte eine hohe Zufriedenheit der Patienten und Apotheker mit dem Betreuungskonzept, die mittels Selbstbeurteilungsfragebögen ermittelt wurde. Die Compliance der Patienten wurde anhand des Morisky- und MESI-Fragebogens, der Selbsteinschätzung der Patienten, Blutspiegelbestimmungen sowie der Einschätzung durch den niedergelassenen Apotheker bestimmt. 86 % der Patienten wurden als compliant eingeordnet. Die Kenntnisse der Patienten über ihre immunsuppressive Therapie, welche anhand von Interviews erfragt wurden, lagen auf einem sehr hohen Niveau. Abschließend kann festgestellt werden, dass die Pharmazeutische Betreuung lebertransplantierter Patienten in den niedergelassenen Apotheken durchführbar ist. Anhand der Dokumentationsprotokolle lässt sich allerdings nur sehr schwer beurteilen, in welchem Maße die Betreuung tatsächlich erfolgte. Das tatsächliche vorliegen einer mangelnden Betreuung oder aber eine lückenhafte Dokumentation der Betreuungsleistung war nicht zu differenzieren. Ein limitierender Faktor für die intensivierte Betreuung ist sicherlich der erhebliche Aufwand für nur einen Patienten mit einem seltenen Krankheitsbild. Das Erkennen und Lösen von 48 ABP durch den Krankenhausapotheker und 32 ABP durch die niedergelassenen Apotheker, d. h. insgesamt 4,5 ABP pro Patient zeigt, dass die Pharmazeutische Betreuung einen wichtigen Beitrag für eine qualitätsgesicherte Arzneimitteltherapie leistet. Die intersektorale Pharmazeutische Betreuung stellt eine wesentliche Hilfe und Unterstützung der Patienten im sicheren Umgang mit ihrer Arzneimitteltherapie dar.rn

Doctor-patient communication in the medical interaction: Context, implications, and practice

Effective communication; whether from an interpersonal, mass media, or global perspective, is a critical component in public health. It is an essential conduit in increasing public awareness of available health resources, potential health hazards and related disease prevention strategies, and in delivering better health care. Within this context, available literature asserts doctor-patient communication as central to healthcare delivery. It has been shown to affect patient health outcomes, satisfaction with care, adherence to treatment recommendations, and even understanding of medical information. While research supports the essential imperative of interventions aimed at teaching doctors and patients the communication skills necessary for a successful and meaningful medical interaction, most interventions to date, focus on teaching these communication skills to doctors and seem to rely, largely, on mass media for providing patients with the information needed to increase communication efficacy. This study sought to fill a significant gap in the doctor-patient communication literature by reviewing the context of the doctor-patient exchange in the medical interaction, the implications of this exchange in resulting care of the patient, and the potential improvements to practice through interventions aimed at improving the communication exchange. Closing with an evaluation of a patient-centered communication intervention, the “How to Talk to Your Doctor” (HTTTYD) program that combines previously identified optimal strategies for improving communication between doctors and patients, this study examined the patients’ perspective of their potential as better communicators in the medical interaction. ^ Specific Aims, Hypotheses or Questions (Aim I) To examine the context of health communication within a public health framework and its relation to health care delivery. (Aim II) To review doctor-patient communication as a central focus within health care delivery and the resulting implications to patient care. (Aim III) To assess the utility of interventions to improve doctor-patient communication. Specifically, to evaluate the effectiveness of a patient-centered community education intervention, the “How to Talk to Your Doctor” (HTTTYD) program, aimed at improving patient communication efficacy.^

Cost -effectiveness of services and treatments for ambulatory dually diagnosed CMHC clients: Implications for managed care

This paper reports a cost-effectiveness analysis of standard therapeutic interventions received by ambulatory dually diagnosed clients of a Community Mental Health Center (CMHC). For the purposes of this study dually diagnosed was defined as a DSM-III-R or IV diagnosis of a major mental disorder and a concomitant substance abuse disorder. The prevalence of dually diagnosed people among the mentally ill and their unique and problematic nature continues to challenge and encumber CMHCs and poses grave public health risks. An absence of research on these clients in community-based settings and the cost-effectiveness of their standard CMHC care has hindered the development of effective community-based intervention strategies. This exploratory and descriptive effort is a first step toward providing information on which to base programmatic management decisions.^ Data for this study were derived from electronic client records of a CMHC located in a large Southwestern, Sun-belt metropolitan area. A total of 220 records were collected on clients consecutively admitted during a two-and-one-half year period. Information was gathered profiling the clients' background characteristics, receipt of standard services and treatments, costs of the care they received, and length of CMHC enrollment and subsequent psychiatric hospitalizations. The services and treatments were compared with regard to their costs and predicted contributions toward maintaining clients in the community and out of public psychiatric hospitals.^ This study investigated: (1) the study groups' background, mental illness, and substance abuse characteristics; (2) types, extent, and patterns of their receipt of standard services and treatments; (3) associations between the receipt of services and treatments, community tenure, and risk of psychiatric hospitalization; and, (4) comparisons of average costs for services and treatments in terms of their contributions toward maintaining the clients in the community.^ The results suggest that substance abuse and other lifestyle factors were related to the dually diagnosed clients' admissions to the CMHC. The dually diagnosed clients' receipt of care was associated strongly with their insurability and global functioning. Medication Services were the most expensive yet effective service or treatment. Supported Education was the third most expensive and second most effective. Psychosocial Services, the second most expensive, were only effective in terms of maintaining clients in the community. Group Counseling, the fourth most expensive, had no effect on community maintenance and increased the risk of hospitalization when accompanied by Medication Services. Individual Counseling, the least expensive, had no effect on community maintenance. But it reduced the risk of hospitalization when accompanied by Medication Services. Networking/Referral, the fifth most expensive service or treatment, was ineffective.^ The study compared the results with findings in the literature. Implications are discussed regarding further research, study limitations, practical applications and benefits, and improvements to theoretical understandings, in particular, concepts underscoring Managed Care. ^

Achieving better in-hospital and after-hospital care of patients with acute cardiac disease

In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF. Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P=0.06) and from 13.4% to 10.1% (P= 0.06) for patients with ACS and from 22.8% to 15.2% (P < 0.001) and from 32.8% to 22.4% (P= 0.005) for patients with CHF. Quality improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes.

Pharmacy and public health: examining the link between strategy and practice

Despite having been described by the then (2003) Chief Pharmaceutical Officer for England as ·probably the biggest untapped resource for health improvement", the development of the public health function of community pharmacists has been limited. However, devolution of healthcare budgets has led 10 differential rates of development of the public health function in each administration of the UK (England, Scotland, Wales and Northern Ireland). This is measured and reflected upon in this thesis. Two large-scale surveys were conducted, one of key strategic personnel (Directors of Public Health and Chief Pharmacists) in Primary Care Organisations (PCOs) and one of practicing community pharmacists. This research highlights the fact that community pharmacists have developed an individualistic, service-based approach to their engagement with public health that is contrary to the more collective approach adopted by the wider public health movement. The study measures the scope and level of health-improving services through community pharmacy across the UK and shows that the nature of the pharmacy contractor (independent, multiple etc.) may impact on the range and nature of services provided. Survey data also suggest that attitudes towards pharmacy involvement in the public health agenda vary markedly between Directors of Public Health, PCO Chief Pharmacists, and community pharmacists. Furthermore, within the community pharmacist population, attitudes are affected by a wide range of factors including the nature of employment (owner, employee, self-employed) and the type of employing pharmacy (independent, multiple etc.). Implications for policy and areas for further research aimed at maximising the public health function of community pharmacists are suggested.

The potential for pharmacists to manage children attending emergency departments

AIM: There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0-16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training. METHOD: A prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases-age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP-cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training-cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only-cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group. RESULTS: 1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0-16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60. CONCLUSION: Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.

Medication review of children on long term medications:a review of the literature

INTRODUCTION: Children on long term medication may be under the care of more than one medical team including the patients GP. Children on chronic medication should be supported and their medications reviewed, especially in cases of polypharmacy. Medicines Use Reviews (MURs) were introduced into the pharmacy contract in 2005. The service was designed for community pharmacists to review patients on long term medication. The service specified that MURs were done on patients who can give consent and cannot be conducted with a parent or carer. Hence the service may be inaccessible to paediatric patients. This review aims to find studies that identify medication review services in primary care that cater for children on long term medication. METHODS: A literature search was conducted on 6th June 2015 using the keywords, ("Medication" or "review" or "Medication Review" or "Medicines use review" or "Medication use review" or "New Medicine Service") AND ("community pharmacy" OR "community pharmacist" OR "primary care" OR "General practice" OR "GP" OR "community paediatrician" OR "community pediatrician" OR "community nurse"). Bibliographic databases used were AMED, British Nursing Index, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO and Health Business Elite. Inclusion criteria were: paediatric specific medication review in primary care, for example by either a GP, community paediatrician, community nurse or community pharmacist. Exclusion criteria were studies of medication review in adults/unclear patient age and secondary care medication reviews. RESULTS: From the 417 articles, 6 relevant articles were found after abstract and full text review. 235 articles were excluded after title and abstract review (11 did not have full text in English); 96 were adult or non-age specified medication review/MUR/New Medicine Service studies; 63 referred to observational, evaluative studies of interventions in adults; 6 were non-paediatric specific systematic reviews and 17 were protocols, commentaries, news, and letters.The 6 relevant articles consisted of 1 literature review (published 2004), 3 research articles and 1 published protocol. The literature review[1] recommended that children's long term medication should be reviewed. The published protocol stated that the NMS minimum age for inclusion in the trial was for children aged over 13 years of age. The four studies were related to psychiatrists reviewing paediatric mental health patients in the USA, a pharmacist using Drug Related Problem to review patients in GP practices in Australia, a UK study based on an information prescription concept by providing children dispensed medications in community pharmacy with signposting them to health information and one GP practice based study observing pharmaceutical care issues in children and adults. CONCLUSION: The results show that there are currently no known studies on medication use reviews specific to children, whereas in adults, published evaluations are available. The terms of the MUR policy restrict children's access to the service and so more studies are necessary to determine whether children could benefit from such access.

Professional development programs in health promotion : tools and processes to favor new practices

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children’s vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde’s (Une grille d’analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297– 312, 2010) analytical grid to assess deductively the program participants’ use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants.

Promoting oral health in adults with learning disability

Introduction: It is complex to define learning disabilities, there is no single universal definition used; there are different interpretations and definitions used for learning disabilities in different countries and communities. Primarily, the term “learning disability” sometimes used as “learning difficulties” is a term widely used in UK. There are various types and degree of severity of learning disabilities depending upon the extent of disorder. Though different definitions used all over the world, its types and classification coupled with their health and oral health needs are discussed in this review. Objectives:  To review the background literature on definitions of learning disabilities and health needs of this population.  To review literature on individual clinical preventive intervention to determine the effectiveness in promoting oral health amongst adults in learning disabilities.  To review literature in relation to community based preventive dental measures.  To determine the interventions in this areas are appropriate to support policy and practice and if these interventions establish good evidence to suggest that the oral health needs of adults with learning disabilities are met or not.  To make recommendations in implementing future preventive oral health interventions for adults with learning disabilities. Methodology: It was develop a comprehensive narrative synthesis of previously published literature from different sources and summarizes the whole research in a particular area identifying gap of knowledge. It provides a broad perspective of a subject and supports continuing education. It also is directed to inform policy and further research. It is a qualitative type of research with a broad question and critical analysis of literature published in books, article and journals. The research question evaluated on PICOS criteria is: Effectiveness of preventive dental interventions in adults with learning disabilities. The research question clearly defines the PICOS i.e. participants, interventions, comparison, outcome and study design. The Cochrane database of systematic reviews (CDSR), Database of Abstracts of Reviews of effects (DARE) through York University and National institute of Health and Clinical Excellence (NICE) was searched to identify need of this review. There was no literature review found on the preventive dental interventions found hence, justifying this review. The guidance used in this review is from York University and methods opted for search of literature is based on the following: Type of participants, interventions, outcome measure, studies and search. The review of literature; author search; systematic and narrative reviews, through the following electronic databases via UFP library services: Pub-Med, Medline, EMBASE, CINHAL, Google scholar; Science Direct; Social and Medicine. A comprehensive search of all available literature from 1990-2015, including systematic reviews, policy documents and some guideline documents was done. Internet resource used to access; Department of Health, World Health Organization, Disability World, Disability Rights Commission, the Stationery office, MENCAP, Australian Learning Disability Association. The literature search was carried out with single word, combined words and phrases, authors' names and the title of literature search. Results: It is primarily looking at the oral health interventions available for adults with learning disabilities in clinical settings and the community measures observed over a period of 25 years 1990-2015. There were 7of the clinical intervention studies and one community based intervention study was added in this review. Conclusion: There is a gap of knowledge identified in not having ample research in the area of preventive dental interventions in adults with learning or intellectual disabilities and there is a need of more research, studies need to be of a better quality and a special consideration is required in the community settings where maintenance of oral hygiene for this vulnerable group of society is hugely dependent on their caregivers. Though, the policy and guideline directs on the preventive dental interventions of adults with LD there still a gap evident in understanding and implication of the guidance in practice by the dental and care support team. Understanding learning disabilities and to identify their behavior, compliance and oral health needs is paramount for all professionals working with or for them at each level.

Cell phone–based health education messaging improves health literacy.

Background: The ubiquity of cell phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention and health education. Objective: To explore the use of cell phone–based health education SMS to improve the health literacy of community residents in China. Methods: A multi-stage random sampling method was used to select representative study communities and participants ≥ 18 years old. Intervention participants were sent health education SMSs once a week for 1 year and controls were sent conventional, basic health education measures. Health literacy levels of the residents before and after the intervention were evaluated between intervention and control groups. Results: Public health literacy scores increased 1.5 points, from 61.8 to 63.3, after SMS intervention for 1 year (P<0.01); the increase was greater for males than females (2.01 vs. 1.03; P<0.01) and for Shenzhen local residents than non-permanent residents (2.56 vs. 1.14; P<0.01). The frequency of high health literacy scores was greater for the intervention than control group (22.03% to 30.93% vs. 22.07% to 20.82%). With health literacy as a cost-effective index, the cost-effectiveness per intervention was 0.54. Conclusion: SMS may be a useful tool for improving health literacy.

Professional development programs in health promotion : tools and processes to favor new practices

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children’s vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde’s (Une grille d’analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297– 312, 2010) analytical grid to assess deductively the program participants’ use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants.

Relatório de Estágio - Escola Secundária Mouzinho da Silveira, Escola Secundária de São Lourenço e Escola Superior de Saúde de Portalegre

Com a elaboração deste relatório, pretende-se descrever as ações por nós desenvolvidas no estágio do Curso de Mestrado em Enfermagem - Especialização em Enfermagem Comunitária, as quais se realizaram na Escola Secundária Mouzinho da Silveira, na Escola Secundária de São Lourenço e ainda na Escola Superior de Saúde de Portalegre. Na Escola Secundária Mouzinho da Silveira foi aplicado um questionário a 264 alunos de 8º ano, 9º ano, 10º ano e uma turma de CEF, para fazer o diagnóstico de situação daquela comunidade escolar relativamente à sexualidade, para tal foi estabelecido um projeto de trabalho entre esta escola e a Escola Superior de Saúde de Portalegre, no sentido de privilegiar a Área da Educação para a Saúde – Sexualidade na Adolescência. Foi elaborado um projeto de intervenção comunitária, tendo por base o planeamento em saúde, onde foram definidas prioridades, fixaram-se objetivos, selecionaram-se estratégias, fez-se uma preparação da execução, executou-se e avaliou-se a intervenção. Nesta intervenção foram realizadas várias sessões de Educação para a Saúde, onde falamos sobre vários temas, todos eles ligados à Sexualidade. Esta intervenção estendeu-se também a duas turmas da Escola Secundária de São Lourenço. A outra área de intervenção comunitária teve lugar na Escola Superior de Saúde de Portalegre e contou com 317 alunos do 9º ano e 12º ano da área ciências e tecnologia do Concelho de Portalegre, tendo sido realizadas várias sessões de educação para a saúde, sessões essas interativas, onde se falou de Suporte Básico de Vida, se aprendeu a avaliar a tensão arterial, o índice de massa corporal e falamos ainda sobre hábitos de vida saudáveis É na adolescência, que se adquirem hábitos e comportamentos saudáveis. Assim, os profissionais de saúde, conjuntamente com a escola, a família e a comunidade envolvente, poderão ter um papel preponderante, capacitando os jovens de competências que lhes permitam optar por comportamentos saudáveis, a nível de alimentação, álcool, uso de drogas, prevenção de infeções sexualmente transmissíveis, gravidez e cidadania, sendo a escola um lugar de excelência para tal capacitação.

Relatório de Estágio de Enfermagem Comunitária

O envelhecimento da população é um dos maiores triunfos da humanidade e também um dos nossos grandes desafios. O envelhecimento é um processo inevitável e irreversível, começa na conceção e continua até ao final da vida. Tal como a saúde a velhice vai-se construindo ao longo da vida através de estilos de vida saudáveis e de um envelhecimento ativo. Assim a educação para a saúde adota um papel fundamental permitindo ao enfermeiro orientar e capacitar o idoso, a família e comunidade da sua competência em gerir a sua própria independência e a sua qualidade de vida. Com base nestes princípios efetuámos o nosso estágio de intervenção na freguesia da Tramaga no período de 16 de Setembro de 2013 a 31 de Janeiro de 2014. Este relatório pretende descrever, analisar e avaliar as atividades planeadas e desenvolvidas durante o estágio. O Diagnóstico de Saúde da população com 65 ou mais anos de idade, levado a cabo na freguesia da Tramaga, permitiu a identificação de problemas e necessidades desta população, direcionando as nossas intervenções para minimização dos mesmos e capacitação de grupos e comunidade na sua resolução. Para a elaboração deste trabalho recorreu-se à metodologia de planeamento em saúde e sessões de educação para a saúde (baseadas na Teoria da Organização Comunitária). Este Estágio de Intervenção permitiu-nos adquirir as competências específicas do Enfermeiro Especialista em Enfermagem Comunitária e de Saúde Pública definidas pela Ordem dos Enfermeiros

Barreiras e facilitadores à prática do acompanhamento farmacoterapêutico nos serviços farmacêuticos hospitalares portugueses

Objectivos: Identificar e compreender as barreiras e os facilitadores à prática do Acompanhamento Farmacoterapêutico (AFT) nos serviços farmacêuticos hospitalares portugueses. Método: Estudo qualitativo mediante realização de entrevistas semi-estruturadas a farmacêuticos hospitalares com e sem experiência no AFT e análise de conteúdo, retroactiva e temática. Resultados: Estrutura dos serviços farmacêuticos: barreiras (1) falta de tempo, organização das actividades orientadas para a logística, instabilidade dos recursos humanos, barreiras físicas à comunicação, relações em divergência; facilitadores (2) reestruturação, trabalho em equipa. Farmacêutico: (1) resistência à mudança, qualificação inadequada; (2) atitude positiva, legitimação, formação. Meio externo: (1) falta de apoio institucional, relacionamento com o doente, o médico e farmacêutico comunitário, ensino inadequado; (2) apoio institucional, procura do doente, cooperação com o médico e o farmacêutico comunitário, ensino adequado. Tecnologia: (1) acesso aos dados clínicos e a informação, método inadequado; (2) acesso à informação, método adequado, documentação, informatização, marketing, boas práticas. Conclusão: As entrevistas semi-estruturadas fornecerem uma visão ampla, detalhada e pragmática dos potenciais determinantes de uma prática generalizada do AFT nos serviços farmacêuticos hospitalares portugueses. /ABSTRACT: Objectives: To identify and understand the barriers and facilitators for the practice of Medication Therapy Management (MTM) in portuguese’s hospital pharmacy. Method: Qualitative study trough semi-structured interviews with MTM experienced and inexperienced hospital pharmacists followed by retroactive content and thematic analysis. Results: Structure of hospital pharmacy: barriers (1) lack of time, activities focused on logistics, instability of human resources, physical barriers to communication, divergent relationships; facilitators (2) restructuring, teamwork. Pharmacist: (1) resistance to change, inadequate skills, (2) positive attitude, legitimating, formation. Environment: (1) lack of institutional support, relationship with patient, physician and community pharmacist, inadequate teaching, (2) institutional support, patient's demand, cooperation with physician and community pharmacist, appropriate teaching. Technology: (1) lack of access to clinical data and information, inadequate method, (2) access to information, appropriate method, documentation, computerization, marketing, good pharmacy practices. Conclusion: The semi-structured interviews provide a broad, comprehensive and pragmatic view of potential determinants for wide practice of MTM in Portuguese’s hospital pharmacy.