Statewide hearings on the reauthorization of the Rehabilitation Act, Universal Health Care and Personal Assistance : summary report /

"Spring, 1992."

Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.

Despite major improvements in access to liver transplantation (LT), disparities remain. Little is known about how distrust in medical care, patient preferences, and the origins shaping those preferences contribute to differences surrounding access. We performed a single-center, cross-sectional survey of adults with end-stage liver disease and compared responses between LT listed and nonlisted patients as well as by race. Questionnaires were administered to 109 patients (72 nonlisted; 37 listed) to assess demographics, health care system distrust (HCSD), religiosity, and factors influencing LT and organ donation (OD). We found that neither HCSD nor religiosity explained differences in access to LT in our population. Listed patients attained higher education levels and were more likely to be insured privately. This was also the case for white versus black patients. All patients reported wanting LT if recommended. However, nonlisted patients were significantly less likely to have discussed LT with their physician or to be referred to a transplant center. They were also much less likely to understand the process of LT. Fewer blacks were referred (44.4% versus 69.7%; P = 0.03) or went to the transplant center if referred (44.4% versus 71.1%; P = 0.02). Fewer black patients felt that minorities had as equal access to LT as whites (29.6% versus 57.3%; P < 0.001). For OD, there were more significant differences in preferences by race than listing status. More whites indicated OD status on their driver's license, and more blacks were likely to become an organ donor if approached by someone of the same cultural or ethnic background (P < 0.01). In conclusion, our analysis demonstrates persistent barriers to LT and OD. With improved patient and provider education and communication, many of these disparities could be successfully overcome. Liver Transplantation 22 895-905 2016 AASLD.

Paradigms in health care and its relationship to the nursing theories: an analytical test

DANTAS, Rodrigo Assis Neves; NÓBREGA, Walkíria Gomes da; MORAIS FILHO, Luiz Alves; MACÊDO, Eurides Araújo Bezerra de ; FONSECA , Patrícia de Cássia Bezerra; ENDERS, Bertha Cruz; MENEZES, Rejane Maria Paiva de; TORRES , Gilson de Vasconcelos. Paradigms in health care and its relationship to the nursing theories: an analytical test . Revista de Enfermagem UFPE on line. v.4,n.2, p.16-24.abr/jun. 2010. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista>.

Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing

The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

Paradigms in health care and its relationship to the nursing theories: an analytical test

DANTAS, Rodrigo Assis Neves; NÓBREGA, Walkíria Gomes da; MORAIS FILHO, Luiz Alves; MACÊDO, Eurides Araújo Bezerra de ; FONSECA , Patrícia de Cássia Bezerra; ENDERS, Bertha Cruz; MENEZES, Rejane Maria Paiva de; TORRES , Gilson de Vasconcelos. Paradigms in health care and its relationship to the nursing theories: an analytical test . Revista de Enfermagem UFPE on line. v.4,n.2, p.16-24.abr/jun. 2010. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista>.

Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES - Australia

OBJECTIVE: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

DESIGN: Diabetes MILES-Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (Age: M=52.1, SD=13.9) with type 1 (T1D; n=680) or type 2 diabetes (T2D; n=944), who responded to a version of the survey containing key measures.

MAIN OUTCOME MEASURES: Self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA1c, medication/insulin adherence. RESULTS: We used Preacher and Hayes' bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes <0.06).

CONCLUSION: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.

A Community Hub Approach to Older People’s Housing

Purpose. This paper explores the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach. Data is presented from the ASSET project (Adult Social Services Environments and Settings) which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings. Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public. Originality and Value. This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.

Self medication behaviors of illegal immigrants living along the U.S.-Mexico border

Mexican immigrants make up the largest subgroup of Hispanics living in the United States. The largest percentage of illegal immigrants comes from México. As such they are a subpopulation with limited access to health care and social services; their health seeking behaviors including self-medication behaviors that, aside from the intake of antibiotics, have not been studied in depth. The analysis of the data presented sought to document the medication behaviors of illegal immigrants living in El Paso County along the U.S.-México border. Of the 80 participants, 31 were taking medication on a regular basis. Of these, 28 claimed that at least one of the medications had been prescribed by a physician, 13 people had bought at least one of their medications in México, nine participants claimed that they had not paid for at least one of the medications they were taking, ten participants reported that they had skipped the doses of at least one of their medications due to monetary constraints. Participants were also asked if they had purchased medication in México during the year prior to the study, 68 of the 80 (85%) participants had bought 295 pharmaceutical products across the border themselves or through a third party. The most frequently purchased medications were antibiotics (17%), followed by syrups, pomades, creams, eardrops, and cold medicine as a group (15%), followed by analgesics (13%) and other non steroidal anti-inflammatory drugs (12%) and oral hypoglycemic agents (6%). ^

Agenda för samverkan eller verksamhetens agenda? Om professionellas erfarenheter av samverkan enligt samordnad individuell plan (SIP)

Agenda for collaboration or an agency agenda? Professionals’ experiences of colla­boration according to a coordinated individual plan (CIP) An increasing number of children and adolescents develop complex needs that require simultaneous action by different professionals. Several reports state that efforts for these children and adolescents have become increasingly specialized and fragmented. Since 2010, there are statutory requirements for collaboration according to a coordinated individual plan (SIP) between health care and social services. Pre-school and school can after regional agreement be involved in the co-ordination as equal partner. Collaboration in line with CIP is expected to offset the fragmentation for benefit of the service users’ ability to monitor and comprehend interventions. The aim was to investigate professionals’ experiences of CIP. The study consists of qualitative analysis of 12 focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. The results indicate that the participants act according to their core mission: nurturing, teaching and investigation. Two main categories with four sub-categories each appeared in the analysis. The main category, hindering factors, contains the categories: different mandates and requirements, requirements for presence initiative, questioning and censure, and timelines and prioritization. The main category of facilitating factors contains the categories: similar interpretation of common agreement, mutual respect and shared learning, common terminology and documentation, and willingness to collaborate. The analysis indicate that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument.