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[PMID]:29472238
[Au] Autor:Guthrie B; Mercer SW
[Ad] Endereço:Population Health Sciences Division, University of Dundee, Dundee, UK b.guthrie@dundee.ac.uk.
[Ti] Título:Divided we fall: the commodification of primary medical care.
[So] Source:BMJ;360:k787, 2018 02 22.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Mercantilização
Atenção Primária à Saúde
[Mh] Termos MeSH secundário: Inglaterra
Seres Humanos
Medicina Estatal
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180224
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k787


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[PMID]:29462144
[Au] Autor:Schriver M; Cubaka VK; Itangishaka S; Nyirazinyoye L; Kallestrup P
[Ad] Endereço:Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
[Ti] Título:Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study.
[So] Source:PLoS One;13(2):e0189844, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. AIM: To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. DESIGN: Qualitative, exploratory study. DATA: Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. RESULTS: Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. CONCLUSION: While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.
[Mh] Termos MeSH primário: Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Grupos Focais
Seres Humanos
Pesquisa Qualitativa
Ruanda
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189844


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[PMID]:29364960
[Au] Autor:McCarthy K; Fielding K; Churchyard GJ; Grant AD
[Ad] Endereço:The Aurum Institute; Johannesburg, South Africa.
[Ti] Título:Empiric tuberculosis treatment in South African primary health care facilities - for whom, where, when and why: Implications for the development of tuberculosis diagnostic tests.
[So] Source:PLoS One;13(1):e0191608, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The extent and circumstances under which empiric tuberculosis (TB) treatment (treatment without microbiological confirmation at treatment initiation) is administered in primary health care settings in South Africa are not well described. METHODS: We used data from a pragmatic evaluation of Xpert MTB/RIF in which persons undergoing TB investigations by PHC nurses were followed for six months. Following Xpert or smear-microscopy at enrolment, investigations for tuberculosis were undertaken at the discretion of health care workers. We identified persons whose TB treatment was initiated empirically (no microbiological confirmation at time of treatment initiation at a primary health care facility) and describe pathways to treatment initiation. RESULTS: Of 4665 evaluable participants, 541 persons were initiated on treatment of whom 167 (31%) had negative sputum tests at enrolment. Amongst these 167, the median number of participant visits to health care providers prior to treatment initiation was 3 (interquartile range [IQR] 2-4). Chest radiography, sputum culture or hospital referral was done in 106/167 (63%). Reasons for TB treatment start were: 1) empiric (n = 82, 49%); 2) a positive laboratory test (n = 49, 29%); 3) referral and treatment start at a higher level of care (n = 28, 17%); and 4) indeterminable (n = 8, 5%). Empiric treatment accounted for 15% (82/541) of all TB treatment initiations and 1.7% (82/4665) of all persons undergoing TB investigations. Chest radiography findings compatible with TB (63/82 [77%]) were the basis for treatment initiation amongst the majority of empirically treated participants. Microbiological confirmation of TB was subsequently obtained for 11/82 (13%) empirically-treated participants. Median time to empiric treatment start was 3.9 weeks (IQR 1.4-11 weeks) after enrolment. CONCLUSION: Uncommon prescription of empiric TB treatment with reliance on chest radiography in a nurse-managed programme underscores the need for highly sensitive TB diagnostics suitable for point-of-care, and strong health systems to support TB diagnosis in this setting.
[Mh] Termos MeSH primário: Antituberculosos/uso terapêutico
Atenção Primária à Saúde
Tuberculose/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
África do Sul
Tuberculose/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antitubercular Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191608


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[PMID]:29236902
[Au] Autor:Zanin LE; Albuquerque IMN; Carneiro MDSM; Melo DH
[Ad] Endereço:Universidade Federal do Ceará - UFC - Sobral (CE), Brasil.
[Ti] Título:Evaluation of speech-language pathology care in the family health strategy from user perspective.
[Ti] Título:Avaliação da assistência fonoaudiológica na estratégia de saúde da família pela perspectiva do usuário..
[So] Source:Codas;29(6):e20160192, 2017 Dec 07.
[Is] ISSN:2317-1782
[Cp] País de publicação:Brazil
[La] Idioma:por; eng
[Ab] Resumo:PURPOSE: To evaluate the satisfaction of users assisted by speech-language pathologists during their Multi-professional Residency in Family Health, considering the structural, organizational and relational categories. METHODS: Qualitative assessment conducted with 30 Family Health Strategy (FHS) users. Data were analyzed using Bardin's content analysis. RESULTS: The organizational category presented aspects associated with the organization of speech-language pathology (SLP) services, describing the specific practice and role of speech-language therapists in the FHS, as well as referral and waiting time for care, speech-language therapy actions, clarification of problems, and promotion of self-care. The relational category showed the relationship between residents and users, with emphasis on humanized care and bonding. The structural category described the dimensioning of speech-language pathologists in the FHS and the aspects related to the resources available in the health unit. CONCLUSION: User satisfaction was associated with the rapid access to the service and the humanized care provided by the residents, promoting a welcoming service and bonding between residents and community. User dissatisfaction was associated with the reduced number of speech-language pathologists available at FHS.
[Mh] Termos MeSH primário: Saúde da Família
Satisfação do Paciente
Patologia da Fala e Linguagem
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Brasil
Seres Humanos
Atenção Primária à Saúde
Garantia da Qualidade dos Cuidados de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28463868
[Au] Autor:Tacy RM; Donaworth S; Ballman K
[Ad] Endereço:Thomas More College, Crestview Hills, Kentucky, (Dr Tacy); and University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Donaworth and Ballman).
[Ti] Título:Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department.
[So] Source:Adv Emerg Nurs J;39(2):123-140, 2017 Apr/Jun.
[Is] ISSN:1931-4493
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project. The Guideline for the Evidence-Informed Primary Care Management of Low Back Pain from the National Guideline Clearinghouse is introduced. Interprofessional collaboration for immediate referrals was implemented. The plan-do-study-act model was applied with descriptive analysis of the data. Reflective of established specific aims of the project, there was increased (1) support for the use of evidence-based practice guideline among the ED providers and staff, (2) use of evidence-based practices, (3) connection of patients to community resources, (4) evidence-based education for patients, and (5) overall satisfaction with pain management. The effectiveness of the application of this primary care guideline in the ED opens the way both for region-wide application of the guidelines and for the introduction of other primary care practice guidelines for patients who present to the ED with other chronic conditions.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Dor Lombar/terapia
Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Doença Crônica
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/TME.0000000000000144


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[PMID]:28460606
[Au] Autor:Hughes BO; Moshabela M; Owen J; Gaede B
[Ad] Endereço:a Centre for Rural Health , University of KwaZulu-Natal , Durban , South Africa.
[Ti] Título:The relevance and role of homestays in medical education: a scoping study.
[So] Source:Med Educ Online;22(1):1320185, 2017.
[Is] ISSN:1087-2981
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The community-based medical education curriculum is growing in popularity as a strategy to bring universal health coverage to underserved communities by providing medical students with hands-on training in primary health care. Accommodation and immersion of medical students within the community will become increasingly important to the success of community-based curricula. In the context of tourism, homestays, where local families host guests, have shown to provide an immersive accommodation experience. OBJECTIVE: By exploring homestays in the educational context, this scoping study investigates their role in providing an immersive pedagogical experience for medical students. DESIGN: A scoping review was performed using the online databases ScienceDirect and the Duke University Library Database, which searches Academic Search Complete, JSTOR, LexisNexis Academic, Web of Science, Proquest, PubMed and WorldCat. Using the inclusion term 'homestays' and excluding the term 'tourism', 181 results were returned. AClose assessment using inclusion criteria narrowed this to 14 relevant articles. RESULTS: There is very little published research specific to the experience of medical students in community homestays, indicating a gap in the literature. However, the existing educational outcomes suggest homestays may have the potential to serve a significant role in medical education, especially as a component of decentralised or community-based programmes. The literature reveals that educational homestays influence language learning, cultural immersion, and the development of professional skills for health science careers. These outcomes relate to the level of engagement between students and hosts, including the catalytic role of community liaisons. CONCLUSIONS: Homestays offer a unique depth of experience that has the potential to enrich the education of participating students, and require further research, particularly in the context of distributed and decentralised training platforms for medical and health sciences students. Future studies should explore the potential for homestays as a pedagogical component of community-based medical curriculum. ABBREVIATIONS: CBME: Community-based medical education.
[Mh] Termos MeSH primário: Serviços de Saúde Comunitária/métodos
Assistência à Saúde/métodos
Educação de Graduação em Medicina/métodos
Atenção Primária à Saúde/métodos
Distribuição Espacial da População
Estudantes de Medicina
[Mh] Termos MeSH secundário: Currículo
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1080/10872981.2017.1320185


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[PMID]:28461286
[Au] Autor:Zhan X; Zhang Z; Sun F; Liu Q; Peng W; Zhang H; Yan W
[Ad] Endereço:Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
[Ti] Título:Effects of Improving Primary Health Care Workers' Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning.
[So] Source:J Med Internet Res;19(5):e116, 2017 May 01.
[Is] ISSN:1438-8871
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs' competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers' education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning. OBJECTIVE: The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach. METHODS: The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs-the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs-the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses' knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]). RESULTS: The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95% CI 92.49-93.93) in experimental group versus 88.29 (95% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95% CI 93.37-94.73) in the experimental group vs 90.22 (95% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95% CI 93.08-94.68) in the experimental group versus 89.09 (95% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95% CI 1.08-2.48; P=.02). CONCLUSIONS: Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings.
[Mh] Termos MeSH primário: Educação a Distância/métodos
Pessoal de Saúde/educação
Internet
Aprendizagem
Atenção Primária à Saúde
Saúde Pública/educação
Serviços de Saúde Rural
Saúde da População Rural
[Mh] Termos MeSH secundário: Adulto
China
Avaliação Educacional
Feminino
Seres Humanos
Masculino
Meia-Idade
Atenção Primária à Saúde/recursos humanos
População Rural
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.2196/jmir.6453


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[PMID]:28453637
[Au] Autor:Daymont C; Ross ME; Russell Localio A; Fiks AG; Wasserman RC; Grundmeier RW
[Ad] Endereço:Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
[Ti] Título:Automated identification of implausible values in growth data from pediatric electronic health records.
[So] Source:J Am Med Inform Assoc;24(6):1080-1087, 2017 Nov 01.
[Is] ISSN:1527-974X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Large electronic health record (EHR) datasets are increasingly used to facilitate research on growth, but measurement and recording errors can lead to biased results. We developed and tested an automated method for identifying implausible values in pediatric EHR growth data. Materials and Methods: Using deidentified data from 46 primary care sites, we developed an algorithm to identify weight and height values that should be excluded from analysis, including implausible values and values that were recorded repeatedly without remeasurement. The foundation of the algorithm is a comparison of each measurement, expressed as a standard deviation score, with a weighted moving average of a child's other measurements. We evaluated the performance of the algorithm by (1) comparing its results with the judgment of physician reviewers for a stratified random selection of 400 measurements and (2) evaluating its accuracy in a dataset with simulated errors. Results: Of 2 000 595 growth measurements from 280 610 patients 1 to 21 years old, 3.8% of weight and 4.5% of height values were identified as implausible or excluded for other reasons. The proportion excluded varied widely by primary care site. The automated method had a sensitivity of 97% (95% confidence interval [CI], 94-99%) and a specificity of 90% (95% CI, 85-94%) for identifying implausible values compared to physician judgment, and identified 95% (weight) and 98% (height) of simulated errors. Discussion and Conclusion: This automated, flexible, and validated method for preparing large datasets will facilitate the use of pediatric EHR growth datasets for research.
[Mh] Termos MeSH primário: Algoritmos
Registros Eletrônicos de Saúde
Gráficos de Crescimento
Crescimento
[Mh] Termos MeSH secundário: Adolescente
Estatura
Peso Corporal
Criança
Pré-Escolar
Conjuntos de Dados como Assunto
Feminino
Seres Humanos
Lactente
Masculino
Atenção Primária à Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/jamia/ocx037


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[PMID]:28448697
[Au] Autor:Maust DT; Blow FC; Wiechers IR; Kales HC; Marcus SC
[Ad] Endereço:Department of Psychiatry, University of Michigan, NCRC 016-222W, 2800 Plymouth Rd, Ann Arbor, MI 48109. maustd@umich.edu.
[Ti] Título:National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care.
[So] Source:J Clin Psychiatry;78(4):e363-e371, 2017 Apr.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe how use of antidepressants, benzodiazepines, and other anxiolytic/sedative-hypnotics among older adults (age ≥ 65 years) has changed over time among visits to primary care providers and psychiatrists. METHODS: Data were from the National Ambulatory Medical Care Survey (years 2003-2005 and 2010-2012), a nationally representative cross-section of outpatient physician visits. Analysis focused on visits to primary care providers (n = 14,282) and psychiatrists (n = 1,095) at which an antidepressant, benzodiazepine, or other anxiolytic/sedative-hypnotic was prescribed, which were stratified by demographic and clinical characteristic (including ICD-9-CM diagnosis) and compared across study intervals. Odds of medication use were calculated for each stratum, adjusting for demographic and clinical characteristics. RESULTS: The visit rate by older adults to primary care providers where any of the medications were prescribed rose from 16.4% to 21.8% (adjusted odds ratio [AOR] = 1.43, P < .001) while remaining steady among psychiatrists (75.4% vs 68.5%; AOR = 0.69, P = .11). Primary care visits rose for antidepressants (9.9% to 12.3%; AOR = 1.28, P = .01) and other anxiolytic/sedative-hypnotics (3.4% to 4.7%; AOR = 1.39, P = .01), but the largest growth was among benzodiazepines (5.6% to 8.7%; AOR = 1.62, P < .001). Among patients in primary care, increases primarily occurred among men, non-Hispanic white patients, and those with pain diagnoses as well as those with no mental health or pain diagnoses. CONCLUSIONS: From 2003 to 2012, use of the most common psychotropic medications among older adults seen in primary care increased, with concentration among patients with no mental health or pain diagnosis. As the population of older adults grows and receives mental health treatment in primary care, it is critical to examine the appropriateness of psychotropic use.
[Mh] Termos MeSH primário: Antidepressivos/uso terapêutico
Benzodiazepinas/uso terapêutico
Hipnóticos e Sedativos/uso terapêutico
Médicos de Atenção Primária/estatística & dados numéricos
Atenção Primária à Saúde/estatística & dados numéricos
Psiquiatria/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Feminino
Pesquisas sobre Serviços de Saúde
Seres Humanos
Masculino
Médicos de Atenção Primária/tendências
Atenção Primária à Saúde/tendências
Psiquiatria/tendências
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antidepressive Agents); 0 (Hypnotics and Sedatives); 12794-10-4 (Benzodiazepines)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.4088/JCP.16m10713


  10 / 65228 MEDLINE  
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[PMID]:28452044
[Au] Autor:Luckmann R; White MJ; Costanza ME; Frisard CF; Cranos C; Sama S; Yood R
[Ad] Endereço:Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lave Ave. N, Worcester, MA, 01655, USA. LuckmanR@ummhc.org.
[Ti] Título:Implementation and process evaluation of three interventions to promote screening mammograms delivered for 4 years in a large primary care population.
[So] Source:Transl Behav Med;7(3):547-556, 2017 Sep.
[Is] ISSN:1613-9860
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The optimal form of outreach to promote repeated, on time screening mammograms in primary care has not been established. The purpose of this study is to assess the implementation process and process outcomes for three interventions for promoting biannual screening mammography in a randomized trial. In a large urban primary care practice over a 4-year period, we randomized women aged 40-85 and eligible for mammograms to three interventions: reminder letter only (LO), reminder letter + reminder call (RC), and reminder letter + counseling call (CC). We tracked information system development, staff training, patient and provider recruitment, reach, dose delivered and received, fidelity, and context measures. Ninety-three of 95 providers approved participation by 80% (23,999) of age-eligible patients, of whom only 207 (0.9%) opted not to receive any intervention. Of 9161 initial reminder letters mailed to women coming due or overdue for mammograms, 0.8% were undeliverable. Of women in the RC and CC arms unresponsive to the first reminder letter (n = 3982), 71.4% were called and reached, and of those, 49.1% scheduled a mammogram. Only 33.4% of women reached in the CC arm received full counseling, and women in the CC arm were less likely to schedule a mammogram than those in the RC arm. Implementing mail and telephone mammography reminders is feasible and acceptable in a large urban practice and reaches a majority of patients. Many schedule a mammogram when reached. A reminder letter followed by a simple reminder call if needed may be the optimal approach to promoting screening mammograms.
[Mh] Termos MeSH primário: Aconselhamento
Detecção Precoce de Câncer/métodos
Promoção da Saúde/métodos
Mamografia
Atenção Primária à Saúde
Sistemas de Alerta
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Neoplasias da Mama/diagnóstico por imagem
Neoplasias da Mama/prevenção & controle
Feminino
Implementação de Plano de Saúde
Política de Saúde
Seres Humanos
Meia-Idade
Atenção Primária à Saúde/métodos
Avaliação de Programas e Projetos de Saúde
Software
Telefone
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s13142-017-0497-x



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BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde