515,949 research outputs found

    Walk in centres: lessons from Canada

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    The current reforms of the United Kingdom's primary healthcare sector intend to improve accessibility to health care. One of the proposals is to introduce "walk-in" primary care centres. The intention is to pilot "a series of nurse led centres which can be used on a `drop in' basis, providing minor treatment, health information and self help advice." The Canadian medical system has many similarities to the British system. Canada's health system is funded through general taxation (and Medicare premiums), and its general practitioners (family physicians) have a gatekeeper role to secondary care in most provinces. Canada has had walk-in centres for over 20 years. However, these centres are a doctor led service. The lessons learnt in Canada about walk-in centres may be relevant to the NHS. In this article I review the available literature about Canadian walk-in centres

    The impact of co-located NHS walk-in centres on emergency departments

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    Objectives: To determine the impact of establishing walk-in centres alongside emergency departments on attendance rates, visit duration, process, costs and outcome of care. Methods: Eight hospitals with co-located emergency departments and walk-in centres were compared with eight matched emergency departments without walk-in centres. Site visits were conducted. Routine data about attendance numbers and use of resources were analysed. A random sample of records of patients attending before and after walk-in centres opened were also assessed. Patients who had not been admitted to hospital were sent a postal questionnaire. Results: In most sites, the walk-in centres did not have a distinct identity and there were few differences in the way services were provided compared with control sites. Overall, there was no evidence of an increase in attendance at sites with walk-in centres, but considerable variability across sites. The proportion of patients managed within the four-hour NHS target improved at sites both with and without walk-in centres. There was no evidence of any difference in re-consultation rates, costs of care or patient outcomes at sites with or without walk-in centres. Conclusions: Most hospitals in this study implemented the walk-in centre concept to a very limited extent. Consequently there was no evidence of any impact on attendance rates, process, costs or outcome of care

    A Multi-channel Application Framework for Customer Care Service Using Best-First Search Technique

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    It has become imperative to find a solution to the dissatisfaction in response by mobile service providers when interacting with their customer care centres. Problems faced with Human to Human Interaction (H2H) between customer care centres and their customers include delayed response time, inconsistent solutions to questions or enquires and lack of dedicated access channels for interaction with customer care centres in some cases. This paper presents a framework and development techniques for a multi-channel application providing Human to System (H2S) interaction for customer care centre of a mobile telecommunication provider. The proposed solution is called Interactive Customer Service Agent (ICSA). Based on single-authoring, it will provide three media of interaction with the customer care centre of a mobile telecommunication operator: voice, phone and web browsing. A mathematical search technique called Best-First Search to generate accurate results in a search environmen

    LIFT: 21st century health care centres

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    Purpose To examine the processes used to procure and develop new primary health care premises in the United Kingdom and in particular the use of the private finance initiative and related methods. Design/methodology/approach An in-depth study of two local improvement finance trust schemes to procure new primary health care premises. These are contrasted against the ad-hoc arrangements for the traditional procurement of general practice doctor's surgery premises. Interviews were undertaken with key participants on both sides of the negotiations. Findings The process can be an unequal struggle between large consortia and small, inexperienced clients that may result in a wasted opportunity to obtain the optimum design and price. Research limitations/implications The research is limited to early use of the local improvement finance trust process and procedures; client bodies, such as primary care trusts, may benefit from the experience of earlier projects. The method of procurement will evolve and be refined and will become more widely used, not only for health but also in the education sector. Further examination of the procurement of education buildings using similar methods would be beneficial. Originality/value This method of procuring buildings is relatively new, and therefore, largely untried

    Poor infant feeding practices and high prevalence of malnutrition in urban slum child care centres in nairobi: a pilot study

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    Little is known about the style and quality of feeding and care provided in child day-care centres in slum areas. This study purposively sampled five day-care centres in Nairobi, Kenya, where anthropometric measurements were collected among 33 children aged 6–24 months. Mealtime interactions were further observed in 11 children from four centres, using a standardized data collection sheet. We recorded the child actions, such as mood, interest in food, distraction level, as well as caregiver actions, such as encouragement to eat, level of distraction and presence of neutral actions. Of the 33 children assessed, with a mean age of 15.9 ± 4.9 months, 14 (42%) were female. Undernutrition was found in 13 (39%) children with at least one Z score <−2 or oedema (2): height for age <−2 (11), weight for age <−2 (11), body mass index for age <−2 (4). Rates of undernutrition were highest (9 of 13; 69%) in children aged 18–24 months. Hand-washing before the meal was lacking in all centres. Caregivers were often distracted and rarely encouraged children to feed, with most children eating less than half of their served meal. Poor hygiene coupled with non-responsive care practices observed in the centres is a threat to child health, growth and development

    Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

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    The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA

    Conducting inspections of secure training centres: guidance for the inspections of secure training centres

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    This guidance is designed to assist inspectors from the Office for Standards in Education, Children’s Services and Skills (Ofsted), Her Majesty’s Inspectorate of Prisons and the Care Quality Commission when conducting inspections of secure training centres. It should be read in conjunction with Inspections of secure training centres: framework for inspection and Inspections of secure training centres: evaluation schedule and grade descriptors. - Age: 12-1

    Comparing care at walk-in centres and at accident and emergency departments: an exploration of patient choice, preference and satisfaction

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    Objectives: To explore the impact of establishing walk-in centres alongside emergency departments on patient choice, preference and satisfaction. Methods: A controlled, mixed-method study comparing eight emergency departments with co-located walk-in centres with the same number of ‘traditional’ emergency departments. This paper focuses on the results of a cross-sectional questionnaire survey of users. Results: Survey data demonstrated that patients were frequently unable to distinguish between being treated at a walk-in centre or an A&E department, and even where this was the case, opportunities to exercise choice about their preferred care provider were often limited. Few made an active choice to attend a co-located walk-in centre. Patients attending walk-in centres were just as likely to be satisfied overall with the care they received as their counterparts who were treated in the co-located A&E facility, although a small proportion of walk-in centre users did report greater satisfaction with some specific aspects of their care and consultation. Conclusions: Whilst one of the key policy goals underpinning the co-location of walk-in centres next to an A&E department was to provide patients with more options for accessing healthcare and greater choice, leading in turn to increased satisfaction, this evaluation was able to provide little evidence to support this. The high percentage of patients expressing a preference for care in an established emergency department compared to a new walk-in centre facility raises questions for future policy development. Further consideration should therefore be given to the role that A&E focused walk-in centres play in the Department of Health’s current policy agenda, as far as patient choice is concerned

    Multidisciplinary integrated parent and child centres in Amsterdam: a qualitative study

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    Background: In several countries centres for the integrated delivery of services to the parent and child have been established. In the Netherlands family health care service centres, called Parent and Child Centres (PCCs) involve multidisciplinary teams. Here doctors, nurses, midwives, maternity help professionals and educationists are integrated into multidisciplinary teams in neighbourhood-based centres. To date there has been little research on the implementation of service delivery in these centres. Study Design: A SWOT analysis was performed by use of triangulation data; this took place by integrating all relevant published documents on the origin and organization of the PCCs and the results from interviews with PCC experts and with PCC professionals (N=91). Structured interviews were performed with PCC-professionals (health care professionals (N=67) and PCC managers N=12)) and PCC-experts (N=12) in Amsterdam and qualitatively analysed thematically. The interview themes were based on a pre-set list of codes, derived from a prior documentation study and a focus group with PCC experts. Results: Perceived advantages of PCCs were more continuity of care, shorter communication lines, low-threshold contact between professionals and promising future perspectives. Perceived challenges included the absence of uniform multidisciplinary guidelines, delays in communication with hospitals and midwives, inappropriate accommodation for effective professional integration, differing expectations regarding the PCC-manager role among PCC-partners and the danger of professionals' needs dominating clients' needs. Conclusions: Professionals perceive PCCs as a promising development in the integration of services. Remaining challenges involved improvements at the managerial and organizational level. Quantitative research into the improvements in quality of care and child health is recommended

    Health System Support for Childbirth care in Southern Tanzania: Results from a Health Facility Census.

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    Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth offered at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2--3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constraints the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive "skilled attendance" and adequate care for common obstetric complications such as post-partum haemorrhage
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