Decisions based on health economic analysis

@#Family and community practitioners sometimes will decide on what community-oriented interventions to propose and implement. The cost and effectiveness of such interventions are often debated by policy makers. A set of formal, quantitative methods for comparing alternative strategies in resource use and expected outcomes is known as health economic analysis. This article presents a tool to help family and community practitioners decide on the cost and effectiveness of such interventions.

Implementing active surveillance for tuberculosis: The experiences of healthcare workers at four sites in two provinces in South Africa

The high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors.Methods: This was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.tisoftware.Results: The factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB.Conclusion: Community health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare.Keywords: tuberculosis; active case finding; community-oriented primary care; community health worker (CHW); community-based services; active surveillance.

Necrotizing fasciitis in a patient with Chiari malformation Type II - A family case analysis / The Health Sciences Journal

@#The biopsychosocial approach to healthcare is fundamental to Family and Community Medicine specialists. Using the patient-centered, family-focused, community-oriented (PFC) matrix, the interplay of a myriad of biomedical and psychosocial factors is assessed in order to provide a thorough medical management that is custom-made to meet the needs and inherent values of a patient and his/her family. Family assessment tools are also utilized to better understand the family dynamics of a patient that may impact on the prescribed management plan. In addition, social determinants of health are evaluated to ascertain which ones may facilitate or hamper proper utilization of community resources. This family case analysis documented the medical ordeal of a young professional who had been diagnosed with two rare medical conditions: necrotizing fasciitis and Chiari malformation Type II. Employing the PFC matrix, the Family and Community Medicine specialist was able to provide inter-disciplinary care for the patient and his family in a holistic manner by recognizing patient needs, creating an enabling family support environment, and helping the family unit navigate various community resources.

Análisis del sistema de salud cubano y del modelo atención primaria orientada a la comunidad / Analysis of the Cuban Health System and the Model of Community-Oriented Primary Care

La integración del cuidado de la salud individual con el de la población a través de la salud pública se ha podido llevar a cabo de forma efectiva a partir del modelo de la atención primaria orientada a la comunidad. En Cuba, la atención primaria es la base del sistema nacional de salud, con acceso universal y cuidado de los individuos, sus familias y la comunidad. El sistema nacional de salud y la atención primaria orientada a la comunidad contribuyen a la mejora de la salud y a la disminución de desigualdades en salud e iniquidades en la provisión de servicios. Este artículo presenta su descripción y análisis(AU)

Individual healthcare integrated with population healthcare through public health has been effective and possible through the model of community-oriented primary care. In Cuba, primary healthcare is the supporting structure of the national health system, including universal coverage and the care for individuals, their families, and the community. The national health system and community-oriented primary care contribute with health improvement and the decrease in health inequalities and in inequities of provided care. This article presents their comprehensive description and analysis(AU)

The "Sharing and Self-Caring" Gym Based on Community-Oriented Primary Care / 日本プライマリ・ケア連合学会誌

We report The "Sharing and Self-Caring" gym on Tarama Island, Okinawa. There are a large number of patients with metabolic syndrome on the island, which is a community health concern. To encourage people in the community to engage in physical exercise and prevent them from developing metabolic syndrome, we established a gym where they shared fitness equipment that they had bought but not used in a while. During the course of establishment, we employed a community-oriented primary care strategy.

The Patient-centered, Family-focused and Communityoriented (PFC) Matrix: A toolkit for biopsychosocial approach in primary care

@#Biopsychosocial (BPS) approach to care is essential in family practice. Teaching this approach in family medicine is usually highlighted in family case presentations and counseling sessions. Little is done in showing how the biopsychosocial approach can be used in the day to day family practice. This article discusses the development of a learning tool called the PFC matrix which is a patient-centered, family-focused and community-oriented approach to care for individual patients and their families. The patient-centered care utilizes understanding of the interplay of biomedical psychosocial factors disease in order to implement management that is tailor-fitted to the needs and values of the patient. The family-focused component of the matrix utilizes family assessment to generate assumptions on how the family dynamics affect or facilitate the prescribed management of the patient’s disease. Lastly, the community-oriented component enables the family physician to use social determinants of health and health systems as a lens to understand how larger systems support or hinder the provision of care. Through the use of this matrix, the family physician is able to manage the patient in a holistic manner by recognizing patient needs, creating an enabling family support environment and helping the patient and family navigate various community resources. This results not only in optimal health for the patient but impacts to create a more responsive health system. In the future, further documentation of the use of the PFC matrix particularly in primary care in the light of universal health care and how it impacts on outcomes and how it connects patients and families at the correct tiers of the health system.

Mobile Stalls Pulled by Family Physicians: A Community-based Salutogenic Project Using Mobile Stalls / 日本プライマリ・ケア連合学会誌

We introduced the "Health Cafe with Mobile Stalls Project" as an example of community-oriented care. The authors, two family physicians and a medical student held salutogenic dialogues at mobile stalls in the "Yanesen" area in Tokyo and Toyooka City in Hyogo Prefecture. Mobile stalls may be able to demonstrate "small scale multi-functional" roles to approach people who are indifferent to health, and serve as a place where multiple generations can connect.

The Medical Education Curricula for Students Selected by Nagoya University for Medically Underserved Areas / 医学教育

  To respond to the physician shortage, the capacity of medical schools has been increased through selective admission of student to practice in medically underserved areas; however, neither a system nor a curriculum for such students has been established. At Nagoya University, selected students have been admitted, and the division of Education for Community–Oriented Medicine was established in fiscal year 2009. We have introduced special curricula for these students, such as a seminar for community–oriented medicine, training for medical research, local hospital tours, and a special interprofessional education course. In fiscal year 2013, community medicine is expected to be implemented as a compulsory subject in the 4th year curriculum. For the education of students selected to practice in medically underserved areas, we believe that older students serving as role models and cooperation with other organizations and community are important.

Feedback for inappropriate behavior of medical students in early clinical exposure / 医学教育

<br>Background: Some early clinical exposure programs in the community have been implemented in our medical school from years 1 to 3: community service for the handicapped in year 1, care for severely handicapped children in year 2, and health care at home with district nurses in year 3. The directors of these programs informed us, in feedback reports, of the inappropriate behavior of medical students. We then provided feedback directly to the students. We investigated the changes in student behavior after feedback during the 3 years they participated in these programs.<br>Methods: We analyzed the feedback reports from these 3 early clinical exposure programs from 2009 to 2011. Inappropriate behavior of medical students and changes in behavior were recorded.<br>Results: Inappropriate behaviors reported were: 1） lack of essential learning behavior, 2） lack of positive attitude and acceptance of learning in the programs, and 3） lack of communication skills. The numbers of students who received feedback about inappropriate behaviors were 26 in year 1, 11 in year 2, and 2 in year 3. Feedback to students from early clinical exposure programs may lead to changes in their behavior.

What do medical students learn from home care practice? / 医学教育

Objectives: This study aimed to investigate what third–year students of the J University School of Medicine had learned in home care practice.<br>Methods: We analyzed the students’ reports and focused on the description of the learning for the practice. We extracted the category of learning using qualitative content analysis.<br>Results and Conclusion: The core categories we extracted from the analyses were: 1） characteristics of home healthcare, 2） patients, 3） families, 4） home–visiting nurses, 5） medical treatment teams, 6） frank remarks of medical students and physicians, and 7） necessities as a physician. The frank remarks of medical students and physicians included the distrust of physicians and the hopes of medical students. The students gained valuable experience from this practice. In particular, learning about the distrust of physicians and the hopes of medical students may be difficult without such practice.

Programas de continuidad de cuidados: éxitos, fracasos y retos futuros / Case management programs: successes, failures and future challenges

Los programas de continuidad de cuidados surgen a finales de los años 70 en EEUU, en respuesta a los problemas detectados durante del proceso de desintitucionalización de los hospitales psiquiátricos. Desde entonces, se han extendido por todo el mundo, con variaciones y peculiaridades según las regiones, convirtiéndose en piedra angular de la atención a las personas con enfermedad mental grave y persistente. En este artículo se revisa el origen de estos programas, su desarrollo a lo largo de más de treinta años, la filosofía que los ha guiado en su devenir, así como los éxitos y fracasos en su desarrollo.

The case management programs arise in the late 70's in the U.S., in response to problems identified during the process of deinstitutionalization of psychiatric hospitals. Since then, the case management and the assertive community treatment programs have spread throughout the world, with variations and particularities in different regions, becoming the cornerstone of the community care for people with severe and persistent mental illness. This article reviews the origins of these programs in U.S., their development for over thirty years around the world, the philosophy and objectives that have guided its evolution, as well as successes and failures in their development.

Programas de continuidad de cuidados: el ejemplo del distrito de Chamartín de Madrid / Continuity of care programs: the example of Madrid Chamartin district

Se presenta el programa de continuidad de cuidados del Centro de Salud Mental de Chamartín en Madrid, para ilustrar con una experiencia fuera del ámbito anglosajón donde surgen estos programas, la teoría expuesta en la primera parte acerca del surgimiento, desarrollo y filosofía de los programas de continuidad de cuidados. Se describen los recursos sanitarios, sociales y personales de los que dispone la población a la que va dirigido y la forma de intervención, con el tipo de actuaciones que se realizan. Por último, se señalan algunos riesgos en el desarrollo y mantenimiento de los programas de continuidad de cuidados.

The case management program of Chamartin Mental Health Center in Madrid is presented to illustrate with an experience outside the Anglo-Saxon context, where such programs arise, the theory advanced in the first part about the emergence, development and philosophy of continuity of care programs. Finally, some risks in the development and maintenance of continuity of care programs are pointed out. The health, social and staff resources are described, and also the population to be targeted, the form of intervention and the type of actions that are performed. Finally, we point out some risks in the development and maintenance of continuity of care programs.

Community-Oriented Primary Care (COPC) for Japanese in Pittsburgh, U. S. A / 日本プライマリ・ケア連合学会誌

 Living overseas affects heath significantly. This needs to be addressed adequately for Japanese who live in the U. S. based on the existing evidence of negative impacts on health such as increased coronary heart disease mortality and stress. In addition to care at individual level as primary care providers, community-oriented primary care (COPC) provides primary care physicians with great potential to use as a tool of community medicine to improve their health at the community level. In this article, we report our case of COPC activity ; defining the community, choosing the health issue, implementing an intervention and its initial evaluation as well as the process of involving the community targeting Japanese in Pittsburgh, USA. The present article also includes a hypothesis-driven research question, measurement, analysis and the results followed by discussion with the lessons learned through our COPC activities. This article will not only inform readers of the COPC case but also provide practical and applicable insight to community medicine in readers' settings.

A workshop to promote interprofessional health care collaboration in the community / 医学教育

1)A workshop to promote interprofessional health–care collaboration in the community is reported.<br>2)The three topics discussed were: "the needs of an interprofessional network in the community," "barriers that can prevent the promotion of an interprofessional network in the community," and "strategies to overcome the barriers."<br>3)The critical issues identified were, communication, information sharing, and leadership. Working to improve the health–care system and clarifying and promoting the significance of an interprofessional network were also identified as critical issues.

The changes in students' consciousness about community medicine during our program / 医学教育

The collapse of community medicine has becomes a serious social problem in Japan, and a variety of measures have been implemented to counter it. In medical education, the model core curriculum has been revised, and many universities have started programs for community medical. We have had a community-based medical course at the Kinki University School of Medicine since 2005. This study examined the changes in students' consciousness about and affinity for community medicine during our program.<br>1)Questionnaires were completed by 494 students taking part in community-based medical training from April 2006 through July 2010. Results from before and after training were compared.<br>2)The questionnaire had 3 parts. The first part concerned medical activities with community residents. The second part concerned medical activities with housebound elderly persons. The third part concerned the students' future plans.<br>3)Many students gave themselves high scores for activities with community residents and housebound elderly persons. More students preferred hospitals in regional towns. A few students chose rural areas.<br>4)In an introduction to community medicine, it is important to first foster cordial relations with community residents. Cultivating problem-solving skills is the next challenge.<br>5)Community-based medical programs enhance medical students' understanding of and affinity for community medicine. Furthermore, some students will choose community-based medicine as a specialty.

Community-Oriented Undergraduate Medical Education / 医学教育

1) Many medical schools in Australia are adopting curricula that encourage medical students to understand the community and the importance of community-based medicine.<br>2) Flinders University has successfully created and implemented a curriculum in which medical students spend time in small community hospitals and clinics during their third year.<br>3) Although there are many types of community-oriented medical education, we must consider what kind of medical education would increase the quality of community medicine in Japan.

Introduction and Implementation of Community-Oriented Medical Education / 中华医学教育探索杂志

Community-oriented medical education is featured by an emphasis on primary health care and population care as well as community-based care. It emphasizes the major problems encountered in the rural areas. This article has described the basic principles and curricular features of community-oriented medical education. The implementation and practice of education reform towards community-oriented medical education at Jiujiang University Medical College has also been introduced. The college puts teaching contents reform first followed by teaching methods. Students' clinical skills and reasoning skills were strengthened in the reform. According to requirements of community-oriented medical education, educational programs and curriculum have been changed. The concept of general medicine has been introduced in the practice of the reformed program.