Analysis of influencing factors of community elderly health services by general practitioners from the perspective of social ecology / 中华医院管理杂志

Objective:To identify the influencing factors for community elderly health services provided by general practitioners (GPs) using the social ecological theory, for reference in improving their participation and satisfaction.Methods:According to the social ecological theory, an ecological model for GPs to carry out community elderly health services was constructed from four levels: public policy ecology, community health service ecology, interpersonal relationship ecology, and individual characteristics ecology of general practitioners. A survey questionnaire was designed with six latent variables: public health policy support, public health service and basic medical service supply, doctor-patient relationship, individual participation and individual satisfaction. The questionnaire was distributed to 220 GPs from 11 primary healthcare institutions in Jiangsu province, China, who were randomly selected between October and November 2021. Exploratory and confirmatory analyses of the model were conducted using AMOS 25.0.Results:A total of 207 valid questionnaires were collected, and all the KMO values of the six latent variables were greater than 0.7, while the composite reliability values and average variance extracted values greater than 0.7 and 0.5, respectively. Both the reliability and validity of the data met the analysis requirements. Exploratory analysis revealed that public health policy support had a direct positive effect on both public health service and basic medical service supply (both effect sizes being 0.37). Public health service had a direct positive effect on doctor-patient relationship, individual participation and individual satisfaction (effect sizes being 0.52, 0.22, and 0.31, respectively). The direct effect of basic medical service supply on doctor-patient relationship was not significant (effect size being 0.03), but it had a direct positive effect on public health service (effect size being 0.46). Doctor-patient relationship had a direct positive effect on individual participation (effect size being 0.51), but its direct effect on individual satisfaction was not significant (effect size being 0.06). Individual participation had a direct positive effect on individual satisfaction (effect size being 0.52). Conclusions:By optimizing the public policy ecosystem, community health service ecosystem, and interpersonal relationship ecosystem, the participation and satisfaction of general practitioners can be systematically improved.

Evaluation of elderly care dynamics in an emergency care unit / Evaluación de la dinámica del cuidado al anciano en unidad de pronta atención / Avaliação da dinâmica do cuidado ao idoso em unidade de pronto atendimento

ABSTRACT Objective: understand elderly care dynamics of an emergency care unit. Method: this is a case study evaluation, using a qualitative approach and the theoretical-methodological reference of a fourth generation evaluation. Data collection was conducted between February and September 2017, through 460 hours of participant observation, interviews with 33 social actors among health professionals, elderly people and their relatives of an emergency care unit located in a municipality in the northwest of Paraná, as well as negotiation meetings with participants. Results: the evaluation showed the elderly care dynamics is mainly influenced by nursing actions that articulate care practices based on priority, frailty, autonomy, independence and family context of the elderly patients. Final considerations: an evaluation of how the emergency care unit operates helps improve elderly care in urgent and emergency services.

RESUMEN Objetivo: identificar la dinámica asistencial del cuidado al anciano en un servicio de pronta atención. Método: investigación evaluativa con abordaje cualitativo, de tipo estudio de caso, con base en el marco teórico-metodológico de la evaluación de cuarta generación. La recolección de datos ocurrió entre febrero y septiembre de 2017, por medio de 460 horas de observación participante, con entrevistas con 33 actores sociales entre profesionales de salud, ancianos y familiares de ancianos de una Unidad de Pronta Atención de un municipio del noroeste de Paraná (Brasil), además de reuniones con los participantes. Resultados: la evaluación permitió identificar que la dinámica asistencial de las prácticas de enfermería necesita la articulación de prácticas de cuidado que consideren la prioridad, la fragilidad, la autonomía, la independencia y el contexto familiar del anciano. Consideraciones finales: evaluar el funcionamiento de la unidad contribuye a mejorar el cuidado al anciano en los servicios de urgencia y emergencia.

RESUMO Objetivo: apreender a dinâmica assistencial do cuidado ao idoso inserido em um serviço de pronto atendimento. Método: pesquisa avaliativa com abordagem qualitativa, do tipo estudo de caso, apoiada no referencial teórico-metodológico da avaliação de quarta geração. A coleta de dados aconteceu entre fevereiro e setembro de 2017, por meio de 460 horas de observação participante, entrevistas com 33 atores sociais dentre profissionais de saúde, idosos e familiares de idosos de uma Unidade de Pronto Atendimento de um município do noroeste do Paraná, além de reuniões de negociação com os participantes. Resultados: a avaliação permitiu evidenciar que a dinâmica assistencial tem implicação, principalmente, das ações da enfermagem que necessitam articular práticas de cuidado que considerem a prioridade, a fragilidade, a autonomia, a independência e o contexto familiar do idoso. Considerações finais: avaliar o funcionamento da unidade contribui para a melhoria do cuidado ao idoso nos serviços de urgência e emergência.

Atuação fonoaudiológica junto a idosos: uma experiência em Centro-Dia / Speech therapy with elderly people: an experience in center-day

Pretende-se compartilhar uma maneira de operacionalizar determinada atuação interdisciplinar, com foco na autonomia do sujeito e na mudança de paradigmas, visando a romper com estigmas e expressões comumente associadas à velhice, como doença e incapacidade. Espera-se que a proposta apresentada possa contribuir com possibilidades de valorização da integralidade no cuidado e a melhoria de vida deste grupo populacional.

Intend to share an interdisciplinary experience focusing on the autonomy of the subject and changing the paradigms commonly associated with old age, such as disease and disability. We hope that this proposal will contribute to the enhancement of comprehensive care and improving the lives of frail elderly.