Proyecto: implementación centros de atención primaria de salud / sss

El proyecto de Implementación de los Centros de Atención Primaria de Salud con enfasis en el ámbito familiar, pretende llegar con acciones de atención primaria a toda la población del área 1 Tupiza. Este proyecto pretende desarrollar en forma articulada con la seguridad social. Tomando encuenta la problemática de salud del area 1 de Tupiza, la Secretaria Regional de Salud lleva adelante este proyecto en el marco de la Ley de Participación Popular y en forma mancomunada con el Municipio. Las secretarias regionales de salud se encuentran en las Provincias Sud y Nor Chichas, Modesto Omiste y Sud Lipez. El Area 1 de Salud de Tupiza esta conformada por la ciudad de Tupiza y las comunidades aledañas de Bolivar, Angostura, Tambillo Alto y Bajo, Yurcuma, Quebrada Seca, Choroma y Caracota

Guidelines for pragmatic assessment for health planning in developing countries.

Although the primary health care strategy implemented since the Alma Ata declaration of 'health for all' appears to have contributed to improvements in selected health outcomes, the current ad hoc approach to health assessment and planning has impeded more substantial gains. A comprehensive yet pragmatic framework for country-level health programmers is needed that would permit consideration of the multiple steps involved in policy formulation and implementation. In the present paper, drawing upon an epidemiologic model (Iterative Measurement Loop) and an economic model (Cost-Effectiveness Analysis), we present guidelines for a pragmatic assessment for health planning. A format is provided for the conduct of these tasks which is operational in nature, is specific to the target country (or relevant region), can simultaneously consider multiple interventions, and is comprehensible to persons without sophisticated medical and/or economic backgrounds. Such a format enables articulation and consideration of local concerns as well as national and global considerations.

The general practice contract scheme: was it targeted?

OBJECT: to determine whether the contracted general practices were situated in areas of greatest health need. METHOD: the health and equity index was used to determine the level of health need of the geographical location of the contracted practices. RESULTS: the health and equity index for the urban contracted practices showed a high level of health need. In the rural practices, the census area unit in which the practices were located showed a high level of health need, however when surrounding census area units were considered, they were located in areas of average health need. CONCLUSION: the general practice contract scheme was well targeted.

Primary care in New York State: report and recommendations of the associated medical schools of New York.

Medical education in New York is unique in the country in its scope and its diversity. It is important, as we go forward, that these strengths be neither eroded nor compromised. The AMS member institutions are making a collective commitment to work together to promote changes that will improve medical education for all students by providing them with enriched experience in primary care. Our major resource is faculty. To whatever degree medical schools can influence career choice, it is essential to this aim that the best possible people are placed in the settings in which primary care is taught. The schools will intensify their efforts to recruit and retain such faculty and, in whatever way is appropriate to each institution, provide them with the stature needed to emphasize the value which the school places on primary care. The schools will also work to provide exposure to primary care early in a student's academic career given anecdotal evidence, at least, that such early experience can influence subsequent specialty choice. Finally, the medical schools will assume greater responsibility for graduate medical education. If, with state support, ambulatory teaching sites are developed, the schools will make every effort to assure that they are staffed with high-quality faculty. Residents and students must see primary care practiced with total commitment to quality. It is hoped that, with state-initiated improvements in the practice environment, the ultimate outcome will be an increase in the number of our graduates selecting primary care disciplines for their practices and locating in areas in need of physicians.2+ Corporation, and the Greater New York Hospital Association. We are ready to work with others toward our common objectives, and we call on all of those who share these concerns to participate with us.

Need for and provision of general practice in London.

This study examines the spatial distribution of general practice in London, taking into account both practice and population characteristics. While need for general practice is higher in inner London, some areas of outer London experience high levels of need. Inner London tends to have a greater quantity but lower quality of general practice. However, as in the case of the needs indices, this situation cannot be described as a simple inner city/outer city dichotomy. It is concluded that not all inner London areas suffer from high need and poor general practice and not all outer London areas have low need and good general practice.

[Can the crowd pressure on primary health services be managed?]. / Se puede gestionar la presión asistencial en los servicios de atención primaria?

The crowd pressure which is placed on Primary Care Services frequently overwhelms the capacity of response of said services. In certain cases the crowd pressure coincides with low demand per inhabitant and year (as compared with the expected average in our environment), while on other occasions there coexist high crowd pressures with high frequencies. The automatic assumption that excess crowding--larger need for human resources obviates the analysis of the organizational factors and of individuals who contribute to the crowding increase. Sometimes, assigning more resources to cope with excess crowding of unidentified origins contributes towards keeping those causes alive, rather than solving them. We propose a method of analysis of excess care demand based on the answer to a short series of questions, while at the same time proposing certain management measures which could be useful to cope with excess demand, depending on the cause or causes which have been found to apply.

The empires strike back. Broken promises: Columbia-Presbyterian Medical Center. Ignoring the community's needs: St. Luke's-Roosevelt Hospital Center.

In the fall of 1985 in an issue titled "Fighting Back Against the Empires" (Vol. 16, No. 5), Health/PAC reported on the plans of four of New York City's academic medical center "empires" for major expansion. The focus of our coverage was the efforts of two of the communities served by these institutions to ensure that the plans were responsive to their needs. At the time, we were cautiously optimistic that these events were signs that "although the empires still dominate New York City's health care system, they no longer rule unchallenged." In the past six months, the plans of two of these institutions, Columbia-Presbyterian Medical Center and St. Luke's-Roosevelt Hospital Center, warrant another look at the success of the efforts to hold the major medical centers responsible for the welfare of the communities in which they are located.

Material resources in Jamaica's primary health care centres

A national study of management aspects of the primary health care services in Jamaica provided data on material resources (facilities, utilities, furniture, equipment and supplies) available at health centres. It was postulated that a description of resources and of their relationship to output could be useful, and the study set out to develop composite indices to measure material resource levels. Staff at a sample of 92 health centres, in all parishes, were interviewed to provide objective statements of resources present and subjective assessments of their adequacy and condition. Results showed that certain basic material resource items were present in a relatively high proportion of health centres but others, perhaps less crucial, were scarce. The lower level health centres were less well supplied with resource items than the others, even after standardising for their different needs. The data provided evidence that output by personnel was related to level of material resource inputs. Experimenting with formulation of composite indices of material resources, considerations of sensitivity, simplicity and creditability led to the conclusion that indices based on objective statements were as appropriate as the more complicated ones based on subjective assessments. Use of indices based on objective data showed that the South-Eastern and Western health areas had higher levels of resource than the North-Eastern and Southern areas. It was concluded that composite indices based on simple statements and calculations can be useful in monitoring levels of material resources, and that material resources probably have an effect on output from health centres (AU)

Health policy brief: obstetrics in nonmetropolitan Oklahoma.

This brief is a summary of a 68-page analysis of a survey conducted by the Center for Health Policy Research, Oklahoma Medical Research Foundation, Tulsa. There are 9 appendices and 96 data analysis tables in the complete analysis. The survey was conducted in the summer and fall of 1988. Survey instruments were mailed to all Oklahoma obstetricians and family and general practitioners not practicing in Tulsa or Oklahoma counties. There were 300 responses, 274 of which were validated for inclusion into the study. The complete survey will be of interest to some institutions and groups and is available upon request. Customized analysis of the survey variables also is available to interested parties upon request.

A mobile surgery for single homeless people in London.

Little is known about the social and medical characteristics of people who regularly sleep rough, or whether medical care can be targeted at these people. In 1987 a mobile surgery was used to provide primary health care at two sites in central London where many single homeless people sleep outdoors. One hundred and forty six patients were seen with illnesses ranging from scabies to osteomyelitis and tuberculosis. Sociodemographic data showed the patients to be generally an isolated group with deprived and unstable backgrounds, often compounded by alcohol abuse. Over a third of the patients from one site attended a drop in surgery for homeless people in Soho within a month after seeing a doctor in the mobile surgery. This suggests that the project can be a first step in integrating this isolated group with health care facilities.