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Biomedical subjects

A Y Ellencweig

Publications and source records attributed to A Y Ellencweig.

At least 19 recordsLinked to original sources
PubMed1994

Utilization patterns of cohorts of elderly clients: a structural equation model.

OBJECTIVE: To identify a model that takes into account the interrelationship of health services utilization variables, and that allows examination of the utilization patterns of health services for a cohort of elderly clients. DATA SOURCES AND STUDY SETTING: The data of each client in the study were taken from three computer databases maintained for administrative purposes by the Ministry of Health in British Columbia. Time frame for the utilization variables is one year before and one year after admission to the long-term care program in BC which occurred in 1981-1982. STUDY DESIGN: A basic model was fitted to the utilization data for the year before admission and patterns of utilization were assessed for each gender-age group for the year before admission and for the two periods, using LISREL: Fifteen utilization variables were included: number of GP and specialist visits in different settings (office, home, etc.) and number of other services such as lab tests, hospital stay, etc. DATA COLLECTION: The three files were linked to produce one record per client. PRINCIPAL FINDINGS: A model was identified that fits the data well. The total effect of GP emergency room visits on hospital stay is 0.30 compared to 0.19 direct effect. The additional impact is produced via the effect of specialist consultations on hospital stay. This and similar findings by age, gender, and period are consistent with the joint dependency of utilization variables. CONCLUSIONS: The analysis shows that males and females have different utilization patterns, while age has no effect on utilization of health services by male clients and only a small effect on utilization patterns by female clients. Admission to LTC causes more specialist contacts resulting from contact with a GP and generally a more intensive use of diagnostic and surgical procedures. However, there is significantly less acute care hospital services utilization.

Age Factors↗
PubMed1993

Factors affecting the utilization of prenatal health care services in Jerusalem.

Health service utilization patterns during pregnancy were studied among 780 women from selected neighborhoods of Jerusalem who delivered between December 1, 1985 and June 30, 1986. Factors affecting the choice of care-provider, the timing of the first contact with the prenatal care service and the frequency of visits to prenatal care centers were studied with respect to several demographic, socio-economic and needs variables. About one half of the women visited the Family Health Centers, the traditional site for delivery of prenatal care. Forty percent visited their regular doctor during pregnancy while about 30% sought private care. In all, fifty two percent of women consulted more than one source of medical care service during pregnancy. Logistic regression analysis showed that the choice of care was determined by the type of insurance, need factors and education. The timing of the first visit depended on origin, level of education and parity. The frequency of visits was related to the type of insurance and to perceived health.

Choice Behavior↗
PubMed1992

Utilization of pediatric health services in Jerusalem.

The high rate of utilization of health services and rising health care costs in Israel, have prompted the need for reform of the health care system. Preventive and curative aspects of mother and child health care in Israel have traditionally been addressed by independent but parallel health systems. Prior to the pilot integration of these services, current patterns of utilization of health services by children during their first year of life, and determinants of use, were analyzed. Mothers of 651 children from five neighborhoods, representing the middle-low, middle and upper social class Jewish population were interviewed. Overall, a high degree of compliance with recommended visits to the preventive family health centers was found, with an average of eleven visits to the public health physician or nurse. The children also made an average of 12 visits to curative practitioners. Combined with all other health care consultations, these children averaged 26 health care visits in the first year of life. This pattern of frequent visitations, and its determinants, is discussed in context of the current framework of parallel health care systems. Multivariate analysis revealed that the birth order of the child was the key factor in determining the number of preventive visits, while the mother's perception of her child's health status held the major influence on the number of curative visits. No association between utilization of services and social class was discovered. Comparison of utilization patterns arising from this study with subsequent investigation of the planned integrated services allows for the assessment of the effects of a major change in the structure and delivery of pediatric services.

Adult↗
PubMed1990

The effect of admission to long-term care program on utilization of health services by the elderly in British Columbia.

Utilization patterns of elderly clients admitted to the British Columbia Long Term Care (LTC) program were recorded and analysed. Patients were either located at home or in facilities and were classified into one of five levels of care. Data on GP and specialist contacts, acute care hospital admissions and hospital length of stay were analysed for each client (N = 7251) for two consecutive years, one before and one after admission to the program. There was only a slight decline or no change in utilization of ambulatory health services following admission to the program but a more pronounced reduction in utilization of hospital related services particularly by clients located in facilities (60-70%). When utilization rates were controlled for peak levels in the period around admission, more moderate trends evolved. Yet, clients located in facilities showed a 20% decrease in hospital admission rates and a 40% decrease in GP hospital visits in the period following admission. The data suggests that admission to LTC may reduce acute hospital utilization and consequent physician utilization among clients who are cared for in an institution.

Aged↗
PubMed1990

Utilization of preventive services by pregnant women in Jerusalem--a cross sectional study.

A study was made of health service utilization patterns during pregnancy of 279 young mothers, a representative sample of the Jewish population in Jerusalem. Only 47% reported that they used the municipal family health centers (FHCs) for prenatal care. Some 82% reported that they had resorted to more than one source of care during pregnancy. Sources other than the FHC were: regular Sick Fund doctor service (33%); private practitioners (25%); hospital-based services (25%). Among the FHC users, there was an unexpectedly high percentage of women of Asian-African origin and of those living in remote neighborhoods. Under-utilization was frequent among wealthy women, those with higher education and members of the Orthodox religious sector. While there was general satisfaction with the service, lower gratification was associated with higher utilization. This phenomenon may intimate that there may be a process of negative selection among women who use the service, when other alternatives are not readily available.

Adult↗
PubMed1990

Effects of the Israel physicians' strike on the treatment and outcome of acute appendicitis in Jerusalem.

We sought to determine whether a prolonged physicians' strike causes changes in the delivery of health care and in the behavior of health care seekers? We compared appendectomy patients during the 1983 physicians' strike in Israel and during a control period in 1984, by analyzing the records of 171 patients in two Jerusalem hospitals. Patients had similar demographic characteristics and disease manifestation, but differed in their health care seeking behavior. The 1983 patients tended to postpone their first contact with the health system and frequently failed to present themselves for a follow-up visit after discharge. Control group patients were more likely to receive preoperative antibiotics and less likely to develop postoperative fever than the strike group patients. The findings confirmed that the differences between the strike and control groups were caused by administrative barriers resulting from the strike rather than by differences in actual medical treatment.

Acute Disease↗
PubMed1989

Inequity in health. A case study.

This article presents a particular case of inequity in health, that of two types of Israeli urban settlement: development towns and veteran towns. Inequity in health is demonstrated by the varying levels of resources allocated to each type of community, by the differences in health-care utilization (process), and by the diversity of external factors affecting the two categories of towns. Despite the existence of almost universal health insurance coverage in Israel, it is shown that inhabitants of less privileged development towns are more prone to inequitable health outcomes with respect to the wealthier populations living in veteran towns. This case illustrates an integrated approach to inequity in health, including the health-care system structure, utilization patterns, and the socio-demographic-economic background of different strata.

Adult↗
PubMed1989

The 1988 polio epidemic in Israel: an analysis and consequences.

This article examines the health crisis that followed the diagnosis of 15 cases of poliomyelitis in Israel late in 1988. The article reviews the recommendations, decisions and activities undertaken by the health authorities during the episode. Consequently, it analyses the role in policy making of each of the principal players: the leadership of the Ministry of Health, the professional Advisory Committee and the executive level of the Public Health Service. The conclusion, that changes in policy are expedited by crises, appears to hold for every health system. In Israel those changes were reflected by the introduction of a new immunization policy and, most important, the establishment of a national Ministry of the Environment.

Disease Outbreaks↗
PubMed1989

Primary care utilization in Israel--analysis of national data.

Analysis of data from the 1981 National Health Services Utilization Survey was carried out in order to identify factors relevant to primary care utilization in Israel on a semi-quantitative basis. The analysis consisted of stratification of the sample population into age- and sex-groups and the use of a logistic regression model for each stratum. Within the strata age still played a major role in explaining the probability of utilization; in addition, origin, employment status and education were also significant for most strata. In men aged greater than or equal to 65, living arrangements (alone, with spouse or with children) affected utilization. These findings were consistent with previous published reports and with findings of small-scale studies in Israel.

Adolescent↗
PubMed1988

Development of medical care technology. The case of Israel.

This article presents a survey of the public and private agencies and institutions providing health care in Israel and examines the degree and nature of the control that these bodies exercise over medical technology. The author demonstrates that while the Israeli government is highly centralized, the Ministry of Health is able to exercise only limited practical influence and is neutralized because of its circumscribed control of government funds. In addition, the Ministry of Health lacks standardized procedures for the assessment of prospective or existing technologies. The author notes that there has been a clear move toward a system to oversee the rational diffusion of technology and outlines several proposals for the future.

Communication↗
PubMed1987

Effects of the Israel doctors' strike on hypertension control in Ashdod.

We examined hypertension control during the Israel doctors' strike in a defined insured population of known hypertensives enrolled in a nurse-based hypertension control program. The strike was associated with a measurable increase in the prevalence of uncontrolled hypertension which was limited to males of relatively higher social class. No strike-related changes in hypertension control were seen for women or lower social class males. We infer from this finding that the presence of a physician is a necessary component of good hypertension control in the sub-group of males of higher socioeconomic status. The incidence of hypertension-related complications in this relatively non-compliant subpopulation needs further investigation.

Adult↗
PubMed1986

Demographic and socio-economic patterns of hospitalization for infectious diseases in Israel.

Hospitalization rates in Israel for five common enteric communicable diseases were computed according to age, sex, religion, origin and place of residence. Higher rates were found for non-Jews of both sexes and males of all origins. Higher rates were also found for settlements inhabited by new immigrants of low socio-economic classes. These findings suggest that more emphasis should be placed upon sanitary improvements and education for better health, rather than on merely improving the health delivery system.

Dysentery, Amebic↗
PubMed1986

Geographical variations in unnecessary hospitalization of the elderly: the effects of local conditions.

Three hundred and fifty-three elderly patients hospitalized in acute-care general wards in Tel Aviv and Jerusalem were studied to check whether their continued hospitalization was medically justified. Of these, 53 (15%) were found not to be in need of acute hospital care, the proportion being significantly higher in Jerusalem (20%) than in Tel Aviv (12%). The major contribution to the overstays in Jerusalem was prolonged hospitalizations of patients in need of custodial care. There was also a significant association between physical and behavioral impairment and patient overstay in both cities. Our findings suggest that hospital overstays could be reduced by the creation of an intermediate level of care for patients with placement problems following acute hospitalization.

Aged↗
PubMed1986

Factors affecting hospitalization for selected diseases in Israel.

Hospitalization rates in Israel for five communicable and four noncommunicable diseases were computed according to age, sex, religion, origin, and place of residence. Higher rates for communicable diseases were generally found for all males and for Oriental Jews and Jews living in rural areas. Higher rates were also found for settlements inhabited by low socioeconomic populations. With few exceptions, hospitalization rates for Arabs were higher for both communicable and noncommunicable diseases, but rates for rural Arab populations were very low. These findings suggest that in a society such as Israel's, with a well-developed medical care delivery system, improvement in the health status of less privileged groups will depend more on health education than on the addition of resources to the health delivery system.

Age Factors↗
PubMed1984

Emergency department utilization during a doctors' strike.

Emergency department (ED) patient volume at Jerusalem's Shaare Zedek Hospital was 33% higher during the 1983 doctors' strike as compared with the same period in 1982. Excess visits were recorded for both sexes (P less than 0.0001), but there were many more excess visits by females than males. The largest increase in visits by adults (60-70%) was in persons aged 40-64 years (P less than 0.02), and there was also a large and unexplained increase in ED visits by girls under age 6 (P less than 0.0003). In contrast to excess ED visits, which were higher during the strike for both sexes, excess hospital admissions via the ED were recorded only among females (P = 0.007). The number of ED visits during the strike was increased on all three hospital work shifts (P less than 0.0001), with the greatest number of excess visits occurring between 7 AM and 3 PM.

Adolescent↗
PubMed1984

Patterns of emergency department use during the Israel doctors' strike.

We studied changes in emergency department utilization at a major Jerusalem regional hospital during the 4-month-long Israel doctors' strike. The number of ED visits was increased by 35% over control levels. There were larger increases in female visitors than male and larger increases in visits by children and in women of childbearing age. Use of laboratory tests, ECGs, and x-rays were increased minimally, and hospital admissions via the ED were unchanged. We conclude that the vast majority of excess strike-related ED visits were for trivial illnesses and that very large numbers of persons with medical symptoms elected not to seek any medical attention at all during the strike.

Adolescent↗