PubMed Health⌕ Search

Biomedical subjects

D I Zwick

Publications and source records attributed to D I Zwick.

17 recordsLinked to original sources
PubMed1987

Trends in physician availability in 10 urban areas from 1963 to 1980.

The overall growth in the physician supply has so dominated the public policy agenda that issues of physician distribution within urban areas have received little attention. In this study, we examined the changes in physician availability in the poverty and nonpoverty areas of 10 U.S. cities between 1963 and 1980. We found that the overall availability of patient care physicians increased in both poverty and nonpoverty areas, with greater growth in the nonpoverty areas. For office-based primary care physicians, however, there was a 45% decline in availability in the poverty areas and a 27% decline in the nonpoverty areas. We conclude that the overall increase in the physician supply may not adequately correct geographic and specialty maldistribution in urban areas. We suggest that special educational, service delivery, and financing strategies within urban areas continue to be needed to address problems of inequitable physician availability.

Adult↗
PubMedDate not supplied

Home health services for the elderly: the English way.

Strengthening home health and related community services for the care of the elderly at home has received high priority in policy statements on the National Health Service. Findings from a series of recent studies and reports on these issues are reviewed, highlighting accomplishments and problems of primary health care teams, especially the district nurses, and the many other contributing community services. Seven lessons are discussed, emphasizing the relationships among home health and other community services, the importance of voluntary services, the impact of hospital and psychiatric services, needs for special training, difficulties of cost analyses, and the slow pace of progress.

Aged↗
PubMedDate not supplied

Geriatric education centers address medication issues affecting older adults.

Serious problems have been identified in the prescribing of medications for elderly patients and use of prescription and nonprescription drugs by older persons. Overuse, underuse, and inappropriate use of drugs by the elderly have been widely documented, and the harmful consequences have been described. This paper reviews information concerning the need for action to improve health professionals' knowledge and skills with respect to drugs and the elderly and activities being undertaken by geriatric education centers (GECs) to enhance these capacities. Grant support for the centers from the Health Resources and Services Administration, a Public Health Service component agency, began in 1983. In fiscal year 1992 there are 31 centers operating in 26 States. The centers are multi-institutional and conduct four types of educational activities. These include review of pharmacological issues for multidisciplinary groups, specialized training for pharmacists, discipline-specific programs focusing on medication issues, and activities aimed at educating the public. Examples of the GECs' educational activities are given.

Curriculum↗
PubMedDate not supplied

Federal health services grants, 1985.

Federal health services grants amounted to about $1.8 billion in fiscal year 1985. The total amount was about $100 million less, about 6 percent, than in 1980. Reductions in the health planning program accounted for most of the decline in absolute dollars. The four formula grants to State agencies amounted to about $1.0 billion in 1985, about 60 percent of the total. The largest formula grants were for maternal and child health services and for alcohol, drug abuse, and mental health services. Project grants to selected State and local agencies amounted to about $.8 billion. There was 12 such grants in 1985 (compared with 34 in 1980). The largest, for community health services, equaled almost half the total. In real, inflation-adjusted dollars, the decline in Federal funds for these programs exceeded a third during the 5-year period. The overall dollar total in real terms in 1985 approximated the 1970 level. The ratio of formula grants to project grants in 1985 was similar to that in 1965. Studies of the impact of changes in Federal grants have found that while the development of health programs has been seriously constrained in most cases, their nature has not been substantially altered. In some cases broader program approaches and allocations have been favored. Established modes of operations and administration have generally been strengthened. Some efficiencies but few savings in administration have been identified. Replacement of reduced Federal funding by the States has been modest but has increased over time, especially for direct service activities. These changes reflect the important influence of professionalism in the health fields and the varying strengths of political interest and influence among program supporters. The long-term impact on program innovation is not yet clear.

Child Health Services↗
PubMedDate not supplied

Establishing national health goals and standards.

Four statements of national health goals and standards were proclaimed from the U.S. Department of Health and Human Services during the 1970s. Two were based on statutory mandates--the National Guidelines for Health Planning and the Model Standards for Community Preventive Health Services. Two were the results of administrative initiatives--the Forward Plans for Health and the complementary publications "Healthy People" and "Promoting Health/Preventing Disease". These efforts present a variety of approaches and experiences and can provide direction and lessons for future endeavors along these lines. The four issuances include guidance on national priorities, resource standards, and accessibility to care. They also offer goals and objectives for local services and health status. They address a multiplicity of issues, ranging from hospital bed supply and recommended uses of specialized medical equipment to infant mortality and proposed reductions in death and disability. Almost all urge further actions to prevent illness and promote health. The development of statements of national health goals and standards has been advocated by some experts and questioned by others. Advocates believe that these materials can help clarify purposes and priorities for health programs, resulting in more effective and efficient uses of resources and greater accountability. Critics are particularly concerned about deleterious impacts on creativity and local initiatives. Among the major lessons identifiable from these undertakings is the importance of committed leadership, broad-based consultation, and reliable data. Implementation inevitably encounters the complexities of the health system and depends upon available resources. In influencing the agenda of deliberation and debate, the symbolic value of these statements may often be more significant than the specific details. The continuing interest in these approaches suggests that future efforts along these lines are likely.

Adolescent↗