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Biomedical subjects

P Kekki

Publications and source records attributed to P Kekki.

At least 19 recordsLinked to original sources
PubMed1998

Quality evaluation of oral health record-keeping for Finnish young adults.

The objective of this study was to assess the quality of oral health record-keeping in public oral health care in relation to dentists' characteristics. A random computerized selection of 239 subjects, born in 1966-71 and clinically examined during 1994 in an administrative unit of the public oral health service in southern Finland, included 4-5 cases per dentist, the number of dentists being 50. Data concerning actual clinical examinations and treatment courses carried out in public dental clinics came from original oral health records. Criteria for assessment of oral health record entries were based on Finnish health legislation and detailed instructions of health authorities. The results showed that each patient's identity was available in 90% of documents. Recordings concerning continuity of comprehensive care were infrequent; a questionnaire concerning each patient's up-to-date health history was in only 26% of the oral health records. Notes concerning each patient's bite and function of the temporomandibular joint were in 37% of the records, notes about oral soft tissues were in 11%, and the check-up interval was recorded in 21%. Recording of indices on periodontal and dental status varied greatly; the community periodontal index of treatment need was found in 93% and the index of incipient lesions in 16% of the records. Female dentists and dentists younger than 37 years tended to record more information. Dentists should be encouraged to better utilize the options offered by oral health records for individual treatment schemes.

Adult↗
PubMed1998

Inadequate dosaging in general practice of tricyclic vs. other antidepressants for depression.

Several prescription database studies suggest major differences between antidepressants in the proportion of patients in general practice treated with doses likely to elicit a true drug response. However, in these studies it has been difficult to differentiate prescriptions for depression from those for other indications, or to distinguish lower starting doses from the final treatment doses. We investigated possible differences between types of antidepressant in the proportions of patients receiving adequate treatment doses for depression from the primary health care services of Helsinki. Doctors at 22 (71%) of the 31 health centres in Helsinki were surveyed with regard to their antidepressant prescriptions over a period of 2 working weeks. There were marked differences in dosaging adequacy between the various types of antidepressant prescribed for depression at final treatment doses. Overall, 71% of the prescriptions for the tricyclic antidepressants, but only 13% of those for the other antidepressants, mainly selective serotonin reuptake inhibitors, were for low doses that are generally considered to be ineffective (P<0.001). These findings endorse the emerging perception that, in general practice, tricyclic antidepressants are usually prescribed for depression in too low doses, and that a greater reliance on other antidepressants would probably improve the effectiveness of treatment in primary health care.

Adult↗
PubMed1995

Adolescent readers' responses to the booklet on sex.

PURPOSE: To investigate the reception and the readers' reactions to a booklet about sex, which is mailed annually to all 16-year old Finnish adolescents. METHODS: Eight hundred youngsters were randomly selected to the study. A questionnaire was sent to them six weeks after the mailing of the booklet, The Sextiin. After three rounds, a response rate of 65% (N = 521) was achieved. RESULTS: The booklet reached 97% of the respondents, of whom 72% read all of it. The respondents' attitudes towards and reactions to the Sextiin were mainly positive. They reacted least positively to the articles on homosexuality and masturbation. Twelve percent of the respondents indicated that they opened the condom package that was attached to the Sextiin. CONCLUSIONS: The study shows that the campaign reached its target group well. As the adolescents' reactions to the Sextiin proved to be mainly positive, a claim for further use of the mass media for educational purposes is justified.

Adolescent↗
PubMed1994

Training managers for primary health care.

The University of Helsinki has devised a powerful in-service training course for managers of health centres. By working together at the University and their own centres on setting objectives, analysing data and solving problems, the participants greatly enhance their management and teamwork skills.

Curriculum↗
PubMed1992

[Postoperative rehabilitation in patients with hip fractures].

The purpose of the present study was to determine the variables associated with the length of hospital stay and to evaluate the ability to reach prefracture ADL-status after operation on patients with proximal fractures of femur. One hundred patients with cervical and trochanteric fracture were operated with internal fixation and endoprosthesis during a two year period. The type of surgical procedure selection was made by the surgeons own decision as part of treatment routine. The data were collected using a structured interview, participating observation and content analysis. The follow-up period was six months. The mean hospitalization time was 31.5 days, when seven patients with extremely long hospitalization, due to waiting for a long term care, were excluded. Stepwise regression analysis was used to determine variables associated with a longer hospital stay. Variables that related to poor prognosis were age, sex of patient, operation delay, weightbearing, medication, dizziness, status post paralysis and circumstances of dwelling. A significant difference was found between internal fixation and endoprosthesis at patient with cervical fracture of femur regarding to the length of hospital stay and ability to reach prefracture ADL-status in two weeks after operation. Results of this study showed, that the objective, to discharge patients in two or three weeks, was not achieved. This study also showed, that all patients did not regain the prefracture ADL-status during a follow-up period. It is important to assure the effectiveness of treatment after discharge from hospital in primary care and to prevent proximal fractures of femur in the elderly.

Activities of Daily Living↗
PubMed1991

Leadership for motivation in health care.

For primary health care to achieve its potential the providers have to be strongly motivated. Supportive leadership can play a significant part in bringing this about. A study in Finnish health centres showed that leadership functions, such as the encouragement of doctors and nurses, were particularly important in helping staff to feel that they were doing worthwhile jobs.

Community Health Centers↗
PubMed1990

Unnecessary visits to health centres as perceived by the staff.

The aim of this study was to assess the present situation concerning unnecessary visits to health centres as perceived by the primary health care staff. Associations of this perception with the internal work motivators were analysed. Data consisted of the personnel of four health centres located in various parts of Finland. A pretested questionnaire was employed with a response rate of 87%. The number of responders was 644, comprising 24 administrative staff, 146 general practitioners, 383 nursing staff, and 91 office staff. An estimate of the number of unnecessary visits (%) was obtained using a scale from 0 to 50%. Estimates less than 20% were regarded in the analyses as acceptable by the authors. The methods of analysis included cross tabulations and logistic regression. The theoretical framework for this research was a modification of the work motivation model by Hackman and Oldham. 41% of responders felt that at least 20% of patient visits could be characterized as unnecessary (49% of doctors, 37% of nursing staff). The health centres also differed from each other. The longer the doctors had worked in their present health centre, the less they regarded the visits as unnecessary. Among those doctors who had worked in the health centre less than four years, 63% indicated that 20% or more of all visits to doctors were unnecessary. There was no similar trend with nurses. With the doctors, the most important risk factors among the internal motivators for perceiving the proportions of unnecessary visits high were the lack of work significance and lack of task identity whereas with the nursing staff the important risk factors appeared to be the perceived lack of skill variety of the work and lack of task identity. The study suggests the need for specific postgraduate training for doctors who intend to work permanently in primary health care.

Attitude of Health Personnel↗
PubMed1990

Use of a tracer activity for health centre evaluation.

The effectiveness of five Finnish health centres was assessed on the basis of a study of their physiotherapy units. This single area of activity proved to be a valid indicator of the general state of affairs in the centres.

Finland↗
PubMed1989

Factors influencing the patient-provider relationship.

This article analyzes some of the central elements of the patient-provider relationship i.e. continuity of care, communication, compliance, and the various elements of the consultation itself. This analysis is based on the review of relevant literature. The same principles apply to this relationship regardless of the provider category. When aiming at good care the recognition of the real need of care and the sharing of information with the patient in a proper and effective way are important. These skills belong to the professional competence of the provider. Continuity of care is the element facilitating the forming of a good patient-provider relationship. The importance of the patient-provider consultation is very great. The immediate, intermediate and long term outcomes of the consultation have been studied by several researchers. The immediate outcomes such as the patient satisfaction strongly influence the intermediate outcomes and also the long term outcomes all-though the intermediate (i.e. compliance) and long term (i.e. change in health status) is also strongly influenced by the patient's sociocultural environment. On the other hand, the patient's health understanding can be much enhanced through skillful communication by the provider during the consultation in a good patient-provider relationship. This, again, connects the elements of consultation very tightly with the success or failure of the care process and the patient's future use of health services.

Communication↗
PubMed1989

Health centre efficiency. First results of an organizational analysis of four Finnish health centres.

First results are given on the opinions and perceptions of the health centre personnel (including administrative staff, doctors, nursing and office personnel) concerning their work at four health centres, which represent different types of organization with respect to urbanrural axis, geographical location, and size of base population. Data were collected using a pretested questionnaire. The number of completed forms was 710, of which 702 were included in the final analysis. The response rate was 95%. The results indicated that doctors and administrative staff considered their work mentally more stressful than the other groups. According to the doctors, important adverse factors in their work were 1) the forced pace of work and 2) the perceived haste and tight schedule. The findings also suggest that, at least in those health centres studied, communication between various professional groups was insufficient. Likewise, the transfer of information between the various functional units was problematic. These findings may indicate difficulties in the planning, organization, and coordination of the work. Therefore the attention should be focused especially on the management of health centre organizations.

Attitude of Health Personnel↗
PubMed1989

[Analysis of use and coverage of a population of a primary health care district in Finland. An epidemiological approach].

The data were collected by recording all office visits to the health center doctor during one year. The health center district population amounted 14,500 persons. The total number of persons visiting was 8701 of which a systematic sample of 2540 persons was drawn. Information on the use of services was collected from the patient files using precoded and pretested forms planned for this purpose. This information was supplemented by population data and data of private medical care reimbursements from the sickness insurance registers. The results are mainly presented by pictures relating the use of various services to 1000 persons in the population at risk. The emphasis is on the methodology not in the actual numbers. The results indicate, however, that in 1977 55% of the population visited the health center doctor at least once during the year. More than 90% of those persons who visited were treated exclusively by the health center general practitioners. 13.7% of the population of the district made 50% of the office visits. 4.7% of persons who visited the health center doctor were immediately referred to the central general hospital outpatient department as emergency cases and 0.4% to mental hospital. 5.5% were admitted to the health center hospital ward. Sixteen percent of the population used private medical services either exclusively or simultaneously during the year.

Community Health Services↗
PubMed1989

Training for primary health care.

New courses in health services studies have been launched at Helsinki University. They offer undergraduates a chance to study this subject to degree and doctoral standards without previous medical training of any kind.

Finland↗
PubMed1987

Quality of care in general practice.

In this article the author discusses some of the principles of evaluation of quality of care in general practice and connects this with some empiric results of a study which attempted to evaluate the quality of work of the general practitioners in a Finnish health centre. Data were obtained by 1) recording all the 8701 persons visiting during one year; 2) drawing a systematic sample of 2540 persons from all those who visited; and 3) abstracting the required information from patient documents to specially planned precoded and pretested forms. The objectives of the study included the investigation of the quality aspects of the health centre doctor services, among other things also the continuity and coordination of care. The results raise questions concerning the quality of work. No general conclusions on the quality of care are drawn, since the data may not be adequate for that. According to the author, the findings emphasise the importance of at least three things: The consideration of what is done in the context of the patients' prognosis, the communication skills of the general practitioners and the communication between the general practitioners who work in the same place. In the light of the described and other findings of the study it is strongly recommended that the study of the contents of the work should be an integral part of today's general practice.

Adult↗
PubMed1984

Assessment of medical certificates with a diagnostic outcome method.

This study which focused on the 169 approved certificates for patients applying for the right for "free" medication in a sickness insurance district during one year in Finland shows two interesting findings. These, cannot of course be generalized because of the low number of observations and of doctors involved (total of 17, of whom three had written the majority of the certificates): the strict application of the official criteria to the certificates would have caused 93% of them to be turned down as very deficient, i.e. not qualifying for insurance fund coverage of medication costs, compared with the 33% when using the generally accepted and tested valid criteria. The proportion of the false negatives when using the minimum number of the official criteria would have been 89%. However, all the 169 certificates had been accepted by the sickness insurance board on the advice of the physician member of the board; It was also found that the control of the BP after a treatment period of four months or longer before qualifying for "free" medication was far from adequate according to these data. Indeed, the longer the treatment period the worse the level of control. Although this does not tell anything about the level of control after granting the right for "free" medicines, it raises very serious questions and obviously needs a thorough clarification. If this finding were to be generalised which as yet it is not, it would mean that the whole system of free medication for chronic hypertension became questionable and that urgent measures would be needed to correct this weakness. The problem is of considerable importance from the economic point of view.

Adult↗
PubMed1983

Primary care physicians and use of health services in Finland.

This article presents results from a study investigating the relationships between the availability of resources and the use of health services in Finland focusing on the health centre physician supply variable. The study uses observations from other studies on the subject and knowledge of the Finnish and other health services as a point of departure. It tries, by using the systems approach, to examine the effects on use of the health services resources considered to be important from the organizational and health policy points of view. The specific aim of the study was to investigate the relationships between the health centre physicians and other health centre resources and use in various health care sectors. The results suggest that the organization of primary health care, including the primary care physicians, has a profound potential effect on the use and costs of the total health care system.

Finland↗
PubMed1983

Quality assurance in primary medical care.

Some general ideas of the evaluation of the work of the physician applicable also to primary care physicians are taken up in this article. The presentation is not trying to be a complete review of the topic. It tries, however, to direct attention to the importance of the subject from the point of view of the practising physician and also to point out some ideas of the possible difficulties to be faced in connection with primary medical care. Certain basic weaknesses of the original audit method in the primary setting are indicated. The usefulness of the structure-process-outcome model and of the understanding of the complex interactions and relationships between the various components of this model are stressed. Finally, a couple of promising methods relating to the work of the primary care physician are described. From the practice point of view the basic problem is to decide to what extent either the process or outcome are valid indicators of quality. Here one should keep in mind that correlation between these two measurements may be low and that it has been expressed by some (1) that, fundamentally, validity depends on the strength of the relationship between process and outcome and on our understanding of that relationship.

Finland↗
PubMed1982

Use of illness-related ambulatory physician services in Finland.

The total utilization rate of ambulatory illness-related physician services in Finland is higher in big urban health center areas than in rural areas. When only the health center physician utilization rates were studied the finding was opposite. A notable finding related to the impact of the national health planning were the surprisingly equal average utilization rates of public sector health services (health center physician and general hospital outpatient services combined) in both areas. In fact, use of cheaper public services was greater in rural than in urban areas. The difference in total use rates was almost entirely due to the larger use of more expensive private physician services in urban areas. At present, there is a great pressure for increasing the supply of health center services in urban areas to the same level as in rural districts. One of the fundamental questions seems to be the pricing of the two service sectors--public and private.

Adolescent↗