Editorial: By way of introduction.
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Biomedical subjects
Publications and source records attributed to R L Kane.
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Vector resolution represents a new method for analyzing consumer data and comparing patterns for a variety of consumer services. The vectors are derived from a measurement of frequency of use and a geographic direction from the origin of the group to the point of service. Although the data presented were drawn from a probability sample survey of southern Utah rural households, the methodology may be readily applied to data derived from a variety of sources.
The perception of Indian health care needs are shown to be related to particular positions within the Public Health Service (PHS) structure. This study is based on interview data gathered from three groups: Navajo consumers (N = 271), Navajo PHS personnel (N = 80), and PHS non-Navajo professional staff (N = 31). The identification of health needs by the Navajo consumer is oriented toward unsolved problems in the immediate social and physical environment. Ninety-five per cent of the problems identified by the consumer centered around disease states, alcoholism, environmental problems, and transportation. Only 28 per cent of the Navajo personnel responses fell within these categories. The responses of the professional staff were systematically distributed among 14 identified health needs. Of major concern is the marginal position held by the Navajo PHS employee who seems to identify health problems which are similar to neither the Navajo consumer nor the PHS professional. While they are still tied to the Navajo culture per se, the Navajo personnel are economically dependent upon the PHS for a livelihood. This "man in the middle" position may require divided loyalties-to their community and to their employer. Such a schism can have serious consequences in their ability to function effectively as health workers.
A system of chart review is presented which develops both auditing skills and patient care skills. The model suggested is a flexible one, applicable at various levels of training in both inpatient and outpatient settings. Its application to family practice resident training is shown by comparing the performances of residents at the beginning and end of a demonstration period.
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