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Commissioning: the community nurse's role.

This article examines the proposal in the White Paper The New NHS (DoH 1997) that community nurses will be involved in commissioning health care and highlights nurses' absence from the commissioning arena in the past. The important contribution nurses can make to commissioning and their interpersonal and communication skills are considered. Factors that may constrain commissioning and strategies to overcome these are also discussed.

Community Health Nursing↗

Interregional labor migration and information flows.

A model of interregional labor migration is developed that incorporates a complex system of information concerning migration and employment opportunities, as well as a heterogeneous population in which groups of workers differ in their assumed levels of skill, attitudes toward risk, and willingness to move. "Three channels are examined: interpersonal communication, general source information, and specific source information targeted at unemployed workers. In this process, trajectories of welfare levels (composed of wage plus nonwage benefits), information flows, vacancy and unemployment levels are generated for different worker and job types, regional aggregates, and the system as a whole. The behavior of the model is examined by means of numerical simulations and sensitivity analyses."

Communication↗

Contraceptive behaviour in the areas served by family welfare assistants and midwives in rural Bangladesh: a comparative analysis.

"The study is an attempt to investigate contraceptive behaviour in the areas served independently by FWAs [family welfare assistants] and Dais [midwives] in...selected areas of Bangladesh....[Findings] indicated that almost every woman (98.5 percent in FWA area and 99.3 percent in dai area) has a basic awareness of at least one method of contraception....The results...suggest that a basic awareness has developed...in both the areas....A significant increase in the response on the knowledge of specific contraceptive methods was observed after prompting had been adopted while interviewing in both the areas. This clearly reveals the influences of prompting...on measures of knowledge among the target population." Data are from surveys conducted in 1985.

Asia↗

'Video, health education and the General Practitioner Contract'.

The 1990 General Practitioner Contract and the 1993 Contract Revision emphasised the role of health education/health promotion within primary care. In this paper, the authors suggest that a highly cost-effective approach is necessary given the premium on time available for general practitioners and members of the primary health care team to undertake such work. The views of general practitioners and the primary health care team in a random sample of general practices within all 15 Health Board areas in Scotland were sought between 1991 and 1993 regarding current experience and future potential in using video-based health education materials, with particular emphasis on the content, structure and parameters appropriate to running effective health education/health promotion programmes. This study has indicated the potential demand for high quality, appropriately targeted video-based materials for use by primary health care workers within a range of practice, community and home settings. Central to this is the need for a better system of information and dissemination of materials and a firmer evaluation framework for health education/health promotion programmes within primary care. The progress of several policy, management and research issues which arose from the findings of the study have been raised by the authors. These include implications for the NHS such as infrastructure resourcing and priority setting, programme development, information and dissemination, research and evaluation, and mechanism(s) whereby general practitioners can be better involved in this process.

Adult↗

Lesbian health care needs.

OBJECTIVE: To define the special health care needs of Canadian lesbians. DESIGN: A questionnaire containing 61 yes-or-no and multiple-choice questions sought information on six areas: demographics; health care use; habits, diet, and exercise; preventive care; mental health; and physical health. SETTING: The organizational meeting of a lesbian softball league in Toronto. PARTICIPANTS: Of 360 women eligible for the meeting, 205 attended and 195 completed the survey. Questionnaires used for analysis were those of the 186 women who answered yes to the question, "Are you a lesbian?" MAIN OUTCOME MEASURES: How lesbian health care needs differ from those of women in general. Results of the survey were compared with results of the 1991 Canadian General Health Survey and the 1986 Health Promotion Survey (for comparable sex and age groups). RESULTS: The lesbians were young, white, and middle class. They visited the same health care professionals as other Canadian women but for different reasons. They smoked, drank alcohol, used caffeine, and exercised somewhat more than other women, but they were not very knowledgeable about healthy diets. The lesbians got Pap smears less often than other Canadian women, even if they were at high risk. They examined their breasts less frequently, but got their blood pressure checked with comparable frequency. Lesbians had a high incidence of mental health problems and often had nontraditional support systems. Lesbians were less prone to gynecologic complaints, especially infectious diseases, but had about the same incidence of common chronic illnesses. CONCLUSIONS: Although lesbians are not afflicted uniquely by any illness, they do have special health care needs. Canadian family physicians should be aware that lesbians are part of family practice and that, like other identifiable group, they have common health concerns that differ from those of the general population.

Adult↗

Improving rural health care in South Dakota.

This study was designed to find ways to improve the quality of health care in rural settings. The study includes three components: a telephone survey of a rural community, a patient quiz, and interviews with ten rural family practice doctors in the southeast corner of South Dakota. This study was conducted in a rural community of about 1,500 people. The results of the survey suggest that rural health care can be improved by more education of the public on what is offered for preventative medicine, especially for the men 55 or younger, a female doctor who is willing to do obstetrical/gynecological services to meet the local demand, and physicians learning new procedures such as colonoscopy, colposcopy, and stress testing to better serve their patients.

Family Practice↗

Antibiotics for coughing in general practice: a qualitative decision analysis.

BACKGROUND: In family practice, medical decisions are prompted most often by complaints about coughing. There is no single yardstick for the differential diagnosis of respiratory tract infections (RTIs). In 80% of cases, the excessive use of antibiotics in the treatment of RTIs is caused by the prescription behaviour of GPs. OBJECTIVE: Our aim was to explicate GPs' diagnostic (and therapeutic) decisions regarding adult patients who consult them with complaints about coughing, and to investigate what determines decision making. METHODS: Exploratory, descriptive focus groups were held with GPs. Hypotheses were generated on the basis of 'qualitative content analysis'. Results. Twenty-four GPs participated in four semi-structured group discussions. In order to differentiate RTIs from other possible diagnoses, less likely diagnoses were not ruled out explicitly. In the case of suspected RTI, there was a low degree of certainty in the differentiation between RTIs (e.g. between bronchitis and pneumonia). Clinical signs and symptoms, which determine the probability of disease, often left GPs with reasonable diagnostic doubt. In the end, the decision whether or not to prescribe antibiotics was taken. GPs' prescription behaviour was also determined by doctor- and patient-related factors (e.g. having missed pneumonia once, patient expectations). The 'chagrin factor' explains why these factors lead to a shift in the action threshold, in favour of antibiotics. CONCLUSION: This inductive research method enabled the generation of meaningful hypotheses regarding the complex decision processes pursued by GPs. The authors are developing an educational intervention that builds on these findings, focusing on the prescribing decision.

Adult↗

Abortions in rural Idaho: physicians' attitudes and practices.

This study surveyed all family physicians, obstetrician-gynecologists, and general surgeons practicing in rural Idaho in 1994. Although most respondents provided a wide range of reproductive health services, less than 4% performed abortions, so most rural Idaho women wanting abortions must travel long distances for this procedure. Physicians report that they do not provide abortion services because of both their own moral objections and local community opposition to the procedure. Yet 26% of the respondents indicated interest in using RU-486 for abortions when it becomes available. This suggests that the development of acceptable medical abortifacients may improve access to this procedure even in very conservative rural areas.

Abortifacient Agents, Steroidal↗