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At least 289 records · Page 16Linked to original sources
PubMed2000

Gatekeeping access to services at the primary/secondary care interface.

This paper examines the role that mental health clinicians play in gatekeeping access to services at the primary/secondary care interface. Layder's research map is used to explore the factors that influence gatekeeping decisions at four interrelated levels of social organization; self, situated activity, setting and context, plus a historical dimension that permeates each level. The main theme that emerges from the analysis is that the dilemmas that arise from attempting to control the demand for care are difficult to resolve for policy makers, managers or clinicians alike. A combination of factors make it difficult to establish consistent priorities including: the uneven distribution of specialist services, the lack of a consensus definition of severe mental illness and the difficulty of weighing the potential benefits of care for the individual against the need to ensure that resources are distributed fairly. It is suggested that there are no easy answers to these dilemmas because gatekeeping is a socially contested process, in which there will be winners and losers.

Community Mental Health Services↗
PubMed1992

Spinning the wheels: a CAPS survey of ethical issues in pediatric surgery.

To evaluate decision-making factors of pediatric surgeons when faced with ethical dilemmas in a clinical setting, questionnaires were mailed to members of the Canadian Association of Paediatric Surgeons. The surgeons were asked to respond to scenarios regarding ethical dilemmas in the treatment of children. Fifty-one responses (57%) were computer analyzed based on chosen responses to the clinical dilemma and demographic factors such as age, sex, marital status, country of citizenship, religion, and "religiousness," a determination of religious conviction as viewed by the respondent. In addition, ethical convictions were sought regarding abortion, fetal research, AIDS, HIV testing, denial of medical care due to religious beliefs (Jehovah's Witness), and limitations in health care access for indigents. In general, respondents found it difficult to separate ethical guidelines for determining aggressive treatment--absolute value of life; best interests of the child; parental authority; and ability of the child to engage in social, intellectual, or emotional attachments (quality of life)--in the face of actual patient care issues. In fact, results of this survey indicate that the operating surgeon applies his/her medical knowledge and surgical "experience" to each individual case, incorporating his or her own ethical beliefs (in a respondent's words: "In the operating room, the surgeon must satisfy his own conscience in making decisions") while cognizant of legal guidelines for "standard care" ("Decisions would be based on personal experience, and what the local society believes to be right").(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1990

Ethics and technological advances: contributions of social work practice.

Rapid technological advances in biomedicine have created ethical dilemmas for social workers and other health professionals. This article reviews three areas in which advances have been most dramatic; life support for terminally ill and elderly persons, reproductive technologies and services to severely impaired newborns. It presents principles and processes that can help structure decision making when choices are many and difficult to make. Finally, it suggests ways that social work can use its own technology to help humanize and demystify sophisticated medical technology.

Ethics, Medical↗
PubMed1992

The request for proposal and vendor selection process.

The RFP and vendor selection process is critical to the successful acquisition and installation of systems to automate health information management departments. The effort expended in the planning process, through the requirements definition, needs assessment, and conceptual system design are absolutely essential to the development of concise requirements for the RFP document. These requirements are also essential in evaluating vendors during the vendor screening and site visit process. Follow-up documentation evaluating all systems under consideration clarifies each system's utility in terms of the ability to meet or exceed conceptual design requirements. In a competitive vendor environment, these decisions will continue to become more difficult. However, the preparation of clear requirements, and the distribution of a concise RFP will assure the successful acquisition of health information management systems to meet health care needs today and in the future.

Abstracting and Indexing↗
PubMed1984

Child abuse treatment and follow-up: can the pediatrician help improve outcome?

The pediatric role in the management of child abuse and neglect has been largely limited to detecting and reporting cases, with little involvement in long-term treatment and follow-up. A review of published clinical experience indicates that customary protective services' "treatment" strategies are all too often ineffective at preventing reabuse, improving child health and developmental status, and improving family functioning. When foster care is used as a treatment modality, children run the added risk of never returning home, nor being freed for adoption, and they may suffer the emotional harm of repeated foster placements. This situation is likely to worsen, in the light of recent cutbacks in social service programs, at a time of rising reports of maltreatment. The pediatrician is widely recognized as an expert in children's health and development, and he can effectively use his position to influence the management of cases and thereby the outcome, by actively participating in treatment decision making and providing close follow-up in a limited but important way. In order to do this, he must first become acquainted with the effects of maltreatment upon children's health and development and with the general principles and available modalities of treatment. He must be sympathetic and supportive of the difficult role of the protective service worker who must make treatment decisions. His role is to assist the worker by making medical resources available in order to adequately define the child's needs and the capacity of the family to meet those needs. Essential to answering these questions is the availability of a child development clinic and mental health resources.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1998

Home care case management. Perspectives from the home front.

Focus groups were held with home care case managers in two cities in Canada which provided information on the role of the case manager, factors that influence decision making, recent changes that have taken place in case management, and the different and positive aspects of home care case management. Factors which influence decision making were grouped into organizational, client, family, other professionals, and case management factors. The differences in case managers' preparation and functions in the two sites are discussed. The difficult aspects of case management included making tough decisions related to client resources, and client, work life, and management issues. The positive aspects included the personal interaction with clients, the opportunity to follow through on services to clients, the diversity of case management work, and the opportunity for relatively independent professional practice.

Attitude of Health Personnel↗
PubMed2007

Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.

BACKGROUND: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers /=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS: Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS: Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.

Adult↗
PubMed2002

The demise of a planned randomised controlled trial in an urban Aboriginal medical service.

To fill a gap in knowledge about the effectiveness of brief intervention for hazardous alcohol use among Indigenous Australians, we attempted to implement a randomised controlled trial in an urban Aboriginal Medical Service (AMS) as a joint AMS-university partnership. Because of low numbers of potential participants being screened, the RCT was abandoned in favour of a two-part "demonstration project". Only 16 clients were recruited for follow-up in six-months, and the trial was terminated. Clinic, patient, Aboriginal health worker, and GP factors, interacting with study design factors, all contributed to our inability to implement the trial as designed. The key points to emerge from the study are that alcohol misuse is a difficult issue to manage in an Indigenous primary health care setting; RCTs involving inevitably complex study protocols may not be acceptable or sufficiently adaptable to make them viable in busy, Indigenous primary health care settings; and "gold-standard" RCT-derived evidence for the effectiveness of many public health interventions in Indigenous primary health care settings may never be available, and decisions about appropriate interventions will often have to be based on qualitative assessment of appropriateness and evidence from other populations and other settings.

Adolescent↗
PubMed1996

[We had an unlimited budget and we have exceeded it...].

The extraordinary costs involved in medical innovation leads, inevitably, to financial restrictions. Doctors need to involve themselves in the decision making process, difficult as this may be. Otherwise, health administrators will assume the full responsibility for decision making, as has become the case in the United States. Doctors must be particularly wary that financial restrictions impinge on neither medical progress--through subtle cut-backs--nor on the fundamental ethical principals--such as a decision to reduce the intensity of care in patients with complications.

Belgium↗
PubMed1994

The terminally ill--secular and Jewish ethical aspects.

Many ethical, religious, social and legal dilemmas are involved in the care of dying patients. Major changes and developments in recent years have greatly intensified these moral problems. In this article a comprehensive analysis of the relevant principles and practical approaches is offered in order to enhance the ability of health care providers to attain morally sound decisions concerning the dying patient. The relevant ethical principles include the following: value of life, quality of life, nonmaleficence, beneficence, autonomy, paternalism, justice, and the physician's integrity. In practical terms, there are three major categories: the patient, the treatment and the decision maker. A comparative analysis between secular and Jewish attitudes towards the terminally ill patient has revealed significant differences both in the fundamental underlying principles as well as in the practical solutions to the diverse and difficult ethical problems.

Attitude to Health↗
PubMed1995

Access to services: what are the real needs?

Adequate accessibility to managed care services is typically a key determining factor when an employer decides to implement a managed care plan. And although it can be difficult for an employer to determine what constitutes adequate accessibility, it is necessary in order for managed care utilization and associated cost savings to be maximized.

Decision Making, Organizational↗
PubMedDate not supplied

Improving safety in health-care institutions.

Floors in hospitals and other healthcare institutions must be hygienically clean but they must also have a high degree of slip-resistance to avoid accidents during walking--especially for patients recovering from illness or surgery, or weakened by the effects of age. Good slip-resistance and clinical cleaning are difficult to combine because conventional slip-resistant floors have a rough surface to provide maximum grip, making them virtually impossible to clean to a high standard. This article discusses the development of materials which satisfy both criteria.

Decision Making, Organizational↗
PubMed1988

Improving the quality and quantity of whole blood supply: limits to voluntary arrangements.

The inadvertent transmission of AIDS virus through contaminated whole blood has shaken the viability of the American voluntary blood supply system. For the first time since the voluntary donor system replaced the commercial blood system, there are widespread doubts about the ability of blood suppliers to meet the nation's increasing health care demands. This paper presents a framework for analyzing blood collection. First, we critique the existing literature on blood collection, arguing that its focus on donor motivation is difficult to integrate with policy analysis. We then present a specific model of the individual's decision to donate blood as a comparison of the costs and benefits of donating. The current system of collecting whole blood relies on donors receiving only altruistic benefits. We explore the limits of this approach to dealing with the quantity and quality problems presented by the AIDS virus. Alternative approaches....

Acquired Immunodeficiency Syndrome↗
PubMed1999

The staffs' views regarding young men involved in decisions on abortion: preliminary information from a study of outpatient clinics for adolescents in Sweden.

The purpose of this study was to obtain knowledge about the opportunities available to Swedish teenage boys and young men for obtaining advice and support during the process involved in making decisions on abortion. The study was carried out at Swedish Outpatient Clinics for Adolescents. We also wanted to obtain knowledge about the staffs' views of male attitudes and feelings regarding abortion. This knowledge is intended for use in developing models for advice and support in this difficult situation. A questionnaire focused on current management routines and staff experiences of questions and problems taken up by the male partner concerning abortion. Questionnaire answers indicated that the potential father, as well as the mother, requires active care and information together with the partner. There was also a need for individual support and information for male partners requiring engagement of health care professionals who are familiar with the problems involved.

Abortion, Induced↗
PubMed1994

Computer systems. Which system for GPs?

With over 100 systems to choose from, buying a computer system for use in general practice can be a difficult and arduous task. The Department of Health provides some guidelines to try and ease the problem, but there is very little empirical evidence which buyers can use to help them make decisions. Cathy Bakewell and Peter Turnbull describe some research which might help.

Ambulatory Care Information Systems↗
PubMed1989

An elderly patient with recurrent falls.

Many elderly patients have conditions which may not merit hospital admission but leave them in danger at home. The situation becomes more difficult if they refuse alternative accommodation and there is no family support.

Accidental Falls↗