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Results for “Family Planning--changes”

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PubMed1989

Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved?

We designed this study to determine whether an intensive 1-day educational workshop involving family physicians in establishing essential criteria for hypertension management would significantly affect the short-term outcomes of hypertensive patients in their practices. Forty randomly selected physicians were separated into three groups: those who would be involved in establishing the criteria (15), those who would receive the criteria by mail (15) and those who would act as controls and not be aware of the criteria (10). We found no significant difference between the three groups in the number of hypertensive patients whose condition remained uncontrolled after the intervention. We conclude that physicians' participation in the establishment of standards of care for conditions such as hypertension or their awareness of such standards does not independently result in significantly better patient outcomes. Consequently, we recommend that physicians and health care planners concerned with improving outcomes not rely on any single intervention strategy when planning change.

Family Practice↗

PubMed1990

Perspectives on health care delivery systems for American Indian families.

The national effort to improve services to children with special health care needs presents unique challenges for the delivery of services to American Indian families. This study took place in New Mexico. American Indian families whose children have special needs and health care providers were interviewed. Their responses about obstacles to health care for their children and suggestions for improving services were examined. Generally, both groups identified similar obstacles, although important differences between groups were noted. The findings point to the need for understanding cultural barriers and the unique concerns of low income families living in rural areas. This has important implications for planning changes in the health care system for American Indian children with special needs.

Child↗

PubMed2006

Integrating palliative medicine and critical care in a community hospital.

Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families. An ambassador program and expanded visiting hours turned the waiting room into part of the therapeutic environment. New palliative order sets and practice guidelines were introduced. Interdisciplinary care planning was guided by a family communication record. Communication with families was enhanced by the use of the ambassadors, comprehensive care planning and sharing with the family within 24-48 hrs of admission, and ongoing meetings triggered by care plan changes. Quality indicators for intensive care unit-based palliative care proposed by experts provided a benchmark for evaluating the completeness of our intervention. Although not easily measured or demonstrated, it is our implicit assertion that this set of process and education interventions changed the daily nature of discourse in the intensive care unit among staff and between the staff, patients, and families.

Communication↗

PubMed1998

Family practice in the new South Africa.

Remarkable changes are taking place in the new South Africa. Planned changes in the health care arena present the new, relatively small discipline* of family practice with great opportunity for development and growth. With established generalist roots and recent formal recognition in South Africa, family practice should be well suited for a lead role in the government's efforts to extend health care access to those denied it under apartheid. Whether family practice moves into that role will depend on whether as a discipline it can project a vision of how it can meet the country's health care needs. Close examination of family practice in South Africa shows how the field reflects many of the societal problems of the past and the challenges of the future. With a clear vision of its role in the new South Africa, family practice could overcome these challenges, as well as answer a broader question about the place of family practice outside of the first world setting.

Family Practice↗

PubMed1992

The impact of home monitoring and daily diary recording on patient status in cystic fibrosis.

An experimental home monitoring system for assessing the progress and planning changes in the care of patients with cystic fibrosis (CF) has been implemented at the University of Minnesota Cystic Fibrosis Center. One group of patients and families did daily recording of physical measurements and symptoms, and sent the diary to the data coordinating center weekly for analysis. The remaining patients were not part of the home monitoring program. Twenty-five patients were randomly selected from the home monitoring group. They were compared to an age- and sex-matched control group not doing home monitoring to ascertain if home self-measurement and daily diary recording, in the absence of any therapeutic intervention, produced any change in physical or psychological status, pulmonary function, or growth over a 4-year study period. Subjects ranged in age from 6 to 43 years. Clinical status was measured by the National Institutes of Health cystic fibrosis scoring system. Pulmonary function was assessed as percent of predicted forced vital capacity and percent of predicted forced expiratory volume in 1 sec (FEV1). Growth was analyzed as percent of predicted weight based on age-, sex-, and height-dependent equations. Psychological status was determined by self-assessment and referral for conseling. Only percent predicted FEV1 in the control group declined significantly. There were no statistically significant changes in any other measures either within or between diary and nondiary groups over the 4-year period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

A survey of health professionals' views on possible changes in the provision and organisation of antenatal care.

OBJECTIVE: To ascertain the views of midwives, obstetricians and general practitioners (GPs) on possible changes in the provision of antenatal care, and to describe any differences in attitude between the three professional groups. DESIGN: survey using postal questionnaire. SETTING: Three hospitals in south-east London. PARTICIPANTS: The questionnaire was sent to 251 midwives, 50 obstetricians, and 438 GPs. The overall response rate was 70%. MEASUREMENTS: A questionnaire asking whether the health professionals would like to see, were undecided, or would not like to see, 12 possible changes in the provision of antenatal care. FINDINGS: The changes that most health professionals wanted to see were individualised visit schedules and an increase in continuity of care-giver. There were significant differences between the three professional groups for 11 of the 12 possible changes, with midwives being the group most keen, and GPs tending to be the least keen, to see change. KEY CONCLUSIONS: It is important to recognise and address the different views of midwives, obstetricians and general practitioners at this time when major changes in the organisation of antenatal care are being planned or implemented. IMPLICATIONS FOR PRACTICE: Differences in attitudes between health professionals need to be addressed when planning changes in the provision of antenatal care.

Attitude of Health Personnel↗

PubMedDate not supplied

Legal trends and issues in voluntary sterilization.

Legal barriers to voluntary sterilization are falling. In both developing and developed countries, new legislation, court decisions, government policy statements, and ministerial regulations increasingly leave the decision whether to be sterilized to the individuals involved rather than to medical experts or government officials. These legal changes confirm that voluntary sterilization is an acceptable means of fertility regulation and a legitimate medical procedure; it is no longer seen as physical mutilation to be condemned in the criminal codes. Nevertheless, barriers still exist in some countries that make it difficult for poor and rural populations to obtain voluntary sterilization. These obstacles arise when voluntary sterilization is excluded from national health and family planning programs and from private insurance plans. Changes in voluntary sterilization law reflect increasing choice of this method of fertility control. Over the last decade voluntary sterilization has become the most widely used means of family planning in the world. Approximately 100 million couples now are protected from unwanted pregnancy by voluntary sterilization. This amounts to one-eighth of the world's couples and one-third of all those practicing contraception. Almost half of these couples are in China. Voluntary sterilization is most prevalent in countries where the procedure has been clearly legal for a number of years. But now it is also becoming more common in countries like Brazil, where the legal status has been less clear.

Adolescent↗

PubMed1990

An assessment of a hospital-based pregnancy testing service.

A proposal to withdraw the hospital-based pregnancy testing service provoked a local debate in which a range of strongly held but conflicting opinions were expressed. It was agreed to seek more detailed information before making any final decision. The authors describe their investigations and findings about the use of the service and the views of its consumers. Subsequently, a solution was reached for a novel but more appropriate form of service provision. It is argued that when planning changes in service provision health authorities should obtain information from and consult widely with all consumers.

Female↗

PubMedDate not supplied

Parent Partners: a parent-to-parent support program in the NICU. Part 1: Program development.

Neonatal intensive care units (NICU) face the challenge of developing family-centered systems of service delivery. An important component of family-centered care is parent-to-parent support. A parent-to-parent support program that meets the needs of both parents and staff can be successfully established in the NICU if the principles of planned change are used to guide the process of program development, implementation, and evaluation.

Health Services Needs and Demand↗

PubMed1994

General practice patient records.

OBJECTIVE: To examine the management and use of patient records as well as plans for future information management. SETTING: General practice in South Australia (68% response, n = 315). METHODS: Descriptive and analytical cross-sectional study using a mail questionnaire. RESULTS: The sample was representative by age, gender and postcode location of practice. Half the GPs used index cards and 5% computer-based records. Users of the RACGP folder were most (92%) and index card users least (65%) satisfied. The use of patient summaries could be improved. GPs planned to change to computer-based billing, more comprehensive paper-based records, and computer-based patient records. Perceived reasons for and obstacles to change were documented. Factors that influenced the use of different forms of patient records were type and place of practice, staff employed, gender, a Diploma in Obstetrics, age, year of graduation, type of record used and satisfaction with it, vocational registration, FRACGP, and FMP training. CONCLUSION: Given the high use of index cards, a variable but generally low satisfaction and planned changes, there is an unmet need for useful patient record systems in general practice. The effect of affluence of suburb and vocational registration warrants further study.

Cross-Sectional Studies↗

PubMed1994

Primary care in transition.

It is generally agreed that too few physicians have chosen careers in primary care. The advent of managed care as a popular method of health care provision is now affecting primary care physicians in ways that may further discourage enthusiasm for the practice of primary care and have an unintended negative effect on the primary care physician supply. In addition, the early implementation of the resource-based relative value scale by Medicare and some insurance carriers has been less beneficial to primary care physicians than expected and may even have been harmful to general internists. Efforts to improve the position of primary care physicians in relation to payers and among peers are hindered by the fact that, as a group, primary care physicians are less affluent, less influential, and greatly outnumbered by their more specialized colleagues. Consequently, some of the support currently directed toward primary care may be more apparent than real. My proposals, which aim both to protect and to enhance primary care practice, are the creation of separate primary care fee schedules and separate primary care budgets within health plans, changes in consumer protection rules that intrude on primary care practice, and the development of statewide primary care associations for mutual support and greater bargaining power. Some aspects of contracting and gatekeeping require further study.

Career Choice↗

PubMed2001

A continuous improvement process for health providers of victims of domestic violence.

BACKGROUND: Health care providers can play an important role in the prevention of domestic violence through established processes of identification, safety assessment, validation, documentation, and referral. In 1998 the Safe Family Project, funded by University Health System (UHS), affiliated with University of Texas Health Science Center at San Antonio, provided for a clinical review of existing services for victims of domestic violence. A subsequent review of the health system's policy and clinical practice supported the need for resources and training and for an improved care process for victims of domestic violence. THE CONTINUOUS IMPROVEMENT PROCESS (CIP) MODEL: UHS adapted the Shewhart cycle of activities popularly referred to as PDSA (plan change, do change, study results, act on results), a systematic, process-focused approach to achieving continuous and measurable improvement, as its CIP model, and it formed a process improvement team. This process led to translation of research findings into best practice guidelines for treatment of domestic violence and staff education. RESULTS: Significant improvements were made in the overall qualitative chart reviews, although the diagnostic coding (using ICD-9 codes and e-codes) did improve. The CIP can be replicated in other settings to improve the care of victims of domestic violence. DISCUSSION: The CIP effort is being extended to outpatient facilities, and managers have requested that the training manual be replicated and placed throughout UHS as a resource manual. Other activities are intended to improve prevention of domestic violence and intervention when it occurs.

Community Networks↗

PubMed1986

Community organization and school liaisons: how to get programs started.

This paper briefly reviews four intervention models, Rothman's community organization, Green's system-centered education, Rogers' innovation-decision process, and Watzlawick's planned change, for their applicability to help initiate community-based programs for drug abuse prevention and health promotion in youth. An expanded model is described, including preprogram assessment of the target population, community, and drug use problem, and continuous evaluation of program process and product. School liaisons are emphasized as a key factor in early adoption and demonstration of a community-based program for youth. The expanded model, including school liaisons, is applied to a comprehensive community drug abuse prevention project being implemented in the Greater Kansas City area. The model--and the project--suggest methods for organizing communities for long-term drug prevention, initially at the level of school and school district, and later to the family, mass media, and community organizations in a proximal-to-distal sequence of programming.

Adolescent↗

PubMed1990

A profile of the 7500 people in aged-care institutions in Auckland.

A study was carried out in 1988 to describe the residents and patients of aged-care institutions in Auckland against which future measures, including planned changes in licensing and funding, could be made. Information was collected for each patient in every hospital (public and private) and each resident in all old people's homes in the Auckland region between January and June 1988. Of the 7516 people surveyed (99.4% response rate), 70% were residents in old people's homes, 25% were patients in private hospitals and 6% were cared for in the public hospital sector. Of the people surveyed, 71% were women. The average age of women, 82 years, was 6.5 years older than that of men. Three-quarters of all women and 44% of men in care were widowed. Women had a higher rate of admission to institutions than did men with almost one in two women and one in four men in the age group 85 years and over being in long term care. Rates of institutionalisation for Maoris and Pacific Islanders were the same as for Europeans. The majority of elderly people received regular contact and concern from family members. This study has demonstrated that Auckland has a higher proportion of the elderly population (7.6% of the population 65 years and over) in long term care compared with other areas of New Zealand.

Aged↗

PubMed2001

Journal article content as a predictor of commitment to change among continuing medical education respondents.

BACKGROUND: Journal reading is a time-tested means of continuing medical education (CME) among physicians. Asking physicians to make a written statement of commitment to change has been shown to increase the likelihood of eventual change in practice behavior when used in conjunction with CME lectures. We describe the type and medical content of articles responsible for commitment to change comments among readers of a large circulation primary care journal. METHODS: Response to the question "what change(s) do you plan to make in your practice as a result of reading the articles in this issue?" were analyzed from CME response cards associated with six issues (1 year's publication) of the Archives of Family Medicine. Responses indicating a commitment to change were analyzed to characterize the type and content of articles responsible for their generation. RESULTS: During the 1-year study period, original contributions (reports of research trials) dealing with medicine and preventive medicine content accounted for the greatest number of comments. After adjusting for the frequency of article type and content, special articles and those dealing with complementary medicine accounted for the highest number of comments on a per-article basis. FINDINGS: Family physicians make commitment to change statements on the basis of a broad range of journal articles. Certain articles are more likely to generate statements of commitment to planned changes in practice.

Education, Medical, Continuing↗

PubMed1992

Psychological functioning of daughters of breast cancer patients. Part II: Characterizing the distressed daughter of the breast cancer patient.

Sixty daughters whose mothers had breast cancer were cross-sectionally studied. Daughters age 11-20 reported feeling significantly more uncomfortable about involvement in their mothers' illness than daughters age 20+. Daughters whose mothers died were more likely to report long-term life plan changes and role changes with their mothers during the mothers' illness. The Global Symptom Index was predicted by the daughter's perceived degree of involvement with her mother (during her mother's illness), current emotional resolution (about her mother's illness), and sexual satisfaction. Sexual satisfaction was predicted by role changes during the mother's illness, frequency of sexual relations, and a depression scale.

Adaptation, Psychological↗

PubMed1999

Moving from policy to practice in curriculum change at the University of Virginia School of Medicine, East Carolina University School of Medicine, and SUNY-Buffalo School of Medicine.

A set of formative evaluation studies from the medical schools of the University of Virginia (UVA), East Carolina University (ECU), and the State University of New York at Buffalo (SUNY-Buffalo) portrays, in qualitative and quantitative terms, evidence of achievements and obstacles to the curricular reform supported by The Robert Wood Johnson Foundation's Generalist Physician Initiative (GPI). In this paper, innovations in the under-graduate curriculum, a specific course, and instructional strategies are examined. Individual interviews of faculty and focus groups with students assessed opinions about curricular change at the University of Virginia. Questionnaires and focus groups provided information about the impact of course changes at East Carolina University. Questionnaires completed by students provided information of the effect of modifying the instructional strategies at SUNY-Buffalo. The obstacles to implementing change at the three schools included breakdowns in the faculty's understanding and support of change, lack of skills required to implement change, and weakness in coordinating and assessing planned change. Although the GPI catalyzed changes in the content and conduct of generalist education at the three schools, many lessons were learned that are applicable to other medical schools.

Curriculum↗

PubMedDate not supplied

Three factors critical for end-of-life care.

Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients.

Community-Institutional Relations↗