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PubMedDate not supplied

Aging of the population of a city and its implications for hospital-based services: the example of Tel Aviv-Yaffo.

The Tel Aviv (Israel) Medical Center serves an area with 270,000 residents, more than 20 percent of whom are over 65 years of age. This high proportion of elderly patients and increasing costs of hospitalization have prompted the center to develop alternative health care services that have made it possible for a number of aged patients to remain at home and ambulatory. Two such alternatives to hospitalization--the center's Day Care Clinic and Home Care Clinic--are described and estimates of savings in hospitalization costs are presented.

Adolescent↗
PubMed1991

Access to cancer prevention, detection, and treatment.

The American Cancer Society Hearings on Cancer and the Poor made visible to the nation the harsh realities and consequences of lack of access to health care among the poor and uninsured in America. Access to care is more than mere availability; it is also financial accessibility, effectiveness, acceptability, appropriateness, and comprehensiveness of care. The problems and consequences of lack of health care access and its impact on the cancer problem among poor Americans are explored, and ways practitioners and public advocates can improve access are suggested. Local communities have risen to action to make health care more accessible. Successful programs have done their research to document access problems; then they have taken their findings to county governments to request additional funding and to health care institutions to request institutional policy and service changes to make health care more available and accessible.

American Cancer Society↗
PubMed1987

Are we training too many psychiatrists?

In contrast to the past decade's concerns about an undersupply of psychiatric manpower, the authors point out that the profession may soon be facing the prospect of an oversupply of psychiatrists. Given the present rate of producing psychiatrists, shifts in demands for psychiatric services, changing payment and access patterns regarding specialty medical care, increasing numbers of nonpsychiatrist mental health professionals, and a probable surfeit of primary care physicians, underemployment of psychiatrists may become commonplace. Future psychiatrists will likely be used more as consultants, and the profession will need fewer, but better trained, graduates. The authors present alternative proposals to deal with service needs related to such reductions.

Community Psychiatry↗
PubMed1994

Intraprofessional teamwork in district nursing: in whose interest?

The purpose of this paper is to examine intraprofessional teamworking between district nurses. Data from an exploratory study, conducted in the United Kingdom, of 130 home visits of 16 district nurses describes intraprofessional relationships in community nursing teams. Participant observation and in-depth interviews were the methods of data collection. The findings suggest that the professional culture of community nursing has led to the development of organizational rules which, in a quest to avoid conflict between team members, potentially militate against patient choice. The data presented here explore three areas of the nurses' practice: committing services, changing care and working unsocial hours.

Community Health Nursing↗
PubMedDate not supplied

[Physiologic evaluation of health status of workers at aluminum casting robot complexes "Rostselmash"].

Physiological parameters of physical state of workers was studied. Results showed relationship between hemodynamics and psychophysiological status and length of service. Changes of physical state and physical capacity for work depend on the hemodynamics. Therefore after-working rehabilitation should include remedies for normalization of vasovegetative reactions in workers.

Adaptation, Physiological↗
PubMed1990

Early identification of hearing loss: screening and surveillance methods.

Service monitoring data on the outcomes of health visitors' screening for hearing loss at 8 months in West Berkshire indicate low sensitivity and low positive predictive value, despite efforts to improve the conduct of the screen. Nevertheless, data on a recent series of severely hearing impaired children indicate significantly earlier diagnosis than previously, due in part in the introduction of other service changes including neonatal 'at risk' screening and surveillance using parental observation. For a trial period the traditional screening method for the detection of hearing loss in babies will be discontinued and effort concentrated on these alternative procedures.

Age Factors↗
PubMed1985

Economic growth of the dental profession: comparisons with other health care sectors.

This paper describes the economic growth of the dental profession and concludes, on the basis of increases in real output in excess of the GNP, that the dental services sector of the economy is a growth industry. The analysis shows that, on a relative basis, dentistry also appears to be growing with respect to other important health service sectors, including physician services. Changes in output appear to be related to the expansion of the supply of dental workforce, the increased productivity of individual general practitioners, population growth, and the increase in the portion of the population with dental insurance.

Dental Care↗
PubMed1995

Uses and misuses of serum hCG--a clinical audit.

A 24-hour laboratory-based service was established in the City Hospital, Birmingham, England, in 1987 for semi-quantitative serum human chorionic gonadotrophin (hCG) assay and specific clinical criteria for requests were agreed. However, a 309% increase in workload between 1988 and 1992 prompted a detailed clinical audit of this service. During a representative month only 35% of 142 requests conformed to the agreed criteria. Those for routine diagnosis of pregnancy, threatened miscarriage, and 'abdominal pain screen' comprised 49% of total requests and seemed inappropriate. No pregnancy was diagnosed by 'abdominal pain screen'. Adhering to agreed clinical criteria, therefore, would not jeopardise patient care and could halve the cost of the service. As a result of this audit the established criteria for serum hCG estimation were reinforced and re-issued to all relevant clinical teams. Additionally, to improve delivery of service and reduce costs a semi-quantitative urine hCG assay was introduced in the Accident and Emergency Department for use by approved staff. Records in this department showed no increase in hCG requests during the six months after the service change, compared with those in the preceding half year. However, theoretical cost savings of 5173 pounds per annum were eroded by an estimated 10% because 208 (26%) tests were unaccounted for. The reasons for this apparent 'wastage' are unclear, and highlight the difficulty in auditing a biochemical test performed outside the laboratory.

Chorionic Gonadotropin↗
PubMed1987

Community mental health services in transition.

Major policy and funding shifts over the last several years have stimulated a series of changes in local mental health agencies. Services offered CMHCs became less comprehensive and more oriented toward chronic and severely ill patients. Decreases occurred in other services, primarily indirect services. Changes in services and in clients served caused reconfiguration in staffing patterns, and also affected the types of activities some staff perform. The implications of these service and staffing changes for local mental health agencies are discussed.

Community Mental Health Centers↗
PubMed1995

Usefulness of a non-experimental study design in the evaluation of service developments for infant feeding in a general hospital.

There are likely to be many situations in which it is not possible to use a randomized controlled trial (RCT) for the evaluation of local service developments, and the usefulness of non-experimental study designs need to be assessed. This is examined with reference to a study carried out to evaluate the appointment of a baby feeding adviser (BFA) and other policy changes for infant feeding at a district general hospital (DGH). Surveys of Maternity Unit staff attitudes and practices, and of mothers' experiences were carried out in 1988 (prior to the changes) and afterwards in 1990. Service changes were; appointment of a BFA, removal from the postnatal wards of dextrose, seminars on baby feeding for midwifery staff, and a reduction of night-only shifts. There was no change in the initial breast feeding rate of about 80%, but there was an increase in breast feeding at 6 weeks postnatally from 57% (95% CI; 51-64) to 64% (95% CI; 59-69); P = 0.15. The percentage of women who stopped breast feeding by 6 weeks fell from 30% in 1988 to 22% in 1990; P = 0.11. Mothers who did not see the BFA (1990 only) were significantly less likely to begin breast feeding (P = 0.03), independent of social class and age, but a similar association was not seen at 6 weeks. There were significant reductions in the percentage of midwifery staff viewing feeding policy as unimportant (P = 0.02), and in the use of supplements for breast-fed babies (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy response and the prevention of the epidemic.

This paper assesses policy development, service changes and trends in HIV infection and risk behavior among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Managing service change in post HIV drugs services--a case study from Inner London.

The advent of HIV/AIDS has presented a major ideological challenge to established drug treatment agencies, where the incorporation of HIV-prevention strategies has proved problematic. This case study analyses the response to the HIV/AIDS epidemic by the drug misuse services of one Inner London district health authority (Bloomsbury) during the period 1985-89. While innovation and enthusiasm were much in evidence, a number of special problems prevented an effective and coherent strategic response. Key factors in the management of change in drugs/HIV services are identified which may be of special importance to clinicians, managers and funders and a number of key organizational and managerial competencies are suggested.

HIV Infections↗
PubMed1991

Evaluation of family support services: changes in availability and accessibility.

Changes in availability and accessibility of family support services were studied by surveying county mental health authorities in Michigan before and after the implementation of new policy on and funding for such programs. An overall increase in the availability of family support services was found. Access to services as measured by length of time families waited for services remained unchanged following the increase in funds. Policy and funding implications of the study were discussed.

Adaptation, Psychological↗