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PubMed2004

Client perspectives on sexual health service provision.

Development of integrated genitourinary medicine (GUM) and family planning (FP) services must take into account the views and requirements of service users. As we strive to modernize sexual health services, various changes are being introduced, such as a policy of no microscopy for selected patients attending GUM clinics. In order to determine the views of our clients prior to implementation of change, we performed a qualitative study in our UK centre, which houses both FP and GUM. One hundred women presenting to FP and 100 to GUM were interviewed. In addition, we collected details of their characteristics to identify any significant differences in users attending each clinic. A summary of their views and characteristics is presented. Although near-patient testing results in a longer time spent in clinic, 99% of participants expressed a preference for immediate microscopy results and treatment. GUM and FP clients exhibited many similar characteristics.

Adolescent↗

PubMedDate not supplied

The individual and beyond: a socio-rational choice model of service participation among homeless adults with substance abuse problems.

While substance user service programs can help homeless adults solve their substance use and housing problems, relatively few needy individuals use and complete these programs. The lack of participation is poorly explained by typical empirical studies, most of which consider the role in service participation of various personal traits and client problems. The current article instead seeks to explain service participation through the application of an alternative, "socio-rational choice" model. This model has three premises: Clients weigh the costs and benefits of participating in services against alternative uses of their time and resources. The clients' weighing procedures reflect their personal situations and perceptions of the treatment environment. The perceptions of their personal situations and perceptions of the treatment environment are affected by the manner in which clients react to representatives of service systems, members of their social network including both housed and homeless persons, and other individuals. Secondary evidence supports many of the model's hypotheses and generally suggests that homeless clients may be heavily affected by their experiences with individuals and systems with which they come into contact.

Adult↗

PubMed2000

The patient care development programme: organisational development through user and staff involvement.

A number of approaches have been developed in recent years to try effectively to engage service users in the process of planning and delivering health-care services. The consumerist methodology for the strategy described in this paper was designed to maximise staff involvement in capturing user views, in order to develop services at a district general hospital. This strategy--the Patient Care Development Programme (PCDP)--provides a framework for both staff and patient involvement in shaping and influencing the development of health-care services. Uses the findings from applying the strategy to modify care packages, roles, skills, layouts, protocols and procedures, in response to both the "shortfalls" and the service strengths that the patient's view uncovers. Discusses the results of an evaluation of the programme which has been replicated in another part of the UK. The PCDP now forms part of a clinical governance framework and is being used to develop multi-agency integrated care pathways.

Community Participation↗

PubMed1994

The function of home visits in maternal and child welfare as evaluated by service providers and users.

This study looks at how public health nurses and clients of maternal and child welfare clinics evaluate the function and meaning of home visits. Another concern is with the options available to the service user. The data were collected during November and December 1992 from a total of 203 health centres across Finland; responses were obtained from 263 public health nurses and 323 clients. The results are presented in the form of frequencies, percentages and cross tabulations. According to the results, the clients felt that the most important function of home visits was to have a competent professional examination of the newborn. They also attached much importance to the information function, i.e. learning about the growth and care of small children. The public health nurses, on the other hand, felt that the most important function of home visits was to support and encourage parents and to ensure the continuity of care. The advantages of meeting in the client's home environment were equally stressed by both sides. By contrast, clients and public health nurses had very different views on the options available to the client. Almost all nurses said that the client can freely choose between home visits and visiting the clinic; however, only about half the clients felt they could choose the service they best preferred.

Adolescent↗

PubMed2004

Organisational simplification and secondary complexity in health services for adults with learning disabilities.

This paper explores the role of complexity and simplification in the delivery of health care for adults with learning disabilities, drawing upon qualitative data obtained in a study carried out in NE England. It is argued that the requirement to manage complex health needs with limited resources causes service providers to simplify, standardise and routinise care. Simplified service models may work well enough for the majority of clients, but can impede recognition of the needs of those whose characteristics are not congruent with an adopted model. The data were analysed in relation to the core category, identified through thematic analysis, of secondary complexity arising from organisational simplification. Organisational simplification generates secondary complexity when operational routines designed to make health complexity manageable cannot accommodate the needs of non-standard service users. Associated themes, namely the social context of services, power and control, communication skills, expertise and service inclusiveness and evaluation are explored in relation to the core category. The concept of secondary complexity resulting from organisational simplification may partly explain seemingly irrational health service provider behaviour.

Adult↗

PubMed2001

Accounting for overlap? An application of Mezzich's kappa statistic to test interrater reliability of interview data on parental accident and emergency attendance.

STUDY RATIONALE: The number of interview studies with service users is rising because of growth in health services research. The level of agreement between multiple interview data coders requires statistical calculation to support results. Basic kappa statistics are often used but this depends on having mutually exclusive data. Researchers should be aware that this is not valid when an interview word or paragraph can be coded into more than one category. The 'proportional overlap' kappa extension by Mezzich et al. (1981, Journal of Psychiatric Research 16, 29-39) has been investigated as an original solution. OBJECTIVES: To assess the level of agreement beyond chance between several raters of interview data by applying the 'proportional overlap' kappa statistic by Mezzich et al. to verbal interview data. The clinical area investigated was child attendance at an Accident and Emergency Department, where parental attendance experiences have been under-explored. METHODS: Two researchers using a coding schedule coded a random sample of interview transcripts. These data were applied to Mezzich's procedure; coder 1 notes that a paragraph refers to category A and B but coder 2 notes A, B and C. The total agreement overlap in this case was 0.66 because two actual agreements out of three possible agreements were made. This was repeated for each paragraph and divided by the number of coding pairs. All agreement values were summed then subsequently divided by the total number of paragraphs to get Po (total number of observed agreements) and by the total number of coding pairs to get Pe (total number of agreements by chance alone). Po and Pe were used in the basic kappa formula to assess interview coding reliability. RESULTS: The overall mean Po was 0.61, the mean Pe was 0.32, with a kappa score of 0.43; a moderate level of agreement which was statistically significant (t=4.8, P < 0.001, d.f.=23). CONCLUSION: Mezzich's procedure may be applied to interview data to calculate agreement levels between several coders.

Accidents↗

PubMed2003

HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan.

We studied prevalence and correlates of injection drug use, awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and risky behaviors among drug users serviced by a nongovernmental organization catering to drug users in three Pakistani cities (Quetta, Peshawar, and Rawalpindi). Logistic regression analysis was used to identify correlates of injection drug use. Of 608 drug users, 99.8% were male; median age was 32 years, and 44% were married. Most (79.8%) were Pakistani; 15.3% were Afghani. The majority used heroin (98.7%), mostly by inhalation; 15.2% injected drugs. Only 41% had heard of HIV/AIDS, and 30% had been paid for donating blood. Injection drug use and needle sharing were highest in Quetta. Injecting drug users (IDUs) were nearly twice as likely to have donated blood and to have heard about HIV/AIDS compared to other drug users. Interventions to discourage transitions to injection, increase HIV testing, and safeguard the blood supply in Pakistan are urgently needed.

Adult↗

PubMed2005

Mental health nurses, promoters of inclusion or perpetuators of exclusion?

The literature identifies that mental health services and those individuals working within them have the potential to facilitate inclusion for their client group, because of their power to initiate potential inclusive opportunities. However, evidence suggests that service users themselves perceive many aspects of mental health services as contributing to the problem of exclusion. This has been attributed to an accumulation of messages, attitudes and disempowering practices that have emanated from mental health care providers over a long period. This study employs focus group methodology in a residential rehabilitation unit in an industrial city in the UK. Discussion of the findings highlight how, in spite of alleged inclusive practices, the attitudes held by members of the unit team could impede the clients' opportunities to become socially included, as a result of defensive practice, paternalistic attitudes, expectations of the local community upon the team and the stagnant views that are embedded in the culture of mental health services. While mental health nurses may see themselves as promoting inclusion, the reality may be quite different.

Adult↗

PubMed2002

Winter support for older people with mental illness.

Older people with mental health problems are often reluctant to use day-care facilities in the winter. This can often have a detrimental effect on their health and put further pressures on overstretched facilities. The authors describe a pilot scheme at a mental health trust in London that provided assertive outreach to service users who found it difficult to engage with services, encouraging them to take part in therapeutic activities and to attend the day centre. After six months the health of the participants showed improvements.

Aged↗

PubMed1994

Evaluating a case management service: a family perspective.

This article describes how a long-standing community-based case management service conducted a survey of clients and their family members. The overall objectives of the survey were twofold: to learn how best to undertake such a survey and to get feedback from service users about the strengths and limitations of the service with suggestions for improvement. A steering committee was established, comprising key stakeholders of the service: consumers, family members, case managers, and other service providers. Steering Committee members were actively involved in shaping the questions, designing the instruments, conducting parts of the survey, and preparing the report and recommendations for the board of directors. This article reports on the process of the survey, the findings of the survey of family members, and service modifications that were introduced as a result of family members' feedback. The benefits and significance of actively involving family members throughout the survey are discussed.

Adult↗

PubMed2002

Costs of village community, residential campus and dispersed housing provision for people with intellectual disability.

BACKGROUND: In recent years, a growing volume of research evidence has been generated about the relative cost-effectiveness of various types of community-based residential supports for people with intellectual disability (ID) in the UK. However, few reliable data are available to inform planners, commissioners or service providers about the quality and costs of providing support within residential or village communities. METHODS: The evaluation described in the present paper aimed to fill some of the gaps in knowledge by examining the comparative costs of supporting people in village community settings, in National Health Service (NHS) residential campuses and in dispersed, community-based housing schemes. The complete service package received by each study participant was described and costed, and a series of statistical analyses was undertaken to identify factors associated with variations in the cost of support. The analyses reported in the present paper were based on comparisons of 86 people living in village communities, 133 in residential campuses and 281 in dispersed housing schemes. RESULTS: Wide variations in cost were found, not only between models of accommodation, but between individual organizations, settings and service users. Multivariate analysis revealed that higher costs were associated with supports for people with higher levels of ID and more severe challenging behaviour. The cost of support was affected by the size of the residential setting, with smaller facilities likely to be more expensive. Associations were also found between increased costs, and services for younger users, male users and people who had not moved from a NHS hospital. Generally, more sophisticated service processes within the setting were associated with higher costs; although systematic arrangements for supervision and training of staff had a negative effect on cost. CONCLUSIONS: The cost findings should be considered alongside evidence on outcomes. A comparison of village communities and dispersed housing schemes suggests that both models of provision appear be associated with particular benefits, although different types of setting are appropriate for different individuals and therefore, the continued development of a range of residential models is important.

Adult↗

PubMed2006

How to involve cancer patients at the end of life as co-researchers.

The importance of user involvement in the organisation and delivery of health services and the conduct of research has increased over recent decades. Involving people at the end of life in research remains an under-developed area of research activity. The Macmillan Listening Study, a UK-wide study exploring research views and priorities of people affected by cancer, adopted a participatory research approach. Patients and carers, including two participants receiving palliative care services, collaborated in all aspects of the study as co-researchers. In this paper, we discuss the experience of working with co-researchers to collect data from two hospices. We will discuss practical, ethical and methodological challenges, including specific training needs and the emotional demands of conducting the research. Recommendations are made to facilitate successful collaboration with palliative care service users in end of life research.

Delivery of Health Care↗

PubMed2004

Conceptualising successful partnerships.

Partnership working has become a central feature of British social welfare policy since 1997. Although this development is applicable to all areas of public welfare, nowhere is it more evident than in the planning and provision of care that overlaps health and social services. The literature survey described in the present paper focused on research examining the impact of partnership working in these areas to assess the evidence concerning its effects and to investigate how partnership 'success' is conceptualised. The literature conceptualised the success of partnerships in two main ways: (1) process issues, such as how well the partners work together in addressing joint aims and the long-term sustainability of the partnership; and (2) outcome issues, including changes in service delivery, and subsequent effects on the health or well-being of service users. The authors found that research into partnerships has centred heavily on process issues, while much less emphasis has been given to outcome success. If social welfare policy is to be more concerned with improving service delivery and user outcomes than with the internal mechanics of administrative structures and decision-making, this is a knowledge gap that urgently needs to be filled.

Community Health Services↗

PubMedDate not supplied

Use of medical services by methylphenidate-treated children in the general population.

OBJECTIVES: To examine selected medical services for children treated for attention-deficit/hyperactivity disorder (ADHD) in a general population setting with universal health insurance. DESIGN: Retrospective analysis of administrative prescription and health services databases spanning from 1990 to 1996. SETTING: British Columbia, Canada. PATIENTS: Children (<19 years of age) who had received the psychostimulant methylphenidate (MPH; Ritalin) on a chronic basis (chronic-MPH group), who had received MPH on any other basis (nonchronic-MPH group), and who were in a no-MPH comparison group. MAIN OUTCOME MEASURES: The number of individuals who received any of the following services based on claims submitted by qualified practitioners: 1) emergency care, 2) critical care, 3) injury-related diagnostic and treatment services, 4) complementary and alternative medical (CAM) care, and 5) other diagnostic and treatment services (audiometry and allergy testing). RESULTS: Prevalence of services users was higher among MPH-treated than nontreated children for all types of services (except critical care services in the chronic-MPH group) after adjusting for effects of age, sex, socioeconomic status, and geographic setting, with odds ratios ranging from 1.49 to 3.17. There were no differences between the 2 MPH-treated groups. CONCLUSIONS: Children treated with MPH for ADHD or presumed ADHD are more frequent users of a wide range of medical services than are other children. Findings support and extend existing evidence of increased use of medical services by this population of children. Findings have implications for service planning, including injury prevention, with these children. High utilization of audiometric, allergy, and CAM services warrants further scrutiny.

Adolescent↗

PubMed2002

Financing reforms of public health services in China: lessons for other nations.

Financing reforms of China's public health services are characterised by a reduction in government budgetary support and the introduction of charges. These reforms have changed the financing structure of public health institutions. Before the financing reforms, in 1980, government budgetary support covered the full costs of public health institutions, while after the reforms by the middle of the 1990s, the government's contribution to the institutions' revenue had fallen to 30-50%, barely covering the salaries of health workers, and the share of revenue generated from charges had increased to 50-70%. These market-oriented financing reforms improved the productivity of public health institutions, but several unintended consequences became evident. The economic incentives that were built into the financing system led to over-provision of unnecessary services, and under-provision of socially desirable services. User fees reduced the take-up of preventive services with positive externalities. The lack of government funds resulted in under-provision of services with public goods' characteristics. The Chinese experience has generated important lessons for other nations. Firstly, a decline in the role of government in financing public health services is likely to result in decreased overall efficiency of the health sector. Secondly, levying charges for public health services can reduce demand for these services and increase the risk of disease transmission. Thirdly, market-oriented financing reforms of public health services should not be considered as a policy option. Once this step is made, the unintended consequences may outweigh the intended ones. Chinese experience strongly suggests that the government should take a very active role in financing public health services.

Budgets↗

PubMed2004

Mental health service use among 18-year-old adolescent boys: a prospective 10-year follow-up study.

OBJECTIVE: To study prevalence and factors associated with mental health service use among 18-year-old adolescent boys. METHOD: Predictors at age 8 and factors at age 18 associated with mental health service use during the preceding 12 months were studied in a general population sample of 2,316 Finnish boys born in 1981 attending military call-up (79% of the original sample). RESULTS: Within the preceding 12 months, 2.1% of the boys had used mental health services. At age 18, internalizing, anxious-depressive, and withdrawal symptoms; health problems; not living with parents; use of illicit drugs; high level of alcohol use; and regular smoking were independently associated with service use. At age 8, a high level of emotional and behavioral symptoms, need for referral, and low school performance according to teacher evaluations predicted service use 10 years later. CONCLUSIONS: Only a minority of adolescents with severe problems had used mental health services. Because of the wide range of problems and comorbidity among service users, there is a need for integration of different services. Education services have a central role in the early detection of those who will later use mental health services.

Adolescent↗

PubMed1996

The use of mental health services in Ontario: epidemiologic findings.

OBJECTIVE: To describe the distribution and predictors of mental health service use for a survey of Ontario household residents aged 15 to 64 years. METHOD: Service use was defined as any past-year contact with formal or informal health care providers for mental health reasons. Data from the Mental Health Supplement (the Supplement) to the Ontario Mental Health Survey were used to compare the sociodemographic, geographic, and diagnostic status characteristics of service users with these characteristics among nonusers. RESULTS: Mental health services were used by 7.8% of respondents in the past year. The majority (57.8%) had a past-year University of Michigan Composite International Diagnostic Interview (UM-CIDI) diagnosis, although 27.1% had never met diagnostic criteria. Other significant predictors were marital status, household public assistance, gender, age, and urban/rural residence. CONCLUSION: Although diagnosis is the strongest predictor of use, the fit between "need" and "care" in Ontario is not perfect. Help seeking differs within specific sociodemographic and geographic groups. Furthermore, the association of marital disruption and economic disadvantage with utilization indicates that prevention and intervention should address needs beyond the medical or psychological.

Adolescent↗

PubMed1999

What constitutes high-quality HIV/AIDS palliative care?

The study assessed the components of high-quality HIV palliative care using the multidimensional model of quality assessment developed by Maxwell (4). Data collection consisted of interviews with individual subjects and focus groups. The interviews took place in three London health authorities. Seven service users and 74 providers of health care and voluntary services were interviewed. Maxwell's model identifies the components of high-quality HIV palliative care as: competent, skilled practitioners (effectiveness); confidential, non-discriminatory, and culturally sensitive care (acceptability); collaborative and coordinated care (efficiency); flexible and responsive care (access and relevance to need); and fair access for all clients (equity). Our results show that the six dimensions of quality appear to be inextricably linked from the client's point of view. Thus, service commissioners and providers need to examine all six of the dimensions when assessing the quality of HIV services. These findings may serve as a model for other palliative care services.

Acquired Immunodeficiency Syndrome↗