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PubMed2005

Client feedback on physiotherapy counselling in primary health care.

The extent of rehabilitation services is adequate, but little feedback is available on these services and service users. This paper is based on a client feedback survey of physiotherapy services conducted in Spring 2000. The purpose of the paper is to compare patients' perceptions of the physiotherapy instruction they received in a private outpatient facility and in a public physiotherapy facility. The results of the study showed that physiotherapy clients were satisfied with the therapy and instruction they received. They felt they received an adequate amount of instructions and advice. The rehabilitee's strong commitment to care, high motivation and a support network are important to independent rehabilitation in the future. As for the point of contact, the majority of clients in the private physiotherapy facility were gainfully employed while the health centre had almost as many retired clients. Client instruction was not dependent on the point of contact.

Activities of Daily Living↗

PubMed1994

Informal support and the use of formal services by older Americans.

Older persons' use of formal services was studied in the context of one medium-sized metropolitan area in the Northeast, with a principal focus on the relation between formal service use and informal help. Most services are used by only a minority of older persons. There is some evidence of both compensatory processes (where family support substitutes for formal care) and bridging (where the informal network helps link the older person to services). Service users are distinguished partly by their greater functional disability. Use of some services is affected by indicators of predisposition, such as sociability and age identity. Enabling factors, such as availability of services or their accessibility by the respondent, have little effect.

Aged↗

PubMed2003

Evaluating a practice-oriented service model to increase the use of respite services among minorities and rural caregivers.

PURPOSE: The goal of this study was to evaluate the practice-oriented model of service use (Yeatts, Crow, & Folts, 1992) relative to the more widely used behavioral model ( Andersen, 1968) in its ability to explain the use of respite services by caregivers of Alzheimer's patients. Unlike the behavioral model, which focuses primarily on characteristics of the service user, the practice-oriented model focuses primarily on characteristics of the service. DESIGN AND METHODS: Interview data from 1,158 caregivers participating in the Alzheimer's Disease Demonstration Grants to States program ( Montgomery, Kosloski, Karner, & Schaefer, 2002) were analyzed. Separate regression models were estimated for adult day care and in-home respite, using the full information maximum likelihood procedure described by Arbuckle (1996), and ordinary least squares regression with listwise deletion of missing data. RESULTS: The findings indicate that the factors related to respite use tapped by the practice-oriented model add significantly to explanatory models of service use over models that use only the factors typically represented by the behavioral model. Additional analyses, including a set of interactions with ethnicity, indicated that this improvement occurs primarily for White and Hispanic caregivers, and less so for African Americans. IMPLICATIONS: The findings are discussed in terms of their implications for enhancing the timely use of respite services and directions for future research.

Alzheimer Disease↗

PubMed2007

The usefulness of day-service in maintaining general nutritional status in elderly Japanese: a longitudinal study.

Day-service, commuting service for elderly people requiring care at home, is one healthcare option in Japan. To date, however, there exist no studies that have examined the effects of day-service use on health outcomes in Japan. The objective of the present longitudinal study was to determine whether there is an association between day-service use and various physical and mental health outcomes in elderly people requiring care. The subjects were 61 elderly persons who required between 25 and 49 min of assistance per day and used long-term care insurance. Measurements included demographic characteristics, activities of daily living, frequency of day-service use, body weight, height, grip strength, thigh muscle volume, degree of depression (Geriatric Depression Scale), the mini-mental state examination, and serum albumin and blood hemoglobin levels in the baseline and follow-up surveys two years later. In the day-service user group, the mean changes in serum albumin concentrations using day-service once, twice and three < or = times/week were -0.2, -0.3, and 0 g/dl, respectively, and the mean changes in blood hemoglobin were -0.7, -0.5, and 0.2 g/dl, respectively. The two-year change in serum albumin concentrations was less (p = 0.024) in subjects using day-service "three < or = times" (0 g/dl) than "twice" (-0.3 g/dl). The two-year change in blood hemoglobin was also less (p = 0.043) in subjects using day-service "three < or = times" (0.2 g/dl) than "twice" (-0.5 g/dl). The present study has shown that frequent use of day-service is useful in maintaining general nutritional status in elderly people.

Activities of Daily Living↗

PubMed2005

Mental health. Barrier grief.

There is a belief in the mental health sector that poor commissioning is slowing modernisation. A problem has been identified in the balance of power, with large trusts providing services for several PCTs. The difficulty in measuring outcomes is key. Strong commissioning needs the involvement of carers and service users.

Attitude of Health Personnel↗

PubMed1983

A survey of hospital audiovisual services.

A survey of 305 potential audio-visual (A/V) service users from 17 disciplines in 7 teaching hospitals determined awareness of A/V services offered, use, and evaluation of these services. Ninety-nine percent of those surveyed were aware of the A/V services. The services most used were equipment loan, overhead transparency production, and slide/print production from type. Services most needing improvement were those providing patient education materials and facilities. Slide libraries and instruction in use of audiovisuals were perceived to need improvement. Conclusions are drawn about services that are best decentralized, or centralized and developed for sharing among hospitals.

Audiovisual Aids↗

PubMed2001

What is consumerism and has it had an impact on health visiting provision? A literature review.

AIMS: This paper analyses the concept of consumerism drawing on methods of concept analysis. It attempts to identify who the actual consumers of health visiting are before examining whether consumerism and the consumer's voice has had an impact on health visiting provision. BACKGROUND: Patients and clients are increasingly being referred to as consumers, but the term seems to be used simply as substitute for patient, client or service user. Consumerism is a complex concept and the extent of its usage in the context of health visiting has not been fully explored. METHOD: An integrative review of a range of literature relating to consumerism is presented. A focused analysis of consumer views of child health clinics is used to illustrate the concept of consumerism. Elements of concept analysis methods such as formulating a model case and a definition are used to illustrate the concept further. RESULTS: The review suggests that consumerism is an outdated concept and has been replaced by other less emotive terms such as partnership and participation. The apparent lack of impact of consumerism research in health visiting is argued by examining empirical evidence relating to child health clinics. CONCLUSIONS: Consumerism has had relatively little impact on improving child health clinics although high levels of consumer satisfaction with the overall service exist. More methodologically sound studies are needed to explore users' views of health visiting services and to implement findings to maintain or improve services.

Adult↗

PubMed2004

[Evaluation of demographic factors for autonomy of the elderly and their families in selecting long-term care insurance services].

PURPOSE: This study was conducted to characterize (1) the autonomy of service users, both frail elderly and of their family caregivers, in selecting Long-term care insurance services, and to evaluate (2) influencing demographic factors. The aim was to propose new directions for the care providing system. METHODS: The subjects were 1,760 users of public Long-term Care Insurance who were randomly stratified and sampled in Higashi-osaka city, Osaka prefecture. Data were collected through a mailed anonymous self-report questionnaire in October, 2001. The number returned was 1,178 (66.9%). In this study, 723 eligible cases were analyzed in separate models: 146 cases for the elderly model, and 577 for the family model. Multiple regression analysis and two-way analysis of variance were performed to identify factors which have direct and interactive effects, respectively, on the autonomy. RESULTS: 1) The degree of autonomy of the elderly (3.1 +/- 0.8 (range 1-4)) was high in comparison with the family (2.8 +/- 0.8). 2) In the elderly model, the ability to collect service information and the level of knowledge about the service contents had a direct effect on the autonomy. In the family model, ability to collect service information and the level of knowledge about the service contents, the degree of informing the provider of own care needs, and good relations among family members had direct effects. 3) In the elderly model significant two-way interactive effects on the autonomy were observed between the level of knowledge about the service contents and the age; attitudes of the service providers and the age or gender of the recipient; the degree of informing the provider of own care needs and the gender. In the family model, significant interactions were noted between the attitudes of the service providers and the age of the family caregiver; the level of congitive disorders of the elderly and the length of service usage. CONCLUSIONS: It was clarified that the score for autonomy of the family was low in comparison with that for elderly, and the essential requisites of service providers for enhancing the autonomy of elderly people and families may vary depending on the basic characteristics or the situation of the user. It was suggested that support to enhance users autonomy should be provided by taking the demographic factors of the user into consideration.

Age Factors↗

PubMed2006

Mobile information and communication in the hospital outpatient service.

OBJECTIVES: Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service. The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users. Initiated in a local hospital in Taiwan, the MOSS pilot project was developed to improve outpatient service quality and pursue higher patient safety. METHOD: This study focuses on the development of the MOSS. The workflow, architecture and target users of the MOSS are delineated. In addition, there were two surveys conducted as part of this study. After a focus group of medical staff identified areas in which outpatient services might be improved by the MOSS, the first survey was administered to outpatients to confirm the focus group's intuitions. The second administration of the survey explored outpatient satisfaction after they used the MOSS service. RESULTS: With regard to outpatient attitudes, about 93% of participants agreed that the mobile outpatient service improved outpatient service quality. In the area of outpatient satisfaction, about 89% of participants indicated they were satisfied with the mobile outpatient service. DISCUSSION/CONCLUSION: Supported by our study finding, we propose that more diverse mobile outpatient services can be provided in the future.

Adult↗

PubMed2004

Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: risk factors for use and correlates of expenditures.

PURPOSE: The purpose of this work was to, among frail dually eligible older adults, determine risk factors for the likelihood of using Medicare home health and Medicaid home health services and to, among service users, determine correlates of Medicare home health, Medicaid home health, and Medicaid waiver service expenditures. DESIGN AND METHODS: Dually eligible individuals enrolled in Connecticut's Medicaid home- and community-based services (HCBS) waiver program for the aged (N = 5,232) were identified from a statewide database containing person-level linked data from Medicare claims, Medicaid claims, and uniform clinical assessment forms. Expenditures, based on claims data, were observed from the month following clinical assessment over the period August 1995 to December 1997. RESULTS: In multivariate models controlling for medical conditions and sociodemographic variables, similar functional disability measures were strongly associated with the probability of the use of, and expenditures for, Medicare home health and Medicaid home health services; severe cognitive impairment was strongly associated with greater Medicaid waiver service expenditures. IMPLICATIONS: Given the similarity of factors associated with Medicare and Medicaid home health service use and expenditures, greater integration of Medicare and Medicaid financing, reimbursement, and delivery strategies for home health services may be feasible and warranted for dually eligible older adults enrolled in state Medicaid HCBS waiver programs.

Aged↗

PubMed2004

A longitudinal population-based study of treated and untreated major depression.

BACKGROUND: Few studies have investigated the factors associated with different outcomes in individuals with major depressive episode (MDE) in relation to mental health service utilization. OBJECTIVES: This study was to, in depressed individuals who used and did not use mental health services, 1) compare the demographic, psychosocial, and clinical characteristics; 2) estimate the risk of MDE in a 6-year follow-up period; and 3) identify the factors associated with the persistence/recurrence of MDE. DESIGN: This was a population- based longitudinal analysis. SUBJECTS: Participants included the longitudinal cohort of the Canadian National Population Health Survey who reported MDE at the baseline survey (n = 609). MEASURES: MDE was measured by the Composite International Diagnostic Interview-Short Form for Major Depression. RESULTS: In the 6-year follow-up period, 49.8% of participants with treated depression developed subsequent MDE; 28.7% of those with untreated depression reported MDE. Multivariate analyses showed that, among those who reported the use of mental health services, childhood and adulthood traumatic events and functional impairment were related to the recurrence of MDE. Among those who did not use mental health services, reported negative life events and the severity of depressive symptoms were predictive of recurrent MDE. CONCLUSIONS: The risk of the recurrence of MDE and associated factors differ in mental health service users and nonusers. Future studies need to confirm these results and to identify service barriers for those who do not use the services and who are at a high risk of MDE.

Adolescent↗

PubMed2005

Using pooled budgets to integrate health and welfare services: a comparison of experiments in England and Sweden.

The lack of collaboration between health, social and other welfare services is believed to impair efficiency and reduce effectiveness in addressing the complex problems of patients. Differences in funding streams, political accountabilities, organisational structures and professional cultures are all alleged to contribute to barriers between services. Drawing on their respective evaluations, this paper describes experiments in England and Sweden that use pooled budgets between services to improve interagency and interprofessional collaboration and presents evidence on their impact. Despite differences in the funding and organisation of health and welfare services in each country, some similar conclusions are reached. Among senior managers and politicians, budget pooling broadened their awareness of interdependencies with other agencies and professionals in promoting patients' welfare. However, these broadened perspectives were not immediately shared by professionals working at the front line, with whom patients had immediate contact. Moreover, neither experiment yielded unequivocal evidence of improved cost-effectiveness or of the benefits of budget pooling on the outcomes for service users. These experiments also raise questions about the equity and accountability of welfare services because in both countries only a limited range of services has been integrated under the umbrella of the pooled budgets.

Budgets↗

PubMed2003

Delayed discharges. Another fine mess.

A simulation exercise on charging for delayed discharges revealed significant potential for conflict between organisations, and no benefit for service users. Participants thought the charging system would work against the development of community services. They favoured joint NHS/local authority approaches to the development of an effective system for preventing delayed discharges.

Efficiency, Organizational↗

PubMedDate not supplied

Improving referral information in community mental health.

This article explains how a questionnaire to improve the quality of information about clients referred to a community mental health team was devised. The questionnaire was drawn up with the help of the local advocacy service and service-user representatives, and led to improved information that enabled us to improve our service to clients.

Community Mental Health Services↗

PubMed1996

A survey of preferred terms for users of mental health services.

To determine how users of mental health services would like to be addressed by professionals, a survey of 302 persons participating in a variety of inpatient and outpatient psychiatric programs was conducted. Forty-five percent of the sample preferred the term "client," 20 percent preferred the term "patient," 8 percent preferred the term "consumer," and 27 percent either expressed no clear preference for one term or provided another term. The results suggest that no one term is favored by users of mental health services. Professionals and persons receiving mental health services are encouraged to talk over individual preferences to help establish a working alliance.

Attitude↗

PubMed1998

Exploring the concept of user involvement in mental health through a participation continuum.

Although recent years have seen an increased emphasis on involving service users in decisions about their care, there has been limited exploration of the theories and ideologies underpinning the concept. This paper identifies two approaches to user involvement, each with implications for the extent to which users can be involved in decisions about their care. The approaches are linked through a 'participation continuum' which is a framework through which the concept of user involvement can be explored, and against which practice can be assessed. The framework must be seen within the context of constraints to user involvement. A more realistic assessment of the extent to which users can be involved in decisions can then be made and the risks of raising unrealistic expectations avoided.

Continuity of Patient Care↗

PubMed1991

Health care users residing on the Mexican border. What factors determine choice of the U.S. or Mexican health system?

Using multivariate analytic techniques, this article examines the factors influencing choice of the Mexican or U.S. health care system by service users residing on the Mexican border. Data were obtained from a 1987 binational health survey of 660 households, conducted in Tijuana. The sample consisted of 1,162 household members who reported having used health services in the U.S. and/or Mexico in the 6 months prior to the interview. The findings indicate that out of all the health care users in a 6-month interval, 7% sought services in the United States and 93% sought services only in Mexico. A weighted logistic regression on entry into care shows that, after adjusting for all the other variables in the model, U.S. insurance coverage, transportation, older age, and male gender were the most significant predictors. U.S. insurance, the strongest predictor of access, was associated with a labor history and legal residence across the border. Among U.S. users, the average number of visits was 2.6 (SD = 2.7). Sex, transportation, and socioeconomic status were significant predictors of volume of visits, in a weighted least squares regression analysis. The probability of more contacts among women is linked to their reproductive needs. An increasing use of U.S. health care is expected as a consequence of the new immigration law.

Catchment Area, Health↗

PubMed2000

HIV incidence among injection drug users in New York City, 1992-1997: evidence for a declining epidemic.

OBJECTIVES: We assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City. METHODS: Data were compiled from 10 separate studies (N = 4979), including 6 cohort studies, 2 "repeat service user" studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs. RESULTS: In the 10 studies, 52 seroconversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk. CONCLUSIONS: The recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a "declining phase," characterized by low incidence and declining prevalence. The data suggest that very large high-seroprevalence HIV epidemics may be "reversed."

Adult↗