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PubMed1999

Effects of a mental health carve-out on use, costs, and payers: a four-year study.

This study examines the effects of a mental health carve-out on a sample of continuously enrolled employees (N = 1,943) over a four-year time frame (1990-1994). The article presents a health care services utilization model of the effect of the carve-out on outpatient mental health use, cost, and source of payment in the three years post implementation relative to the year prior to the carve-out model. In the first three years of the carve-out, the likelihood of employees seeking mental health care increased in significant part because of the carve-out. For the outpatient mental health services user, the carve-out was not associated with the level of mental health services received. The carve-out was significantly associated over time with a reduction in the patient's and employer's mental health costs. This effect was more pronounced in the second and third years of the carve-out. The article explores the policy implications of these and other findings.

Adult↗

PubMed2003

Implementation of a model for service delivery and organisation in mental healthcare: a qualitative exploration of service provider views.

The purpose of the present study was to investigate factors influencing the implementation of a model for service delivery and organisation in mental healthcare. A qualitative case-study approach was employed involving in-depth interviews with 25 service providers from across mental health and social care in one local authority area in northern England. Purposive sampling achieved a broad coverage across geographical areas, voluntary and statutory services, and primary, secondary and specialist mental healthcare. The findings indicate that implementation was influenced by three interrelated factors: the means by which the model was introduced to the workforce; use of the model itself by service providers; and the broader service context. Thus, negative reactions to the way the model was initially presented strongly influenced service providers' subsequent views of it. Moreover, observations regarding the broader context of mental healthcare revealed a service that was ill-equipped to manage change because of over-stretched resources and that was disinclined to accept imposed change because of poor staff morale. Finally, differential interpretation of the model's tiers by service providers led to defensive practice that manifested itself as over-referral of service users within the system. Changing practice behaviour is a complex process, particularly at a service level that consists of numerous professional groups with differing cultural norms. Successful reorganisation of services is unlikely if those responsible for delivering care are not part of the process of change. Moreover, unsuccessful attempts to change professional practice may exacerbate existing tensions within a workforce, which may be to the detriment of those requiring care. A full diagnostic analysis of the system, including service providers' concerns, should be carried out before introducing change or reconfiguring services.

Attitude of Health Personnel↗

PubMed2004

Social research on the under-16s: a consideration of the issues from a UK perspective.

This article aims to consider the current situation with regard to the issue of consent in relation to health-based research on the under-16s. It considers the legal situation with regard to the issues of consent, assent and dissent, and their application to research. Although under-16s can consent to treatment if deemed competent according to the 'Fraser guidelines', application of this principle in relation to research appears to be less clear with variability in published guidance and the approach taken by ethics committees. Recent policy changes including Research Governance have increased the scrutiny of consent to research, and current changes appear likely to increase the requirement for parental consent for those aged below 18 years. The impact of these ambiguities and changes upon young people as service users are considered with particular reference to sexual health, where they often access the service as autonomous individuals.

Age Factors↗

PubMedDate not supplied

Innovative ways of responding to the information needs of people with MS.

There have been a number of studies looking into the information needs of people with multiple sclerosis (MS). All the studies have shown that people with MS want information tailored to their individual requirements, delivered in different formats and within a time-frame to suit them. This article reviews the studies and demonstrates how two neurology centres in Leeds and York have striven to meet the needs and expectations of the client group. By continuing to include service users in developments, and carrying out audits, these centres are continually aiming to improve services for people with MS, as well as responding to the recommendations in the National Institute for Clinical Excellence guidelines for MS and the recently published Department of Health "National Service Framework for Long-term Conditions".

Attitude to Health↗

PubMed2006

Broad issues to consider for library involvement in bioinformatics.

BACKGROUND: The information landscape in biological and medical research has grown far beyond literature to include a wide variety of databases generated by research fields such as molecular biology and genomics. The traditional role of libraries to collect, organize, and provide access to information can expand naturally to encompass these new data domains. METHODS: This paper discusses the current and potential role of libraries in bioinformatics using empirical evidence and experience from eleven years of work in user services at the National Center for Biotechnology Information. FINDINGS: Medical and science libraries over the last decade have begun to establish educational and support programs to address the challenges users face in the effective and efficient use of a plethora of molecular biology databases and retrieval and analysis tools. As more libraries begin to establish a role in this area, the issues they face include assessment of user needs and skills, identification of existing services, development of plans for new services, recruitment and training of specialized staff, and establishment of collaborations with bioinformatics centers at their institutions. CONCLUSIONS: Increasing library involvement in bioinformatics can help address information needs of a broad range of students, researchers, and clinicians and ultimately help realize the power of bioinformatics resources in making new biological discoveries.

Computational Biology↗

PubMed1985

High-volume and low-volume users of health services: United States, 1980.

Data from the National Medical Care Utilization and Expenditure Survey of 1980 are used to examine the characteristics of high-volume users of health care services, contrasting them with low-volume users and those who used no services at all. The three major types of medical care services examined are hospital inpatient care, ambulatory visits, and prescribed medications. Low users were defined, respectively, as those who during the year had either one or two hospital days, one nondental visit to a physician or nonphysician, and one prescribed medicine acquisition. High users were those with, respectively, 17 or more hospital days, 20 or more visits, and 25 or more prescribed medicine acquisitions. A very small percent of the U.S. civilian noninstitutionalized population and of those who used services at all during the year consume a large percent of services in each of the three service types. High users of inpatient hospital care constitute 1.7 percent of the civilian noninstitutionalized population and 15 percent of persons hospitalized during the year, yet they used 54.4 percent of all hospital days used by the reference population. High users of ambulatory services constitute 4.5 percent of the reference population and only 5.7 percent of all users of ambulatory services, yet they accounted for 32.3 percent of all ambulatory visits. For prescribed medications, only 3.7 percent of the civilian noninstitutionalized population are high users, comprising 5.9 percent of all users, but they account for 32.9 percent of all prescription acquisitions. At the other extreme, low users of ambulatory care visits represent 17 percent of the reference population, and 21 percent of all users of such care, but only 3.3 percent of all visits. High users share certain characteristics. They are more likely than low users to be older and poorer, to have poorer health status and more medical conditions, and are more likely to have functional limitations. Both univariate and multivariable analyses show that the most important distinguishing characteristics of high users of any of the three medical services are poor health status, severe functional limitations, and the presence of multiple medical conditions--most importantly cancer, cardiac disorders, musculoskeletal diseases, respiratory diseases, and injuries and poisonings. Almost all high-volume users of every category of service (88 percent for hospital days, 89 percent for ambulatory visits, and 94 percent for prescribed medications) had at least three different diagnostic conditions reported during the year.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2003

Conspicuous consumption: characterizing high users of physician services in one Canadian province.

OBJECTIVES: To examine medical care use and costs, patterns of morbidity and co-morbidity, and other patient characteristics of high users of physician services in British Columbia. METHODS: This population-based study uses physician claims, hospital discharge summaries and vital statistics data linked at the level of the individual to compare characteristics of high users, other users and non-users of physician services in the Province of British Columbia, Canada. The study included all enrolled adults in the universal health care plan during fiscal year 1996/97. High users were defined as the most costly 5% of users of fee-reimbursed services. Key variables included age, sex, an ecological socio-economic status indicator and a comprehensive set of morbidity indicators, derived from the diagnoses recorded on the utilization records. RESULTS: The top 5% of users consumed a disproportionate 30% of spending on physician services. High users were overwhelmingly characterized by a significant burden of morbidity. Over 80% had at least six different types of morbidity during the study year compared with fewer than 20% of other users. High users were also much more likely to have major diagnoses that were both acute and chronic in nature. Co-morbidity involving psychosocial and chronic medical conditions was also very common. CONCLUSIONS: High users of physician services are overwhelmingly characterized by multiple and complex health problems. Policy tools based on a philosophy of deterrence such as cost-sharing are unlikely to have much impact on their costs and will likely do considerable harm.

Adolescent↗

PubMed1991

A systems approach to planning biomedical information services.

A systems approach to planning was applied within the Biomedical Information Communication Center at Oregon Health Sciences University when its User Services division launched a strategic planning effort. By looking at the choice subsystem, the organizational structure, and the behavioral subsystem, those engaged in planning attempted to assure that desired change would permeate the entire system. The challenge of applying a theoretically ideal planning model within an environment averse to planning is delineated.

Information Centers↗

PubMed2005

Empowerment, policy levels and service forums.

This article will examine empowerment through policy at three levels: governmental, service and 'street'. It will focus in particular on 'street level' policy, drawing on qualitative interviews and an analysis of documentation within a day centre for adults with learning difficulties. The recorded behaviour of the workers and the structure of the day centre affected service users' experience of power. This is discussed through the theoretical construction of the organization's 'service forum' that contains its 'posture', a set of formal values and beliefs owned by the organization, and the 'culture', which is the unofficial day-to-day presentation of the service. Finally the use of such an approach is considered with regards to the future analysis of services for people with learning difficulties.

Adult↗

PubMed2004

A survey of the perspectives of specialist palliative care providers in the UK of inpatient respite.

One of the major reasons for admission of patients to hospital in late stage disease is the inability of carers to continue to provide care at home. Specialist palliative care services have typically admitted patients for acute symptom control, terminal care and respite care to benefit them and their carers. This paper reports the results of a cross-sectional survey of inpatient respite care provision provided by specialist palliative care services and hospices in the UK. A structured questionnaire was mailed to 242 clinical services managers listed in the Hospice Information Directory in 2003. A 69% response rate was achieved. The questionnaire explored the nature of respite services, their purpose, organization, delivery and examined definitions used. The analysis indicated that 80% of the sample provided inpatient respite care. Most inpatient respite admissions were planned, of fixed duration (7-14 days) and were intended to benefit patients and carers. There was some evidence that respite provision was regarded as a lower priority than admissions for symptom control and terminal care, and that patients' needs were prioritized over those of carers. Only 10% of services conducted regular, routine audit, with very few seeking the views of service users. Findings suggest that carers' needs and wishes are not prioritized by specialist palliative care services offering inpatient respite, which may mean that they find it difficult to maintain their caregiving roles over longer disease trajectories or in the face of overwhelming demands.

Caregivers↗

PubMed2003

Developing self-evaluation skills: a pragmatic research-based approach for complex areas of nursing.

Using a newly established community rehabilitation service as the research context, Gill Hek explores ways in which practitioners pragmatically developed self-evaluation research skills. Within the practice setting, community practitioners learnt how to conduct and analyse interviews with service users, and to develop connected database records that could be used across health and social services. The teaching-learning process and the teacher-learner relationship were used as models for researching in this complex area. The project demonstrated how community rehabilitation teams developed self-evaluation research skills to a point where they were able to reflect critically on the service they were providing. Supported by a research team, they were able to use research skills to analyse the volume and throughput of their service. They were also able to establish what needed to be done next within the challenging environment at the interface of health and social care in the community.

Community Health Nursing↗

PubMed2006

Mental health. Together we're stronger.

Ten mental health trusts will this year become four as the sector moves towards the 'super trust' model. The move is designed to help trusts compete with others, move towards foundation status and protect improvements after funding stops going up in 2008. With the new trusts to control budgets in the region of pounds sterling 290m, there are fears that their size could distance them from commissioners and service users.

Health Facility Merger↗

PubMed2006

Characteristics of e-therapy web sites.

OBJECTIVE: This study examined what a person seeking e-therapy services might find on the Internet, and how e-therapy Web sites characterize their services and providers. METHOD: Using the search engines Google and Yahoo!, we obtained a list of 55 e-therapy Web sites, which we reviewed from May 2005 to September 2005. We used the search terms online counseling, online therapy, and e-therapy. We reviewed the Web sites' content for data in 7 categories: description of services, terminology for providers, providers' qualifications, terminology for service users, characteristics of clients, information for individuals in crisis, and information about confidentiality and security. RESULTS: There was a wide range in the Web sites we accessed. Web sites often contained confusing information about the nature of the service offered and did not always specify qualifications of providers. Some providers did not appear qualified to provide the services the Web sites advertised. Other sites offered Internet-based services of legitimate mental health professionals. Most sites referred to users as clients rather than patients, and some sites specified criteria that would render prospective clients ineligible to receive services (e.g., suicidality). Some Web sites excluded individuals with specific diagnoses. Web sites were not generally proactive about providing resources for visitors in crisis. Less than half of the Web sites disclosed limits to client data security and confidentiality. CONCLUSION: Experiences with e-therapy might influence a patient's attitude toward traditional psychotherapy. With the wide variety in e-therapy services that are searchable on the Web, clinicians may want to be more aware of what their patients might encounter online.

Confidentiality↗

PubMed1999

Access all areas: wound care resources on the Internet.

The World Wide Web provides access to a plethora of information on every conceivable topic. More and more, the Internet is been used to access health information, making service users better informed about their conditions and the choice of treatment. It is essential that healthcare professionals embrace this technology so that they are able to access information from around the world. Ideally, access to such technology should be as close as possible to the point of care delivery. The expansion of the NHSnet over the next 3-5 years should make this a reality for more and more practitioners.

Computer User Training↗

PubMed1998

'I wanted to be a nurse ... but I didn't get that far': women with serious ongoing mental health problems speak about their lives.

Within mental health services there are fewer women than men with serious mental health problems and there is evidence that their needs are relatively neglected resulting in specific deleterious effects. In research, as in services, the abilities of women with serious mental health problems appear to be under-estimated, and there is almost a total absence of research into the views and experiences of such women. This study aimed to explore the lives of women with serious ongoing mental health problems and their experience of services, to develop understanding of the context and impact of mental distress. In a series of 5 focus group interviews, the women, who were using a range of services for people with long-term mental health problems, described lives which, even before the onset of mental health problems, were marked by material, social and personal disadvantage. Their mental health problems led to numerous losses: loss of homes, jobs, relationships, children and loss of 'normality', yet the women retained hopes and aspirations for the future. The women clearly identified aspects of the service that they valued, in particular the support and company of women workers and other women service users. The implications of these findings are discussed in relation to planning and providing mental health services for women.

Activities of Daily Living↗

PubMed1998

Present status of the pohang light source.

The Pohang Light Source (PLS), the first large-scale accelerator complex in Korea, is a national users facility for basic and applied science research using synchrotron radiation. It consists of a 2 GeV linac as a full-energy injector and a low-emittance storage ring. The PLS linac is 150 m long with eleven 80 MW klystrons for a high accelerating gradient; the storage ring has the TBA-lattice with 12 super-periods and a 280 m circumference. Since the accelerators were commissioned in December 1994, the annual operation time exceeded 4600 h in 1996, and the user service time is expected to reach 3500 h in 1997. The facility was opened to general users in 1995 with two beamlines. Six beamlines are now operating: white-beam, NIM for ARUPS and gas-phase, photoemission spectroscopy, EXAFS, X-ray diffraction and lithography. Our long-term plan is to construct three new beamlines every year.

Journal Article↗

PubMed2006

Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial.

BACKGROUND: The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse. AIMS: To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction. METHOD: One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately. RESULTS: Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups. CONCLUSIONS: The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

Adolescent↗

PubMed1995

Utilisation of primary curative services in Diepkloof, Soweto.

A study was undertaken to compare characteristics of attenders at primary curative services in Diepkloof, Soweto, and their reasons for the utilisation thereof. A structured questionnaire was administered to a sample of patients attending a provincial clinic and two general practitioners (GPs) in the Diepkloof area. The demographic characteristics, utilisation characteristics and reasons for choosing the service are compared. The most important characteristic determining choice of primary care was an individual's access to medical aid: 14% of clinic attenders compared with 67% of GP attenders. Other significant differences between the service users were employment and income. Perceived quality of care, attitude of health workers, distance to the service, availability of credit, waiting time, and the type of illness were also important determinants of choice of service. Methodological issues with regard to the heterogeneity of GP practices and ways of dealing with attitudinal data from a facility-based survey are illustrated.

Adolescent↗