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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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PubMed1998

The changing health care environment: implications for residency training.

Throughout the United States, the growth of managed care is forcing pediatric providers (physicians and hospitals) to reconstruct and integrate the health care delivery system with a focus away from the academic center and toward the community. Managed care also is forcing new financing approaches geared toward the assumption of economic risk for patient management and utilization of services. Radical changes in pediatric training programs will be necessary to accommodate the strategic and operational changes being pursued in response to these evolving market forces. These changes, while disruptive, will strengthen the breadth and diversity of graduate medical education and will better prepare trainees for the new delivery system in which they will practice. In this article, we examine how the evolution of managed care is redefining the basic financial and organizational framework for pediatric care and the implications of this redefinition for children's hospitals and academic medical center-based pediatric programs. We draw on our experience in the greater Philadelphia market to illustrate the impact of these changes and discuss one pediatric system's response. Finally, we review the educational opportunities provided by these changes.

Delivery of Health Care↗
PubMed1997

Regional experience of evaluation of professional practice and quality assurance implementation in Aquitaine.

We report the establishment of a voluntary programme for developing the assessment of professional practice and quality assurance conducted since 1989 in the Aquitaine region of south-west France. This experience, in a region where there are 14,000 hospital beds in about a hundred institutions, has aimed at two objectives: (1) the adoption by the region's health professionals of medical guidelines for good practice and methods for measuring quality and outcomes obtained, by means of university training in evaluation and the conducting of several surveys of professional practice and clinical audits; (2) similar adoption by the regional political, administrative and medical directors of quality assurance procedures defined by an organizational audit concerning the prescription of preoperative tests in the university hospital and in the main public hospitals of the region. The critical impetus that this experience has created, together with other factors related to the political decision-makers and health managers of the region, has led to an operational regional structure for developing clinical evaluation and quality in Aquitaine.

Decision Making, Organizational↗
PubMedDate not supplied

Developing and implementing a pharmaceutical care model in an ambulatory care setting for patients with diabetes.

This study evaluated pharmaceutical care as an adjunct to an existing, coordinated-care program at a Regional Diabetes Center. The progress of a control group receiving the standard pharmacist instruction was compared with two treatment groups receiving additional small group or individual supplementary education for a 2-month period. Outcome evaluation included assessment of individual diabetes management through blood glucose monitoring and responses on a pretest and posttest questionnaire. Patients in the treatment groups demonstrated significantly lower average weekly blood glucose levels and a decreased incidence of hyperglycemic episodes compared with the control group. Questionnaire data for both treatment groups demonstrated a significant increase in patient understanding of diabetes medications and medications for associated illnesses, an increase in knowledge about blood glucose monitoring, and a positive difference in perceptions/attitudes toward diabetes and communication with the pharmacist. This approach is consistent with the concept of pharmaceutical care in which the pharmacist helps patients avoid long-term complications and thus improve their quality of life.

Adult↗
PubMed1998

Regionalization of infection prevention and control services in a publicly funded health care system.

In 1994 health services in the Edmonton region were consolidated into an integrated network called Capital Health. Infection control professionals in the region met to develop a vision for the future of infection control; the tasks were to prepare a proposal for a regional program, develop indicators for outcome measurements, and standardize guidelines and products. Although regionalization of infection control is a complex process, we have had success with a proactive approach led by infection control professionals.

Alberta↗
PubMed2000

The framing of teenage health care: organizations, culture, and control.

Adolescent health is one of the most polemical health issues that has swept the United States in recent years. This study is about documenting the process of a project on teenage sex, drug, and alcohol abuse in a small rural California town. It illustrates a dynamic set of concerns that impinge on health issues: development and underdevelopment, experts and lay people, young and old, in a context of the transformation of a rural economy to a prison-based industry. It is also about covert forms of control, pacification, burnout, and teenagers caught in the crossfire between bureaucratic institutions and contradictory messages about adolescent health as they correspond to changing conditions between institutional power holders.

Adolescent↗
PubMed1999

Regionalization of perinatal health care: a lesson learned but lost.

Regionalization of perinatal health care has offered appropriate services to mothers and babies as close to their homes as possible. The need for regionalized service has not changed, but the concept has been challenged by the managed care dictate that patients receive referral services at the least expensive option available that qualifies to give that service by virtue of an assigned designation of level of care. When regionalization first became extant, hospitals qualified as tertiary (highest level) perinatal centers if they had neonatologists on staff. Now, however, far more is required of a hospital if it is to qualify to provide the highest level of care available. The so-called national guidelines of perinatal health care do not clearly specify this, and thus hospitals with limited scopes of perinatal services may still be recognized as tertiary or subspecialty centers. Third-party payers contract with such hospitals to provide tertiary care and are able to do so at a lower cost because these hospitals are not capable of offering more complex and thus more expensive services. However, some patients require the more comprehensive services and are at least initially denied them because of the costs involved. I believe it is improper for third-party payers to dictate what services patients receive and where they receive them. This has been and should be the province of physicians and physicians alone. Furthermore, I believe that a more detailed and descriptive system of guidelines for perinatal health care at the state level could help to clarify the true level of functioning of any hospital and thus make it more difficult for third-party payers to opt only for the least expensive services.

Child Health Services↗
PubMed1976

Policies to influence the spatial distribution of physicians: a conceptual review of selected programs and empirical evidence.

To increase the usefulness of existing physician location literature for policy evaluation, literature is grouped into intraurban and urban-rural studies. A conceptual overview of physician location literature is presented. Consensus results, if any, are discussed. A list of hypotheses suggested by the literature is then utilized in a discussion of economic social, prior exposure, and professional development incentives embodied in selected public and private sector programs. Programs are evaluated by type of incentive mechanism and geographic target area to determine if present program structures are based on a solid empirical foundation. This assessment indicates that, in general, use of prevalent location incentive mechanisms is not justified by a consensus of empirical evidence.

Economics↗
PubMed2006

Developing cancer services strategy in primary care in England: primary care trust managers' views of the primary care cancer leads initiative.

PURPOSE: Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative. DESIGN/METHODOLOGY/APPROACH: A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses. FINDINGS: PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue. ORIGINALITY/VALUE: The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

Attitude of Health Personnel↗
PubMed2004

Fee-for-service revenue for school mental health through a partnership with an outpatient mental health center.

School mental health programs are increasingly prominent in the United States and in other countries, but funding remains tentative. This article describes a partnership between a school mental health program and an outpatient mental health center, and considers the larger goal of promoting sustainability and increasing revenue. Issues related to using fee-for-service revenue to support school mental health are explored, and strategies for promoting effective partnerships are discussed. Recommendations for programs facing the challenge of incorporating fee-for-service activities into their current model of service provision are provided.

Adolescent↗
PubMed1989

[Assessment of the impact of nutritional rehabilitation programs on preschool children: test of a methodology].

Two different approaches to the evaluation of the impact of food supplementation given to malnourished children are assessed on the basis of the experience of a program undertaken in the county of Diadema, in the metropolitan area of S. Paulo, Brazil. The first approach--a traditional one--is based on the proportion of children that at the end of one year's participation in the program present no weight deficit (weight for age more than 90% of the expected value). The second approach--proposed in the article--takes into account only the rate of growth and accepts weight increments superior to those expected among well-nourished children as favorable. The advantages of this second approach are fully demonstrated.

Body Weight↗
PubMed1991

National Library of Medicine programs--PHS. Final rule.

These regulations govern the programs of the National Library of Medicine (NLM). The regulations permit the Regional Medical Libraries to recover part or all of the costs of providing photocopies of biomedical materials; improve readability of the regulations; and update references to statutory authorities and uniform administrative requirements.

Copying Processes↗