SEARCH · PubMed Health

Results for “Service user”

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources

PubMed2005

Seeking and using families' views to shape children's hospice services.

Child and family involvement is key to improving the quality of children's hospice services. This article reports on a quality assurance initiative undertaken as one component of a clinical governance strategy. Service users participated in focus groups followed by lunch to discuss how staff communicated with them about their child's care, their family support needs, and how staff liaised with other professionals and organizations. There was general commendation of hospice services (in-house and community), but parents wished for more quantity and consistency with all elements of the care model. There was tension between respite and end-of-life care needs. Parents considered that the myth of hospices being 'just for death' needed dispelling and wanted other professionals to be more aware of its role, and the choice of earlier referral. Transition, both age and prognosis related, caused concern, with anxiety about long-term future or loss of support when prognosis improved. Parents also wanted better information about practical help and psycho-social support as well as up-to-date information about their child's treatment and management from all care providers.

Adolescent↗

PubMed2006

The nature and correlates of unmet health care needs in Ontario, Canada.

Using data from the Canadian Community Health Survey (CCHS) Cycle 1.2, we examine the nature of unmet mental health care needs in Ontario, Canada and how this is associated with socio-demographic, social support, health status and mental health service use factors. Unmet mental health care needs result from experiencing barriers to three issues: acceptability, accessibility and availability. Unmet needs due to acceptability issues are the most frequent type; the largest proportion of people within this category report experiencing unmet needs because they "preferred to manage the problem themselves". Unmet needs are greater among the young and among females. Surprisingly, service users report higher rates of unmet needs than non-users. Some social support variables have associations with unmet needs. Based upon these results, unmet needs pose a major challenge to the health care system since they cannot be resolved solely by enhancing access to and availability of mental health services. Thus, to address unmet mental health care needs, efforts should be focused on the acceptability barriers that women and young people in particular face. Enhancing education and certain social support mechanisms are potential strategies.

Adolescent↗

PubMed2005

"We don't really have cause to discuss these things, they don't affect us": a collaborative model for developing culturally appropriate sexual health services with the Bangladeshi community of Tower Hamlets.

OBJECTIVE: To identify barriers to accessing sexual health care among the Bangladeshi community of east London and to develop a model of community participation in service development. METHODS: Qualitative study using one to one interviews with sexual health service users plus focus groups in community settings. RESULTS: 58 people participated in the study, 12 in individual interviews and the remainder in six focus groups. All were of Bangladeshi origin. Four main themes were reported as impacting on access to services; confidentiality concerns, relevance of services to the community, problems with discussing sexual issues, and problems with previous experiences of health promotion. Community values regarding sex outside of marriage were an important underlying factor in participants' responses. Existing sexual health services were seen as culturally insensitive by patients and community groups. CONCLUSIONS: Community based health initiatives among hard to reach ethnic minority groups should use existing networks of statutory and non-statutory groups to benefit from local expertise and relationships. Steering groups composed of members of the local communities served by the clinic can usefully inform service development.

Adult↗

PubMed2004

Improving transition: a qualitative study examining the attitudes of young people with chronic illness transferring to adult care.

Transition is a process that attends to the medical, psychosocial and educational needs of young people as they transfer to adult-orientated care. With a growing population of adolescents surviving with chronic illness well into adulthood, it is remarkable that empirical research has paid little attention to transition. This qualitative study examined the attitudes of young people with chronic illness who were facing transition, considering what young people wanted from a transition service and the ways in which provision could be improved from a service-user's perspective. A purposive sample of seven adolescents (aged 14-17) attending a hospital youth club were interviewed. To increase the likelihood of successful transition, strategies need to be informal, flexible, highly individualized and prepare adolescents steadily for adult services.

Adolescent↗

PubMed2005

Stakeholder views regarding cultural diversity teaching outcomes: a qualitative study.

BACKGROUND: Cultural diversity teaching is increasingly present in both undergraduate and postgraduate training programmes. This study explored the views of stakeholders in medical education about the potential outcomes of cultural diversity teaching and how they thought cultural diversity programmes might be effectively evaluated. METHODS: A semi-structured interview was undertaken with 61 stakeholders (including policymakers, diversity teachers, students and users). The data were analysed and themes identified. RESULTS: Many participants felt that clinical practice was improved through 'cultural diversity teaching' and this was mostly as a result of improved doctor-patient communication. There was a strong view that service users need to participate in the evaluation of outcomes of cultural diversity teaching. CONCLUSION: There is a general perception, rather than clear evidence, that cultural diversity teaching can have a positive effect on clinical practice. Cultural diversity teaching needs to be reviewed in undergraduate and postgraduate medicine and better evaluation tools need to be established.

Adult↗

PubMed2001

Effect of unexpected outcomes and causal attributions on key workers' expectancies of goal attainment.

Goal planning is an integral part of the role of the key worker in services for people with intellectual disability. The present study investigated the effect of the Weiner stability-expectancy principle on unexpected outcomes in goal planning. Four hundred and twenty-two actual goal attainment scales were constructed, with each scale describing the key workers' expected levels of outcome. Two hundred and twenty-six (54%) unexpected outcomes, both successful and unsuccessful, were then rated by key workers to provide a causal explanation for each outcome. These explanations were then grouped according to whether the attributions represented stable or variable causes. Finally, key workers were asked to provide a new expectancy rating to forecast future goal attainment. Two predictions from Weiner's model were confirmed by statistical analysis: (1) that success attributed to stable factors would lead to higher revised forecasts of goal attainment than success attributed to variable factors; and (2) that failure attributed to stable factors would lead to lower revised forecasts of goal attainment than failure attributed to variable factors. The results of the present study confirm that stability attributions do alter key workers' revised forecasts of goal attainment. The results are discussed in terms of the possible consequences for key worker behaviour, such as goal abandonment, differential treatment of service users and the need for a knowledgeable approach to performance appraisal by managers.

Adult↗

PubMed2006

Personalised social care for adults with disabilities: a problematic concept for frontline practice.

This paper explores the complexities and contradictions of frontline practice that pose problems for personalised social care through enhanced choice. It draws on semi-structured interviews with community care workers, social workers, occupational therapists and care managers in a social service department. Practitioners interviewed were asked about their current assessment and documentation system, including the assessment documents currently used; how they approached information gathering and the topics they explored with service users; and their experience of documenting assessment and care management. The paper argues that the validity and sustainability of personalised social care in frontline practice relies on developing a thorough understanding of the complex and implicit assessment processes operating at the service user/practitioner interface and the inevitable tensions that arise for practitioners associated with the organisational context and broader service environment. The findings demonstrate the variability among practitioners in how they collect information and more importantly, the critical role practitioners occupy in determining the kinds of topics to be explored during the assessment process. In so doing, it shows how practitioners can exert control over the decision-making process. More importantly, it provides some insight into how such processes are shaped by the constraints of the organisational context and broader service environment. Complexities and contradictions may be an inherent part of frontline practice. The issues discussed in this paper, however, highlight potential areas that might be targeted in conjunction with implementing personalised social care through enhanced choice for people with disabilities.

Adult↗

PubMed2004

Depression in South Asian women living in the UK: a review of the literature with implications for service provision.

Research has shown that South Asian people in the UK underutilize health services compared with White people. Also, where services are accessed, they may not adequately meet cultural and religious needs. In exploring the relationship between the cultural and religious beliefs of South Asian service users about perceptions, beliefs about aetiology, cause and treatment of mental illness, past studies have illustrated a wide range of expectations, experiences, beliefs and attitudes. This article reviews research on depression in South Asian women in the UK, highlighting implications for services.

Asia, Southeastern↗

PubMed2005

Creative solutions: Innovative use of the arts in mental health settings.

A recent study of occupational stress on the unit (Clare, 2004) highlighted that staff valued the importance of the socialization process in reducing their stress levels. This process incorporates the need for peer support and acceptance, and an understanding of what is expected of them (e.g., roles and responsibilities), supported by a culture of learning, problem solving, and working together. This process is similar to the approach taken by the arts project in nurturing ideas and initiatives in a safe, respectful way. It is apparent that the arts project has been more than just a creative activity; it has had wider implications for both staff and service users in reducing stress. It has: * Enabled staff retention. In fact, there is a waiting list of nurses wishing to work on the unit. * Reduced incidents of damage to property. * Reduced use of p.r.n. medication. * Enhanced the good reputation of the service, which is often commented on by visitors to the unit. The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity.

Art↗

PubMed1996

Quality of mental health service care: the forgotten pathway from process to outcome.

The validity of the concept of outcome depends on a relationship between routine treatment and later health status. Outcome evaluations and audits are very rare in psychiatry. A substantial expansion in epidemiologically based, naturalistic, observational, process-outcome data collection in routine psychiatric practice is essential in order to identify treatment allocation biases and other reasons for unexpected outcomes. Identified causes of undertreatment should lead to locally agreed detailed clinical guidelines. Experimental evaluation should take place in routine clinical practice settings, with change in both process and outcome as the objective. Ultimately, the results of both experimental and observational outcome studies on representative service users should converge, permitting outcomes to be the ultimate arbitrator of quality.

Cost-Benefit Analysis↗

PubMed1999

Expert patients. So you think you know it all?

The government's proposal to set up an expert patients programme to enable those with chronic illnesses and disabilities to manage their condition is a welcome step towards greater user involvement. The programme should avoid a medical model and take account of patients' social circumstances. The programme must include evaluation. Health professionals in the UK have yet to embrace patient self-management. To date they have been reluctant to refer service users to self-help groups.

Chronic Disease↗

PubMed2000

[Breast cancer screening and medical consumption].

BACKGROUND: The use of general health services by women targeted by breast cancer screening campaigns, and its variations, are poorly known. A survey has been undertaken during one of these campaigns in a britton department. This study aimed at pointing out possible differences in use of general health services: search for an overuse by women whose screening resulted positive/negative, in relation to women whose screening resulted full negative; search for an overuse by women having participated, in relation to women within the age range of the screening campaign and not having wished to participate. METHODS: Three groups of women, aged 50 to 69 years, free of breast cancer, were compared. A random sample was drawn in each group, weighing for age in group D0. Inclusion of cases was undertaken between January 1995 (beginning of the screening campaign) and June 1996. Use of health services was recorded during the six months following the first screening test, using the health insurance services data. Expenses related to inpatient care were not recorded. RESULTS: The structure of age of the three groups was comparable. The proportion of women having requested no reimbursement was identical between the groups D+ and D-. For the D+ group, the average cost was 4,246 Francs per woman. It dropped to 3,871 Francs after deduction of expenses related to additional medical examinations following the finding of a positive screening test. It was 5% higher than the average cost in the D- group (3,698 Francs). The cost varied a great deal within each group and the differences observed between the groups were not statistically significant The proportion of women of the D0 group not having requested any reimbursement was significantly lower than those of the groups D- and D+, overall, and for the majority of the categories of expenditure. CONCLUSION: The result of the screening does not induce significant variation of use of general health services, apart from the expenses induced by the invalidation of the positive result. The group of women not having participated in screening includes a stronger proportion of both low and higher health services users.

Age Distribution↗

PubMed1999

Evidence-based practice. A philosophical and political analysis: some matters for consideration by professional practitioners.

This paper evaluates the concept of evidence-based practice (EBP) and appraises critically the implementation process of the EBP initiative, noting its consonance with the aspirations of the dominant political culture and offering a critique of the inherent contradictions and ethical dilemmas associated with it. A critical evaluation of the implications for practitioners and service users is offered and the authors argue that while the concept of EBP is a laudable one, there is a need to exercise caution about uncritical acceptance and evidence that a more eclectic and less reductionist approach to EBP is essential for quality service development.

Diffusion of Innovation↗

PubMed1993

Devising a multidisciplinary audit tool.

Discusses the audit processes in health care from the existing perspectives and argues the need to extend the current unidimensional approaches which include medical, clinical and managerial quality. Argues that one way of expanding these approaches is to develop an audit instrument based on the views of service users. The implementation of audit has been a process with regional variations, which have created centres of excellence and centres where there is very little happening. Considers elements that are involved in devising an audit tool which is based on customers' perceptions of service quality, and reports on an empirical study which is still in progress and which aims to develop a tool which is effective, efficient and based on patients' views.

Aged↗

PubMed2005

Transcultural nursing: the relationship between individualist ideology and individualized mental health care.

This article attempts to clarify and underpin the view that individualized mental health nursing is culture biased and politically instrumental, adding weight to the transcultural argument that mental health care should be more culture sensitive than is often the case within conventional UK settings. It examines the political history of individualist ideology, and then uses social conflict theory to explore the potentially counter-therapeutic relationship of individualism and individualized nursing care in the UK mental health sector. The article challenges the widespread idea that individualized mental health nursing is 'liberal', 'democratic', 'holistic' and 'scientific', and in so doing extends the transcultural agenda to large scale infracultural differences within the UK population. It also explores the potential for policy change towards a more pluralistic service, and outlines some of the practical steps which may be taken to access alternative care approaches. It is a power analysis, which may be of transferable value to nurses in mental health care inpatient units where conventional individualized approaches are failing to reintegrate service users into the community. A glossary of terms is presented at the end of this article.

Conflict, Psychological↗

PubMed1997

An analysis of the sociopolitical context of mental health nursing practice.

This paper will explore the delivery of mental health nursing care within a neo-liberal model of mental health care delivery in New Zealand. Mental health nursing as a socially constructed activity occurs within a particular political context, which determines its role and function. This environment determines the nature of the nurse-patient relationship which is integral to the role of mental health nurses. Critical analysis of the New Zealand Government's neo-liberal health policies will be conducted to explore their effect on mental health care delivery and the nurse-patient relationship. Some of the ideologies and values maintained by current dominant discourses within nursing and the State are discussed. To establish therapeutic partnerships with service-users, mental health nurses are urged to critically analyse their practice and the context in which it occurs.

Delivery of Health Care↗

PubMedDate not supplied

[Conceptual and methodologic bases of the National Health Survey II, Mexico, 1994. Conceptual Coordinating and Designing Group of ENSA-II].

The conceptual and methodological basis of the National Health Survey II (NHS-II) are described and recent advances in multidisciplinary public health research in Mexico, both conceptual and methodological, are synthesized. The design of the NHS-II concentrated on the study of the access, quality of care and health attention expenses in ambulatory and hospitalization services. Details on the conceptual framework related with the analysis and processing of data are also included. Five geographic regions were covered; 12,615 households at national level were visited and information on 61,524 individuals was gathered. The overall response rate was 96.7% both for households and for identified health service users. The general conclusion emphasises the need to incorporate the population perspective to the planning and allocation of health resources.

Age Distribution↗

PubMed1998

Models of community care for severe mental illness: a review of research on case management.

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

Activities of Daily Living↗