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PubMed1998

The role of the old age psychiatry consultation liaison nurse.

OBJECTIVE: To assess and describe service changes when a psychiatric consultation liaison nursing service is introduced. DESIGN: Prospective collection of basic service data before and after implementation of the service change. SETTING: A newly established comprehensive old age psychiatry service. PATIENTS: People on medical and surgical wards aged over 65 years referred for psychiatric assessment. OUTCOME MEASURES: Numbers of referrals made and patients seen, details of psychiatric diagnoses made and follow-up offered before and after the change in the service. RESULTS: Within 6 months there was an increase in liaison referrals to the service. The proportion of people offered follow-up showed little change and delay before assessment decreased substantially with the PCLN service. CONCLUSIONS: A psychiatric consultation liaison nursing (PCLN) service was successfully initiated. Numerous difficulties were encountered but this is a useful model for old age psychiatry services to consider researching and developing further.

Aged↗
PubMed1987

Community mental health services in transition.

Major policy and funding shifts over the last several years have stimulated a series of changes in local mental health agencies. Services offered CMHCs became less comprehensive and more oriented toward chronic and severely ill patients. Decreases occurred in other services, primarily indirect services. Changes in services and in clients served caused reconfiguration in staffing patterns, and also affected the types of activities some staff perform. The implications of these service and staffing changes for local mental health agencies are discussed.

Community Mental Health Centers↗
PubMed1995

Usefulness of a non-experimental study design in the evaluation of service developments for infant feeding in a general hospital.

There are likely to be many situations in which it is not possible to use a randomized controlled trial (RCT) for the evaluation of local service developments, and the usefulness of non-experimental study designs need to be assessed. This is examined with reference to a study carried out to evaluate the appointment of a baby feeding adviser (BFA) and other policy changes for infant feeding at a district general hospital (DGH). Surveys of Maternity Unit staff attitudes and practices, and of mothers' experiences were carried out in 1988 (prior to the changes) and afterwards in 1990. Service changes were; appointment of a BFA, removal from the postnatal wards of dextrose, seminars on baby feeding for midwifery staff, and a reduction of night-only shifts. There was no change in the initial breast feeding rate of about 80%, but there was an increase in breast feeding at 6 weeks postnatally from 57% (95% CI; 51-64) to 64% (95% CI; 59-69); P = 0.15. The percentage of women who stopped breast feeding by 6 weeks fell from 30% in 1988 to 22% in 1990; P = 0.11. Mothers who did not see the BFA (1990 only) were significantly less likely to begin breast feeding (P = 0.03), independent of social class and age, but a similar association was not seen at 6 weeks. There were significant reductions in the percentage of midwifery staff viewing feeding policy as unimportant (P = 0.02), and in the use of supplements for breast-fed babies (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy response and the prevention of the epidemic.

This paper assesses policy development, service changes and trends in HIV infection and risk behavior among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The behavior of Italian family physicians regarding the health problems of women and, in particular, family planning (both contraception and NFP).

The hospital-centered trend that has dominated medical culture and the management of health care during this entire century has, in the last few years, undergone a reversal in Italy. Conditions in other countries suggest that similar changes have or will become increasingly common. The family physician today manages many of the functions previously handled by hospitals and specialists. In the field of reproductive health, family physicians are responsible not only for diagnosis and treatment, but also for prevention and education. The present study considers this new context with the objective of investigating the knowledge and behavior of Italian family physicians in the field of women's health, with particular regard to family planning (including natural family planning), through (1) a qualitative study (focus groups) of a small group of family physicians and (2) a questionnaire sent to 500 family physicians throughout Italy. The results of the focus group are summarized in the form of obstacles that the family physician finds in providing family planning services and proposals for change. The results indicate that because of their holistic approach, the family physician is an appropriate provider of family planning services although continued use of specialists' services, changes in logistics of the family physicians' practice, increased gender sensitivity, and additional training and information are necessary. The results of the questionnaire (121 responses, 24.2%) indicate that the Italian family physician currently lacks certain important information about family planning and would require logistical support to provide these services but is interested in acquiring information and is an appropriate family planning provider. An additional challenge for encouraging family practitioners to provide natural methods is that they favor a "medical" approach rather than a "behavioral" one in their treatment preferences for several other conditions.

Contraception↗
PubMed1998

All change: cancer services in transition.

The policy and health service background to this discussion are the radical changes in cancer services currently underway in the wake of the Calman-Hine Report and the wider changes ushered in by the NHS and Community Care Act 1990 (UK). Using the changing face of hospice care as the focus, the authors explore some of the potential issues and dilemmas involved in providing supportive care for cancer patients and their families. Three 'themes', or areas of concern, are highlighted: links between services, changing organizational factors, and increasing 'medical imperialism'. Potential benefits and drawbacks of the changing ethos and organizational structures are discussed. Interview data are used as 'triggers' for the presentation of the authors' own reflections on developments in the hospice and cancer services' arenas. The paper draws on interview data collected in the pilot phase of a 3-year study on the psycho-social needs of cancer patients and their informal carers in north-west England. Twenty-nine interviews were conducted with a range of professionals involved in the provision of cancer services in Lancaster and Kendal. In the spirit of 'gathering thoughts' and facilitating debate, a commentary on developments in the hospice sector is offered rather than any firm conclusion.

Health Care Reform↗
PubMed1992

Managing service change in post HIV drugs services--a case study from Inner London.

The advent of HIV/AIDS has presented a major ideological challenge to established drug treatment agencies, where the incorporation of HIV-prevention strategies has proved problematic. This case study analyses the response to the HIV/AIDS epidemic by the drug misuse services of one Inner London district health authority (Bloomsbury) during the period 1985-89. While innovation and enthusiasm were much in evidence, a number of special problems prevented an effective and coherent strategic response. Key factors in the management of change in drugs/HIV services are identified which may be of special importance to clinicians, managers and funders and a number of key organizational and managerial competencies are suggested.

HIV Infections↗
PubMed1996

Validity and reliability of the Parent Satisfaction Questionnaire.

The development of a postal consumer satisfaction questionnaire for a child and adolescent psychology service is reported. A preliminary analysis of content, construct and concurrent validity suggests that the questionnaire has an acceptable degree of validity. Factor analysis identified five factors with three being identifiable as relating to the outcome of contact, appointments and the timing of contact. The remaining two factors were minor dyads which were difficult to interpret. The reliability and utility of the questionnaire is good, proving a useful way of identifying service shortfalls and directing service change. The need to methodologically evaluate consumer satisfaction questionnaires is stressed and their routine use in monitoring and assuring service quality highlighted.

Adolescent↗
PubMed1988

Planning for alternative futures in the NHS.

'The NHS needs the ability to move much more quickly' (The Griffiths Report, 1983, p13) This paper grew out of preliminary research undertaken for the research project on which we both work, entitled the Management of Change in the NHS. The project is based in the Centre for Corporate Strategy and Change at the University of Warwick, and is directed by Professor Andrew Pettigrew, who has previously undertaken a longitudinal study of strategic change in ICI (Pettigrew, 1985), and also a pilot study within the NHS which identified the implementation of strategic intent as the jugular problem confronting NHS managers. But a central research problem is why it is that some Health Districts manage to achieve a faster rate of change than others. Hence there was a need to trace the evolution of local systems through time, with the result that the historical analysis of changing is a key aspect of this research. The project is financed jointly by the NHSTA and a consortium of eight of the English Regions and ten case study districts are included. The research design focusses on strategic service changes in both the acute and priority group sectors and incorporates developments and contractions. The choice of strategic changes was informed by a detailed review of the most recent regional strategic plans and the review itself prompted this paper. It led us to a number of observations about the content of the change agenda. First, there is a high rate of change projected in the current strategic round and earlier studies of incrementalist approaches to change may have to be revised (Hunter, 1980; Ham, 1981). Secondly, these regional change agendas to a great extent reflect national/central policy and the pattern is one of uniformity. These standard agendas include RAWP; the construction of a DGH network; the run-down of long-stay mental illness/handicap hospitals; cost improvements and an increase in health promotion activity. Thirdly, alongside the top-down mechanisms to secure implementation of national objectives, another mode of planning emerges which more closely approaches the concept of 'local learning' (Glennester et al, 1983) where organisations seek to explore possible forces for change and how they might respond. Planning here is seen as a means of 'problem-sensing' and awareness building (Quinn, 1980) and getting new issues onto the agenda (Pettigrew, 1985). The paper will explore the content of the change agenda in detail and the nature of the planning process.(ABSTRACT TRUNCATED AT 400 WORDS)

Forecasting↗
PubMed1989

Managing strategic service change in the NHS.

This paper reports some early findings from a major research project which explores strategic service change in the NHS in the post-Griffiths era. We begin by briefly reviewing the relevant literature on change and general management in the NHS, and go on to outline the particular features of the research design. We then isolate some key emergent themes from a preliminary analysis of the data, highlighting two themes in greater depth. In our final section, we will attempt to reflect on some of the common factors associated with the achievement of strategic change. The project is funded by the NHSTA and a consortium of eight Regional Health Authorities.

Administrative Personnel↗
PubMed1996

Informal care vs. formal services: changes in patterns of care over time.

Longitudinal data from a representative sample of community-residing older persons were used to document changes in patterns and costs of care, both informal and formal. It was found that use of formal services was usually in conjunction with, and secondary to, informal care. Limited availability of informal care as well as increased disability raised the odds of using services. Substitution of formal services for informal care was limited and usually temporary. Total costs of community care, including living expenses, were generally less than the cost of nursing home care.

Activities of Daily Living↗
PubMed1996

Changes in utilization and cost sharing within the Danish National Health Insurance dental program, 1975-90.

The aims of the analysis were 1) to examine the development in utilization of dental care provided for adults in Denmark under the National Health Insurance during the period 1975-90; 2) to assess the appropriateness of available dental care statistics for studies of oral health trends; and 3) to analyze the price development of dental services during 1975-90 and its impact on patient and Insurance expenses, respectively. Utilization and economic data were retrieved from available registers and analyzed. Three trends were found. First, the utilization has increased more than what could be explained by the population increase; secondly, the panorama of dental services changed from predominantly restorative/extraction services to predominantly diagnostic/preventive services. Thirdly, the price paid by Danish adults for dental care increased disproportionately to other price developments in society. On the basis of traditional health economic theory this development could be expected to affect demand for dental services negatively.

Adult↗
PubMed1997

Health service reform: the perceptions of medical specialists in Australia (New South Wales), the United Kingdom and New Zealand.

OBJECTIVE: To examine the effect of recent healthcare service changes (including significant resource constraint and a greater role for the non-medical manager) in the United Kingdom, Australia and New Zealand on medical specialists' perceptions of their healthcare organisation goals and service delivery, and their enthusiasm for their work. DESIGN: Postal questionnaire survey, answered anonymously. PARTICIPANTS AND SETTING: Medical specialists employed either part- or full-time in two United Kingdom National Health Service Trusts (one acute, one mental health/community service), an Australian Area Health Service and a New Zealand Crown Health Enterprise in 1995. MAIN OUTCOME MEASURES: Participants' rating of their knowledge of employers' organisational goals, ability to influence management, perceptions of changes in resources and service availability since 1990 and changes in enthusiasm for their work over the past four years. RESULTS: 369 of 521 eligible specialists responded (71%); by country-United Kingdom, 123/186 (66%); New Zealand, 123/160 (77%); Australia, 123/175 (70%). New Zealand specialists were less aware of their employers' organisational goals and had less congruence between these and their own personal goals than United Kingdom or Australian specialists (P < 0.05). Interest in influencing central management was similar in the three countries, but Australian specialists felt management was less likely to follow their advice compared with United Kingdom specialists (P < 0.05). New Zealand specialists perceived that waiting times for non-urgent patients were currently longer than in 1990 compared to United Kingdom specialists (P = 0.02). In all three countries, inpatient beds were perceived to be less available than in 1990, but less so in New Zealand. The ease of replacing equipment was better in New Zealand than in Australia and the United Kingdom (P = 0.00001). More than 50% of participants in all three countries (183/361; 50.7%) reported that their enthusiasm for their work had decreased in the past four years. CONCLUSION: The effects of health service reforms seem to have reduced enthusiasm for work among medical specialists in Australia, the United Kingdom and New Zealand.

Attitude of Health Personnel↗
PubMed1995

The hidden competitive weapon supporting innovation in health care.

It is trite to say health care is experiencing an era of unprecedented change. However, with the preoccupation with reimbursement and economic reform, it is easy to focus on this single dimension and lose sight of the pervasiveness of the need for continuous change throughout the entire health care organization. Health care organizations that will emerge as leaders within the industry will have incorporated not only radical changes to deal with new patterns of reimbursement, but also simultaneous changes in core medical services--changes that not only incorporate new technology, but also push down costs. They will also have to cope with radical changes in information and quality systems. Physical facilities will look less like citadels, and new flexible architectures will emerge. Coping with transportation logistics and remote site service provision will be part of the new industry. Patients will become full partners in ¿health,¿ requiring very different approaches to patient education and involvement in prevention, not simply treatment. Indeed, without belaboring the almost endless list, it is impossible to think of a single dimension of health care that will be untouched.

Catchment Area, Health↗
PubMed1991

Evaluation of family support services: changes in availability and accessibility.

Changes in availability and accessibility of family support services were studied by surveying county mental health authorities in Michigan before and after the implementation of new policy on and funding for such programs. An overall increase in the availability of family support services was found. Access to services as measured by length of time families waited for services remained unchanged following the increase in funds. Policy and funding implications of the study were discussed.

Adaptation, Psychological↗
PubMed1995

Harnessing the heightened public awareness of celebrity HIV disclosures: "Magic" and "Cookie" Johnson and HIV testing.

This article investigates the impact NBA basketball star Earvin ("Magic") Johnson's HIV disclosure had on changes in demand for HIV counseling and testing services in New York State's 61 Anonymous HIV Counseling and Testing sites. Interrupted time-series analyses were conducted on weekly data from over 34,000 clients seeking anonymous HIV counseling and testing services from January 1991 to June 1992, to determine whether demand for these services changed as a result of the disclosure. Results indicated that immediately following the HIV disclosure, there was a substantial increase in service demand, which transcended all sex, race, age, and most HIV risk-related boundaries. Seven months later, demand had not returned to pre-disclosure levels. The strong impact on females, coupled with additional data analyses in obstetrical settings, suggests that previous research has been too narrow in focus, and that the effect of Johnson's HIV disclosure has been enhanced, in part, by the publicity surrounding his wife and baby. The importance of harnessing the heightened public awareness of celebrity HIV disclosures is discussed.

AIDS Serodiagnosis↗
PubMed1998

Teleradiology in KwaZulu-Natal. A pilot project.

OBJECTIVE: This was a pilot teleradiology project connecting two secondary KwaZulu-Natal hospitals' radiography departments to a central Durban teaching hospital. The purpose of the study was to assess the usefulness of same-day teleradiology reports to the medical staff and whether such a service changed patient management. DESIGN: After 1 month's service at each hospital, the first 200 teleradiology reports, original radiographs and patients' case notes were reviewed to determine whether any errors in interpretation of the radiographs had been made and whether the reports had changed patient management. RESULTS: The service changed patient management in 10% of cases. Undetected pathology was recognised by the radiologist in 20 patients--pulmonary tuberculosis in 10, spinal tuberculosis in 3, miliary tuberculosis in 2 and fractures in 5. Problems were encountered with transmission of data using the current telephone network, loss of data at the receiving station and the increased workload of the radiographer transmitting the data. CONCLUSIONS: Teleradiology services do make a positive impact on patient management in rural hospitals. However, there are many technical pitfalls that must be avoided in order to establish an effective service.

Hospitals, Rural↗