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PubMed2003

Partner counseling and referral services to identify persons with undiagnosed HIV--North Carolina, 2001.

Approximately one fourth of the 850,000-950,000 persons living with human immunodeficiency virus (HIV) in the United States are not aware of their infection and their risk for transmitting HIV. Identifying HIV-infected persons promptly after infection and directing them to medical care and prevention services is a national priority. Voluntary partner counseling and referral services (PCRS) help HIV-infected persons notify sex and needle-sharing partners of their need for HIV testing, enabling partners to receive early care and prevention counseling. To evaluate the success of these services in North Carolina, CDC analyzed PCRS data collected in 2001 by the North Carolina Department of Health and Human Services (NCDHHS). This report summarizes the results of that analysis, which determined that 125 (20.5%) of 610 tested partners of HIV index patients had HIV infections that were undiagnosed previously. These findings suggest that local and state health departments should consider PCRS an essential component of any comprehensive HIV-prevention program.

AIDS Serodiagnosis↗
PubMedDate not supplied

Attitudes of patients towards voluntary human immunodeficiency virus counselling and testing in two Nigerian tertiary hospitals.

BACKGROUND: Despite new scientific evidence establishing the benefits of counselling and testing as key elements in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention strategy, inappropriate HIV screening without consent and counselling is frequent in Africa. Presumed high rejection rate of HIV test has been adduced to this practice. OBJECTIVE: To determine the acceptability of HIV conselling and testing among Nigerians. METHODS: Consecutive sixty indigenous Nigerians aged 35.10+/-11.31 years with male: female ratio of 2:1, and made of clients with clinically suspected AIDS (20), diseases unrelated to AIDS (15), dermatological problems (10), sexually transmitted diseases (9), and asymptomatic persons (6) were studied. RESULTS: Fifty-three (88.3%) subjects gave informed consent to HIV screening. Of the 53 consenters, 32 (60.4%) were seropositive while 21 (39.6%) were seronegative. Five clients (9.4%) (1seropositive + 4 seronegative consenters) did not turn up for their results, and 2 (3.8%) seronegative consenters did not want to know their serostatus. The reactions to disclosure of seropositive results included grief 9 (28.1 %), indifference 8 (25 %), surprise 5 (15.6%), family concern 5 (15.6%), denial 3 (9.4%) and suicidal ideation 2 (6.3%). Thirteen (40.6%) seropositive clients showed willingness to disclosure of their serostatus to family members including the father (58%), senior brother (23%), wife (11%) and others (8%). Direct cost of screening was N400.00 (U$3.10) per client. An average of 18 minutes per client was spent on counselling. CONCLUSIONS: This study demonstrates the feasibility of VCT in Nigerian hospitals.

AIDS Serodiagnosis↗
PubMed2006

Estimation of human resource needs and cost of adding registered dietitians to primary care networks.

PURPOSE: Information on human resources and costs is needed to plan for the addition of registered dietitian (RD) services to new models of primary health care (PHC). Estimates were developed, based on an analysis of an enhanced RD model of counselling and health promotion services in three Ontario Family Health Networks (FHNs). METHODS: Both direct and indirect costs were averaged over the three FHNs. Costs and RD activities were tracked throughout 2005. The FHN staff completed two questionnaires addressing communication, case management, and satisfaction with RD services. RESULTS: Actual and reported case management indicated that an estimated 1.3% to 2.4% of the 60,000 enrolled patients may require individual nutrition counselling in a year. If one full-time equivalent (FTE) RD can manage 380 new referrals, then one FTE RD is needed per 15,800 to 29,000 patients. The estimated direct costs of adding one FTE RD (including expenses and fixed costs) is US dollars 78,169 to US dollars 80,169, when the RD is an independent contractor. CONCLUSIONS: Additional studies are needed to develop better estimates of human resource needs and costs of interdisciplinary nutrition services in all PHC settings. These estimates should be based on population characteristics and direct and indirect costs for all models of nutrition services in PHC settings.

Cost-Benefit Analysis↗
PubMed2005

Easing the burden of caregiving: the impact of consumer direction on primary informal caregivers in Arkansas.

PURPOSE: We assess the effect of consumer-directed care on the emotional, physical, and financial well-being of the primary informal caregivers of the Medicaid beneficiaries who voluntarily joined Arkansas's Cash and Counseling demonstration. DESIGN AND METHODS: The demonstration randomly assigned beneficiaries to a program in which they could direct their own disability-related supportive services (the treatment group) or rely on traditional agency services (the control group). We constructed outcome measures from telephone interviews with 1,433 caregivers who provided beneficiaries with the most unpaid assistance at baseline, and we used multivariate regression models to estimate program effects. Interviews occurred between February 2000 and April 2002, 10 months after beneficiaries' random assignment. RESULTS: At follow-up, treatment group caregivers provided fewer hours of assistance than did their control group counterparts, on average, and they reported better emotional, physical, and financial well-being. IMPLICATIONS: Permitting interested Medicaid beneficiaries to direct their own in-home supportive services reduces burden on informal caregivers, which may help reduce beneficiaries' nursing home use.

Activities of Daily Living↗
PubMed2002

Which sorts of pharmacies provide more patient counselling?

OBJECTIVE: This paper investigates the characteristics of pharmacies that are associated with the degree of counselling provided to customers purchasing medicines. METHODS: Twelve 'mystery shoppers' (research assistants posing as normal customers) purchased restricted medicines at 180 pharmacies around New Zealand. One drug (diclofenac) and one class of drugs (vaginal antifungals) were purchased. The amount of counselling provided was recorded, and linked to profile data on the pharmacies, obtained through a questionnaire, from Census data, and from direct observations of pharmacies. RESULTS: Location within a city, a large town, or strip shopping did not affect the level of counselling pharmacies provided. Pharmacies adjacent to medical centres gave significantly less counselling to diclofenac purchasers than other pharmacies. No consistent relationship was found between pharmacy size and the level of counselling provided. There were large differences between areas of the country. A strong negative relationship was found between the amount of counselling given about thrush, and the proportion of Pacific Island people in the population around the pharmacy. Although only some results reached statistical significance, there seems to have been a similar trend for pharmacies to provide less counselling in areas with more Maori people and with higher levels of social deprivation. CONCLUSIONS: Regional variation in the provision of pharmacy services, and in particular the tendency for pharmacies to provide less counselling in areas that are likely to have higher health care needs, must be addressed if pharmacies are to fulfil their potential as health care providers.

Chi-Square Distribution↗
PubMed1998

Primary care groups. Staff's counsel.

Staff are concerned that the establishment of primary care groups may lead to more direct employment of community staff by GPs. PCTs will have to control staff resources if they are to plan services of maximum benefit to patients. As primary care trusts develop, practice staff should be given the option of transferring their employment to the trusts. Regional clearing house arrangements should be established to assist the redeployment of NHS and fundholding staff displaced by the establishment of PCGs.

Budgets↗
PubMed2006

A discrete choice experiment of preferences for genetic counselling among Jewish women seeking cancer genetics services.

To determine which aspects of breast cancer genetic counselling are important to Ashkenazi Jewish women, a discrete choice experiment was conducted. Participants consisted of 339 Australian Ashkenazi Jewish women who provided a blood sample for research used to test for Ashkenazi Jewish ancestral mutations in the genes BRCA1 and BRCA2, and were offered their genetic test result through a cancer genetics service. Main outcome measures were women's preferences for, and trade-offs between, the genetic counselling aspects of providing cancer, gene, and risk information (information); giving advice about cancer surveillance (surveillance); preparing for genetic testing (preparation); and, assistance with decision-making (direction). Respondents most valued information, about twice as much as advice about surveillance, four times as much as preparation for testing, and nine times as much as assistance with decision-making, which was least valued. Women's preferences were consistent with the major goals of genetic counselling, which include providing information and surveillance advice, and avoiding direction by facilitating autonomous decision-making. There were differences between the women in which aspects they most favoured, suggesting that counselling that elicits and responds to clients' preferences is more likely to meet clients' needs.

Adult↗
PubMed2001

Activating patients for smoking cessation through physician autonomy support.

OBJECTIVE: Test whether physicians' counseling patients for smoking cessation with an autonomy supportive rather than controlling style would increase patients' active involvement in the counseling session and increase maintained abstinence. DESIGN: Randomized trial of 27 community-based physicians using two interview styles, with observer ratings of patient active involvement and assessments of patient smoking status at 6 months, 12 months, and 30 months. PATIENTS: Adult smokers: 336 recruited; 249 for final analyses. INTERVENTION: Physicians used an autonomy- supportive or controlling interpersonal style, randomly assigned within physician, to briefly counsel patients about smoking cessation, using the National Cancer Institute's 4-A's model. MEASUREMENT: Patient active involvement was rated from audio tapes of the interviews. Continuous abstinence came from self-reports at 6 months, 12 months, and 30 months, CO validated at 6 months or 12 months and at 30 months. RESULTS: Physician style did not have a significant direct effect on smoking cessation but did significantly increase patient active involvement in the interview. Active involvement, in turn, increased smoking cessation. Structural equation modeling confirmed a theoretical model in which the intervention positively predicted patient active involvement after controlling for patient reports of wanting to stop smoking, and active involvement significantly predicted continuous abstinence after controlling for previous quit attempts. CONCLUSIONS: Although physicians' autonomy- supportive style while counseling smokers to quit did not have a direct effect on smoking cessation, it increased patients' active involvement in the counseling session which in turn increased continuous abstinence over 30 months. Further research should clarify the direct effects of physician interpersonal style on health outcomes.

Adult↗
PubMed1985

Evaluation of clinical skills for nutrition counseling.

This report describes the procedures for and feasibility of an evaluation program that provides a direct assessment of the use of specific clinical skills during an interview with a simulated patient. The specific aims of this evaluation were to assess untrained graduate students in nutrition on their application of a set of 31 specific clinical skills for resolving dietary adherence problems. Each student conducted two interviews with each of two different simulated patients with hyperlipidemia presenting typical problems following a diet low in saturated fat and cholestrol. The evaluation program provided analyses that identified the strengths and deficits of each student and the performance of the entire group. It is suggested that the evaluation program offers a practical, objective method for examining the entry-level clinical skills of students in training and may be useful in other educational programs (eg, in-service, continuing education workshops).

Cholesterol, Dietary↗
PubMed2000

An investigation of the effectiveness of a voluntary sector psychodynamic counselling service.

Clients attending a London voluntary sector counselling centre completed assessments pre- and post-psychodynamic counselling and at follow-up. Although there was a very high attrition rate following initial assessment, this did not appear to affect adversely the representativeness of the sample completing the later assessments. Clients were found to improve in terms of psychological well-being, control and various other aspects of their lives, and attributed many of the changes to counselling. Counsellors also rated the counselling as effective with most clients, and particularly those who were inner directed, had expectancies favourable towards psychotherapy, had greater perceived control over their lives, attended more sessions, and with whom an interaction/transference approach was taken. Clients with more severe problems showed less improvement in other areas of their lives. There was no difference in the outcome of clients seen by qualified and trainee counsellors.

Adult↗
PubMed1999

Norms and prenorms on prenatal diagnosis: new ways to deal with morality in counseling.

This paper consists of two parts. In the first part, we report the results of an empirical study on Dutch women's decisions about prenatal diagnosis. We were interested in the norms these women used as guidance. One clear norm was found that was shared by everyone: everybody should decide for herself. Despite this clear norm, almost all women expressed difficulty with the choice, often regretted the fact that they had to make it and sometimes even expressed disgust about having to choose. These findings indicate that the choice is often experienced as a burden, which we think should be taken more seriously. In the second part of the paper, we present a way to do so. The core of our proposal is to pay more attention in counseling to the moral character of choices about prenatal diagnosis. We discuss difficulties and possibilities in that direction.

Abortion, Therapeutic↗
PubMed1994

Trisomy 8 mosaicism in chorionic villus sampling: case report and counselling issues.

We report an unusual case involving chorionic villus sampling (CVS) and trisomy 8 mosaicism. CVS showed a normal direct preparation while the culture showed mosaicism for trisomy 8. Subsequent amniocentesis revealed only normal chromosomes. A peripheral blood culture after birth revealed low-level trisomy 8 mosaicism. The patient appeared phenotypically and developmentally normal at 30 months of age. We conclude that prenatal counselling for similar cases needs to include the rare but real possibility that chromosome mosaicism detected prenatally may be found postnatally with largely unknown consequences. Secondly, low-level chromosomal mosaicism may be more common than previously recognized. Thirdly, very low-level trisomy 8 mosaicism may be compatible with a normal phenotype but long-term follow-up is required. And lastly, the use of fetal blood sampling is questionable in these cases because the phenotype may not be accurately predicted. Further studies of such cases are needed to address these important and unanswered issues, including the potential implication of mosaicism on academic performance and cognitive functioning.

Adult↗
PubMed2003

[Resource oriented counseling--conceptual and methodological considerations].

In the last years resources have become one of the most discussed topics, nearly a magic word, in psychotherapy and in psychosocial practice. The orientation towards human strength and potentials can be considered as a central dimension within the reflections about an independent psychosocial understand of counselling apart the field of psychotherapy. The point of view connected therewith is not only fixed on personal resources as it mostly the case within the methods of psychotherapy but also on the interaction between the individual strength and abilities and the resources regarding the context which is mainly arranged by the social network. In order to realize this interactive view counselling makes use of different methods and strategies according to schools of psychotherapy, especially narrative psychology and community psychology. The perspective of empowerment gives direction of the development of an integrative concept.

Adolescent↗
PubMed1997

Cash and counseling demonstration and evaluation. Start-up activities.

One possible approach for making long-term-care systems more consumer-directed is to provide the consumer with a cash alternative. Advocates have touted the possible advantages of this approach, while nay-sayers have worried about the potential for abuse and questioned the claims of cost savings. This article describes the Cash and Counseling Project, a large-scale demonstration project with a rigorous, policy-driven evaluation built into it. Written prior to the project's actual implementation, this article specifically reviews the major evaluation questions, and the state selection process.

Case Management↗
PubMed2000

Educational outreach visits: effects on professional practice and health care outcomes.

BACKGROUND: Outreach visits have been identified as an intervention that may improve the practice of health care professionals, in particular prescribing. This type of 'face to face' visit has been referred to as university-based educational detailing, public interest detailing, and academic detailing. OBJECTIVES: To assess the effects of outreach visits on improving health professional practice or patient outcomes. SEARCH STRATEGY: We searched MEDLINE up to March 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles. SELECTION CRITERIA: Randomised trials of outreach visits (defined as a personal visit by a trained person to a health care provider in his or her own setting). The participants were health care professionals. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Eighteen studies were included involving more than 1896 physicians. All of the outreach visit interventions consisted of several components, including written materials and conferences. Reminders or audit and feedback complemented some visits. In 13 studies, the targeted behaviours were prescribing practices. In three studies, the behaviours were preventive services, including counselling for smoking cessation. In two studies, the outreach visits were directed toward improving the general management of common problems encountered in general practice, including asthma, diabetes, otitis media, hypertension, anxiety, and acute bronchitis. All studies examined physician behaviour and in three studies other health professionals such as nurses, nursing home attendants or health care workers were targeted. Positive effects on practice were observed in all studies. Only one study measured a patient outcome. Few studies examined the cost effectiveness of outreach. REVIEWER'S CONCLUSIONS: Educational outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health professional behaviour, especially prescribing. Further research is needed to assess the effects of outreach visits for other aspects of practice and to identify key characteristics of outreach visits that are important to its success. The cost-effectiveness of outreach visits is not well evaluated.

Education, Medical, Continuing↗