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PubMed1995

A pilot study of a computerized assessment (AGE-PC) for the elderly in general practice.

A pilot project was undertaken in Liverpool UK, to investigate whether data useful for both general practice and public health purposes could be collected by primary care personnel using a computerized semi-structured interview (AGE-PC) for assessment of patients aged 75 and over. A high degree of variation between practices was found in the proportion of elderly assessed with AGE-PC largely related to motivation to undertake assessments and methods employed to approach patients. Considerable differences between and within practices were evident in staff attitudes to the need for detailed formal assessments and the use of computers. Several aspects of the AGE-PC package itself were identified as requiring modification including streamlining data transfer methods, adding facilities for analysis and giving users a degree of choice over content of the assessment. This technique does offer a potentially efficient means of collecting very detailed standardized data for intra- or inter-practice analysis while at the same time generating a comprehensive report for individual patients. However, in the context of the over-75 assessments it was too time-consuming. Possible future strategies are discussed such as using an initial screening stage with a self-report questionnaire to reduce numbers needing full assessment and the use of the package for the community care assessments. The pilot project highlighted some of the potential advantages and disadvantages of collecting data from primary health care for public health purposes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1998

Telemedicine in Nova Scotia: report of a pilot study.

OBJECTIVE: To provide and evaluate telemedicine services for rural physicians and patients in Nova Scotia. MATERIALS AND METHODS: As a pilot project, three telemedicine services (videoconference continuing medical education [CME], teledermatology, and teleradiology) were provided to four hospitals in Nova Scotia communities. All four sites received CME (a total of 269 physicians, 53 other health care professionals); three sites received teledermatology (66 consultations), and two sites received teleradiology (808 radiologic examinations). At the consulting site, 12 faculty members presented 24 one-hour videoconferences, and there was one consulting radiologist and dermatologist. Each service was evaluated independently. Methods included participant questionnaires; focus groups; numbers and categories of participants or examinations; comparison of operational costs, capitol costs (teledermatology and teleradiology), and travel costs (CME); technical assessments of hardware, software, and telecommunications; assessment of clinical diagnostic procedures (teledermatology); and comparative study of original and digitized films (teleradiology). RESULTS: Despite growing pains, the technologies effectively provided the three services: the services were acceptable to referring and consulting physicians and patients. Improvements in patient care and outcomes comparable to those of traditional methods were demonstrated in teleradiology and teledermatology, especially for emergencies. Physician access to CME and patient access to dermatology consultation services were improved. Financial savings were demonstrated for CME, but further investigation is required to determine the savings attributable to teleradiology and teledermatology. CONCLUSIONS: The telemedicine services supported rural physicians, their patients, and their communities. Although telemedicine is not a panacea for all concerns of rural physicians, the pilot project provided a strong foundation for further development and study.

Adolescent↗
PubMed1998

Pilot study of six Colorado dental hygiene independent practices.

PURPOSE: The purpose of this pilot study was to gather demographic data about six Colorado dental hygienists who were practicing independently and their practices as well as assess productivity and service mix, evaluate structure and process, and compare the findings in these practices to those of a study of California Health Manpower Pilot Project #139. METHODS: A convenience sample of six dental hygiene independent practices was studied. A 21-item survey was distributed by mail to obtain demographic and practice information. Weekly surveys tracking patient visits and services provided were completed for three months. A general office audit to evaluate structure and a record audit of 22 patient records to evaluate process were conducted during visits at each practice site. The overall responses for each phase of this study were tabulated and frequencies were calculated using the SPSS/PC+ statistical package. RESULTS: The dental hygienists had practiced for an average of 13 years prior to establishing their practices. Four of the six practices were office-based, one was institution-based, and one was office- and institution-based. Health history, extraoral/intraoral examination, periodontal probing, adult prophylaxis, and oral hygiene instruction were provided during a majority of patient visits. The general office audit revealed compliance with infection control, office protocols for emergency situations, and practice management protocols. The patient record audit indicated a high standard for process of care for the practice sites. CONCLUSION: The six practices revealed a variety of backgrounds among the dental hygienists and diverse practice characteristics regarding both the populations served and practice settings. The services provided were consistent with allowable services for unsupervised practice. Compliance with specific guidelines was verified during the general office and patient record audits. Consistent with the findings of California Health Manpower Pilot Project #139, the care provided by the Colorado dental hygiene independent practitioners in this study and the environment in which the care was provided do not exhibit any undue risk to the health and safety of the public.

Adult↗
PubMed2003

DOTS-Plus for multidrug-resistant tuberculosis in the Philippines: global assistance urgently needed.

SETTING: The Philippines, a high burden country for tuberculosis (TB). STUDY DESIGN: Health Operational Study. OBJECTIVE: To describe preliminary data from the Makati Medical Center (MMC)-DOTS Plus pilot project. METHODS: Patients were consecutively enrolled after confirmation of MDR-TB status. Individualized treatment regimens were based on drug susceptibility testing and history of previous intake for the other drugs that were not tested. Treatment outcome in those who had completed at least 18 months of therapy and interim outcome for those who received more than 12 months but less than 18 months were analyzed. RESULTS: One hundred forty-nine patients with MDR-TB were enrolled from April 1999 to 30 May 2002 at the MMC DOTS Clinic. Referrals were from private institutions and practicing physicians in 73.2% of cases. Approximately 30% of isolates tested were resistant to all five first-line drugs, 39.4% to four, 16.8% to three, 12.1% to two. Fluoroquinolone resistance was noted in 40.9% of all the isolates, including 54.5% of those resistant to five drugs and 34.6% of those resistant to four drugs. The outcome of 23 patients who completed therapy and 62 who have received more than 12 months therapy showed cure and likely cure in 73.4% of cases and failure in 3.8% and likely failure in 6.3%. Death occurred in 3.8% and default was observed in 11.4%. CONCLUSION: The MMC DOTS-Plus pilot project is a public-private collaboration in TB Control. Response to therapy was encouraging. Complete subsidy of medicines and laboratory and clinic services and DOT were essential in the successful implementation of the program. DOTS-Plus and DOTS should go hand in hand in TB control if MDR-TB is highly prevalent.

Adolescent↗
PubMed2004

Changes in health indicators related to health promotion and microcredit programs in the Dominican Republic.

OBJECTIVE: To assess the impact of health promotion programs and microcredit programs on three communities in the Dominican Republic. One community had only the health promotion program, one community had only the microcredit program, and one community had both a health promotion program and a microcredit program. This pilot project examined the hypothesis that the largest changes in 11 health indicators that were studied would be in the community with both a health promotion program and a microcredit program, that there would be intermediate changes in the community with only a health promotion program, and that the smallest changes would be in the community with only a microcredit program. METHODS: The health promotion programs used community volunteers to address two major concerns: (1) the prevalent causes of mortality among children under 5 years of age and (2) women's health (specifically breast and cervical cancer screening). The microcredit program made small loans to individuals to start or expand small businesses. Outcome measures were based on comparisons for 11 health indicators from baseline community surveys (27 households surveyed in each of the three communities, done in December 2000 and January 2001) and from follow-up surveys (also 27 households surveyed in each of the three communities, in June and July 2002, after the health promotion program had been operating for about 13 months). Households were randomly chosen during both the baseline and follow-up surveys, without regard to their involvement in the microcredit or health promotion programs. RESULTS: The health indicators improved in all three communities. However, the degree of change was different among the communities (P < 0.001). The community with parallel microcredit and health promotion programs had the largest changes for 10 of the 11 health indicators. CONCLUSIONS: Multisector development is known to be important on a macroeconomic scale. The results of this pilot project support the view that multisector development is also important on a microeconomic level, given that the parallel microcredit and health promotion programs resulted in greater change in the measured health indicators than either program alone. As far as we authors know, this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program.

Dominican Republic↗
PubMed1979

Cost of snail control.

In the last 10 years, there has been general agreement that niclosamide (bayluscide) is the preferred molluscicide for control of the snails transmitting Schistosoma mansoni and Schistosoma haematobium. This chemical has been widely tested in pilot projects and is in use in expanded control projects in Brazil, Puerto Rico, Egypt, Iran, and other countries. A comparison of the results from six pilot projects in these countries was analyzed with particular attention to the costs of the programs, since the benefits were fairly similar in terms of rapid snail control. It was shown that costs were generally related to simple geographic parameters such as volume of snail habitat and distance between habitats. The annual costs in 1972 prices ranged from a minimum of US $1 per 100 m3 of snail habitat treated for dry regions with large irrigation systems, to a maximum of US $40 per 100 m3 treated in areas of high rainfall with only a few scattered, natural waterbodies. Use of the reported data for estimating the cost of current programs was demonstrated by projecting costs for Puerto Rico and the Sudan in 1978 prices.

Animals↗
PubMed1995

[Mutual aid as a complement to professional intervention].

This paper aims to illustrate and emphasize the relevance of Frank Riessman's futurist new paradigm for human services which proposes a restructuring that enables those who ordinarily receive help to function as providers of help. Some of the best known mutual-aid programs are briefly presented, followed by a more detailed description of pilot projects which have used the mutual-aid principle with multi-problematic clientele. Most of these pilot projects took place in the province of Québec and aimed at bridging the gap between public services and local communities by linking with informal support systems. Two specific modalities of mutual aid are discussed: pairings between clients and pairings between clients and natural helpers. The integration of mutual-aid strategies within clinical practice is not easy because of the important changes it requires of the professional both at the practical and the organizational level.

Adolescent↗
PubMed2004

General practitioners' response to depression and anxiety in the Australian community: a preliminary analysis.

OBJECTIVES: To examine the uptake by general practitioners (GPs) of the five key components of the Better Outcomes in Mental Health Care (BOiMHC) initiative: education and training for GPs; the three-step mental health process; focussed psychological strategies; access to allied health services; and access to psychiatrist support. SETTING: All Australian states and territories during the first 15 months of the initiative (1 July 2002 - 30 September 2003). DESIGN: Retrospective survey of de-identified registration data held by the General Practice Mental Health Standards Collaboration (training uptake), de-identified Health Insurance Commission (HIC) billing data (provision of the three-step mental health process, focussed psychological strategies and case conferences with psychiatrists), and reports from "access to allied health services" projects to the Australian Department of Health and Ageing (project participation). MAIN OUTCOME MEASURES: Number and percentage of Australian GPs certified as eligible to participate in the initiative; provision of the three-step mental health process and focussed psychological strategies by GPs; participation in allied health pilot projects; and access to psychiatrist support. RESULTS: Within 15 months of the BOiMHC initiative commencing, 3046 GPs (about 15% of Australian GPs) had been certified as eligible to participate, including 387 who had registered to provide focussed psychological strategies. GPs had completed 11 377 three-step mental health processes and 6472 sessions of focussed psychological strategies. Sixty-nine "access to allied health services" projects had been funded, with the original 15 pilot projects enabling 346 GPs to refer 1910 consumers to 134 individual allied health professionals and 10 agencies. In contrast, the "access to psychiatrist support" component was less successful, with the HIC billed for 62 case conferences at which a psychiatrist and a GP were present. CONCLUSION: The level of uptake of the main components of the BOiMHC initiative has expanded the national capacity to respond to the needs of people with common mental disorders, such as depression and anxiety.

Anxiety Disorders↗
PubMed2000

The transfer of harm-reduction strategies into prisons: needle exchange programmes in two German prisons.

In Autumn 1995, the Minister of Justice of Lower Saxony (a northern state of Germany) gave the green light for the implementation of a 2-year pilot project. This project provided for the distribution of sterile injection equipment and provision of communicative methods of prevention to drug addicted inmates in a women's prison with 170 inmates (Vechta) and a men's prison with 230 inmates (Lingen). The decision to go ahead with the project was based on positive experiences in Swiss prisons and the supporting recommendations of a panel of experts. The pilot project in Vechta started on 15 April 1996, using five dispensing machines which allow a needle exchange to guarantee an anonymous access. The project in the men's prison started on 15 July 1996. Here the staff of the drug counselling service and of the health care unit hand out sterile syringes to inmates. The social scientific evaluation was carried out by the Carl von Ossietzky University in Oldenburg. The study focused on the aim of the project which is to assess the feasibility, usefulness and efficacy of the measures undertaken. Of special interest was whether and how changes occured in the prison system itself (i.e. acceptance of the measures by staff, medical service and management), and in the drug user's behaviour and knowledge (i.e. development of needle sharing, change in drug use patterns). The study used a multi-methodological approach: documentation of the project practice, half standardized, longitudinal examination of inmates (n=224) and staff (n=153), qualitative examination of management, selected groups of prisoners, staff and external organisations (AIDS-Help-Groups; n=75) for at least two times. The evaluation intended to be dynamic, process accompanying, in order to communicate the empirical data and developments with the practice already during the pilot phase. Results of the final report of the study are presented here. Finally this paper discusses shortly what is known so far about the impact of needle exchange programmes in prisons in Germany and Switzerland.

Journal Article↗
PubMed2000

[The BAK/KBV/AWMF curriculum "Quality management for physicians": summary of three years of putting a practical program in a goal-oriented qualification].

Since 1996 a curriculum "Quality management for physicians" exists with a three-level training concept. Based on this, a purposeful course program has been developed by the Centre for Quality management in Public Health (ZQ), qualifying physicians for new professional roles as hospital quality managers. Up to December 1999 eight level I-, seven level II- and ten level III-courses have been performed in Hannover. After these three years of experience, the training concept has been evaluated by three approaches: 1. The evaluation of a standardized questionnaire shows a 90% achievement of course objectives, and that the concept is highly accepted--meanwhile by other professionals in health care as well; 2. The projects performed by participants as part of the course show the successful transfer into practice and a wide variety of applications and methodological aspects; 3. Standardized interviews of participants after several months (pilot project) concerning the practical experience, which were first performed as a pilot project, support continuous quality improvement of the training course. The revision of the curriculum in March 2000 will update the contents of the training program for actual needs--an important aspect due to the fact that quality management will play a central role in health care, and an up-coming model of quality assessment for German hospitals.

Curriculum↗
PubMed1983

Urban Zulu mothers' views on the health and health care of their infants.

During a research project aimed at the establishment of developmental norms for Black infants, the lack of information on Black mothers' views on infancy and child-rearing became apparent. A pilot project was therefore undertaken in order to delineate areas for further study. During this pilot project data were obtained on urban Zulu mothers' views on the health and health care of their infants. It appeared that urban Zulu mothers have accepted Western medicine to a certain degree, without having completely relinquished beliefs in traditional health care. We report these views on the health and health care of infants because they seem important not only for those active in community obstetrics and paediatrics, but also for those concerned with the health care facilities provided for urban Blacks.

Adolescent↗
PubMed2006

A framework for developing evaluation tools used in Washington State's Healthy Communities projects.

Washington State's Healthy Communities pilot projects were developed to test approaches and recommendations of the Washington State Nutrition and Physical Activity Plan and to provide a statewide model for implementation. The Healthy Communities program included plans for ongoing process evaluation to ensure implementation. Two years into the first project, however, the evaluation team recognized that data for evaluation were inadequate to explain the experiences of the pilot community partnership. The team sought a framework through which to better understand how the community partnership functioned, including what worked well and how guidance and technical assistance could best be provided. The evaluation team identified the community health governance model of Lasker and Weiss through a literature search and applied this model to existing Healthy Communities project evaluation data. The team also designed a new survey tool based on the model and used it in the second pilot community. The new tool provides feedback to community partners to help guide project implementation and tests the applicability of a theoretical model to public health practice.

Health Education↗
PubMed1970

The role of a medical faculty in reorganizing family practice to meet current community needs.

There exists a crisis in the delivery of medical services, particularly by family doctors of whom there is an apparent shortage.A STUDY OF FAMILY PRACTICE IN KINGSTON, ONTARIO, AND IN THE NEARBY COUNTRYSIDE INDICATES THREE CRITICAL NEEDS IN FAMILY PRACTICE: professional assistants for the family doctors, efficient office facilities and new methods of delivering family medical care in rural areas. The Faculty of Medicine at Queen's University has involved itself in a study of these matters and is developing a program to help solve them, by research into the nature of the problems and into methods for alleviating them, by keeping practising physicians informed through research reports and the continuing education program of the Medical School, by the development of pilot projects, and by the evaluation of new services aimed at these problems, independently launched by physicians in the community. Pilot projects to date include two designed to study the use of registered nurses as doctor assistants and another which involves the organization and operation of a university-sponsored community health centre. Last, but by no mean least, the Provincial Government is continually briefed on all these activities.

Attitude of Health Personnel↗
PubMed2001

Interval cancers in the Norwegian breast cancer screening program: frequency, characteristics and use of HRT.

Breast cancers diagnosed between screening examinations among women who attend a breast cancer screening program are defined as interval cancers. The Norwegian Breast Cancer Screening Program started as a pilot project in 1996, and data from the first 2-year interval are available. Our study quantifies interval cancers in the pilot project and explores characteristics and factors that may be associated with interval cancer. Interval cancers in the screening population were identified through the Cancer Registry of Norway. The frequency of invasive interval cancer was calculated as cases per 10,000 screened and as observed/expected ratio. Characteristics of the interval cancers were compared to screening-detected and clinical cancers. Breast density was assessed in a blinded review of 3 categories of screening mammograms. Information on hormone replacement therapy (HRT) use was collected from a questionnaire. The frequency of invasive interval cancers was 18.2 (15.9-20.7) per 10,000 screened and the observed/expected ratio was 0.49 (0.43-0.56). The frequency in the second year of the interval was higher than reported from other programs. The median tumor size of the interval cancers was 19.5 mm and 44.0% of the patients had affected axillary lymph nodes. The interval cancer cases had higher proportions of dense breasts and reported use of HRT compared to screen normal and screening-detected cases. The reported frequency of interval cancers is similar to comparable programs. The interval cancers differed significantly from the cancers detected in the first screening round and were more similar to clinical cancers. Interval cancer was associated with dense breasts and use of HRT. Screening programs must keep these associations in focus.

Aged↗
PubMed1999

QUALIDIAB: implementation of the Diabcare project in the French-speaking environment: regional, national and international issues. Qualidiab Group.

Diabcare is an international Project devoted to the evaluation of the Quality of Care [1] in the population of diabetic patients. As Diabetes is one of the most frequent chronic illnesses, the management of its treatment has a strong impact on the public health policy both regional and national [2]. Funded by the European Commission, initiated by WHO and the International Diabetes Federation (IDF), this Project is now recognised as a Pilot Project throughout the world as an example of a large international collaboration for the surveillance of quality of care in a typical chronic disease.

Computer Security↗
PubMed2005

Contextualizing and assessing the social capital of seniors in congregate housing residences: study design and methods.

BACKGROUND: This article discusses the study design and methods used to contextualize and assess the social capital of seniors living in congregate housing residences in Calgary, Alberta. The project is being funded as a pilot project under the Institute of Aging, Canadian Institutes for Health Research. DESIGN/METHODS: Working with seniors living in 5 congregate housing residencies in Calgary, the project uses a mixed method approach to develop grounded measures of the social capital of seniors. The project integrates both qualitative and quantitative methods in a 3-phase research design: 1) qualitative, 2) quantitative, and 3) qualitative. Phase 1 uses gender-specific focus groups; phase 2 involves the administration of individual surveys that include a social network module; and phase 3 uses anamolous-case interviews. Not only does the study design allow us to develop grounded measures of social capital but it also permits us to test how well the three methods work separately, and how well they fit together to achieve project goals. This article describes the selection of the study population, the multiple methods used in the research and a brief discussion of our conceptualization and measurement of social capital.

Aged↗