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PubMedDate not supplied

Health service quality and users' perceptions in West Nile, Uganda.

Save the Children (UK) has been working in health in the West Nile region of Uganda since 1980. Between 2000 and 2002, a number of operational research studies have been conducted which shed light on patient perceptions of the quality of services, of barriers to access and utilization patterns. These are brought together in this paper. They show that despite considerable progress in rebuilding infrastructure, training staff and investing in health systems in these districts, there is still a long way to go to provide services of an acceptable quality to users.

Consumer Behavior↗
PubMed2005

The use of carers' and users' expectations of services (CUES) in an epidemiological survey of need.

BACKGROUND AND METHOD: This study surveyed need in a group of psychiatric patients in Gloucester, using a new instrument, the CUES. Keyworkers gave out questionnaires to all patients with psychosis in contact with specialist services. A total of 148 forms were anonymously completed, with a response rate of 37% of the mental health services caseload. RESULTS: 53.5 to 83.2% of patients were satisfied and 61.5 to 89.6% expressed their experiences 'as good as' a normative statement across the 16 domains. There was mostly 'moderate' agreement between satisfaction and normative questions by Kappa correlations, although responses to normative questions tended to be about 10% higher. Extensive free text responses were subject to content analysis, demonstrating needs across a wide range of health, social and leisure areas, many of which were not directly linked to the adequacy or otherwise of psychiatric treatment. CONCLUSIONS: The results imply that the CUES may be of value at an individual level to aid in care planning, and also have some value in aggregated form to benchmark user experiences of services.

Adult↗
PubMed2006

[Gender violence prevalence in female users of health services in Mexico].

OBJECTIVE: To identify the prevalence of violence against females among those who are health service beneficiaries in Mexico. MATERIAL AND METHODS: The National Survey on Violence against Women (ENVIM, per its Spanish abbreviation) was applied in 2003 to female users of public primary and secondary health care services. The sampling framework was based on a stratified, probabilistic sample in two stages. First the health care units were selected with probability proportional to the number of physicians' offices in the unit, from a list of possible care units. Second, women 15 years and older who sought care at the health care unit were selected for participation in the study through systematic sampling. Univariate analysis and then bivariate analysis were carried out on the data collected with a questionnaire. RESULTS: The sample included 26 042 women between 15 and 92 years of age, with a mean age of 35.8 years. Physical violence during childhood was reported by 42% of the women. Only 7.8% answered yes to a general question about whether they experienced domestic partner violence, but 21.5% reported experiencing violence of any type during the last 12 months as measured by a scale including specific acts of psychological, economic, physical and sexual violence. The most frequently reported type of violence was psychological (19.6%). Of the women who had been pregnant, 14.1% reported having experienced violence during pregnancy, and 4.4% reported being hit in the abdomen. The prevalence of sexual violence was 17.3% and close to half reported being victims of this type of violence before age 15. Higher prevalence of violence was found among women with lower levels of formal education, living in a rented home, in areas with higher overcrowding indices, and users of Ministry of Health care services. CONCLUSIONS: Identifying and measuring violence is complex, given the diverse types of violence and how they are perceived and therefore reported by women themselves. This is an important public health problem, in view of the high frequency observed in this study and the immediate implications. These findings indicate the urgent need for interventions to prevent and treat violence.

Adolescent↗
PubMed1993

The use of primary care services by drug users attending a HIV prevention unit.

Intravenous drug using clients of a Dublin HIV Prevention Unit were interviewed about their use of general practitioner services. Sixty eight percent of clients had visited a GP within the previous year and 48% were registered with a GP under the General Medical Services (GMS) Scheme. Of 161 interviewees 60 were being treated with a fixed dose regimen of methadone at the Prevention Unit; this group was far less likely to visit a GP with a drug related problem and far less likely to have received methadone from a GP. Members of the GMS were much more likely than non members to have visited a GP and also more likely to have attended a specific GP for all problems besides methadone treatment. Methadone treatment and medical cover within the GMS Scheme emerged as important influences on the behaviour of clients with respect to general practitioners.

Adolescent↗
PubMedDate not supplied

Access to health and human services for drug users: an urban/rural community systems perspective.

Publicly funded drug-user treatment programs in both urban and rural areas are under unprecedented pressure to adapt to multiple perspectives of their mission, reduced governmental funding, diminished entitlement program resources for clients, managed care reforms, and continuing unmet need for services. This article describe an ongoing health services research study that is investigating how these and related health and human service programs currently serve and cross-refer chronic drug users and how they perceive and are reacting to systemic pressures. Interim analysis on intra-agency diversity and managed care perceptions are reported.

Attitude of Health Personnel↗
PubMedDate not supplied

Maternal-child health and family planning: user perspectives and service constraints in rural Bangladesh.

This article presents a microanalysis of interactions between female fieldworkers and women in rural Bangladesh, and a discussion of the broader organizational constraints that hamper service delivery. It is argued that the fieldworker, herself a rural woman, is faced with considerable demand for both maternal-child health (MCH) and reproductive health care services, but that operational constraints prevent her from realizing her potential in both of these areas. Qualitative data show that, in the eyes of rural women, contraceptive use and health care are intricately intertwined, and that this association often raises a range of questions that the worker cannot address competently. A number of specific operational barriers--worker densities, staff motivation, supervision, technical competence, supplies--are identified. These barriers reflect a general institutional weakness in the Ministry of Health bureaucracy that prevents it from organizing itself to deliver user-oriented health and family planning services while maintaining adequate and appropriate standards of care.

Bangladesh↗
PubMedDate not supplied

European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study.

The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse. German psychosomatic C-L services saw virtually no such patients, although in other C-L services these patients constituted one-quarter to one-third of the patients referred. The second difference lays in the remaining group of referred patients. This group is best characterized by two dimensions. One describes the severity of psychopathology -- ranging from organic mental conditions to somatization. The other describes the clarity of the physical diagnosis -- ranging from patients referred by surgical wards to those referred by general medicine and neurology wards.

Adult↗
PubMed2003

[Development of a screening instrument for heavy users of psychiatric inpatient services].

Patients who show an above-average utilization of medical care are described as "heavy users". Heavy utilization of psychiatric inpatient care could be reduced by well directed community based services. Heavy users should, therefore, be identified at the beginning of a period of heavy service consumption. For this reason, a screening instrument (SPSI) was developed. Six predictors of heavy utilization of inpatient care were included as items in the SPSI. Weighting of items and examination of the instrument were carried out with a sample of 184 schizophrenia patients, whose utilization of inpatient care was recorded prospectively over a period of 30 months. 83 percent of heavy users and 85 percent of ordinary users were correctly identified with the SPSI test at a cutoff score of - 6.7. The SPSI is a short questionnaire which could be used without special rater training in psychiatric care in order to offer identified heavy users well directed community based services, which are less costly than inpatient care, but at least just as appropriate for the special needs of these patients.

Adult↗
PubMed2004

Determining factors of patient satisfaction for frequent users of emergency services in a medical center.

BACKGROUND: The present era of a competitive healthcare environment indicates that providers have been convinced that attentiveness to patient satisfaction is integral to care quality and market share. Patient satisfaction is especially critical for frequent users of the emergency department (ED). The aim of this study was to compare satisfaction of overall ED care between frequent and infrequent ED users, and to find out the factors determining satisfaction among the frequent ED users. METHODS: Frequent ED users (> or = 4 visits/per year) and infrequent ED users (< 4 visits/per year) were selected randomly from patients visiting the adult ED of a public tertiary medical center from October 1, 2000 to September 30, 2001. Retrospective telephone interviews were completed for 200 frequent users and 200 infrequent users. Ordinal logistic regression analysis was performed. RESULTS: Infrequent ED users tended to give a higher satisfaction rating than frequent ED users to emergency care (OR = 2.14; 95% CI = 1.40-3.25). The 2 significant determinants associated with satisfaction with emergency care among frequent ED users were discharge instructions (OR = 2.78; 95% CI = 1.27-6.12) and subjective waiting time (OR = 12.6; 95% CI = 4.22-37.8). CONCLUSIONS: The frequent ED users were unique, and their satisfaction with overall emergency care was significantly lower than that of infrequent ED users. Managing waiting time perceptions and providing discharge instructions may be an effective strategy to achieve improved patient satisfaction among frequent ED users.

Adolescent↗
PubMed2001

[Regionalization of rehabilitation services. Survey of users of a Quebec center].

OBJECTIVE: To understand the situation of and difficulties encountered by users of a supraregional rehabilitation institute when they are transferred from the institute to facilities in their own regions, and to discover how they address these difficulties. DESIGN: Qualitative descriptive study. SETTING: Regions in Quebec served by a physical rehabilitation institute (Institut de réadaptation en déficience physique de Québec). PARTICIPANTS: Thirty-nine people who used services at the institute and then sought rehabilitation in their own regions. METHOD: Telephone survey using a validated questionnaire with both open-ended and closed questions. MAIN FINDINGS: About 69% of users had difficulty obtaining adequate follow up in their regions; the regions lacked professionals with expertise; more efficient methods of communication are required; and physicians' role in providing continuity of care needs to be recognized. CONCLUSION: Providing continuity of care on a regional basis is a formidable challenge for the entire health and social services network, but ways of meeting this challenge are within reach.

Adolescent↗
PubMed2002

Met and unmet need for dental services among active drug users in Miami, Florida.

This study considers both met and unmet need for dental services among chronic drug users in Miami, Florida, and compares them with non-drug users recruited from the same neighborhoods (N = 1,479). Three primary findings emerged: (1) dental problems are among the most frequently reported health problems, (2) drug use is independently associated with need for dental services, and (3) injection drug use is independently associated with increased odds of unmet need for dental services. These findings suggest that policies that increase access to dental services for drug users and other disadvantaged groups are needed. These services could be integrated into existing behavioral health programs already targeting active drug users.

Adult↗
PubMedDate not supplied

[Perception of the quality of care in the health services in Mexico. perspective of the users].

OBJECTIVE: To describe the quality of health services as perceived by users in Mexico, as well as an analysis of predisposing and enabling factors to the use of these services. MATERIAL AND METHODS: Data were selected from the National Health Survey II of 1994. The survey contains information from 3324 ambulatory health service users who sought care in the two week period previous to the survey. RESULTS: 81.2% of users perceived the quality as good and 18.8% thought it was poor. The main reasons for good quality of care were: personal attention (23.3%) improvement of the health problem (11.9%). For poor quality of care, the main reasons were: long waiting time (23.7%) and poor clinical examination (11.7%) Social security health service users perceived 2.6 times more frequently quality of attention as poor, than those who consulted private health services. Quality is represented by the aspects of the attention process (44.8% 9, its results (21.3%), the structure (18.0%) and accessibility (15.7%) The main reasons for not returning to the same health service center were: deficient attention (18.2%) and long waiting times (11.8%). CONCLUSIONS: The perspective of the population should be studied further and actions for the continuous improvement of the quality of health care should be implemented.

Consumer Behavior↗
PubMed2006

Assessment of service use patterns in out-patients with schizophrenia: a Spanish study.

OBJECTIVE: The objective is to describe and characterize patterns of service use by out-patients with schizophrenia in Spain. METHOD: A representative treated prevalence sample of cases with schizophrenia was selected from four Spanish health areas. The evaluation included health service use, clinical severity, functioning and disability. Statistical analysis was based on hierarchical clustering methods. RESULTS: A total of 356 patients were included in the analysis. Five patterns of health service use were defined: heavy out-patient mental health users; mental health and general health service users; heavy hospital service users; nursing service users; low users of mental health services. Patients in each group showed differences in clinical and disability status. Patterns of health service use showed consistency, but also variability, among the geographical areas. CONCLUSION: Development and organization of mental health services should take into account the combinations of services patients most frequently use.

Adult↗
PubMedDate not supplied

[The characteristics of opiate users seen in an emergency service].

INTRODUCTION: Despite of the fact that it was reported for years that emergency rooms are the first health services where drug users attend, there are very few direct studies of this population. In most emergency room studies, the information was obtained from data available in the clinical records, and in very few drug users were interviewed. With the aim of having a deeper knowledge of opiate users who attend the emergency room it was planned to carry out a cross-sectional study interviewing them. The aims of this paper are to describe demographic characteristics, patterns of drug use and to know whether they contact first to an emergency room or to a treatment centre. METHODS: The sample included all patients detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. A descriptive bivariate analysis with simple stratification was carried out. RESULTS: Of the subjects referred by the doctor 383 opiate users were interviewed and 76 were not interviewed. The male/female ratio for the 383 interviewed opiates users was 2. Women were younger than men (25.8 vs 28.3, p (3/4) 0.001). Heroin or cocaine ever injected was reported by 93% and 76% reported injecting in the last 30 days. The mean age at the first use of heroin was higher for those who started use during 1989 or after (21.6) than those who started before 1989 (17.9) (p (3/4) 0.0001). Patients attending the emergency room for organic pathology were older (28.5) than those who attended for withdrawal (26.2) and those who attended for overdose (27.3) (p (3/4) 0.05). Thirty eight percent reported to attend first an emergency room for a drug related problem since they started drug use, and 47% to contact first with a treatment centre for drug dependence. CONCLUSION: Drug users interviewed seem to be more heavy users than those who started drug treatment in the public centres of Barcelona in 1992. Also, the hypothesis that emergency rooms are for this population the first contact point with health services is not supported by this study.

Adult↗
PubMed1999

Public participation in the design of educational programmes for cancer nurses: a case report.

Genuine involvement of the public in planning, monitoring and evaluation of health care is a prerequisite to a better quality of service. Similarly users of health services and their carers can contribute much to the planning and delivery of professional education, although this contribution has only recently been acknowledged in any strategic way by nursing educational and professional bodies. This paper provides one example of user and career involvement in the design of continuing education and higher education in cancer care nursing within the University of Leeds School of Healthcare Studies. The author reflects upon the positive aspects and some of the challenges presented in the achievement of public involvement in nurse education.

Consumer Behavior↗
PubMed2002

[Heavy users of inpatient psychiatric services].

OBJECTIVE: This paper describes the extent of heavy use of inpatient psychiatric services. It reveals predictors of heavy use. METHODS: 969 users of inpatient psychiatric services in the city of Leipzig were identified based on health insurance data. RESULTS: 16,7 % of the patients had at least 3 admissions and were classified as heavy users. They accounted for 36,4 % of the total inpatient cost. Patients suffering from schizophrenia or a comorbidity with personality disorders had a higher risk to be a heavy user. The kind of facility and the way of discharge were also predictors for heavy use. CONCLUSIONS: Further qualitative analyses should identify reasons for heavy users to utilize inpatient services and find out other opportunities of care for these patients.

Adolescent↗