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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.

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PubMed2004

The development of a user-led clinical service for newly diagnosed rheumatoid arthritis patients. An action research study.

OBJECTIVE: To identify the clinical services required to meet the perceived needs of patients within the first 6-12 months following a diagnosis of rheumatoid arthritis in an orthopaedic NHS trust. METHODS: An action research methodology was utilized. Twenty three newly diagnosed patients were asked to complete a questionnaire focusing on their needs at the time of diagnosis. The content included reactions to diagnosis, physical and psychological implications and clinical services that were required. A sub-sample of patients (n = 6) participated in an interview to explore these issues in more depth. A questionnaire was also distributed to 14 members of the multidisciplinary team (MDT) to ascertain their views on the purpose, content, and provision of a clinical service for newly diagnosed patients. RESULTS: Eighteen patients agreed to take part (M:F, 9:9, age range 23-74 years, mean age 52.3 years, mean disease duration from diagnosis 16 weeks). Data from the questionnaires and interviews led to the following themes being identified: pre-diagnosis anxiety and fear, the impact of the diagnosis, physical and psychological implications of the diagnosis, and issues related to control perceptions. There was concordance between the MDT and the patients regarding impact of the disease and the need for information. Areas of the service that were identified independently by patients related to the importance of the period of time pre-diagnosis while awaiting the hospital appointment, and employment issues. CONCLUSIONS: This study has identified the impact of RA in the early stages of pre- and post- diagnosis on physical, psychological and social functioning and has consequently informed service development.

Journal Article↗
PubMed1992

Perspectives of users of the services.

This article draws on social science evidence concerning the views and experiences of those using the antenatal services. It identifies several important themes in this evidence, including the need to consider pregnancy a normal process, to provide care that is sensitive to individual circumstances and that offers continuity of care throughout the antenatal period, and the obligation on providers to assess scientifically the effectiveness of the care they give.

Communication↗
PubMed1981

Some interim results from a controlled trial of cost sharing in health insurance.

A total of 7706 persons are participating in a controlled trial of alternative health-insurance policies. Interim results indicate that persons fully covered for medical services spend about 50 per cent more than do similar persons with income-related catastrophe insurance. Full coverage leads to more people using services and to more services per user. Both ambulatory services and hospital admissions increase. Once patients are admitted to the hospital, however, expenditures per admission do not differ significantly among the experimental insurance plans. In addition, hospital admissions for children do not vary by plan. The income-related cost sharing in the experimental plans affects expenditure by different income groups similarly, but adults' total expenditure varies more than children's. Sufficient data are not available on whether higher use by persons with free care reflects overuse, or whether lower use by those with income-related catastrophe coverage reflects underuse. Both may well be true.

Ambulatory Care↗
PubMed2004

The effectiveness of vocational services for substance users in treatment.

Employment appears frequently in the literature as an outcome criterion for substance users in treatment, and most clinicians subscribe to the belief that work plays an important role in recovery from addiction. Despite the importance attached to employment, the major standard treatment modalities have not been shown as effective in increasing client employment after treatment. The article presents a critical review and synthesis of three decades of research on the effectiveness of specialized vocational intervention for addiction treatment clients.

Employment↗
PubMed1996

Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used.

Gender differences in reports of chronic pain, in coping responses to the consequences of painful conditions, and in the use of health care services have recently received considerable attention. This report examines the gender effects of referral practices to a chronic pain specialty clinic and the nature of the relationship between health care needs and use of health care services. This historical cohort analytic survey of 571 patients referred to the pain clinic assessed them by gender for selected referral variables through a chart review, and randomly sampled (n = 222) these patients' current adjustment and health service use through mailed questionnaires or telephone interview. The questionnaire consisted of psychosocial scales (PAIS-SR; Social Support); cognitions, including the Meaning of Illness Questionnaire (MIQ); and a health service utilization inventory designed to assess direct, out-of-pocket, indirect, and cash transfer expenditures. Selected referral demographic characteristics were similar between the gender groups at referral with the exception of three factors: distance from clinic, referring physician, and having a disability pension. At follow-up, the adjustment groups were similar to their gender counterparts on all sociodemographic and clinical variables including a high prevalence of poor psychosocial adjustment. Women's adjustment was accounted for by cognitive variables, whereas men's adjustment was by social variables. There were differential expenditures for health service use by gender with similar health care needs. Women used specific health care services more than men, which was explained in part by psychological need and meaning. Men's use of services, on the other hand, was explained in part by meaning alone. The importance of gender, differences in the role that social support and meaning variables play in predicting psychosocial adjustment to chronic pain is elaborated in this study. The interaction effects between health care need and gender to explain variations in use of health care services indicates that users of services varied in ways that suggest a bias or barrier of their own or of service providers to access services.

Adaptation, Psychological↗
PubMed2005

Childhood abuse in Swedish female users of psychiatric services.

INTRODUCTION: The aims of this study were to investigate: (1) the prevalence of childhood abuse in women admitted to psychiatric services in a county in the south of Sweden; (2) who the perpetrators were; and (3) the women's self-reported consequences of childhood abuse. METHOD: The study had a cross-sectional design and was a part of a more comprehensive study. An anonymous self-reported questionnaire was used which included both closed and open-ended questions. The data material were analysed by means of descriptive statistics, Mann-Whitney U-test and manifest content analysis. RESULTS: The total number of women who participated in the study was 259, 51% of whom reported experiences of abuse during childhood, with 53% of these having been exposed to more than one type of abuse. The most frequent perpetrator was the woman's parents; mainly the fathers but also the mothers turned out to be frequent perpetrators of abuse. Some 75% of the women reported current psychological problems in adulthood related to abuse in childhood. According to a manifest content analysis, five themes of self-reported psychological problems emerged: psychiatric problems, shortcomings in social relations, poor self-confidence, fears and bad memories.

Adolescent↗
PubMed1996

Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice.

Attitude of Health Personnel↗
PubMed2000

Lessons from a comprehensive clinical audit of users of psychiatric services who committed suicide.

OBJECTIVE: Characteristics of patients who committed suicide were examined to provide a picture of the treatment they received before death and to determine whether and how the suicides could have been prevented by the service system. METHODS: The unnatural-deaths register was matched to the psychiatric case register in the state of Victoria in Australia to identify suicides by people with a history of public-sector psychiatric service use who committed suicide between July 1, 1989, and June 30, 1994. Data on patient and treatment characteristics were examined by three experienced clinicians, who made judgments about whether the suicide could have been prevented had the service system responded differently. Quantitative and qualitative data were descriptively analyzed. RESULTS: A total of 629 psychiatric patients who had committed suicide were identified. Seventy-two percent of the patients were male, 62 percent were under 40 years old, and 51 percent were unmarried. They had a range of disorders, with the most common being schizophrenia or schizoaffective disorder (36 percent). Sixty-seven percent had previously attempted suicide. A total of 311 patients (49 percent) received care within four weeks of death. Twenty percent of the suicides were considered preventable. Key factors associated with preventability were poor staff-patient relationships, incomplete assessments, poor assessment and treatment of depression and psychological problems, and poor continuity of care. CONCLUSIONS: Opportunities exist for the psychiatric service system to alter practices at several levels and thereby reduce patient suicides.

Adult↗
PubMed2003

Interest in psychiatric advance directives among high users of crisis services and hospitalization.

OBJECTIVES: This study examined rates of interest in creating psychiatric advance directives among individuals at risk of psychiatric crises in which these directives might be used and variables associated with interest in the directives. METHODS: The participants were 303 adults with serious and persistent mental illnesses who were receiving community mental health services and who had experienced at least two psychiatric crises in the previous two years. Case managers introduced the concepts of the directives and assessed participants' interest. The associations between interest in the directives and demographic characteristics, psychiatric symptoms, level of functioning, diagnosis, history of hospitalizations, history of outpatient commitment orders, support for the directives by case managers, and site differences were examined. RESULTS: Interest in creating a directive was expressed by 161 participants (53 percent). Variables significantly associated with interest were support for the directives by a participant's case manager and having no outpatient commitment orders in the previous two years. Reasons for interest included using the directives in anticipation of additional crises and as a vehicle to help ensure provision of preferred treatment. CONCLUSIONS: Substantial interest in psychiatric advance directives was shown among individuals with serious and persistent mental illness. The results strongly suggested that attitudes of clinicians about psychiatric advance directives are associated with interest in the directives among these individuals. Therefore, it is important to educate clinicians and address their concerns about the directives so that they can more comfortably support creating the documents. A shift in values may also be necessary to more consistently recognize and honor patients' treatment preferences as specified in the directives.

Adult↗
PubMed1978

Frequent users of doctor services in a small rural community.

Thirty-six per cent of the visits to doctors in a small rural community were made by the 6% of the population having the most diseases or symptoms. About 90% of the population accounted for about one-half of the medical services provided by the Kuusamo doctors; the other half was taken up by the 10% of the inhabitants in greatest need of medical attention. Adults consulted a doctor 2.1 times a year on the average. The most common reasons for consultations were respiratory diseases (23%), diseases of the genito-urinary system (16%) and accidents (14%).

Adult↗
PubMed2006

[Prevalence of violence against women users of health services].

OBJECTIVE: Intimate partner abuse is a complex phenomenon and a public health problem and health care services are one of the places sought by women in this situation. The objective of this study was to assess the prevalence of violence against women attending a health care center. METHODS: This study was carried out in a municipality of Southeastern Brazil, in 2003. A sample of 265 women, aged 18 to 49 years old, was interviewed using a questionnaire administered face-to-face. Violence was classified as psychological, physical, sexual and general. Statistical analyses utilized were exact logistic regression and Fisher's exact test. RESULTS: Psychological violence, at least once in life, was reported by 41.5%, physical violence by 26.4%, and 9.8% reported sexual violence. "General violence", which refers to anyone of the above mentioned types of violence, was reported by 45.3% of the women, and, in 20.3% of the cases, they stated it had occurred during the last 12 months before the interview. However, when asked whether they had suffered any kind of violence in life, only 22.3% answered affirmatively. The multivariate analysis indicated that the risk factors for each type of violence were: drug use by the partner, socioeconomic status and family history of violence for both psychological and general violence; drug use by the partner, schooling and family history of violence for physical violence; and, socioeconomic status and family history of violence for sexual violence. CONCLUSIONS: This study indicates that the prevalence of violence among women attending the health center is high and consistent with the results of other investigations. It also suggests that most of the violence is invisible to the health center.

Adolescent↗
PubMed1998

A longitudinal study of schoolchildren's experience in the North Carolina Dental Medicaid Program, 1984 through 1992.

OBJECTIVES: This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. METHODS: Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. RESULTS: Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. CONCLUSIONS: Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care.

Adolescent↗
PubMed1995

Adult diabetic and nondiabetic subjects as users of dental services. A longitudinal study.

Utilization of dental services by 30 diabetic and 30 nondiabetic subjects was assessed by longitudinal monitoring over a period of 3 years. All subjects were examined clinically three times, and their treatment consisted mainly of cariologic and periodontal treatment. The treatment was delivered by a dentist and an expanded-duty dental hygienist. The study groups were similar with regard to the total number of dental visits needed. However, the treatment of diabetic subjects was more demanding in that more dentist's workload was needed for the diabetic group. They also missed more appointments without cancellation and therefore more office time had to be reserved for them.

Adult↗