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PubMed1997

User support for a library-managed online database search service: the BMA Library free MEDLINE service.

This paper discusses user support in the context of a library-managed online database search service. Experience is drawn from the British Medical Association (BMA) Library's Free MEDLINE Service. More than 9,600 BMA members, who are largely unfamiliar with computer communications and database searching, have registered as users of the service. User support has played a significant role in the development of the service and has comprised four main aspects: an information pack, a help desk, online help, and MEDLINE courses. The paper includes an analysis of help desk usage statistics collected from January 1996 through June 1996, and highlights other relevant research. Plans for further service enhancements and their implications in terms of future user support are discussed.

Computer User Training↗
PubMedDate not supplied

Cluster analysis of psychogeriatric characteristics and service use among rural elders.

In developing models of psychiatric service delivery, nurses must be able to target groups on the basis of their health status and service needs. This investigation attempted to develop profiles of rural elderly, a significant risk population, by subjecting data on the psychogeriatric nursing status and health services utilization of 125 subjects to cluster-analytic methods. The cluster analysis yielded a three-cluster model: Cluster 1 (n = 39) predominantly comprised unmarried women in moderate health, but with a high degree of health service utilization; Cluster 2 (n = 53) had rural elders with moderate physical impairments, self-perceptions of poor health, and moderate health service utilization; and Cluster 3 (n = 33) comprised elders with severe cognitive and physical impairments and high health service utilization. Cluster 2 subjects were judged to be mild users of services because they were younger and married without a regular source of health care. Because subjects in Cluster 1 tended to be unmarried women who lived alone, with mild to moderate physical impairments and a regular source of health care, these subjects were assessed as moderate users of services. Cluster 3, which comprised the oldest and most impaired, both physically and cognitively, were judged to be intensive users of services.

Activities of Daily Living↗
PubMed1993

User charges for health services in developing countries: a review of the economic literature.

Literature suggests that in theory, the efficiency of user charges for health services is related to the level of externality, the price elasticity of demand, the proportion of total costs which are private access costs, and the level of the government budget constraint. Theoretical models predict that price elasticity of demand for health services is likely to be higher for lower income groups and that user charges are therefore unlikely to promote equity, or reduce the discrepancies between the utilisation rates of the rich and poor, 'ceteris paribus'. Empirical evidence tends to confirm the latter prediction but to suggest that user charges in many countries provide the scope for welfare gains for the majority. Unfortunately, this scope is seldom exploited in practice. It is argued that many countries have little choice but to try to exploit the potential for majority gains, but that more emphasis should be placed on ensuring quality improvements than on superficial financial measures of success.

Developing Countries↗
PubMed1996

Acting on complaints about mental health services. Implications of power imbalances.

Complaint procedures are meant to provide an effective safeguard for users of services, but they do not always work well. Applies an analysis of three views of power to complaint procedures in mental health services. Identifies three factors which might affect the effectiveness of complaint procedures: the lack of credibility often accorded users of mental health services; the fear service users may have about complaining; and the difficulties they might experience in knowing what they can expect from a service. Uses this analysis to identify what managers need to do to ensure the complaint procedures are effective.

Communication Barriers↗
PubMed1995

Heavy utilization of inpatient and outpatient services in a public mental health service.

OBJECTIVE: The purpose of the study was to develop a descriptive profile of heavy users of services in the South Australian Mental Health Services. METHODS: Case notes for 50 heavy users were reviewed to obtain demographic and diagnostic information and data on service use over a three-year period. To supplement and verify this information, 35 of the patients were given structured interviews. RESULTS: The mean age of the 50 patients was 34.9 years, and there was a slight predominance of females. Most patients had never married and had been unemployed for a long time. All had a low income. The mean number of years of education was ten. The group was seriously disabled by psychiatric illness. The most common diagnosis was schizophrenia, followed by schizoaffective disorder and bipolar disorder. Comorbid axis I disorder and personality disorder or physical illness was common. Drug and alcohol abuse often complicated patient management and patients' ability to live successfully in the community. The average annual cost per patient was $13,598 (Australian), largely from inpatient care. CONCLUSIONS: This study contributes to an emerging global profile of the heavy service user. Such a profile may help service systems identify patients in this subgroup and target management strategies to these often very disadvantaged and challenging patients.

Adolescent↗
PubMed1985

A study of remote users' satisfaction with online services before and after procedural modifications.

As libraries evolve into database management centers with network capabilities, they increasingly serve users who are remotely situated from them. This paper explores some of the problems encountered by a national association library in serving the remote user. User satisfaction is evaluated, procedures are subsequently modified, and satisfaction is again measured to determine variables that affect user response to the services.

Attitude of Health Personnel↗
PubMedDate not supplied

The impact of user fee exemption on service utilization and treatment seeking behaviour: the case of malaria in Sudan.

This experimental study was undertaken to assess the effect of different levels of exemption, 25%, 50% and 75%, from health centre user fees on health service utilization and treatment seeking behaviour for malaria by a high risk group of pregnant women and children under 5 years. These are groups in need of special medical attention to prevent progression of the disease into complicated or severe malaria. Sinnar State, one of Sudan's highly endemic malaria regions, was selected to be the experimental area. Exemptions were introduced for one year in six health centres. Two centres for each exemption level, and a further two health centres without exemptions were studied. At the beginning and the end of the trial year, households surveys were conducted in the catchment areas of the health centres, and focus group discussions with pregnant women and mothers of children under 5 years were conducted. Routine data were reviewed for malaria cases in the health centres and six studies on malaria cases were done upon exit from the health centres. In-depth interviews with health staff of the health centres were conducted. Exemption from user fees increased health services utilization, improved treatment-seeking behaviour and promoted early diagnosis. The changes during the experimental year were the largest in the centres with the largest exemption. Therefore, policy changes towards exemptions are necessary to facilitate early diagnosis and treatment of malaria.

Fees and Charges↗
PubMed1993

Users' satisfaction with mental health services.

The opinion and level of satisfaction of the users of three different mental health services are presented as a way of evaluating the outcome of institutional and community approaches to psychiatric services. The information was collected in the cities of Concepcion (Chile), Sheffield (England) and Trieste (Italy) interviewing a sample of the users of the psychiatric services using a questionnaire specifically designed to suit the study's aims. The patients in Sheffield tended to support an eventual move towards a more community based service while the relatives appeared more interested in a general improvement of the traditional institutional facilities. In Trieste, patients as well as relatives are fully supportive of the community based services and reasonably aware of the difficulties. They want to improve things in the community. Finally, Chilean users show a considerable adherence to the more traditional and institutionalised ways of offering services and the levels of satisfaction were very high considering the conditions in which the help was delivered.

Chile↗
PubMed2006

Periodic presumptive treatment for cervical infections in service women in 3 border provinces of Laos.

OBJECTIVES: The objectives of this study were to determine whether periodic presumptive treatment (PPT) for sexually transmitted infections (STIs) in service women could be implemented in 3 border provinces of Laos and whether its implementation was associated with a reduction in the prevalence of cervical infections. STUDY DESIGN: Four hundred forty-two service women were interviewed using a standardized questionnaire in 3 border provinces at baseline (day 1) and 419 3 months (day 90) later. Azithromycin at a dosage of 1 g was administered at monthly intervals over 3 months in Khammouane province, on days 1, 30, and 90 in Oudomxai and days 1, 60, and 90 in Savannakhet. Urine samples were collected at baseline and day 90 for gonorrhea and chlamydia testing. RESULTS: Baseline samples showed very high levels of both gonorrhea and/or chlamydia of 42.7% in Oudomxai, 39.9% in Khammouane, and 22.7% in Savannakhet. At day 90, after 2 or 3 rounds of PPT, these were, respectively, 12.3%, 21.9%, and 17.0%. Overall, the prevalence of any cervical infection decreased by 45% from 32.4% (95% confidence interval [CI] = 28.1-36.9) at day 1 to 18.0% (95% CI = 14.5-22.1) at day 90 (P < 0.001). CONCLUSIONS: Lower prevalences of cervical infections were observed after 2 to 3 rounds of PPT. The optimal time between rounds of PPT is uncertain, but while these high STI rates prevail, a 1- to 2-month gap is recommended. After the introduction of this PPT project, costs of STI drugs reduced 5-fold making PPT a sustainable intervention in Laos for service women until user-friendly services are developed.

Adolescent↗
PubMed1977

Three utilization styles at an urban mental health center.

The authors report a study of utilization of services based on data obtained on two patient groups at an urban mental health center: a one-year applicant population, consisting of an unduplicated count of all adults applying for psychiatric care during a one-year period; and a one-day prevalence population, consisting of all persons on a psychiatric roster on a single selected day. Juxtaposing diagnosis, applicant-to-prevalence ratios, and treatment or services used, they found three styles of utilization of services--the intensive user, as exemplified by the neurotic in psychotherapy, the casual user (the schizophrenic attending medication clinic), and the pseudo user (the alcoholic using detoxification services). The intensive user represents a minority utilization style, while the last two styles are predominat at the center. Taken together they characterize the typical patient as a therapeutically passive user of services.

Alcoholism↗
PubMed2004

Patients or partners? Case studies of user involvement in the planning and delivery of adult mental health services in London.

User or patient involvement (UI) in the planning and delivery of health services is an aspiration of many industrialized economies, and has been promoted by United Kingdom (UK) governments for over two decades. This paper reports the findings of qualitative case studies of UI in two mental health provider Trusts in London. Semi-structured interviews were conducted with a variety of stakeholders, including Trust staff at all levels and user group members, to compare the expectations of diverse stakeholders and the extent to which these were achieved. We found that UI remained in the gift of provider managers: providers retained control over decision making, and expected users to address Trust agendas and conform to Trust management practices. Users wanted to achieve concrete changes to policies and services, but had broader aspirations to improve the status and condition of people with mental health problems. Suggestions are made about the direction of future strategies to improve UI.

Adult↗
PubMed1990

An evaluation of CD-ROM MEDLINE use in Thailand.

An analysis of requests for CD-ROM MEDLINE* searches from June to December 1987 at the Medical Library, Chulalongkorn University, was performed. Requests were received from eighty-two places, in Bangkok and the provinces; 97.8% were from government organizations. MEDLINE on CD-ROM was available from 1982 to date. Most users requested searches covering the previous five or six years. Users were surveyed regarding the service: just over 87% found the service user-friendly. In addition, users suggested that the library conduct search training programs, and more than half of the users noted that a single work station could not meet the search load.

Information Services↗
PubMed1999

The effects of fee bundling on dental utilization.

OBJECTIVE: To examine dental utilization following an adjustment to the provincial fee schedule in which preventive maintenance (recall) services were bundled at lower fees. DATA SOURCES/STUDY SETTING: Blue Cross dental insurance claims for claimants associated with four major Ontario employers using a common insurance plan over the period 1987-1990. STUDY DESIGN: This before-and-after design analyzes the dental claims experience over a four-year period for 4,455 individuals 18 years of age and older one year prior to the bundling of services, one year concurrent with the change, and two years after the introduction of bundling. The dependent variable is the annual adjusted payment per user. DATA COLLECTION/EXTRACTION METHODS: The analysis was based on all claims submitted by adult users for services received at recall visits and who reported at least one visit of this type between 1987 and 1990. In these data, 26,177 services were provided by 1,214 dentists and represent 41 percent of all adult service claims submitted over the four years of observation. PRINCIPAL FINDINGS: Real per capita payment for adult recall services decreased by 0.3 percent in the year bundling was implemented (1988), but by the end of the study period such payments had increased 4.8 percent relative to pre-bundling levels. Multiple regression analysis assessed the role of patient and provider variables in the upward trend of per capita payments. The following variables were significant in explaining 37 percent of the variation in utilization over the period of observation: subscriber employment location; ever having received periodontal scaling or ever having received restorative services; regular user; dentist's school of graduation; and interactions involving year, service type, and regular user status. CONCLUSIONS: The volume and intensity of services received by adult patients increased when fee constraints were imposed on dentists. Future efforts to contain dental expenditures through fee schedule design will need to take this into consideration. Issues for future dental services research include provider billing practices, utilization among frequent attenders, and outcomes evaluation particularly with regard to periodontal care and replacement of restorations.

Adolescent↗
PubMed2005

A contingent valuation study of the appropriate user price for ambulance service.

BACKGROUND: In Japan, anyone can use an ambulance free of charge, but this policy may encourage unnecessary ambulance use. OBJECTIVES: To determine the user price that would reduce unnecessary ambulance use, without discouraging medically necessary ambulance use. METHODS: The study was conducted by means of a three-part self-administered questionnaire. The first part consisted of questions covering demographic variables such as respondent age, gender, family structure, and pretax annual household income. The second part was made up of contingent valuation questions on ambulance use. Respondents were presented hypothetical situations and prices and then asked whether they would call an ambulance. The last part consisted of general questions pertaining to the city ambulance system. Answers to the hypothetical questions were analyzed in relation to demographic characteristics of the respondents. RESULTS: A total of 2,029 out of 3,363 recipients completed the questionnaire (response rate, 60.3%). Analysis of the responses indicated that the demand for ambulance service in serious situations is inelastic with respect to price, whereas the demand for ambulance service in nonserious situations is fairly elastic with respect to price. These data showed that a user charge of 190 dollars (20,000 yen) may be an acceptable price, i.e., the price that will reduce the number of ambulance calls by persons with nonserious conditions, but not by persons with serious conditions. CONCLUSIONS: Introducing a user charge for ambulance service may improve efficiency of the service operation.

Ambulances↗
PubMed2005

An analysis of high-cost users at an Australian public health service organization.

High-cost users generate extremely high costs when compared with average users in the same diagnostic-related group (DRG). They represent a major financial loss for a health service organization. The research was conducted using an area health service patient database for online analytical processing to produce descriptive statistics and graphs of 'high-cost' and 'non-high-cost users'. Trends and patterns were identified across key variables derived from clinical, financial and operational categories. The main results are: 20% of costs are spent by 3% of the population; elective admission is higher in the high-cost group; tracheostomy has the most number of cases and is the most expensive DRG; LOS is mostly longer for complex cases however, high costs can be attributed to other factors. In conclusion, these findings are potentially useful to patients, medical staff, management and health service decision-makers. The limitation of this study is the exclusion of profitability.

Costs and Cost Analysis↗
PubMed2000

Preferred terms for users of mental health services among service providers and recipients.

OBJECTIVE: The terms used to refer to recipients of psychiatric services continue to be controversial. Terms in current use include "patient," "client," "consumer," and "survivor." In this study mental health service recipients and providers were surveyed about their preferences among these terms, and responses were analyzed to identify factors associated with various preferences. METHODS: A total of 550 service providers and 427 recipients at four sites in Ontario-two provincial psychiatric hospitals, a private mental health center, and a psychiatric unit of a general hospital-participated in a brief anonymous survey. RESULTS: Among service providers, 68.4 percent preferred the term "patient," 26.5 percent preferred "client," and.5 percent preferred "consumer." Logistic regression analysis showed that service providers' preferences were associated with age and gender. Among service recipients, 54.8 percent preferred the term "patient," 28.8 percent preferred "client," 7 percent preferred "survivor," and 2.8 percent preferred "consumer." Service recipients' preferences were associated with site, self-reported diagnosis, and employment status. CONCLUSION: The study results indicate lack of universality in preferences for terms for users of mental health services and suggest the need for dialogue about preferred terms between service providers and recipients.

Adult↗
PubMedDate not supplied

Women opiate users' perceptions of treatment services in New York City.

This paper focuses on the treatment experiences of women opiate users in New York City. Historically, drug research has used male samples, and drug treatment programs have been based upon the concerns of men. Treatment counselors and administrators are typically male, and female clients are frequently outnumbered by male clients. In addition, unique needs of women are not addressed. Primary among these needs is child care, a provision that is not a standard feature of most programs. Additionally, many women opiate users may be in dysfunctional families and/or have histories of sexual victimization that may require special counselling. Using data from 208 women drug users who had been in an opiate treatment program, this paper examines their perceptions of the extent to which these programs incorporate women's distinctive concerns and the degree to which such provisions are affected by the perceived numbers of women clients in these programs.

Adolescent↗