HBV vaccination should be performed in service centres for drug users: an Italian experience.
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Feasibility Studies↗
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Results for “Service user”
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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Factors related to the use of ambulatory mental health services in three provider plans.
The use of ambulatory mental health (MH) services by adults was studied in three provider plans: Blue Cross (BC), Group Health Cooperative (GHC) and United Healthcare (UHC), an experimental new plan in which a patient's primary care physician managed all of his care. Approximately 8.3% of the enrollees in each plan had some MH use in the 18 months of the study. We studied correlates of MH use (yes/no). Sex was not a significant predictor of MH use. In general, worse health and lower socioeconomic status (SES) were correlated with having at least one MH visit, but better health and higher SES were correlated with a higher quantity of use for those who had some MH use. The three insurance plans did not differ significantly in the proportion of people who had any MH services, but BC users of MH services had 2-3 times more MH visits and higher costs than GHC and UHC users. This suggests that the reliance on primary care providers in UHC and GHC may have changed the nature of MH care as compared to Blue Cross. The effects of income, MH need and symptom sensitivity on MH use were different among the three plans.
Ambulatory Care↗
The intructional media service framework: a user-oriented organizational structure for intructional media operations.
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Audiovisual Aids↗
The on-line user network: organization and working procedures.
The National Library of Medicine's on-line user community has grown from a small group of 25 institutions in October 1971 to more than 900 in January 1978. Management of the MEDLINE User Network, co-ordination of on-line data-bases, and provision of user support services are an important function of the MEDLARS Management Section (MMS). MMS is the point of contact for on-line users; a service desk is maintained to provide immediate assistance; and technical materials describing the various data-bases are prepared including the monthly NLM Technical Bulletin and the On-Line Services Reference Manual. Other management and support activities include the preparation of statistical reports; handling of on-line centre applications received from the Regional Medical Libraries; co-ordination of codes and passwords for users; and the distribution of off-line prints, off-searches, and tape copies of the data-bases. A monthly current awareness service is also provided. The working procedures for these support activities are described.
Fees and Charges↗
[The relationship between normal swallowing functions, food ingestion and the lifestyle of users in a day service center].
OBJECTIVES: The physical and mental condition of elderly people changes every day and we hypothesized that this influences food intake and swallowing functions. The present study was undertaken to clarify relationships between daily living conditions and swallowing function. METHODS: The subjects were users (105 males and 219 females) of 6 day-service centers. We performed a survey of IADL (Instrumental Activities of Daily Living), mobility, eating and swallowing behavior, and general health. In addition, we used RSST (Repetitive Saliva Swallowing Test) as a screen for functional dysphasia. RESULTS: Women who had normal food ingestion and swallowing functions were capable of doing shopping, housework and taking care of money independently. Males and females who were capable of moving around from place to place had normal food ingestion and swallowing functions. With regard to daily eating habits and health condition, males and females who had normal food ingestion and swallowing functions were able to consume ordinary food, able to eat without any help, and often laugh. CONCLUSION: It was concluded that a normal swallowing condition in the elderly is related to laughing often, being independent in daily life, moving around and eating ordinary meals without any help.
Activities of Daily Living↗
User charges for rural health services in Papua New Guinea.
This paper reports on a review of user charges for health services in rural areas of Papua New Guinea. Facilities implementing both fee for service and community risk sharing schemes were studied. This study found that there is a lack of any policy framework or practical guidelines on cost recovery. In some areas fees are being used as a fiscal tool rather than to further health policy. This study from Papua New Guinea raises serious questions about the virtue of cost recovery for health services in rural areas. Equity is an issue and the fees are creating a barrier both for entry and continuation in the health system; accountability is poor, and issues of cross subsidization are not addressed; fee revenues from rural health services are small and primarily of local significance; and are not being used to improve quality of health services. Cost recovery schemes in rural areas have the potential to provide a valuable contributory source of income to operate and improve health services. In practice, few are achieving this. It is concluded that health sector financing focus could be more fruitfully directed to financing mechanisms with greater potential to improve and expand health services.
Community Health Services↗
If services are sensitive to users' needs, they are moving in the right direction.
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Community Health Centers↗
Access to medical care and service utilization among injection drug users with HIV/AIDS.
Access to care and optimal service utilization among 287 low income African American former and current drug injectors was examined. Results indicated suboptimal outpatient care, and no evidence of alternative use of hospital services. Participation in drug treatment and case management were associated with greater access to care and use of outpatient services, even after controlling for current drug use, gender, and insurance. AIDS and physical functioning limitation were associated with emergency room (ER) use and hospitalization. Participation in drug treatment and case management and an AIDS diagnosis were associated with optimal outpatient service use. Daily alcohol use was associated with ER as the usual facility for care. Integration of substance abuse treatment, case management, and medical services delivery may contribute to improved HIV care for this population.
Adult↗
Programme factors that influence completion of residential treatment.
The aim of this study was to predict retention in residential rehabilitation (RR) services for drug users, focusing on service provider factors. A national postal survey of RR services in England and Wales was carried out and information was obtained from 57 of 87 services identified (65.5%). Service managers were asked to complete a questionnaire asking about treatment philosophy, treatments provided, staff characteristics and staffing levels, as well as overall service size and funding. Services also provided information on the number of clients admitted and the number who had completed, dropped out and been asked to leave in the past year. Completion rates varied widely, from 3% to 92%, with an average of 48%. Higher completion rates were associated with lower counsellor caseloads, fewer beds, single rooms, shorter scheduled treatment durations, higher fees per client and provision of what could be termed a balanced treatment programme containing adequate amounts of individual counselling and programme-free time, and with only moderate demands for domestic duties. Programmes with more drug than alcohol users had lower completion rates, but the proportion of dual diagnosis or criminal justice referred clients did not appear to affect retention. Completion rates varied as a function of a number of service factors that are amenable to manipulation. To retain clients successfully, programmes should not be too large and should have adequate levels of therapeutic staff, a well-developed treatment schedule which is not too demanding for the client in terms of duties or overall time spent in structured activities, and which incorporates sufficient levels of individual counselling. [Meier PS, Best D. Programme factors that influence completion of residential treatment. Drug Alcohol Rev2006;25:349 - 355].
Demography↗
Teenagers seeking condoms at family planning services. Part I. A user's perspective.
The promotion of condom use is an essential part of any AIDS prevention programme. By distributing condoms and promoting their use, clinics that provide family planning services can play an important role in preventing the spread of AIDS. This study assesses the accessibility of condoms to teenagers at selected family planning services in Durban. Twelve randomly selected clinics in Durban were visited by each of 4 teenage fieldworkers. During these visits, the fieldworkers' experiences were recorded in detailed notes which were subsequently analysed for content. The fieldworkers experienced difficulty in locating a few of the clinics and some were embarrassed by security staff. The two female fieldworkers, in particular, were intimidated by their reception at the clinics and found resistance to their requests for condoms. On two occasions, supplies of condoms had run out. When condoms were available, they were distributed in a setting that lacked privacy. Information on how to use condoms, if offered at all, was supplied by way of pamphlets and information on AIDS was rarely offered. Overall, the experiences of the fieldworkers indicated that it was difficult for teenagers to obtain condoms from clinics providing family planning services in Durban. It is recommended that there be signs indicating the location of the clinics, and that privacy be ensured and adequate stocks of condoms maintained. Most importantly, clinic staff need to use every opportunity to discuss AIDS prevention with teenagers attending the clinic.
Acquired Immunodeficiency Syndrome↗
Factors predicting unmet health services needs among incarcerated substance users.
Negative health consequences of illicit drug use, such as cardiovascular complications and infectious diseases, increase the likelihood of the need for health care. However, evidence suggests that, with the exception of emergency services, drug users generally are medically underserved. Furthermore, the effect of illicit drug use on health care utilization is becoming an especially important issue for the criminal justice system, because an increasing proportion of inmates in correctional institutions have a history of drug use. This 1998-1999 study of 661 incarcerated men in the Kentucky prison system focused on predictors of unmet physical, behavioral, and overall health care needs among chronic substance users. Analyses revealed that White incarcerated drug users were more likely to report unmet physical and overall health care needs than non-Whites and those with high school education or above were more likely to report unmet physical, behavioral, and overall health care needs. In addition, more episodes of serious illness, more mental health problems, and poorer self-rated health were predictive of all three types of unmet health care needs. A longer career of drug use emerged as a significant predictor of unmet behavioral health care needs, whereas more frequent drug use in the year before incarceration predicted unmet physical health care needs. Further research directions and implications for in-prison health care planning are discussed.
Adult↗
The effects of clinical case management on hospital service use among ED frequent users.
This study examined the impact of case management on hospital service use, hospital costs, homelessness, substance abuse, and psychosocial problems in frequent users of a public urban emergency department (ED). Subjects were 53 patients who used the ED five times or more in 12 months. Utilization, cost, and psychosocial variables were compared 12 months before and after the intervention. The median number of ED visits decreased from 15 to 9 (P < .01), median ED costs decreased from $4,124 to $2,195 (P < .01) and median medical inpatient costs decreased from $8,330 to $2,786 (P < .01). Homelessness decreased by -57% (P < .01), alcohol use by -22% (P = .05) and drug use by -26% (P = .05). Linkage to primary care increased 74% (P < .01). Fifty-four percent of medically indigent subjects obtained Medicaid (P < .01). There was a net cost savings, with each dollar invested in the program yielding a $1.44 reduction in hospital costs. Thus, case management appears to be a cost-effective means of decreasing acute hospital service use and psychosocial problems among frequent ED users.
Adult↗
[Drug users outside medical treatment: methodological and practical aspects].
A legal context that classifies the consumption of heroin and cocaine as an illegal act, poses a considerable methodological challenge to research on users of these substances. This is in particular the case for research on those users who are not in treatment and, therefore, cannot be recruited through treatment settings. In a research project on heroin and/or cocaine users outside treatment settings, a sample of 917 individuals was recruited through "Privileged Access Interviewers" in the whole of Switzerland. In the first part of this article, we discuss matters of reliability as well as of validity concerning this method of data collection. In the second part of the article, we discuss the use of low threshold syringe exchange schemes by the user groups represented in the sample. Only intravenous drug users frequent those services - they are however a minority in the sample (n = 238). In several regions of Switzerland syringe exchange schemes do not exist. Where they do exist, they appear to correspond to a need which they are able to cover largely. In the regions without such services, intravenous drug users get their supply of syringes more frequently from pharmacies. However, pharmacies do not compensate the absence of specific syringe exchange schemes. In regions without such schemes, injections with used syringes are more frequent. Thus, regarding Aids-Prevention, there is an urgent need to develop syringe exchange schemes in all parts of the country.
Acquired Immunodeficiency Syndrome↗
Satisfaction with the access to the health services of the people with chronic conditions in Estonia.
UNLABELLED: After the implementation of the primary health care reform in Estonia, most of chronic conditions are managed by family doctors (FD) in collaboration with specialists. Although the general population has demonstrated the increase in satisfaction with health care after the reform, it has been questioned if people with chronic diseases have been left on a more disadvantaged position in the new system with some restrictions in the access to specialists. OBJECTIVE: To investigate the satisfaction of people with chronic conditions with the access to the health services and compare them to those who did not have a chronic illness. METHOD: In November 2005, a random sample of Estonian residents aged 15-74 were personally interviewed using structured questionnaires (n=1446), 29% of them reported to have a chronic illness. RESULTS: The people with chronic conditions were less satisfied with the access to the health services. They were more satisfied with their family doctors, but less with the health insurance system and they often reported their problems in seeing the specialist. Compared to other respondents, the people with chronic conditions visited their FDs and specialists more often, but no significant differences were found between their waiting times to see the FD or a specialist. CONCLUSION: In Estonia, the people with chronic conditions do not have organisational barriers in their access to the health services. As frequent users of health services, they perceive the shortages of the health system more obviously than the rest of the population and it may reflect their satisfaction with the different aspects of the health system as well as the access to the health services.
Adolescent↗
Implementation and evaluation of local-level priority setting for stroke.
We aimed to develop and evaluate a prioritisation process to combine the evidence base with stakeholder involvement within a stroke programme for a Health Improvement Programme (HImP). Implementation involved: formation of a district stroke group (DSG); review of the evidence; survey of DSG members; survey of other key professionals; consensus within the DSG; consultation with local users of the service. Evaluation was through semi-structured interviews and documentary analysis. The process was accepted as appropriate and valuable by the majority of participants, and a district HImP implementation group allocated pound sterling 100 000 for stroke development as a result of this process. However, some felt that stroke itself had been an imposed, rather than an agreed, local priority. The priority setting process was not clear to all participants and change of personnel, particularly in the NHS trusts, led to some perceived lack of ownership. Professionals from secondary care participated, but later criticised the process when they felt that the priorities in the HImP could limit their ability to access money for other service developments. The user consultation days occurred too late to influence the 1999/2002 HImP. We have shown that it is possible to develop an approach that is broadly accepted by stakeholders and balance the evidence base with local ownership. The participation of stakeholders, clarity of procedures, local ownership and awareness of local politics are important in effective priority setting. The model developed will be of value in other settings.
Evidence-Based Medicine↗
Validation of the measure of processes of care for use when there is no Child Development Centre.
INTRODUCTION: Clinical governance requires measurement of the outcomes of health care. The Measure of Processes of Care (MPOC; King, Rosenbaum & King 1995) is a postal questionnaire developed in Canada to reflect parents' perceptions of the quality of services received. AIM: To examine the usefulness of the MPOC for the evaluation of services for children with disabilities and their families. METHODS: The MPOC was revised minimally for British idiom, taking out explicit references to a 'Centre'. Surveys of parents using child disability services were carried out in three rural and two urban communities, where there are no Child Development Centres, with a total of 495 analysable questionnaires returned. In addition, 32 parents using a home nursing service for children with multiple disabilities completed questionnaires. RESULTS: The rate of return ranged from 49% to 67%. Factor analysis confirmed a five-factor solution but only one factor mapped clearly onto the Canadian structure. Using the revised structure, the surveys provide evidence of the discriminating potential of the MPOC, comparing the perceptions of parents who do or do not have a care coordinator, and comparing recipients of a home nursing service with matched users of general services. CONCLUSIONS: The MPOC can be used as a measure of outcome for child disability services of differing organizational structures.
Adolescent↗
Associations of race, education, and patterns of preventive service use with stage of cancer at time of diagnosis.
OBJECTIVE: To go beyond the documentation of disparities by race and SES by analyzing health behaviors regarding preventive and cancer screening services and determining if these behaviors are associated with stage of cancer when first diagnosed. DATA: Stage of cancer for Medicare patients diagnosed in 1995 with breast, colorectal, uterine, ovarian, prostate, bladder, or stomach cancer; and use of influenza and pneumonia immunization, mammography, pap smear, colon cancer screening, and the prostate specific antigen test during the two years preceding diagnosis of cancer. STUDY DESIGN: Hypothesis tested: health behaviors regarding use of preventive and cancer screening services are associated with stage of cancer when first diagnosed. DATA COLLECTION/EXTRACTION METHODS: Information was extracted from the database formed by the linkage of Surveillance, Epidemiology, and End Results (SEER) cancer registries with Medicare files. PRINCIPAL FINDINGS: Black and white patients (of higher and lower SES) who used more of the preventive and cancer screening services were at a lower risk of having late stage cancer for six cancers studied (breast, colorectal [male and female], prostate, uterine, and male bladder cancer) than their counterparts who used fewer of these services. CONCLUSIONS: The use of preventive and cancer screening services is a health behavior associated with better health outcomes for the elderly diagnosed with cancer. The lack of preventive service use can serve as a marker for identifying persons at risk of late stage cancer when first diagnosed. Strategies that encourage the use of preventive services by low users of these services are likely to reinforce a range of healthy behaviors that help to ameliorate disparities in health outcomes.
Black or African American↗
The 'Bodywise' initiative.
Young people want access to good information in suitable settings so they can discuss sexual matters openly. Services are needed to bridge the gap between paediatric and adult health services. Interprofessional collaboration can provide effective, integrated and supportive services for users and providers. Static and outreach services are essential to facilitate young people's access to the services.
Adolescent↗