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PubMed1990

HIV infection and intravenous drug users. Implications for emergency services.

HIV-1 infection among IVDUs is increasing at a rapid rate in the U.S. Because many Emergency Departments experience many visits from patients with this risk factor, the impact on emergency services can be considerable. Because many of these patients currently have asymptomatic infection, knowledge of clinical presentations of HIV-1 infection is valuable, as the Emergency Department may be the site for the initial presentation of complications related to HIV-1. Finally, Emergency Departments may play a vital role in preventing further progression of this deadly and destructive disease among this risk group.

Ambulatory Care↗
PubMed1995

[Evaluation of the financial participation of the users of 102 health services in 3 districts of Senegal].

Primary Health Care (PHC) financing is today one of the major concern of public health system managers in developing countries. Their governments never allocated appropriate and sufficient resources to the sector of PHC. The external donors' funds are mostly allocated to short term PHC projects. They stop with the end of the projects. The undesirable consequences of that situation are well known. They are mainly related to a persistence of high rate of mortality and morbidity due to preventable diseases. To better address that situation the health ministers of the WHO african region adopted in September 1987 in Mali the Bamako alternative, to the country economical situation, for PHC services financing. It permitted to finance up to 80% of the recurrent costs of health system of Pikine department in 1980. In the three pilot districts where the Bamako initiative strategy has been tested: Podor, Matam and Bignona, all of the one hundred and two (102) health posts are self financed for their recurrent costs, since 1992.

Adult↗
PubMed1992

Use of two online services as drug information sources for health professionals.

The utility of the online computer services BRS Colleague and Dialog Medical Connection, when used primarily as drug information sources by physicians, nurses, and pharmacists and attitudes toward their use, are described. Study sites included office-based medical practices, a university clinic family medicine group, and a university clinical pharmacy department. Participants had access to either of the computer services during two 9 1/2-month periods. All searches were automatically recorded and analyzed. A total of 1,112 search sessions were conducted (78% by pharmacists, 16% by nurses, 6% by physicians) by 38 of 65 participants. Information which completely answered questions was found for slightly less than one-third of searches. Errors occurred in about 81% of searches which retrieved incomplete information. Lack of time was a major factor which limited use of the services, and infrequent users felt that the services did not fit in well with their daily work routine.

Attitude to Computers↗
PubMed1995

Cost-effective health information systems: user-driven internal development at the University of Iowa.

GOALS: The Information Network For Online Retrieval & Medical Management (INFORMM), health information system (HIS) for the University of Iowa Hospitals and Clinics (UIHC), was analyzed with regard to development of a Computer-Based Patient Record (CBPR) in a cost-effective manner. The analysis: i) profiles INFORMM system functionality; ii) displays INFORMM use and satisfaction among physicians, nurses, and other hospital employees; iii) characterizes dynamics affecting INFORMM growth; and iv) evaluates the cost of a system of internal-development of software. DATA SOURCES: INFORMM utilization for 1989, 1994, and 1995; service requests from users for the years 1985, 1990, and 1994; 1994 MECON-PEERx data; gap analysis user survey conducted by an independent consulting firm. MAIN RESULTS: 1) Physician use has been dominated by a single function: retrieval of laboratory results. 2) Nurse use of the system was more diverse. A recent surge of nurse and physician use resulted from the introduction of online documentation of nursing care. 3) Overall use has been predominantly by non-clinician users, no one function dominating their pattern of use. 4) User service requests were predominantly from the non-clinician group of users. Requests from non-physician groups have been coordinated by a limited number of representatives of those groups, unlike requests from physicians. 5) The UIHC HIS ranked high in user satisfaction. 6) The overall cost of the UIHC HIS system is relatively low as a percentage of the gross operating budget or as a ratio to the volume of patient activities in this medical center. CONCLUSIONS: Internal development of INFORMM has been a cost-effective solution to the information demands of nursing staff and other users. INFORMM system composition reflects the quantity and organization of user requests. Satisfying the needs of physicians requires a change in the manner in which physician needs are assessed.

Attitude to Computers↗
PubMed2002

Access to resources for substance users in Harlem, New York City: service provider and client perspectives.

The Urban Research Center (URC) in Harlem, New York City, is a collaboration of community members, service providers, and academics. A Community Advisory Board (CAB) meets regularly to formulate priorities for action and to direct research. A conceptual model of social determinants of health relevant to the Harlem community was developed. Early meetings of the CAB identified substance use as a health concern in the Harlem community. Access to social services was identified as a key social determinant that should guide research and intervention efforts of the URC. Surveys of service providers and of substance users were carried out to quantify availability of information and barriers to access. This article discusses the CAB process that led to the model of social determinants, development of surveys, and interpretation of results. The authors also discuss survey results and how the URC will use these results to develop interventions.

Adult↗
PubMed1992

Welfare gains from user charges for government health services.

The World Bank's Financing health services in developing countries emphasizes demand-side issues--highlighting user fees, insurance, and the private sector as tools for strengthening the health sector. That approach is a major departure from the focus on the supply side--public sector spending, costs, management, and efficiency--that has dominated the international health finance agenda for many years. An important set of empirical papers by Paul Gertler and his co-authors coincided with the release of the policy paper. Gertler's work has questioned a policy of greater dependence on user fees by emphasizing the potential welfare costs to consumers of higher fees for medical services. Many health professionals have adopted the jargon of this new approach without understanding the underlying analysis. This article attempts to demystify the debate that has ensued by illustrating economists' idiosyncratic approach to welfare, explaining how the policy paper and Gertler differ, and suggesting alternative approaches to testing the feasibility of the policy paper's prescriptions.

Fees, Medical↗
PubMed2001

Patients admitted to emergency services for drunkenness: moderate alcohol users or harmful drinkers?

OBJECTIVE: Most of the patients admitted to hospital emergency services are drunk. Some of them may need specific treatment after acute intoxication remits. At present, treatment for alcoholism is offered to less than 5% of these patients. The authors evaluated the biological markers carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) in patients admitted for acute alcohol intoxication (per DSM-IV criteria) supported by blood alcohol assay. These tests distinguished between otherwise moderate alcohol users who were acutely intoxicated and harmful drinkers or alcohol-dependent patients. METHOD: The authors conducted an exhaustive survey 24 hours a day during 2 nonconsecutive months. The study involved 166 patients (124 men and 42 women) who were admitted for acute alcohol intoxication as a principal or additional diagnosis. Their blood was analyzed for alcohol, GGT, and CDT levels. The CAGE questionnaire was administered, and social and demographic data were collected. RESULTS: About 80% of the population studied displayed elevated GGT or CDT levels (65.7% had CDT levels >60 mg/liter; 41.6% had GGT levels >65 IU/liter). Less than 10% of the patients with acute alcohol intoxication revealed results in the normal range for both markers and a negative finding on the CAGE questionnaire. CONCLUSIONS: Patients admitted to emergency services with high blood alcohol levels should not be assumed to be moderate drinkers. Any drunkenness should be interpreted as a sign of likely harmful alcohol consumption or alcohol dependency requiring clinical and biological tests, including GGT and CDT assays. Specific treatment for alcoholism should be systematically offered to these patients.

Adolescent↗
PubMed1984

Preventive care and overall use of services. Are they related?

The relationship between the use of services of children constantly enrolled in a prepaid group practice medical plan for six years and the completeness of their preventive care were examined. Children who were consistently low users of services were more likely to be lacking one or more components of standard preventive care, particularly general health assessments in older children and vision, hearing, and tuberculosis screening in younger children. Teenage children who were low users were at some risk of not receiving their tetanus-diphtheria immunization on time. The relationship between low use of services and incomplete preventive care persisted after controlling for the severity of morbidity, although children with more severe morbidity were somewhat less likely to be missing preventive care. Health facilities and practitioners should pay special attention to assessing the need for standard preventive care in children who are infrequent users of services.

Adolescent↗
PubMed1993

Costing medical libraries: the feasibility of functional cost analysis.

As a result of organizational changes in the National Health Service (NHS) there is a need for a coherent costing model for NHS libraries, particularly for the smaller libraries based in postgraduate medical centres. One possible model is functional cost analysis, whereby all costs are assigned to library functions representing services to users, such as loans from stock, interlibrary loans, enquiry services, etc. Using data from a 1991 survey of postgraduate centre-based libraries in the North West Thames (NWT) Region of the NHS, the feasibility and appropriateness of functional cost analysis is examined.

Budgets↗
PubMed2004

Survey of the use of transport by recipients of a regional Electric Indoor/Outdoor Powered (EPIOC) wheelchair service.

PURPOSE: To determine the extent to which Electric Indoor/Outdoor Powered wheelchair (EPIOC) users travel in vehicles, their concerns about safety, any accidents occurring during transportation and difficulties with their equipment. METHOD: All 268 EPIOC users on the departmental database were sent a purpose-designed postal questionnaire asking whether the respondent:--used the chair during transportation and in what type of vehicle; understood clamping processes; had a 'mishap' or an 'accident'; felt safe during transportation and wished to comment. Replies from two mailings resulted in 203 usable replies (76%). Responses and comments were entered into an Excel database. RESULTS: Thirty-seven (18%) users did not use any transport. Of the 170 (82%) who did: 51% used Dial-a-Ride, 44% taxis, 41% ambulances, 37% local authority transport, 34% cars and others 17%. Twenty-one (12%) experienced 'mishaps'--8 toppled out of their chairs and 6 reported clamping-related accidents. Headrests were only used by 69 (41%). Thirty-four (19%) of 182 expressing a view about 'feeling safe' felt unsafe sometimes. Wheelchair users often feel vulnerable when being transported by public providers. DISCUSSION: Risks of vehicular travel by wheelchair users could be reduced with appropriate equipment and regular review of NHS prescriptions, education of users, wheelchair services and transport providers.

Accidents, Traffic↗