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PubMed2001

Counselling for alcohol problems in primary care in Forth Valley--an innovative approach?

OBJECTIVE: To explore the implications of establishing a voluntary sector provided alcohol counselling service within a Primary Care setting in Forth Valley Health Board area, and to evaluate the potential of such a project. DESIGN: Analysis of routinely held information and postal questionnaire survey. SETTING: North and South Local Health Care Co-operatives, Forth Valley Primary Care NHS Trust in conjunction with Central Scotland Council on Alcohol (CSCA). SUBJECTS: Users of counselling service and local general practitioners. RESULTS: General practitioners referred a total of 349 people with 284 attending for counselling. Survey of a sample of 80 service users achieved a 45% response rate. Of those who responded a majority (89%) said that the health centre location was an important factor in their ability to use and therefore benefit from the service. Accessibility, quality and confidentiality of the counselling service were important factors determining ability to attend and benefit from counselling. The survey of local general practitioners achieved a 69% response. The majority (96%) of general practitioners reported the service to be either extremely valuable or very helpful. General Practitioners listed 3 major benefits as confidentiality, accessibility and cost effectiveness. A significant minority of general practitioners (24%) reported that they were unaware that the service existed. Compared with other routine CSCA counselling services people's reported alcohol consumption was some 18% higher in those referred to the primary care based counselling service. At review, four weeks later, the average reported alcohol consumption had decreased considerably. People using the counselling service reported that the service helped them reduce their alcohol consumption, improve their general health and their personal relationships. CONCLUSION: This project has demonstrated that a voluntary sector agency can work closely and successfully with primary care services in establishing counselling services for those with alcohol problems. Early evaluation would point towards success in terms of reducing reported levels of drinking and improved health. Local general practitioners indicated their support for continued development of this type of service provision.

Adult↗

PubMed2006

Health services usage by Alaskan injection drug users.

OBJECTIVES: The purpose of this study was to explore health services usage among injection drug users in Anchorage, Alaska. DESIGN: 645 participants were recruited as part of a federally funded study of needle exchanges. They completed a health services usage questionnaire that elicited information on use of a health care provider (physician or nurse) and emergency room services. Chi-square and t-tests were used for the bivariate analyses, and multiple logistic regression was used to develop the final predictive models. RESULTS: The majority of respondents (n = 646) were male (77 percent). Race/ethnicity included 58 percent White, 22 percent Alaska Native, and 20 percent African American. The multivariate model predicting accessing a health care provider (HCP) included ever having had chlamydia (OR 2.7, CI 1.6, 4.5), current income from welfare or public assistance (OR 2.6, CI 1.7, 3.9), current income from disability (OR 5.0, CI 2.2, 11.4), current income from SSI (OR .30, CI .12, .77) and the number of days in the last 30 used opiates other than heroin (OR 1.04, CI 1.002, 1.078). The multivariate model predicting use of an emergency room (ER) was similar to that predicting use of an HCP, with the additional finding of a negative association between being African American and ER use. CONCLUSION: The role of public assistance benefits enabling access to health care for IDUs has policy implications. Large public programs, such as the Indian Health Service, paid for much of the health care received by the IDUs recruited as part of this study.

Adult↗

PubMed1999

User involvement in identifying health needs and shaping and evaluating services: is it being realised?

The rhetoric of user involvement has featured in health policy documents for over a decade. However, there is mixed evidence as to the extent to which it is being achieved. This paper explores what is meant by user involvement, proposing that it exists at a series of levels ranging from information giving to true empowerment. Examples are presented from two practice development projects. The first sought to develop multidisciplinary audit in primary care, attempting to involve users in defining health needs and determining services. Although the project co-ordinators were highly committed to user involvement this was only achieved to a limited extent. It was concluded that there was a resistance to user involvement grounded in the fear that such involvement would increase user expectations and add to the pressures of overworked primary care teams. The second project used interviews with service users to assess the effectiveness of a team building initiative. Users were found to be knowledgeable about practitioner roles and how to access the care they required. The overall conclusion is that there needs to be a shift from rhetoric to reality at governmental and practitioner level if true user involvement is to be achieved.

Attitude of Health Personnel↗

PubMed1996

A new clinical laboratory information system architecture from the OpenLabs project offering advanced services for laboratory staff and users.

The OpenLabs project aims to improve the efficiency and effectiveness of clinical laboratory services by integrating decision support systems with laboratory information systems and equipment. Standards for electronic data interchange between laboratories and other medical systems using the EUCLIDES/OpenLabs coding scheme and an open architecture for clinical laboratory information systems have been specified. This article gives an account of the proposed architecture and outlines new software applications being developed using the architecture which provide advanced services for ordering and reporting of laboratory tests, advanced instrument workstation and laboratory management services, including an OpenLabs Service Manager application which co-ordinates the available services.

Chemistry, Clinical↗

PubMed1997

[Prescription of generic drugs in the health area of Zamora. Benefits for the users and the National Health Service].

OBJECTIVE: To know the highest possible saving in pharmaceutical expenditures for the active user and for the National Health System (NHS), by replacing trademark specialties of Social Security prescriptions in 1995 by other generic medicines. DESIGN: Economic evaluation study for minimizing cost. SETTING: Health Area of Zamora, 1995. MEASURES AND MAIN RESULTS: 32 active components were selected (58 presentations and 24 therapeutic groups) marketed under generic denomination that were equivalent to specialties with identical composition-presentation and more expensive. For all those medicines that include the 32 active components, the following data were obtained from the pharmacy Management Computer System (SIFAR in Spanish): number of containers, amount and percentage prescribed to pensioners and active population, breaking down the amount of actives for the Health System and for the user. Out of the 153,885 dispensed containers analyzed in the study, 2.83% belong to those dispensed under generic denomination. The estimated possible saving could have been about 56,991,515 PTAs corresponding to 85.5% of pensioners and 14.5 of the active population. The saving for active users could have reached 4,387,523 PTAs. CONCLUSIONS: The prescription of generic medicines allows us to improve the efficiency of the NHS because the saving generated may positively have an effect on the system itself without loosing quality or freedom in the prescription.

Costs and Cost Analysis↗

PubMed2001

User focus groups and Best Value in services for people with learning disabilities.

This paper examines the problems and potentials of employing user focus groups as part of an approach to defining and reviewing Best Value in local authority and jointly commissioned services for people with learning disabilities. Drawing on experience from three local authority initiatives and wider experience with Best Value, the paper describes the development of user focus groups for helping review adult placement, outreach and day services for people with learning disabilities. The key methodological considerations for consulting with service users with learning disabilities through focus groups are identified and the interpretation of outcomes considered. The paper concludes with pointers for the effective operation of user focus groups in local authority Best Value reviews of services for people with learning disabilities, of use to practitioners, service managers and commissioners.

Adult↗

PubMed2004

Use of mental health and substance abuse treatment services by female injection drug users.

This article examines whether female injection drug users (IDUs) who have a history of using mental health services (i.e., one or more psychiatric hospitalizations or counseling) enter types of drug treatment different from those of female IDUs who do not have a history of using mental health services. Data used for this exploration originate from a statewide drug-treatment database covering all women who entered drug treatment in the state of Massachusetts from 1996 to 2001. A total of 7776 women were included in the study. Through the use of logistic regression analysis, the study determined that those female IDUs who had a mental health service history, compared with female IDUs who had no such history, were about two-thirds more likely to enter substance abuse treatment other than detoxification only. Specifically, women with a mental health service history were about 66% more likely to enter substance abuse treatment modalities such as drug-free outpatient counseling, methadone maintenance, and/or long-term residential services rather than detoxification alone. This is a positive result, indicating that female IDUs who have mental health problems and therefore have high needs for effective substance abuse treatment are entering the more intensive and/or longer term modalities likely to lead to better outcomes. Possible factors accounting for this, including the referral process within detoxification centers, the role of community referral agents, and the experience women gain as a consequence of receiving services in more than one service system, are discussed.

Adolescent↗

PubMed2005

Illness incidence and health seeking behaviour among street children in Rawalpindi and Islamabad, Pakistan - a qualitative study.

BACKGROUND: This is the first study in Pakistan to elicit street children's perceptions of health and the barriers to service utilization. METHODS: A descriptive, cross-sectional study was carried out during September and October 2000. The data were collected in twin-cities of Rawalpindi and Islamabad through individual, semi-structured street-based interviews; with 40 school age participants; in addition, three focus group discussions were also completed. The sampling was convenience based. This strategy was applied because of the non-existence of a sampling frame for the street-based children owing to the absence of any census or other reports, and also the difficulty of tracking very mobile street children. RESULTS: Results indicate that these youth were highly susceptible to many adverse health outcomes. The common ailments were injuries, respiratory and skin infections. Along with low self-perceived severity of medical problems, self-medication was preferred and medical pluralism existed. Their perceived constraints to services included long waiting time, monetary, negative attitude of service providers and their inferior status. CONCLUSIONS: In developing user-friendly services, it is important to be sensitive to street children's needs and requirements. Eliminating these barriers and the integration of health services among public and private resources are imperative for the regular and sustainable provision of health care to this vulnerable, under-served group of children.

Adolescent↗

PubMed1992

Children in foster care in California: an examination of Medicaid reimbursed health services utilization.

The number of children in foster care in California doubled from 27,534 in 1980 to more than 62,419 in 1988, representing approximately 1% of the child population in the state. Past studies have demonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care. Although children in foster care represent 4% of Medi-Cal-eligible children younger than 18 years of age, they account for approximately 5% of children using Medi-Cal services and 6.7% of expenditures, representing a 23% greater utilization rate and 41% greater expenditure rate than all children covered by Medi-Cal. Using the entire Medi-Cal population younger than 18 years of age as comparison group, examination of inpatient and outpatient service utilization for specific condition categories showed few differences between children in foster care and the comparison group except for mental health service utilization, where children in foster care were much higher users of services.

Adolescent↗

PubMedDate not supplied

[Bi-national utilization of health services in the Mexico-United States border: the case of the population of Tijuana].

The U.S.-Mexico border is a region where two neighboring countries share a dynamic exchange of cultural, demographic and economic activities. Regarding the use of health services, there is growing concern among American officials that part of the indigent health care burden in the Southwestern United States may be caused by residents of Mexico who cross the border to use U.S. health services. If this is true, it could be the result of unmet needs in the Mexican health care system which spill over across the border. This article examines the extent and volume of use of health care services by Tijuana residents in both countries. It also identifies the factors that predict the use of U.S. health services. The data reported were obtained from a community survey, conducted in June 1987, based on a random sample of 660 households. The results reveal that despite the geographical proximity and a tradition among Mexican border residents to consume American products, when it comes to health services, the local Mexican health care system is prefered. In fact, the use of Tijuana based services is 16 times higher than in the U.S. The users of services in the U.S. tend to choose the private sector and pay out of pocket. The findings indicate that socioeconomic status, sex and age are significant predictors of U.S. service utilization. We conclude that the low demand for U.S. services does not interfere with Mexico's health system. However, we recommend that future studies assess the extent of use of Tijuana services by U.S. residents, so that we can assess the magnitude of cross border utilization.

Adolescent↗

PubMed1990

Subsequent behavior of users of an arthritis information telephone service.

Followup telephone interviews were conducted with a stratified random sample of 305 users of a prototype telephone information service for arthritis 2-4 months after their initial contact with the service. The percentage of respondents who reported taking at least 1 positive action for their arthritis because of service usage was 79%. The most frequently reported actions of users were asking their doctor more questions and greater compliance with their doctor's orders. About one-half of the respondents felt more in control of their arthritis because of service usage. Both the taking of at least 1 action and the taking of certain specific actions were significantly correlated with feeling more in control of the arthritis (P less than 0.01). Respondents who were less than 60 years old, black, or symptomatic were significantly more likely to take an action and took significantly more actions (P less than 0.01). This minimal intervention may stimulate positive behaviors for individuals with arthritis.

Arthritis↗

PubMedDate not supplied

[From "how many" to "why": the utilization of health services from the perspective of the users].

Parallel to the National Health Survey-II, in 1994 a qualitative study was conducted on the patterns and microsocial determinants of health services utilization. The study was conducted in eight urban areas from all over the country among middle class and middle-low class sectors. A total of 192 individual open-ended interviews and eight focus groups were completed among users of health services; 61 service providers both from public and private services were also interviewed. This paper reports the main findings regarding the users' perspective. The first part summarizes the conceptual and methodological design. The second part presents the results from the users' point of view. Individuals distinguish between "becoming sick" and "falling sick"; preventive measures are adopted when becoming sick, in order to avoid falling sick. Another finding refers to the population tendency to add up different and even contradictory curative paradigms, as opposed to the modern medical paradigm which tends to exclude any competing alternative knowledge. A third series of findings refers to the dilemmas that utilizing health services poses for the population, given the high costs, and the low quality that characterize these services, according to the users' point of view. This paper concludes with a series of recommendations for policies, aimed at improving the quality of the health services provided to the population.

Health Behavior↗

PubMed2005

Digital chat reference in health science libraries: challenges in initiating a new service.

Digital reference service adds a valuable new dimension to health science reference services, but the road to implementation can present questions that require carefully considered decisions. This article incorporates suggestions from the published literature, provides tips from interviews with practicing academic health science librarians, and reports on data from students' exploration of academic health science library Web sites' digital reference services. The goal of this study is to provide guidelines to plan new services, assess user needs, and select software, and to showcase potential benefits of collaboration and proactive and user-friendly marketing. In addition, tips for successful operation and evaluation of services are discussed.

Computer Communication Networks↗

PubMed2001

Hepatitis services at an injecting drug user outreach clinic.

AIMS: To provide a culturally appropriate, accessible and affordable hepatitis outreach clinic for injecting drug users, a traditionally hard-to-reach population. METHODS: The community-based clinic, a collaborative project between the Wellington Drugs and Health Development Project and Capital Coast Health, was established in Wellington in 1997. Characteristics of the first 100 injecting drug users with hepatitis C assessed through the clinic are presented. RESULTS: Of 51 patients found to be hepatitis C positive, five have received hepatitis C treatment, four at the outreach and one at a base hospital. 25 have been vaccinated for hepatitis B. The clinic has established trust and rapport with the injecting-drug-user community. CONCLUSIONS: The hepatitis outreach clinic is an innovative project, crossing the primary/secondary interface of health services provision and providing personal health services within a public health initiative. The success of this model indicates potential value in offering outreach hepatitis clinics for injecting drug users in the major cities to close a gap in health service provision.

Adult↗

PubMed1999

Information services for primary care: the organizational culture of general practice and the information needs of partnerships and primary care groups.

In a primary-care led National Health Service it is imperative for librarians not only to develop user-centred services for health professionals based in the community but also to facilitate information management within Primary Care Groups. In this article recent research in the field is discussed, and challenges intrinsic to delivering information services to primary care are identified. Drawing on the experience of one Practice Librarian in the Aylesbury area, the importance of organizational culture is considered, along with its implications for making successful approaches to partnerships. Five factors that motivated these practices to contract the services of an independent librarian are identified. The information needs of Primary Care Groups are discussed and the essential characteristics of future service provision are noted.

Cooperative Behavior↗

PubMed2000

GABAagent: a system for integrating data on GABA receptors.

MOTIVATION: Scientific data pertaining to GABA receptors, which are of medical importance, are widely scattered throughout numerous heterogeneous Internet resources. This situation has made the integrated acquisition of such data difficult and substantially time consuming even for researchers who are Internet aficionados. Thus, there exists a genuine need for the development of Internet applications, such as GABAagent, which provide efficient and timely access to concise and integrated information. RESULTS: We report here the establishment of a novel server (GABAagent) which has been written in Perl script, and which is freely accessible through the Internet. GABAagent is designed to assist researchers in retrieving focused and integrated information related to GABA receptors from various public domain databases. GABAagent relies on server-side flat-file databases that have been created through data mining from Internet sources such as the PubMed, DDBJ, SWISS-PROT and TrEMBL, in addition to the many World Wide Web (Web) sites which are accessible through Excite (E-Web). These warehouse databases are regularly updated and contain among other things, information concerning: (i) GABA receptor publications, (ii) DNA and protein sequences and (iii) the contents of related E-Web sites along with their addresses. Our system also provides hard links to the above-mentioned Web sites and E-Web sites; the feature which adds to it the character of virtual federation type of database. The current version of GABAagent provides two user-friendly services. The first is a search engine possessing intelligent query reformulation support (GABAengine), the second an elaborate email alert service was designed into the system (GABAalert). The GABAengine allows the user to search server-side databases exclusively for GABA receptor-related queries. Whereas, GABAalert allows the user, by means of subscription, to receive immediate and/or monthly updates automatically. AVAILABILITY: GABAagent is freely accessible at the following Web address http://www.ust.hk/gaba.

Databases, Factual↗

PubMed2003

Health sector reforms--what about hospitals?

Health is a changing concept. There are cultural, social, economic and technical aspects involved in this concept. Out of the eight Millennium Development Goals adopted by the UN in 2002, three goals in particular address health issues. But all the goals have a strong bearing on health--be it poverty and hunger eradication, education, gender equality and women empowerment, the physical environment or social and economic development. Health care must be complete and offer specialist and hospital services as well. Hospital services must be related to the major outcomes desired by its users. Hospital service provision must also be connected to current needs and not based on history or physical infrastructure. The roles of hospitals as specialist service providers are today widely acknowledged. They, however, do not just provide health care, but also training for staff in different skills, generating trained nurses, laboratory technicians and other health professionals. Against this background, how then can a hospital, which plays a number of necessary, highly desired or sometimes unavoidable roles, be best defined--besides the buildings themselves?

Global Health↗

PubMed1998

Long-term evaluation of the CancerNet WWW service.

To improve the quality of healthcare, we offer access to high quality guidelines to physicians as well as information harmonized with these guidelines to concerned patients via internet. We launched this service in 1994. Since then, we have been offering user-friendly access to the NCI's CancerNet via WWW (http://www.meb.uni-bonn.de/). Among other information, CancerNet by the National Cancer Institute contains up-to-date summaries on the prognosis, staging, and treatment of more than 80 major tumor types. To obtain information about how users navigate through this service, all users' activities are logged by using cookies for tracking them without injuring privacy. To get additional information about our users and their interests regarding our service, we performed user surveys in 1996 and 1997. The analysis of 538 valid answers in 1996 and 1001 in 1997 show that the attempt to bring high quality information and guidelines to physicians and patients was successful. About 95% of our users rated our service "excellent" or "good".

Female↗