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PubMed1990

Screening for hepatitis B and vaccination of injecting drug users in NHS drug treatment services.

Hepatitis B vaccines are now available for people at high risk of infection. Injecting drug users are at particular risk. A UK national survey of statutory drug treatment facilities was conducted to assess what screening and vaccination procedures were offered to drug takers. Of the respondents 64% did not screen for hepatitis B and 71% did not offer vaccination to hepatitis B negative individuals. However, 63% respondents said they would advise vaccination for injecting drug users who continued to share. Fifty-eight per cent thought that the partners of hepatitis B positive clients should be screened and 50% thought that vaccination of partners was advisable. A policy of screening and vaccination for hepatitis B is recommended.

Hepatitis B↗
PubMed2003

Use of mental health and substance abuse services among high-cost Medicaid enrollees.

Users of mental health and substance abuse (MH/SA) services were examined among nonelderly high-cost Medicaid enrollees in 10 states in 1995. Although MH/SA service users constitute 11% of all Medicaid enrollees, they make up nearly a third of high-cost enrollees. Adults account for two thirds of this high-cost MH/SA group, and most frequently qualify for Medicaid through disability-related eligibility categories. In contrast, a majority of children in the high-cost MH/SA group are eligible for Medicaid through child-related categories, rather than disability. In diagnostic makeup, the high-cost group was somewhat more likely to have serious disorders than the general Medicaid MH/SA user population.

Adolescent↗
PubMed2001

User fees, health staff incentives, and service utilization in Kabarole District, Uganda.

OBJECTIVE: To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda. METHODS: Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. FINDINGS: After the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%. Utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues. CONCLUSIONS: Incentive payments led the health workers to offer improved services. Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas.

Attitude of Health Personnel↗
PubMed1989

A strategy for coordination of end-user computing in hospital departments.

This paper discusses issues associated with end-user computing and describes an approach for coordination of departmental end-user computing that was implemented at Concord Hospital, Sydney, Australia. There are a number of pressures for end-user computing. These include the inability of IS departments to provide the services that users require, the increasing spread of computing skills and the advent of the microcomputer. The traditional approaches to computing are discussed and the concern over security explained. The potential benefits of greater involvement of users in systems development and support is discussed. Information systems development needs to be a collaborative activity. At Concord Hospital, a number of departments have responsibility for their own local minicomputer and microcomputer based systems. Coordination of this systems effort was seen as important in order to maximize the benefits of end-user computing while seeking to minimize duplication of effort, data or systems, or security risks.

Hospital Bed Capacity, 500 and over↗
PubMedDate not supplied

[Changes necessary for continuing health reform: I. The "external" change].

The article analyzes the need to obtain support from all actors if the reform of the health system is to be finalized. The relevant groups are the government, professional groups, workers, the population, civil servants, managers and firms with interests in the health field. It is necessary to develop a social marketing strategy that reinforces and broadens the current supports to change. Basic elements would be: Develop new service to satisfy users' needs; orient the services to defined "market" segments; position new services or "re-position" the existing ones in order to communicate their advantages; develop a plan of marketing based on promotion, prize and place focused on the role of health professionals as the main service sellers.

Commerce↗
PubMed1980

Geriatric day care and homemaker services: an experimental study.

The purpose of this study was to examine the impact of geriatric day care and homemaker services on patient outcomes. Patients were randomly assigned to receive the experimental services in three study samples. In comparing outcomes between the experimental and control groups, it was found that there were significant differences in physical functioning and activity level for the day care samples, in physical functioning and contentment level for the homemaker study sample, and in all of these outcome measures for the combined services group. Among users of the experimental services, increased use of the services was associated with improved outcomes of care. Multivariate analysis of data showed that factors other than the use of the experimental services were more effective in explaining variation in outcomes. Significant factors that affected all four outcome measures in both the day care and homemaker study were primary diagnosis, impairment prognosis, and number of inpatient hospital days.

Activities of Daily Living↗
PubMed1989

Participant observation and its place in the study of illicit drug abuse.

Participant observation has long been utilized as a valuable research methodology in the study of illicit drug abuse. It should not be viewed in isolation, but seen as an essential complement to the quantitative analysis of trends in drug use, such as epidemiological studies and the monitoring of services for drug users. Fieldwork conducted at the Drug Indicators Project and other relevant studies highlight the practical and ethical problems faced by the participant observer, including issues of access, co-operation and confidentiality. This is particularly pertinent when working with drug users not in contact with services. When working with drug users in a treatment context, the need to be flexible and sensitive to the needs of agency staff is stressed, and the ways in which participant observers can operate as volunteers are explored. Contemporary concern about HIV infection, AIDS, and risk behaviour amongst drug users, raises the potential for an expansion and redefinition of the role of the participant observer to take on some of the functions of health educator, and two options are suggested.

Humans↗
PubMed2005

Free does not mean affordable: maternity patient expenditures in a public hospital in Bangladesh.

OBJECTIVE: This study investigated a) the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b) the factors influencing these expenses, and c) the impact of these expenses on household income. METHODS: Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital. Patients were selected by quota sample to match the distribution of maternity patient categories in the hospital. Patients were interviewed with a semi-structured, in-depth questionnaire. RESULTS: All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was $65 (range $2-$350), equivalent to 7% (range 0.04%-225%) of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%-30% per month. A third of these families reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy) and unnecessary (e.g. episiotomy) medical procedures. CONCLUSION: Free maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures, otherwise adding service fees without reform of current hospital practices would lead to even more burdensome expenditures and inequities.

Journal Article↗
PubMed1997

Community participation in determining the needs of users and carers of rural community care services. Highland Community Care Forum.

In this paper we present the methods and key outcomes of a community led needs assessment exercise. The needs assessment sought to enhance the development of rural community care services by ensuring the views of users and carers were secured and considered in joint planning processes. The research was developed by members of the North and West Sutherland Community Care Forum. A community profiling template was developed and employed in five parish areas of Sutherland. This was drawn from 45 interviews with key informants and 2 community workshops, In addition 54 users and carers were interviewed. The outcomes of the needs assessment exercise identified geographical and cultural factors which present difficulties in developing services as well as posing barriers to user involvement.

Community Health Services↗
PubMed1997

Effect of primary care treatment of depression on service use by patients with high medical expenditures.

OBJECTIVE: The study examined the impact of identifying and treating depression among patients who had a history of high medical expenditures. Effects on service use, disability, and quality of life were measured. METHODS: A total of 786 high users of services from two primary care clinics and an equal number of randomly selected patients who were not high users were screened for depression using the Medical Outcomes Study (MOS) depression screen. High-user patients who screened positive were subsequently seen by their primary care physician for a diagnostic interview. The 20 patients with a confirmed diagnosis of depression were offered open-label antidepressant treatment by their primary care physician for six months. RESULTS: All 20 patients completed the six-month study. Treatment resulted in significant reductions in depression and significant improvements in quality of life in the areas of social functioning, general health, mental health, physical functioning, emotional role functioning, and vitality. Days of missed work per month were reduced, and the percentage of patients who reported not being at all impaired by their depression at work increased. Costs for service use fell from $13.28 to $6.75 per day; when costs for the treatment study were added, the daily service use cost was $12.55. CONCLUSIONS: Identification and treatment of depression among patients with a history of high medical expenditures improved depression and increased work productivity and quality of life. Service use decreased with treatment. A larger sample and control group are needed to determine if treatment is associated with a statistically significant decrease in medical expenditures.

Adult↗
PubMedDate not supplied

Dimensions of offsite distribution: a case study.

How does Support Services maintain user confidence while moving the laundry and central supply departments offsite? That challenge faced The Mont Sinai Medical Center, a 1112-bed Manhattan hospital and medical school, as it prepared for a 5-year, $488 million major modernization program, set to begin in the summer of 1985. Users were openly mistrustful of relocating two departments which had provided responsive on-site services to the hospital and the Mount Sinai School of Medicine since their incorporation in 1852 and 1963, respectively. Yet, the transition to temporary offsite facilities was structured, and generated sufficient user confidence to facilitate a planned move to permanent, state-of-the-art facilities and systems.

Hospital Administration↗
PubMed1998

What does quality mean to lay people? Community perceptions of primary health care services in Guinea.

The success of strategies to revitalize primary health care services such as those advocated by the Bamako Initiative requires a response adapted to the expectations of the population, especially in terms of quality. The goal of this study, conducted in two rural communities in Guinea, was to identify, characterize, and classify the criteria that the public uses to judge the quality of primary health care (PHC) services. This study included 180 participants in 21 focus group discussions. Forty-four main criteria were identified. These criteria vary depending on the respondents' sex and age, and their ability to access primary health care services. Some of the criteria correspond to those used by health care providers, while others do not. The general public places considerable emphasis on outcomes, but little emphasis on preventive services. The users appear very sensitive to aspects of the interpersonal relations they have with professionals and the technical quality of the care provided. A taxonomy of perceived quality is developed, which includes the following five categories: (1) technical competence of the health care personnel; (2) interpersonal relations between the patients and care providers; (3) availability and adequacy of resources and services; (4) accessibility and (5) effectiveness of care. It is a major challenge to refocus on quality in the development of health care services. This will require considerable changes for which training may be an effective, but certainly not a sufficient means. Promoting professionalism and changing the relations between public authorities and the general public are the only means of improving the quality of health care services as well as user perception.

Adult↗
PubMedDate not supplied

Web portal to an image database for high-resolution three-dimensional reconstruction.

The exponential increase of image data in high-resolution reconstructions by electron cryomicroscopy (cryoEM) has posed a need for efficient data management solutions in addition to powerful data processing procedures. Although relational databases and web portals are commonly used to manage sequences and structures in biological research, their application in cryoEM has been limited due to the complexity in accomplishing the dual tasks of interacting with proprietary software and simultaneously providing data access to users without database knowledge. Here, we report our results in developing web portal to SQL image databases used by the Image Management and Icosahedral Reconstruction System (IMIRS) to manage cryoEM images for subnanometer-resolution reconstructions. Fundamental issues related to the design and deployment of web portals to image databases are described. A web browser-based user interface was designed to accomplish data reporting and other database-related services, including user authentication, data entry, graph-based data mining, and various query and reporting tasks with interactive image manipulation capabilities. With an integrated web portal, IMIRS represents the first cryoEM application that incorporates both web-based data reporting tools and a complete set of data processing modules. Our examples should thus provide general guidelines applicable to other cryoEM technology development efforts.

Cryoelectron Microscopy↗
PubMed2001

A 'fair innings' for efficiency in health services?

This paper reviews the severe visual focus problems of health economists-they have developed a one-sided fixation with equity issues, neglecting the efficiency agenda. The problems of meeting need are not just about access--they will vary with cost and supply. Economists in fact developed a more balanced agenda in the 1970s but have failed to follow it up. The paper defines the triple nationalisation of the National Health Service (NHS), and presents evidence that pluralism, using the purchaser/provider split, has become more efficient in long term care, home care and services for people with learning difficulties. Health economics has failed to explore options for using the dynamic forces of choice and competition for improving health services. The paper makes the case for a decision rule that "we should seek the process of health care service supply and development which maximises the delivery of high quality, lower cost user relevant services".

Cost Control↗
PubMed2006

Assessing the need for certainty in users of a clinical genetic health service.

AIM: This paper presents a study investigating the need for closure in users of a genetic health service. BACKGROUND: Genetic healthcare services are used by people who are concerned about a genetic condition in the family. Many clients expect information about the condition, risk assessment and discussion of options available to minimize the impact of the condition on the family. Some use the information to try to obtain certainty or cognitive closure. The psychological theory termed 'need for cognitive closure' explains individual differences in motivation to seek information. The tendency to seek closure can be measured by the Need for Closure Scale, which has five sub-scales: preference for order, preference for predictability, discomfort with ambiguity, decisiveness and closed-mindedness. METHODS: Clients who were referred to our genetic service in 1998 were approached before personal contact with staff of the genetic service. Fifty-two people completed the need for closure scale questionnaire. Six months after the genetic consultation, participants were asked to complete the questionnaire again (n = 45). The data were statistically analysed using Cronbach's alpha, paired t-tests and independent t-tests. RESULTS: There were no statistically significant differences in Need for Closure Scale scores in this cohort before and after the genetic consultation. Participants scored highly on the preference for order and discomfort with ambiguity sub-scales, but scores for closed-mindedness were low. Intolerance of ambiguity was statistically significantly higher in participants whose main concerns centred on their children. CONCLUSIONS: This psychological theory can help healthcare professionals to understand the motivation of clients who seek information from genetic services, and enhance understanding of those who avoid using the service. It cannot be assumed that additional knowledge is helpful to all clients, nor that knowledge of bad news is necessarily an adverse event if prior uncertainty has existed.

Adolescent↗
PubMed1978

An epidemiological approach to the study of users and nonusers of child health services.

A case-comparison study was carried out in 1972 to determine the characteristics of users and nonusers of child health services. A sample of 529 mothers with children under five years of age (eligible children) residing in one poor barrio in Cali, Colombia was selected. The characteristics of mothers and their eligible children were described in relation to their use or nonuse of health services and a set of indicators was develop which differentiated the nonuser group from the user group. A two-stage sampling technique was used. First, blocks in the barrio were sampled, and second, an equal number of mothers with eligible children who used and who did not use services in the year prior to the study were selected for interview. Nonusers were matched with users on distance from home to local health center. The set of indicators which best discriminated the groups was: the number of eligible children, age of mother, access to free medical care, the action proneness score (attitudes), and knowledge of health, illness, and services. The study method permitted identification of the target population for services, determination of current patterns of use, and quantification of morbidity and immunization levels.

Adult↗