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PubMed2006

Ryan White CARE Act Title II survey: services for HIV-positive substance users.

A national survey was conducted among Ryan White CARE Act-funded providers to determine what types of services are specifically provided for HIV-positive substance users through Title II within the context of the overall delivery system for substance abuse treatment services. There was an 87% return rate on questionnaires representing 47 states. Only 18 of the 47 states reported funding some form of substance abuse services. The results show (1) the types of substance abuse services funded under Title II, (2) what special populations are served by those programs, (3) additional funding sources utilized by those programs, (4) the common systemic barriers to care, (5) the greatest programmatic barriers to care, and (6) gaps in knowledge about unmet needs for HIV-positive substance users. Some states have been quite innovative in targeting resources to support HIV-positive substance users while others report less activity. Although design and implementation of innovative programs for HIVpositive substance users rests with service providers, state agencies responsible for Title II planning are in the best position to identify system strengths and weaknesses.

Adolescent↗

PubMed1983

Cost-effectiveness and user characteristics of clinic based services for the treatment of diarrhea: a case study in Bangladesh.

This study compares the cost-effectiveness of three services for the treatment of diarrhea, in a rural area of Bangladesh. It also examines patterns of user composition, and how these depend on factors other than disease severity and incidence. The three services are a large hospital-style treatment center, an ambulance system bringing patients from greater distances, and a small treatment center staffed by paramedics. The results show that the long run average cost per patient is about +16 at the large center, with an additional +13 if the patient came by ambulance, compared to +3 at the small center. Corresponding costs per death averted were +1300, an additional +360, and +190 respectively. Previous studies have suggested that there is no more cost-effective alternative for the prevention of diarrhea, although in future home-based oral rehydration therapy may be a potential alternative. Each service exhibits use patterns suggesting that males and especially small boys receive preferential access to treatment. This bias is exacerbated as distance from the center increases, or if a fee is charged. The study concludes firstly that diarrhea treatment costs in clinics are relatively high, and secondly that unintended biases in service use should be an important consideration in service design.

Allied Health Personnel↗

PubMed1993

Characteristics of repeat users of a psychiatric emergency service.

OBJECTIVE: Patients who visited a psychiatric emergency service were studied to determine whether repeat visitors, who consume a disproportionate share of services, could be identified by demographic and diagnostic characteristics. METHODS: Data were obtained from a semistructured diagnostic interview given to all 16,257 persons who made 29,214 visits to an urban psychiatric emergency service in Pittsburgh, Pennsylvania, from 1985 to 1989. Patients were categorized into four groups based on the number of visits in the five-year period. Patients in group 1 made a single visit, while those in group 2 averaged less than one visit per year; those in group 3 made one or two visits per year, and those in group 4, more than two visits per year. RESULTS: Groups 3 and 4 constituted 5.1 percent of the sample but made 27.1 percent of the total visits. Repeat users were significantly more likely to be male, younger, unmarried, unemployed, and nonwhite and to have diagnoses of schizophrenia, other psychotic disorders, and personality disorders. CONCLUSIONS: Repeat users of psychiatric emergency services appear to have demographic and diagnostic characteristics that may permit their early identification. For such patients, implementation of alternative management strategies, such as intensive case management, may reduce their use of services.

Adolescent↗

PubMed2001

User charges and utilisation of obstetric services in the National Capital District, Papua New Guinea.

This cross-sectional study examined user charges on the utilization of obstetric services in the 4 urban clinics and antenatal and postnatal wards of the Port Moresby General Hospital (PMGH) in the National Capital District, Papua New Guinea. Analysis of previous records showed attendance to antenatal clinics on first visits declined by 30% soon after the introduction of use charges. However, the frequency of attendances increased and stabilized 12 months after the introduction of the user fees. The mean age for the 482 mothers interviewed was 25 years (range = 15-46 years, SD = 5.3). Over 50% of mothers were between 15-24 years of age and 47% over 24 years. 98.6% were married and a small proportion were single and divorcees (1.4%). Over 85% of mothers had some formal education while 15% without. The frequency of hospital deliveries did not change despite increased in user charges in the PMGH delivery and postnatal care services. Twenty four percent of mothers interviewed indicated they were unable to pay user fees. Mothers unable to pay the user charges were those without income or whose spouses were without regular income. In 23.2% of mothers with some income, majority indicated ability to pay the user fees. There was a minority group of mothers without income but relied heavily on their spouses income to meet the user fees. Mothers living in households with some income were twice more likely (OR = 2.18, 95% CI 1.24-3.83, p = 0.002) to have the ability to pay user fees than those without. Two other significant indicators associated with mother's ability to pay user fees were employment and knowledge of existence of the user charges. Over 79% of mothers indicated willingness to pay user charge fees. Mothers with income were nearly three times more likely (OR = 2.77, 95% CI 1.36-5.78, p = 0.002) willing to pay user charge fees than those without income. Other indicators that showed significant association with willingness to pay user charge fees were employment, income and knowledge of user charges. Although small proportion of mothers were unable to meet the user charges, results in this study showed majority of mothers were able and willing to pay user charges if they had prior information to the charges and supported by some form of income. The results of the study suggests the typical support practised by the society where the spouse and relatives assist with health care especially with maternal health is encouraging. However, the scope of this study cannot be used to generalise the trend in PNG because the scenerio in the rural areas will vary from urban.

Adolescent↗

PubMed2005

Mission statements: an example of exclusive language in palliative care?

This article discusses the language used in palliative care and the possibility of exclusive language being a barrier to uptake of services by users. The author illustrates this with an analysis of mission statements from palliative care services in an Australia state. Although language is just one aspect affecting service use, this author argues that services need sensitivity about the language they use, so that public statements are understandable and remain consistent with the philosophy of care.

Communication↗

PubMed2006

Providing opioid substitution treatment to Indigenous heroin users within a community health service setting in Adelaide.

In the late 1990s there was major concern regarding heroin use among the Nunga community in Adelaide. [Nunga is a generic term used for Aboriginal people from South Australia, similar to Koori's from Victoria and Nyungars from south-western Australia.] Heroin use was so common that community members reported that most families were affected by it in some way. There were few Nunga specific services provided, and those mainstream services available were not seen as culturally appropriate or for other reasons were difficult to access. In response to this, the Parks Community Health Centre, together with the Drug and Alcohol Services Council (DASC) [in 2005 the Drug and Alcohol Services Council (DASC) changed its name to Drug and Alcohol Services South Australia (DASSA)], and with the assistance of Nunkuwarrin Yunti Aboriginal Health Service [Adelaide's Aboriginal Community Controlled Health Service, based in the City Centre], commenced a programme offering treatment interventions for Nunga heroin users. The 'Way Out' Program commenced in March 1999. It is multi-faceted and includes an opioid substitution programme which is attracting and maintaining Nunga clients in greater numbers than ever before in South Australia. The programme locates the drug problem within a holistic view of the individual's health. It utilises networks throughout the Nunga community and in recent years has formed a strong working partnership with the Aboriginal Kinship Program [the Aboriginal Kinship Program (Department of Human Services, Metropolitan Health Division) works with Aboriginal families and individuals seeking support for family members in relation to illicit drug issues by providing support, referral, follow-up and advocacy services]. The 'Way Out' Program is succeeding in making essential treatment services available to Aboriginal people using heroin within Adelaide. This article provides an overview of the programme.

Buprenorphine↗

PubMed1992

Costs and use of public mental health services by ethnicity.

This paper used data obtained from Santa Clara County, California, to study the costs and use of public mental health services among ethnic populations (Asians, Blacks, Hispanics, and Whites). The study had access to 12,436 unduplicated users of services. The study found Whites had the highest per capita costs, while Asians incurred the lowest. However, after controlling for other demographic characteristics, Asians incurred higher costs than Whites. This reversal of Whites and Asians occurred because cost distributions are more skewed for Whites than Asians. Asians had the highest median costs and Hispanics the lowest. The top 5% of users incurred about 50% of the total public mental health costs.

Adolescent↗

PubMed2004

The wound dressing supply chain within England's National Health Service: unravelling the context for users.

AIM: To explore the representation of user needs (nurses and patients, both individuals and groups) at the industrial (wound dressing manufacture) and National Health Service interface. MAIN ISSUES: The wound dressing supply chain is outlined, tracking organizational changes. The methods that are used to transfer user information between industries that produce dressings and those using the products are reviewed in terms of their ability to communicate what users need from dressings. Organizational policies and systems are outlined, with the focus on their role in facilitating the communication of user needs. CONCLUSION: Methods for generating user information that can directly inform dressing design are needed together with interactive communication routes within the supply chain, specifically between users, manufacturers, purchasers and suppliers. This will facilitate dual benefits for nursing management through improvements in purchasing decisions and nurses' management of wound care.

Bandages↗

PubMed2001

An analysis of stressors and co-morbid mental health problems that contribute to youth's paths to substance-specific services.

Substance-specific services are tailored to address the inappropriate use of chemicals such as alcohol and marijuana. Unfortunately, few teens ever access such need-based services. This article explores the paths to substance-specific service use in a sample of urban adolescents who are public service sector users: a direct path from substance misuse and an indirect path from general mental health service use. Results indicate that even though a significant percentage of youths frequently consume substances and display negative use-related behaviors, few actually received substance-specific services. Contributors to the substance misuse path included youths' family substance dependence and environmental stressors. Contributors to the mental health services path were comorbid depression and substance misuse.

Adolescent↗

PubMed2004

Better definition of vocational services is critical within substance user treatment programs.

Vocational rehabilitation in substance user treatment programs is often poorly defined; programs rarely provide adequate descriptions of the vocational services they offer. There is no standardization in the content of vocational counseling, in the format of its delivery, or in the qualifications of staff that deliver it. Thus, the type, intensity, and quality of vocational services can vary widely among programs, as well as over time within a given program due to vocational staff turnover. However, current demands for greater accountability in social services pose a challenge to this state of affairs. There is no evidence that vocational services as currently delivered in treatment programs are either effective or even reasonably efficient. Note that "programs are increasingly called on to justify their existence, their expenditure of funds and their achievement of objectives. Behind the call for accountability is an awareness of the gap between almost unlimited social need and limited resources" (Weiss, 2004). It is difficult to achieve accountability for ill-defined and variable vocational services.

Counseling↗

PubMed1982

Hospital association libraries: an overview.

Results of a survey conducted by the Library of the American Hospital Association to gather data about library and information services provided by other hospital associations are reported. Topics covered include staffing, funding, collection size, users, and services. The interface of these libraries with other health sciences libraries and the national Biomedical Communications Network (BCN) is discussed.

American Hospital Association↗

PubMed1983

An analysis of the use of Medicare services by the continuously enrolled aged.

This article discusses the utilization patterns of the Medicare aged who were continuously enrolled in the program for over a 4-year period. Data used for this study were compiled from a random sample of Medicare beneficiaries in Colorado who were continuously enrolled from October 1974 through December 1978. Five utilization variables: medical office visits, medical relative value units (RVUs), surgical RVUs, inpatient days, and covered dollars were examined in the article. Results from this study are consistent with previous longitudinal analyses. Consistent high users of services who consume substantial proportions of total expenditures and consistent nonusers having no or few services were found. During an average year of the 4-year period, it was observed that 18 per cent of the beneficiaries accounted for 88 per cent of the cost of services delivered. Because these high users tend to remain high users over time--more than one third of the high users in a given year continue to be high users during the following year--the findings here suggest that cost-containment strategies targeted to these high users may have a strong impact on overall Medicare program costs. Multivariate analysis is also conducted in this article so that the determinants of utilization patterns over time could be examined. Of particular interest is the finding that seasonal and trend variables play an important role in determining utilization over time.

Aged↗

PubMed1986

[Psychiatric emergency care and crisis intervention--concepts, experiences and results].

Psychiatric emergencies and life crises are located at opposite ends of a broad scale of stages requiring acute help: Emergency cases need immediate medical care in order to prevent danger to life. For the same reason, immediate hospital admission and additional treatment of risks of internal medicine have to be provided, if necessary. Crises often have not only mental but also social aspects. The immediate urgency of treatment is determined by the psychiatric (suicidal) or the physical risk. Emergency cases and severe crises require a 24-hour medical service. Social aspects cannot be settled in the night-time, even if they are urgent. Emergency and crisis intervention services with a multidisciplinary staff therefore ascribe different roles to physicians, nurses and social workers. Since 1976, the Central Institute of Mental Health provides a 24-hour crisis intervention and emergency service both at the Institute and at the emergency ward of the Mannheim University General Hospital. Within few years, the number of treated episodes has increased to 1,800-1,900 per year. The distance between the place of work or residence is a decisive factor of service utilization. Over 50% of the users of the emergency and crisis intervention service are mentally ill. Only a small part are contacts for crises without psychiatric disorder. Suicidal attempts or intentions account for about 30% of the service users, marriage crises for about 25% and alcohol problems also for about 25%. The development of complementary care in Mannheim has led to a parallel increase in the proportion of chronically mentally ill living in complementary facilities. This clearly indicates that a 24-hour emergency and crisis intervention service is a compulsory prerequisite for the implementation of an efficient system of complementary care for the mentally ill.

Adaptation, Psychological↗

PubMed1985

TACOS: TAble of COntents Service in the hospital library.

TACOS is an acronym for TAble of COntents Service. It provides recipients with photocopies of the contents pages of journals selected from the hospital's list of serials. The service enables users to augment their journals by scanning additional tables of contents. TACOS coexists with and complements computer, SDI and other current awareness services. Growth over a five-year period is evident by an increased number of both TACOS requesters and TACOS journals requested. User satisfaction, as measured by a survey and willingness to pay, is high. TACOS is a simple, viable concept well worth implementing even in times of tight budgetary constraints.

Chicago↗

PubMed2004

What words and where? Applying usability testing techniques to name a new live reference service.

OBJECTIVE: A user-focused design approach was taken to develop a new "live reference" service at the Health Sciences Library, University of Saskatchewan. The name of the service, the placement of the links, and the design of a graphical button were seen as key elements in creating service awareness and its subsequent use. METHODS: To ensure library users recognized and understood the label for the new service, selected library users were given an opportunity to choose a phrase that would best describe the service. The top two preferred phrases were then placed on the library Web pages as text and graphic images for further testing. Some pages had links in multiple locations to determine which placement worked best. Task-based usability testing was carried out with participants who were unaware of the new service. Participants were observed as they completed seven Website tasks arranged in increasing levels of difficulty to see whether they would notice the live reference service and seek assistance. RESULTS: The high level of recognition and use of the service indicate that the label name and link placement were effective with library Website users. CONCLUSIONS: Using user-centered design methodology helped ensure that the new live reference service was visible and used and demonstrated the effectiveness of the user-centered design approach for adding new services to an existing Website.

Computer Communication Networks↗

PubMedDate not supplied

Using the drug abuse screening test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting.

The dual purpose of this study was to: (1) determine whether problematic drug users, defined through the Drug Abuse Screening Test (DAST-10), exhibited differences in health services utilization and cost relative to a combined group of non-problematic drug users and non-drug users; and (2) assess whether the findings were similar to those for chronic drug users (CDUs) and injecting drug users (IDUs). Results showed that health services utilization and total cost were very similar for problematic drug users defined through quantity-frequency (i.e., CDU, IDU) and diagnostic (i.e., DAST-10) criteria. Findings suggest that quantity/frequency criteria for problematic drug use were reasonable approximations for diagnostic-based measures.

Adult↗

PubMed1988

GRATEFUL MED searching: a hospital library perspective.

The Health Sciences Information Center of Cedars-Sinai Medical Center implemented an end user search service utilizing NLM's GRATEFUL MED software. A librarian-taught seminar is required of all end users. The course's teaching strategies are described. A survey of users was conducted and results are shared.

Computer User Training↗

PubMed1997

Service utilization and expenditures for the treatment of panic disorder.

The outpatient service utilization and estimated expenditures for the treatment of panic disorder for patients prior to their enrollment in a large clinical trial were examined. Data were drawn from the Cross-National Collaborative Panic Study. The sample consists of 391 patients who met DSM-III criteria for panic disorder and were enrolled at one of the US sites of the trial. The rate and frequency of outpatient mental health visits to primary care and specially mental health providers for the current episode of panic disorder are examined. Estimates of direct expenditures for these services are presented (in 1993 US dollars). Over 70% of the patients used primary care for mental health services whereas about 47% of the patients used specialty mental health services. Nearly half of the patients (46.8%) saw a nonpsychiatrist medical specialist, most often a cardiologist (20.6%). Among all patients, those with more frequent panic attacks were more likely to use some form of outpatient mental health services for panic disorder. Among users of any services, those with more severe impairment were more likely to use specialized mental health services. The mean estimated expenditure for the panic episode was $3339, about half of which was accounted for by specialty mental health expenditures. Among users, the median estimated expenditures was $518 for primary care physicians and $2122 for specialty mental health services. In conclusion, the service utilization in this sample of patients with panic disorder is highly varied. Both the primary care and specialty mental health sectors play prominent roles in the community treatment of panic disorder.

Adult↗