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PubMed2000

Predictive characteristics of users of alternative medicine.

BACKGROUND: The use of alternative medicine has become an important factor in health care delivery. OBJECTIVES: To evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilisation in general practice patients using alternative medicine. DESIGN: Cross-sectional survey of GP patients completing a self-administered questionnaire. SETTING: A stratified sample of 36 GP offices in Slovenia. MAIN OUTPUT DATA: Patient's age, sex, educational status, residence, presence of chronic condition, incidence of anxiety or depressive symptoms, incidence of patient-expressed need for emergency care in one year, data on self-care, data on functional status, quality of life, satisfaction with care, incidence of use of out-of-hours services and specialist or hospital services in users versus non-users. RESULTS: 115/1753 patients (6.6%) reported visits to alternative practitioners in 1997. Users of alternative medicine were from midlife age groups, were more likely to have a chronic condition, had a lower perception of life quality and a higher incidence of anxiety and depressive symptoms, and had had more need for emergency treatment. They are heavier users of primary as well as secondary care services; they have changed their GP recently but are not significantly dissatisfied with their current regular GP. CONCLUSIONS: Use of alternative medicine appears to be characteristic of patients with a more active approach to managing their problems. GPs should enquire about the use of alternative medicine by their patients, especially those more likely to seek such help. Raising the question of alternative medicine will improve doctor-patient communication and help to resolve underlying health problems.

Adult↗

PubMed1995

Can academic medical centers compete in a managed care system?

The authors review characteristics of successful group practices, health maintenance organizations, and integrated service networks and then identify the critical actions that academic medical centers must take in order to compete with such service-oriented community providers. Centers must (1) form the clinical faculty into a competitive medical group that offers more price-competitive and user-friendly services; (2) restructure clinical training to be more relevant to the emerging practice situation; and (3) clearly delineate funding streams and identify the cross-subsidies taking place in the teaching, research, and patient care enterprises. These changes have the potential to strengthen clinical training and improve the financial positions of both the faculty and the university hospitals. The authors maintain that centers can make these and other necessary changes while still providing high-quality care and maintaining their educational and research functions; they cite organizations that have succeeded in these ways. However, as with all complex, large-scale organizations, public and private alike, the major factor limiting centers' ability to make the organizational changes required to successfully compete in the new health care environment is the lack of political will. It will be very difficult for academic medical centers to unite their powerful internal interest groups and take action without first experiencing a rather severe external jolt. The challenge for the leaders of academic medical centers is to prepare for the managed care jolt so that they can then guide their institutions to a new, more competitive position.

Academic Medical Centers↗

PubMed1997

Patient information systems: unbiased information is key.

Successful patient information systems must have user-friendly services to transfer vast amounts of information. Whether it is preprinted discharge instructions for standard wound care, an algorithm-based triage discussion of one's chest pain, or simply a database to search out the current recommendations for flu shots or pediatric immunizations, the challenge for patient education in the communications revolution is high stakes indeed.

Humans↗

PubMed1990

Drug problems and patterns of service use amongst illicit drug users in Edinburgh.

Some results are presented from a continuing prospective study of patterns of illicit drug use in the community. A study group of 115 illicit drug users in Edinburgh were contacted by a non-random method known as 'snowballing'. These were interviewed using a standardized schedule that related to over 200 variables. The use of drugs services are discussed and it is noted that reasons for making contact with such services are complex and not directly associated with any one factor. Extent of illicit substance use and adverse consequences experienced as a result of illicit substance use, are seen to be associated with agency contact, although it is suggested that many other reasons such as social pressure have a role to play. Some individuals, including opiate users, reported that their drug use had not led to any adverse consequences, others had experienced a variety of adverse consequences yet had had no contact with a drugs agency. The implications of these results are discussed.

Adult↗

PubMed2000

'All the services were excellent. It is when the human element comes in that things go wrong': dissatisfaction with hospital care in the last year of life.

Patient satisfaction surveys are seen as an important way of obtaining 'user views' of health service provision. However, there is a growing body of research and theoretical literature that questions the validity of the concept of 'patient satisfaction' and hence the use of this type of survey. A postbereavement survey of people who registered a random sample of cancer deaths in an inner London health authority was undertaken in 1996/7. The survey questionnaire (VOICES) included 14 open-ended questions which asked respondents to add any comments they felt were relevant about the care of the deceased. This paper uses these data to examine the causes of dissatisfaction with hospital-based care. Of the 229 informants responding to the questionnaire, 138 included some written comment about care in hospital. At least one negative comment was made by 59% (82) of those making any comment. Of these, 55% (44) rated the care given by doctors as 'excellent' or 'good' and 63% (50) rated that given by nurses as 'excellent' or 'good'. Qualitative analysis of responses to open questions suggest that expressions of dissatisfaction arise from a sense of being 'devalued', 'dehumanized' or 'disempowered' and from situations in which the 'rules' governing the expected health professional-patient relationships were broken. As such, the causes of dissatisfaction for this particular group of patients are similar to the causes of dissatisfaction with health care in general reported elsewhere. The palliative care approach emphasizes patient- and family-centred care and aims to promote physical and psychosocial well-being. The study findings suggest that adoption of the palliative care approach could reduce the experience of dissatisfaction for many service users, not only those whose deaths are anticipated.

Dehumanization↗

PubMed2004

Drug treatment modalities in psychiatric inpatient practice: a 20-year comparison.

OBJECTIVES: The present study investigated whether the increased number of psychotropic agents available in Italy in the last 20 years increased the proportion of inpatients being treated with individual medication classes and the proportion receiving combined treatments with agents of the same class or of different classes. METHODS: This study was conducted in South-Verona, Italy. From the local Psychiatric Case Register (PCR) all patients consecutively admitted to the inpatient unit during the years 1981/1982, 1991/92 and 2001/02 were extracted. Drug use at discharge was derived from clinical records, while service use data were extracted from the PCR. RESULTS: During the six years surveyed 160 patients were admitted in 1981/82, 139 in 1991/92 and 228 in 2001/02. An increasing proportion of subjects receiving antipsychotic, antidepressant and benzodiazepine treatment at discharge was observed. In addition, we found an increasing proportion of patients receiving two or more psychotropic drugs at discharge, which accounted for almost 80% of cases in 2001/02. The number of psychotropic agents prescribed at hospital discharge was positively correlated with the total consumption of psychotropic drugs. A relevant proportion of patients were also dispensed agents for medical conditions, yielding an average number of 3.2 prescriptions in 2001/02. The Lavik score, a summary index of service use, indicated that subjects admitted in 1981/82 were moderate users of psychiatric services, while those admitted in 1991/92 and in 2001/02 were high users of psychiatric services. CONCLUSION: This study documented emerging trends toward polypharmacotherapy and higher total doses. Additional pharmacoepidemiological research is needed to clarify both the beneficial and, potentially, adverse effects associated with these trends in psychiatric pharmacotherapy.

Adolescent↗

PubMed1999

Clinical skills of nurses in mobile health services.

The purpose of this study is to explore and describe the acceptability of the clinical skills of community nurses in mobile health services. An explorative, descriptive design was employed. After a literature study, interviews were conducted with patients, and analysed, the results were verified by means of observation of the mobile services. The clinical skills were described as favourable and not favourable by patients some of which were confirmed during the observation phase. Guidelines for a more user friendly service were written.

Attitude to Health↗

PubMed2001

User-payment, decentralization and health service utilization in Zambia.

The study was undertaken to assess the impact of health sector reform from 1993 to 1997 in Zambia in respect of health care service utilization and the shift of caseload from hospitals to health centres. Four key indicators were chosen: general attendance, measles vaccinations, general admissions, and deliveries. Complete sets of district data were analyzed, covering 4.5 million people out of the total population in 1997 of 9.7 million. The results show, on the one hand, a dramatic decrease of about one-third in general attendance for both hospitals and health centres over a 2-year period, followed by a period with a continued but slower decrease. On the other hand, the results also show increases at health centres in measles vaccinations (up 40%), in admissions (up 25%) and in deliveries (up 60%). The study further documents a shift of caseload from hospitals to health centres for some key services. The health centre share increased from 72.2% to 79.8% for measles vaccinations, from 23.9% to 31.0% for general admissions, and from 22.9% to 32.4% for deliveries. However, the intended overall shift in outpatient caseload from hospitals to health centres did not materialize. The main lessons are: utilization patterns can be influenced by policies such as user-payment and decentralization; user payment in poor populations leads to dramatic declines in utilization of services; and decentralization with local control of resources could be an alternative to the traditional vertical disease programme approach for priority interventions.

Community Health Centers↗

PubMedDate not supplied

Injection drug users and the provision of hepatitis C-related services in a nationwide sample of drug treatment programs.

Drug treatment facilities are important sites for providing targeted prevention and health services to injection drug users (IDUs) who are infected with the hepatitis C virus (HCV). A nationwide survey was conducted to examine whether differences exist in the HCV-related services provided by drug treatment programs that have varying proportions of IDUs among their patients. The results indicate that, overall, drug treatment programs with a greater proportion of IDUs offer significantly more HCV services as compared to programs with a smaller proportion of IDUs. However, important components of hepatitis C-related care, such as universal basic education and counseling about HCV and extensive HCV-antibody testing, are not yet being provided by all programs with a large proportion of IDUs among their patient populations.

Health Care Surveys↗

PubMedDate not supplied

[New strategies for prevention in adolescents and young adults].

For various reasons, it is justified to revise the classical strategies of intervention concerning medical and social action to help young people. New behaviours such as drug addiction, for instance, have emphasized the inadequacies of the conventional means of treatment. Since 1970, Youth Advisory Services have appeared in Europe. Their aims may be various: information, counselling, lodging, social and educative help, medical assistance. These services which were created by the community have such ethical and organizational features that it is easy to discern them among the conventional administrative services. Their users are mainly teenagers and young adults whose reasons for consultation are due to various causes. The originality of the methods, facilities and principles of these innovating services may be considered as a decisive contribution to the research of new prevention strategies to help young people.

Adolescent↗

PubMed1991

A 'crisis' of closure and openness: the present state of the Swedish mental health system in the light of a policy of sectorisation.

The Swedish mental health system has undergone rapid, if uneven change, since the early 1970s. Following a policy of sectorisation and mental hospital closure, there has emerged a new and more 'open' psychiatry. The expansion of community services has particularly benefited psychologists, while it has produced clashes of perspective as to the orientation of services. This paper explores the nature of these changes and the conflicts between psychiatry and psychology, and it points to the consequences of sectorisation for long term users of services.

Health Facility Closure↗

PubMedDate not supplied

Factors relating to the use of mental health services in a neighborhood health center.

Six-month utilization data are presented for the mental health unit of a comprehensive neighborhood health center. Almost 5% of the 16,877 people in Charlestown, Mass., used these services at a rate of 48.7 per 1,000 residents. Nearly all the residents of this Boston neighborhood were white; the median family income was $8,828 annually; and 14% of the families received public assistance. Age, sex, marital status, census tract of residence, and diagnostic factors were quantitatively related to the use of services. Those 0-17 years represented 39.6% of the total caseload and had a utilization rate of 57.0 per 1,000. Boys and women were the biggest users of service, and married adults constituted 47.7% of the adults using the service. About 55% of the patients paid through Medicaid. During the study period 999 diagnoses were recorded for 822 separate patients, or 1.2 diagnoses per patient. Findings from the center's caseload are compared with utilization data for other mental health services and available national data. The study data demonstrate that the health center's goals of providing accessible, family-oriented, comprehensive mental health services that are targeted particularly to the lower socioeconomic groups in the community were largely accomplished.

Adolescent↗

PubMed1989

Methodological lessons from the Italian psychiatric experience.

One of the main reasons why the Italian experience has been the object of much controversial attention in the international literature over the last decade lies in the ambiguity of the terms of reference used. Methodologically, it is of critical importance to re-establish the permanent dialectical relationship between the reality of the Italian experience, the prescription of the Law, and the administration of the reform. In this context, the evaluative variables are less the 'process' indicators of implementation of the reform, and more the qualitative 'outcome' assessment of the fate of the policy. The following concepts are discussed in detail, both in relation to Italy and to the broader status of psychiatry: de-Institutionalisation and de-hospitalisation; psychiatric hospital; rehabilitation-Home; Service-Services-Intervention; User; primary health care; evaluative research.

Commitment of Persons with Psychiatric Disorders↗

PubMed2002

Use of specific dental treatment procedures by dentate adults during a 24-month period.

OBJECTIVES: To (a) describe the incidence of use of specific dental services; (b) test the hypothesis that certain predisposing, enabling, and need (PEN) factors are differentially predictive of service use; and (c) test the hypothesis that even with other PEN factors taken into account, race and household income are differentially predictive of certain dental services. Previously, this study identified PEN factors that predicted use of any care; herein we identify whether these same factors were differentially predictive of specific service use among users of at least one service. METHODS: The Florida Dental Care Study was a longitudinal study of persons aged 45 years or older who had at least one tooth. Subjects participated for interviews and clinical examinations at baseline and 24 months later, with 6-monthly telephone interviews between those times. RESULTS: Seventy-seven percent of subjects reported one or more visits. Results from a single multivariate multiple logistic regression suggested that even once analysis was limited to persons who used at least one dental service, at least one measure from each of the PEN domains was predictive of specific dental service use. CONCLUSIONS: Each PEN domain was predictive of service use, even once limited to persons with at least one visit. Even with differences in other PEN variables taken into account, African-Americans were much less likely to receive dental cleanings, restorative dentistry and fixed prosthodontic services, and were much more likely to have a tooth extracted. Household income was predictive of receipt of fixed prosthodontic services, but not other service categories.

Black or African American↗

PubMedDate not supplied

Implementation of physician order entry: user satisfaction and self-reported usage patterns.

OBJECTIVES: To evaluate user satisfaction, correlates of satisfaction, and self-reported usage patterns regarding physician order entry (POE) in one hospital. DESIGN: Surveys were sent to physician and nurse POE users from medical and surgical services. RESULTS: The users were generally satisfied with POE (mean = 5.07 on a 1 to 7 scale). The physicians were more satisfied than the nurses, and the medical staff were more satisfied than the surgical staff; satisfaction levels were acceptable (more than 3.50) even in the less satisfied groups. Satisfaction was highly correlated with perceptions about POE's effects on productivity, ease of use, and speed. POE features directed at improving the quality of care were less strongly correlated with satisfaction. The physicians valued POE's off-floor accessibility most, and the nurses valued legibility and accuracy of POE orders most. Some features, such as off-floor ordering, were perceived to be highly useful and reported to be frequently used by the physicians; while other features, such as "quick mode'' ordering and personal order sets, received little self-reported use. CONCLUSIONS: Survey of POE users showed that satisfaction with POE was good. Satisfaction was more correlated with perceptions about POE's effect on productivity than with POE's effect on quality of care. Physicians and nurses constitute two very different types of users, underscoring the importance of involving both physicians and nonphysicians in POE development. The results suggest that development efforts should focus on improving system speed, adding on-line help, and emphasizing quality benefits of POE.

Attitude of Health Personnel↗

PubMed1994

Bibliographic instruction in the hospital library.

The nature of bibliographic instruction in this hospital library continues to evolve. As the library makes easy-to-master, menu-driven tools for online searching available to end users, the demand for this service and the accompanying training increases. The demand for formal sessions covering research techniques is also increasing. Upon request, the library offered an extended research orientation to the housestaff in Obstetrics and Gynecology in May of 1993. An introduction to the use of CD-ROM was included to highlight its usefulness for citation verification, author searches, and for periodic current awareness searches on a particular topic. The UMH Library staff strive to offer the most current and comprehensive facilities and services to their users. These include automated access to the library's book, journal, and audiovisual holdings using the Data Trek system; online bibliographic searching by library staff and end users using CD Plus MEDLINE on CD-ROM and Grateful MED software; participation in clinical rounds to provide research support for clinical care; and several types of bibliographic instruction. In addition to the informal teaching of library research techniques that the library staff offers on a daily basis, the Library at Union Memorial Hospital is pleased to be able to provide a formalized and evolving bibliographic instruction program.

Computer User Training↗

PubMed2006

Minority status, consumer outcomes, and service inputs in four States.

Data from the Center for Outcome Analysis were subjected to independent secondary analysis involving comparisons by ethnic group of eight indicators of service quality for users of adult developmental disability services in four states. Ethnic group membership had very limited or no association with the consumer outcomes and service inputs evaluated. Where significant ethnic group differences were found, they were small, and there was no consistent pattern of a particular ethnic group doing better. These findings may relate to the substantial influence of developmental disability services in the lives of service recipients and to the effect of disability itself, in that adaptive behavior was strongly related to most consumer outcomes.

Cross-Sectional Studies↗

PubMed2003

Health services use by children of migratory agricultural workers: exploring the role of need for care.

OBJECTIVE: For migrant children: 1). to assess the determinants of health services use among users and nonusers of health services; 2). to evaluate the association between health status and health services use, while controlling for potential confounders. DESIGN: A cross-sectional household survey using multistage, partially random sampling to identify migrant families in eastern North Carolina. PARTICIPANTS: Adult caretakers of 1 randomly selected child under 13 years old. RESULTS: Forty-four percent of children (N = 300) visited a doctor in the preceding 3 months. Those visiting a doctor disproportionately reported having less than very good health (29% vs 10%), insurance (46% vs 11%), interpreters (45% vs 27%), a family member receiving Special Supplemental Nutrition Program for Women, Infants, and Children (50% vs 16%), and a legal caretaker (30% vs 18%). Compared with those without a doctor visit, a larger proportion of children visiting a doctor were 6 years or younger in age (71% vs 35%), born in the United States (51% vs 15%), female (64% vs 45%), and had not moved in 6 or more months (19% vs 10%). Controlling for enabling resource and sociodemographic confounders, children with less than very good health were 2.4 times more likely than those in very good health to have visited a doctor (95% confidence interval [1.1-5.2]). CONCLUSIONS: Migrant children using health services are distinct from nonusers with regards to sociodemographic factors, enabling resources, and need for care. Health services use is associated with less than very good perceived health, despite resource barriers and sociodemographic disadvantages. More efforts are needed to improve access to health care for migrant children.

Adolescent↗