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PubMed1990

Quality assurance goals in clinical pathology.

Certain conditions must be fulfilled to meet quality assurance objectives in clinical pathology. Commitment to goals for improving quality and participation by everyone involved are prerequisites. Quality assurance is driven by information that is used to examine processes so that they can be improved. Inspection alone, however, does not produce quality; quality must be designed into the process to reduce the likelihood of errors and to produce long-lasting improvement. Specifications for meeting quality assurance goals should be determined by the expectations of users of the service. Accomplishments are measured by users' perceptions. Integration of laboratory and clinical information, together with communication links between all components of the health care processes, is critical for success.

Goals↗

PubMed2004

Determinants of pill failure in rural Bangladesh.

The pill is the most popular family planning method in Bangladesh. However, the failure rate of this method in Matlab, a typical rural area, has been found to be very high. It is estimated that with the current level of failure of the pill and other temporary contraceptives in Matlab, it is unlikely that fertility in Bangladesh will come down to replacement level without a change in contraceptive method mix. It is, therefore, important to know the reasons for the high failure in pill use. Data for this study came from a case-control study in Matlab. A pill failure was considered a case, and no-failure was considered a control. The study included 167 cases and 167 controls. In addition, five focus group discussions were conducted to supplement the data collected from the cases and controls to gain a deeper understanding of pill failure. Results of the analysis of both quantitative and qualitative data suggested that the following were the risk factors for pill failure: no mobility of women, poor knowledge of women about the effectiveness and consequences of drop-out from pill use, weak confidence in the pill, a gap between the use of subsequence pill cycles, delay in starting the pill after menstruation for the first use, not taking any measures consistently for missing the pill, and not following the arrow sign given on the pill cycle. Extensive training of field workers and pill users, covering the reasons for pill failure identified in this study and strong supervision of the work of field workers, is likely to reduce the rate of pill failure in Bangladesh. Also, information, education and communication services for users, and management of side-effects, may be helpful in reducing pill failure.

Adult↗

PubMedDate not supplied

Toward a comprehensive evaluation of the impact of electronic aids to daily living: evaluation of consumer satisfaction.

PURPOSE: It is generally accepted that electronic aids to daily living (EADLs) play an important role in the lives of many people with severe disabilities by providing the means to access and control devices for daily living activities. Despite this, little proof exists to support the contention that consumers are satisfied with relevant aspects of these assistive devices. The purpose of this study was to explore consumer satisfaction with EADLs and investigate the value that people with degenerative neuromuscular conditions place on these technologies. METHOD: Interviews were conducted with 40 EADL users and non-users to compare their views about these devices and their daily life experiences. Users were interviewed twice, six months apart, to establish the stability of their views and experiences with EADLs. The Functional Independence Measure (FIM instrument), the personal profile and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) were administered to determine functional levels of participants, gather personal data pertinent to the study of device utility and explore user satisfaction with EADLs. RESULTS: Results suggest that overall consumers were quite satisfied with their EADLs and that this was relatively stable over time. However, some consumers expressed concerns regarding the cost of these technologies and their associated services. Both users and non-users rated EADLs similarly in relation to relative degree of importance ascribed to them. CONCLUSIONS: Combining the QUEST with outcome measurement tools that explore other important dimensions such as the effect on quality of life and psychosocial impact will help service providers to justify the costs associated with the prescription of sophisticated, costly assistive devices such as EADLs.

Activities of Daily Living↗

PubMed2005

Knowledge is power: using nursing information management and leadership interventions to improve services to patients, clients and users.

AIM: This paper examines the purpose, role and function of information and information management within health care today. It is set within the context of a specialist forensic learning disability setting. BACKGROUND: Changes in politics, government legislation and reforms of the National Health Service (NHS) have created a need to equip managers with the necessary tools and skills to be able to lead and manage effectively. As such there has been a great emphasis upon specialist training, such as the government-driven Leading an Empowered Organisation courses, for nurse managers and nurses with leadership potential. Yet with the drive to generate a new wave culture within the NHS of inspirational leaders, are we still overlooking a critical and key area which is fundamental in achieving and delivering cost effective, quality health care--the area of information management within health care today? METHODS: The processes presented in this paper are structured through a strategic nursing management and leadership performance implementation model, the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model, which facilitates work-based learning and capability development in the reality of everyday clinical activities. Through the model, the emphasis is to make clinical goals specific, roles explicit, processes clear and encourage these activities to be carried out within an environment of open relationships. RESULTS: The use of CLINLAP model assisted as a management and leadership technology to manage change in the workplace so as to improve services to patients in Yelday Lodge. Structured management and leadership interventions led to observable positive change in information management on Yelday Lodge. CONCLUSIONS: The conclusion is that sustained quality information could be embedded in nursing practice at Yelday Lodge or elsewhere by evaluating and discussing the different information management approaches within the practice area through the use of structured management and leadership interventions. The use of the CLINLAP model is recommended for use as a model for managing information, knowledge and communication for results within nursing and health care services.

Budgets↗

PubMed2003

Brief report on user involvement at St Christopher's Hospice.

As part of their Clinical Governance agenda, St Christopher's Hospice in southeast London has established a system for gaining patient and carers' views, in order to ensure these are given adequate consideration in planning and providing services. A users forum has been set up, and this article discusses some of the issues that had to be addressed in organizing the forum. Items such as who to invite, who should facilitate the meetings, venue, timetable, and boundaries all needed to be agreed. Evaluation of the usefulness of the forum is still required, with many questions still to be answered, but so far staff, patients and carers have enthusiastically embraced the forum. This report identifies some of the challenges in developing a person-centred user involvement scheme in a voluntary hospice.

Attitude of Health Personnel↗

PubMed1994

Psychiatric and social reasons for frequent rehospitalization.

OBJECTIVE: The authors attempted to identify factors that commonly contributed to the decision to rehospitalize patients who made heavy use of mental health services. METHODS: The case notes of 50 patients with frequent readmissions to the South Australian Mental Health Services over a three-year period were examined to identify which of 15 factors most frequently contributed to hospital readmission. RESULTS: Lack of insight or denial of illness was cited in 62.2 percent of the patients' 442 total admissions, followed by relationship problems (61.1 percent), suicidal ideation (44.8 percent), and noncompliance with medication (43.2 percent). When the 15 factors were combined into four major categories, social factors were found to contribute to 38.9 percent of admissions, followed by factors related to psychiatric and physical illness (31.1 percent), dangerousness to self or others (20.3 percent), and substance abuse (9.7 percent). CONCLUSIONS: The substantial contribution of social factors to the readmission of patients to acute mental health services is strong evidence that the mental health system must provide appropriate targeted resources and assertive, continuous case management to avoid social crises. Issues surrounding drug and alcohol abuse among heavy users of services must be actively addressed.

Adult↗

PubMed1988

High users of outpatient mental health services, I: Definition and characteristics.

Mental health coverage generally limits benefits for high use, which is assumed to be discretionary. The authors present data from the National Medical Care Utilization and Expenditure Survey. Of the individuals who made mental health outpatient visits in 1980, 9.4% made 25 or more visits and accounted for 50% of mental health visits and expenditures. These high users were compared with low users and with high users of other health care. One-third of the mental health high users were highly disabled and had multiple medical disorders. The authors point out the heterogeneity of this population and suggest that psychiatric benefits be differentiated according to patients' needs and services offered.

Ambulatory Care↗

PubMedDate not supplied

Revenue-driven in TB control--three cases in China.

One quarter of all TB cases occur in China, which, during the past 20 years has moved from a planned economy to a socialist market economy. In the health sector, an important proportion of the financing originates from user payment. TB control is not an exception and different programmatic models are in place. This study examines, using a case study approach, three different TB programmes, one supposed to provide free service, one subsidized service and one with full cost recovery. The aim was to better understand the driving forces for programme performance in terms of case detection, case management and patient payments. The study found for all models that control and case management approaches were, to some extent, adapted to generate maximum income to the providers. The drive for income led to fewer cases detected, administration of unnecessary procedures and drugs, and a higher than necessary cost to the patients. The latter possibly leading to exclusion of poor people from the services. If user charges are to stay, TB control programmes need to be designed to take advantage of the financial incentives to improve performance. The referral system needs to be restructured, not to provide disincentives for good practices.

China↗

PubMed2001

When the perpetrator gets killed: effects of observing the death of a handgun user in a televised public service announcement.

This study evaluates the cognitive effects of an anti-handgun violence public service announcement (PSA) on sixth-, seventh-, and eighth-grade students (N = 294). Participants were randomly assigned to a treatment group, which viewed a PSA depicting the death of an aggressive handgun user, or a comparison group, which viewed identical content except that the PSA showed no negative consequence for the handgun user. Logistic regression analysis, adjusting for race and gender, revealed that the treatment group was more likely to report negative expected outcomes for aggressively using a handgun and lower behavioral intentions to aggressively use a handgun compared with the comparison group. These findings suggest that observing handgun violence on television that depicts death as a negative physical consequence for the perpetrator may produce lower handgun-encouraging beliefs compared with observing no consequence for the perpetrator--the norm for most televised violence today.

Adolescent↗

PubMed2005

Rural American Indian Medicaid health care services use and health care costs in California.

OBJECTIVES: We determined differences in Medicaid service use and health care costs in a rural Indian Health Service (IHS) user population of American Indians and Alaska Natives as compared with Whites. METHODS: California Medicaid eligibility and claims files were linked to IHS user files to obtain a sample of Medicaid-eligible American Indian/Alaska Native users (n=7910). A random sample of Whites was matched for age, gender, aid category, length of eligibility, and county of residence (n=15075). We used generalized linear models to compare risk-adjusted use of resources-ambulatory visits, prescriptions, emergency room visits, hospitalizations, and costs-both adjusting and stratifying for dominant source of ambulatory visits. RESULTS: American Indians/Alaska Natives had significantly lower use of Medicaid-paid ambulatory visits, prescriptions, emergency room visits, and hospitalizations and lower associated costs than Whites. Medicaid-paid total costs and use of services were lower for those who predominantly used Indian health program clinics, as well as for those who predominantly used other sources of ambulatory care. CONCLUSIONS: Barriers to receiving Medicaid services and payments exist for American Indians/Alaska Natives in the rural IHS-user population. If American Indians/Alaska Natives are to have Medicaid resources comparable to those of Whites, these barriers must be reduced.

Adult↗

PubMed2004

Characteristics of repeat users of an inpatient psychiatry service at a large military tertiary care hospital.

OBJECTIVE: The purpose of this study was to identify clinical and demographic variables that correlated with readmission to a large tertiary care military psychiatric inpatient service located in the Washington, DC area. METHODS: Data from 983 consecutive inpatient admissions (comprised of 814 individual patients) over a 13-month period (July 1999-July 2000) were abstracted from medical records for retrospective analysis. Repeat users were defined as those individuals receiving two or more inpatient admissions to Walter Reed Army Medical Center during the study period. Statistical comparisons were made between repeat and single admission groups to identify variables predictive of rehospitalization. RESULTS: Of 814 individual patients under study, 117 (14%) were identified as repeat users. A history of childhood psychiatric problems, previous psychiatric hospitalization, current or past substance abuse, legal problems, and presence of a psychotic or nonbipolar mood disorder were associated with readmission after controlling for active duty status. Current comorbid substance use or personality disorder diagnoses were not predictive. Having at least one child was protective against readmission. The 117 repeat users accounted for 3,838 (37%) of the total 10,393 hospital bed-days during the study period. Logistic regression analysis of all variables correlated with readmission demonstrated statistical significance for past psychiatric hospitalization and age of onset of psychiatric problems before age 18 when active duty status, age, and gender variables were included in the equation. CONCLUSIONS: This study is one of the largest to investigate predictors of rehospitalization in a population that enjoys universal "free" access to comprehensive mental health care services and other benefits of employment. This retrospective analysis documented three important facts: That there seem to be only minor differences between military and civilians with respect to variables associated with psychiatric rehospitalization, that a relatively small proportion of patients accounted for a disproportionately large number of inpatient bed-days, and that an unexpectedly high proportion of active duty patients admitted to this study site reported childhood psychiatric problems and psychiatric hospitalizations before their first hospitalization at Walter Reed Army Medical Center.

Adult↗

PubMed1986

Online information retrieval in pharmacy and related fields.

Online information retrieval in pharmacy and related fields is described. Factors involved in determining whether to conduct an online search are discussed, including characteristics of appropriate and less suitable topics, advantages and limitations of online searching versus manual searching, and possible types of searches. The process of preparing for an online search, involving the determination of search vocabulary, relevant citations, important authors, time frame, special categories (such as language, publication type, and reviews), and the number of citations needed, as well as choosing a database, is explained. Sample search strategies on MEDLINE and IPA are illustrated to demonstrate the basic search commands and to compare file retrievals on the sample subject. Pharmacy-related bibliographic databases, general-interest databases, end-user search services, and full-text and numeric databases are profiled. Online database searching can be a cost-efficient and flexible alternative to manual literature searching for pharmacists. Although most online searching is currently conducted by librarian-search specialists, end-user searching is a growing trend, as is the availability of full-text databases.

Abstracting and Indexing↗

PubMedDate not supplied

[The Net 'a la carte': virtual communities of users and integrated thematic telematic services].

INTRODUCTION: Internet and its society of information and communication should be considered to be a smaller society evolving--others would say is trapped--within our society. Therefore, it should be considered not only from a technical or technological point of view but also regarding its human, cultural, social and intellectual aspects. DEVELOPMENT: This article starts with a general view of the present situation on the Internet. We also define the concept of a Virtual Community of Users (VCU). In view of this concept, debate centers on the communities of scientific, professional and academic communities using the Internet, analyzing the present situation, its needs and problems. We continue with the concepts of Virtual Thematic Service (VTS) and Integrated Virtual Thematic Services (IVTS) introduced as a means to solve the needs and problems of VCU. Finally, we describe a real pilot study, based on the IVTS paradigm, known as UniNet.

Humans↗

PubMed1998

The challenge to restoring basic health care in Uganda.

This paper presents the results of a health facility survey conducted in Uganda between June 1992 and December 1993. The survey covered both government and non-government organisation (NGO) facilities from 10 districts in the five regions of the country. The main objective of the survey was to assess resource use, costs and financing of health facilities. The survey found differences between resource levels of NGOs and government facilities. Government facilities were inadequately maintained, and mostly in a state of disrepair. The user fee scheme that had been recently introduced in some government units to meet running costs was not only inadequate, but was not being used to meet the needs of consumers. In addition, most available resources, including human resources, were concentrated in hospitals. As a result, there was heavy demand for hospital services and less use of services in the lower level facilities. And furthermore, staff in government facilities were paid much less than staff working for NGOs, who not only got better pay but also in-kind forms of rewards, which made them better motivated to work. The number of qualified staff, particularly for primary health care, was grossly inadequate, and most of the work in local facilities was being done by unqualified employees, such as ward maids and dressers. In order to alleviate some of the problems identified, particularly in government facilities, there is a need to explore ways in which more can be done with the available resources to improve the efficiency of health services. The user charge system could be effective in improving the resource base of the health facilities, but it must result in visible improvement in the quality of services for consumers to be willing to pay. Collection methods should be standardised, and expenditures supervised. As part of the government's decentralisation programme, districts should be given the power to recruit and fire personnel. Once this authority is in place, the district should consider employing fewer personnel at all levels and aim to pay them a living wage.

Appointments and Schedules↗

PubMed1988

High users of outpatient mental health services, II: Implications for practice and policy.

Four assumptions underlie the stereotyped view of use of outpatient mental health services: 1) all use is alike, 2) any use leads to high use, 3) all high use is discretionary, and 4) insurance encourages excessive use. The authors refute the first three assumptions and suggest that different types of treatment episodes vary in their responsiveness to price. Diagnosis appears to be a poor indicator of inpatient needs; some coverage limits outpatient benefits according to type of treatment. The authors favor a combination of pricing strategies, as well as case management and clinical review for high users, which would not impede initial treatment but would limit excessive use of mental health services.

Ambulatory Care↗

PubMed1981

[Structure of medical care services].

This paper analyzes in detail the principal patterns of the organization or structure of medical care observed in Latin American countries. It reviews the salient features of their structures and examines the major strategies adopted for reorganizing them to respond to new operating requirements. The authors state the conceptual basis and the components of the structure of medical care services and their nature, and then discuss different organizational models both of health systems as a whole and of operating units within them. The four organizational models considered are public or government service, social security, group medicine, and private medicine. The aspects selected for review in these four models are financing, remunerations, the investment in technology, the local service units, the formal structure of the services, the user's participation, information for decision-making, equity and economic efficiency, and the capacity to deliver benefits. The paper emphasizes throughout the patent need for change at all levels of the structure of the services so as to attain the goals of coverage expansion and health for all by the year 2000. These changes must take account of factors deriving from population growth and the changes in the systems made necessary by the present state of the services. A few considerations are also presented on the principal problems that will confront health services in the process and, lastly, there is emphasis on the importance of health services research to establish the facts in each particular situation, and on the need to redirect the training of the manpower needed to attain the established goals.

Health Maintenance Organizations↗

PubMed1986

The demand for adult outpatient services in the Bicol region of the Philippines.

The absence of demand analysis for primary health care services has hampered efforts to finance these services and to make them permanent parts of Third World medical systems. This paper introduces a demand model for adult outpatient services, describes the types of data required for estimating it, and presents the results of a preliminary estimation using data from a poor rural region of the Philippines. The results indicate that prices and distance are not nearly as important as determinants of demand in this sample as has usually been assumed by planners. There appears to be considerable room for full or partial financing of outpatient services from user fees.

Adult↗

PubMed1992

Responsibility for funding NHS library services.

This paper is intended to contribute to discussion and debate on sources of funding for NHS library services which is a complex issue in the present climate of organizational change. Topics covered include the management and organization of services, the users, their requirements and sources of funding. In conclusion a number of specific issues that need addressing are raised.

Financing, Organized↗