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PubMed2001

Meeting the needs of consumers in the community: a working partnership in mental health in New Zealand.

AIM: The aim was to evaluate whether the services community mental health nurses provide are meeting the needs of consumers in the community. RATIONALE: The role of the mental health nurse in the community is changing as a result of deinstitutionalization, the consumer movement and the market model of health care delivery. In this context it is important for mental health nurses to evaluate whether the service they are currently providing is meeting the needs of consumers. DESIGN: This was a joint project between nurses and consumers. It was a service-specific descriptive research project utilizing qualitative methods of data collection and analysis that provides a model for working in partnership. FINDINGS: The results of this research identify collaboration in planning care and sharing information as two areas of concern but generally the consumers were very satisfied with the care provided by community mental health nurses. The analysis of the data suggests that consumers value nursing care because nurses provide support in their own home; they help consumers develop strategies for coping with their illness and their life; they provide practical assistance when it is required; they are vigilant about any deterioration or improvement; and they are available and accessible. CONCLUSION: The results of this study have demonstrated that nurses will remain critical to the success of community-based care because of their ability and willingness to be flexible to the demands of their own organization and the users of services.

Adult↗
PubMed1998

The Quality of Surgical Care Project: a model to evaluate surgical outcomes in Western Australia using population-based record linkage.

BACKGROUND: The aim of this study is to establish a model to evaluate surgical outcomes and, where indicated, recommend changes to improve the quality of surgical care in Western Australia (WA). Open resection for aneurysm of the abdominal aorta was the first procedure evaluated and the results are reported in an accompanying paper. METHODS: The Quality of Surgical Care Project (QSCP) is conducted under the aegis of the Royal Australasian College of Surgeons (RACS) in WA, and brings together a multidisciplinary team of surgeons, public health researchers and health service administrators. The Western Australia Health Services Research Linked Database (the WA Linked Database) is used to provide linked chains of patients records residing in the state health department from the following sources: hospital morbidity data system, birth and death records, mental health services data, cancer registrations and midwives' notifications. This links 16 years of population-based patient records from 1980, including all public and private hospital admissions and re-admissions. The Quality of Surgical Care Project was established to use and to correlate the data from the WA Linked Database. RESULTS: The result is a powerful database for a contained population that is available for scientific analysis by a multidisciplinary team of clinical epidemiologists, surgeons and health service managers. Users will have the ability to establish benchmark standards for the outcomes of surgical procedures in WA for use in quality improvement programmes run by the College and will facilitate self-directed performance auditing activities as a commitment to greater community accountability. CONCLUSIONS: The Quality of Surgical Care Project provides a potential model of benefits to be realized by both the medical profession and the community through multidisciplinary collaboration supported by adequate information. Although migration from WA is relatively low, future linkage to the state electoral roll will allow correction for any population change.

Aortic Aneurysm, Abdominal↗
PubMed2002

Telehealth for older patients: the Hong Kong experience.

We studied the feasibility, acceptability and cost-effectiveness of using telemedicine to provide geriatric services to residents of nursing homes. A local 200-bed nursing home supported by the community geriatric assessment team (CGAT) participated in a one-year study, during which videoconferencing was used to replace conventional outreach or clinic-based geriatric care. The feasibility of telemedicine was evaluated by participating specialists in a total of 1001 consultations. Other outcome measures included productivity gains, utilization of hospital emergency and inpatient services, and user satisfaction. Telemedicine was adequate for patient care in 60-99% of cases in seven different disciplines. The CGAT was able serve more patients and see them earlier and more frequently. Telemedicine was cheaper than conventional care, and well accepted by health-care professionals as well as clients. Substantial savings were achieved in the study period through a 9% reduction in visits to the hospital emergency department and 11% fewer hospital bed-days. Telemedicine was a feasible means of care delivery to a nursing home and resulted in enhanced productivity and cost-savings. Linking more such institutions to care providers would further increase cost-effectiveness.

Aged↗
PubMed1999

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic.

In early 1996, 481 women visiting the antenatal services of the 3 major governmental health centres in the capital city of the Central African Republic (CAR) were included in the study. All study participants underwent the health centre's routine gynaecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhoea, syphilis and bacterial vaginosis. Cervical secretions and blood samples from study participants were sent to the National STD Reference Centre for diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Treponema pallidum, and HIV. Overall, 34% of the study women were diagnosed with at least one sexually transmitted infection (STI) (3.1% N. gonorrhoeae, 6.2% C. trachomatis, 9.9% T. vaginalis, 6.7% T. pallidum, 12.2% HIV-1). In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. Only a small proportion of these women had sought treatment during the weeks before, despite the recognition of genital symptoms. Self-reported and health worker-recognized symptoms, signs and laboratory results exhibited only low sensitivities, specificities, and positive predictive values in the diagnosis of STIs. These findings confirm the high vulnerability of young African women to STIs and emphasize the need for specific control interventions which should include affordable and user-friendly services. Moreover, these results call for more effective quality control in case of laboratory-based STI control strategies and question the validity of syndromic STI management strategies in women attending antenatal care services in Africa.

Adolescent↗
PubMed1978

Use of out-of-plan services by Medicare members of HIP.

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.

Aged↗
PubMed2000

Comprehensive community effectiveness of health care. A study of malaria treatment in children and adults in rural Burkina Faso.

Malaria is one of the most important causes of morbidity and mortality in children in sub-Saharan Africa, yet community effectiveness of treatment is not well understood. This study presents a quantitative estimate of community effectiveness of malaria treatment in Burkina Faso, based on population surveys, observational studies of health services and user surveys. Analysis of seven steps in the process of treating malaria reveal the following: (1) 21% of people with malaria attend health centres; (2) 31% of them have a sufficient history taken; (3) 69% receive a complete clinical examination; (4) 81% receive the correct dosage of drugs prescribed; (5) 91% purchase the drugs; (6) 68% take the drugs as prescribed; (7) the drugs are estimated to be 85% effective. Taking all the steps into account, overall community effectiveness is estimated to be 3%. Statistically significant differences in age and gender are seen in some steps. Quinine is prescribed too frequently. Critical issues in educating health care workers include complete history-taking and clinical examination, rational indication for quinine and adjusted drug dosages for children. We identify utilization and diagnostic quality as offering the greatest potential for improvement in overall community effectiveness.

Adolescent↗
PubMed1981

Utilization of medical services by psychiatric patients.

The relationship between medical and psychiatric utilization of services was examined in a two-year study of two groups of psychiatric patients: high users of psychiatric services (more than ten visits in one year) and low users of psychiatric services (ten or fewer visits in one year). The high-utilization group made more than 60 per cent of the total psychiatric visits in the two-year period, but only 21 per cent of the total medical visits. However, patients in this group increased their utilization of medical services when psychiatric utilization was reduced, raising the question of whether high-utilization patients tend to substitute medical visits for psychiatric visits. In contrast, patients in the low-utilization group were able to hold their medical utilization constant when they reduced psychiatric utilization. Analysis of factors influencing utilization patterns might allow illness behavior in patients to be predetermined and lead to better and more cost-effective health care.

Adult↗
PubMed2003

MEDLINE SDI services: how do they compare?

INTRODUCTION: Selective dissemination of information (SDI) services regularly alert users to new information on their chosen topics. This type of service can increase a user's ability to keep current and may have a positive impact on efficiency and productivity. Currently, there are many venues available where users can establish, store, and automatically run MEDLINE searches. PURPOSE: To describe, evaluate, and compare SDI services for MEDLINE. RESOURCES: The following SDI services were selected for this study: PubMed Cubby, BioMail, JADE, PubCrawler, OVID, and ScienceDirect. METHODOLOGY: Identical searches were established in four of the six selected SDI services and were run on a weekly basis over a period of two months. Eight search strategies were used in each system to test performance under various search conditions. The PubMed Cubby system was used as the baseline against which the other systems were compared. Other aspects were evaluated in all six services and include ease of use, frequency of results, ability to use MeSH, ability to access and edit existing search strategies, and ability to download to a bibliographic management program. RESULTS: Not all MEDLINE SDI services retrieve identical results, even when identical search strategies are used. This study also showed that the services vary in terms of features and functions offered.

Equipment Design↗
PubMed1998

Predictors of mammography use among women veterans.

We examined mammography use patterns of women veterans and explored Veterans Administration (VA) health care use and military experience as predictors of mammography use by this population. We conducted a national telephone survey of women veterans. A sample of 397 women veterans was selected from all military discharges from 1971 through 1994. A 3 x 2 stratification scheme was used: three age groups (35-49, 50-64, > or = 65 years old) and two VA user groups indicating whether (VA user) or not (VA nonuser) they received any health care from a VA Medical Center in the last 5 years. The response rate was 75% (297 of 397). Analyses included bivariate techniques and weighted logistic regression. We found that women veterans told to have a mammogram by a health care professional were more than five times more likely to have ever had a mammogram (OR 5.41, CI 4.63-6.32) and nearly twice as likely to have had a mammogram within the past 2 years (OR 1.81, CI 1.57-2.09) as those who were not told to do so, controlling for age, race, VA user status, and length of military service. Regular VA users were more likely to have had a mammogram ever and within the past 2 years, controlling for other factors. Mammography use was not necessarily at a VA medical center. Interventions that promote better provider-patient communication and target older women veterans may have the most potential benefit. Whether VA health care is filling an important gap in access to mammography for older women veterans is an important policy question and warrants further research.

Adult↗
PubMed1996

Health care of children and adults with acquired immunodeficiency syndrome. A population-based analysis.

OBJECTIVES: To compare the use of medical services by pediatric and adult patients with acquired immunodeficiency syndrome (AIDS) in the 6 months before and after the diagnosis of AIDS when demand for care is often high and to study the influence of human immunodeficiency virus specialty care on survival of pediatric patients. DESIGN: Retrospective analysis of Medicaid files. SETTING: New York State Medicaid Program. PATIENTS: A cohort identified as having AIDS from 1985 through 1990 and enrolled on Medicaid from birth or 1 year or more before diagnosis. Because of differing prognoses, 3 groups were studied by age at the time that AIDS was diagnosed: infants younger than 6 months, children aged 6 months to 12 years, and adults aged 13 to 60 years. MAIN OUTCOME MEASURES: Frequencies of any service use and, among users, monthly rates of services. From Cox proportional hazards models, the adjusted hazard of death for human immunodeficiency virus specialty ambulatory care. RESULTS: Nearly all infants (n = 122) were hospitalized before and after the diagnosis of AIDS was made--the most of all groups. After diagnosis, only 81% of older children (n = 612) were hospitalized vs 93% of infants and 90% of adults (n = 5602). Hospitalized children had a median of only 3.3 inpatient days per month vs 12.3 and 7.8 inpatient days for infants and adults, respectively. Of older children, 45% used the emergency department vs 33% of adults. Human immunodeficiency virus specialty care for infants and children was associated with a 40% lower risk of death after the diagnosis of AIDS. CONCLUSIONS: In this AIDS cohort, infants had the greatest use of inpatient care, and older children used the emergency department more than adults. The finding of improved survival for infants and children with human immunodeficiency virus specialty care warrants further study in more recent years.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Psychiatric impairment in rural communities.

This household survey of 713 adults residing in nine rural Middle Tennessee counties was conducted to estimate the prevalence of psychiatric impairment in the rural population, to determine which groups in the population are characterized by higher levels of impairment, and to assess the validity of three indices of psychiatric impairment (HOS, CES-D, and GWB). The data indicate that approximately 12% of the rural population may be impaired and that impairment is most likely among females, the divorced, widowed, or separated, and those in lower socioeconomic strata. While depression was more common among the young, physical and psychosomatic complaints were more common among older respondents. Further, respondents classified as impaired by the indices tended to view themselves as having "substantial" or "major" problems and were likely to feel that they might require professional help. While the GWB appeared to discriminate between users and non-users of services, the other indices were less effective as predictors of service utilization.

Female↗
PubMed1991

Older adult users of outpatient mental health services.

Descriptive demographic, clinical and interview data from clients of an outpatient mental health clinic for older adults are presented. These clients are better educated and have a more frequent history of marital difficulties than older adults in general. Although a significant minority received V code and Adjustment Disorder diagnoses, the majority were depressed and had histories of prior mental health services. Economic factors are a major issue in seeking services.

Aged↗
PubMed2006

Treating incarcerated women: gender matters.

Research on incarcerated women has shown they have a high degree of comorbid psychopathology, including substance dependence, posttraumatic stress disorder (PTSD), antisocial personality disorder (ASPD), and major depression. Incarcerated women differ from their community peers by having more symptoms related to addiction, ASPD, and PTSD. At the same time, incarcerated women are every bit as likely as incarcerated men to be dependent on drugs and almost as likely to be dependent on alcohol. What emerges is a picture of the incarcerated woman far more likely to have had traumatic experiences, including early sexual and physical abuse, than her male peers but every bit as likely to have substance dependence and, in some correctional populations (eg, sentenced felons), antisocial personality disorder. Central to the discussion of how best to treat female offenders is the need to address how programs would best be structured for women with severe substance dependence, substantial trauma histories, and personality pathology, including ASPD. Incarcerated women are a population with complex medical and mental health needs and are likely to be high users of services within the correctional system. This poses challenges to a system already stretched thin in caring for these complex inmates. This article emphasizes that gender differences need to be appreciated, and that service delivery to male and female inmates needs to be structured with gender in mind. The article recommends case management, treatment in highly structured therapeutic communities, and emphasizing abstinence from substances and development of skill sets to engage in healthy relationships.A major future challenge lies in researching treatment interventions for women in the correctional system. There are few existing trials of treatment efficacy and, as previously noted, the incarcerated female population differs from populations of incarcerated men and women in the community. Opiate-dependent women undergoing treatment in the community may prove to be a reasonable comparison group in beginning to develop evidence-based treatment for female offenders in prisons and jails. Ultimately, the development of services for incarcerated women will consider gender, race, and psychopathology in determining treatment setting and modalities. We are on new ground. It is a promising and exciting time to be involved with treatment of female offenders.

Antisocial Personality Disorder↗
PubMed1992

Users' perceptions of mail-service pharmacy.

This survey studied the satisfaction of university employees with the mail-service pharmacy option of their major health insurance provider. Nearly 92% reported good or excellent satisfaction with the mail order service. Of the 76.5% who reported receiving drug information brochures with some or all of their prescriptions, 91.5% rated the information excellent or good. When asked what sources they used to get additional information, 31.2% used a mail service pharmacist. These data suggest that mail order pharmacies, which have increased volume 50% per year since 1981, can expect to maintain and expand their market share. All pharmacy sectors should use this information to determine ways to enhance their competitive position.

Consumer Behavior↗
PubMed1999

Response to HBV vaccine in relation to anti-HCV and anti-HBc positivity: a study in intravenous drug addicts.

Drug addicts represent the group of young adults with the lowest response to hepatitis B virus (HBV) vaccine. A study was carried out on 110 current intravenous heroin users attending the service providing assistance to intravenous drug users (IVDUs) (SERT) in Padua: 66.4% of them were found anti-hepatitis C virus (HCV)-positive and 33.6% were anti-HBc positive; 29.9% were positive for both. The subjects were vaccinated with 10 microg of yeast-derived vaccine at months 0, 1 and 2 (fast schedule). The overall response rate was 66.4%. Response seems to be affected by positivity to anti-HBc, but not to HCV infection.

Adult↗
PubMed1997

Traditional medicine in contemporary Ghana: a public policy analysis.

Discourses on the future of traditional medicine in Africa and other indigenous societies often assume government recognition and integration into the formal health care systems. There is very little attempt, however, to understand the contexts in which the knowledge and practice of traditional medicine are currently reproduced, let alone the social, economic and cultural factors that determine consumer choices. Based on the participant observation combined with in-depth interview method, a longitudinal study was designed to determine the longer term trends in the reproduction of the knowledge and practice of traditional medicine in contemporary Ghana. This preliminary report covers: socio-economic conditions of the typical village practitioner, their belief systems and how that affects practise orientation; and perceptions as to whether traditional medicine could be taught and practised as part of the formal health care sector. This paper highlights some of the key issues which policy-makers may wish to explore with regard to the future of traditional medicine in Ghana and other African countries. These include: the role of "spiritually based" traditional practitioners in the provision of care, especially for people with mental health and other psychosocial problems; professional relationships between the biomedically trained and the traditional practitioner, particularly with regards to policies aimed at integrating traditional medicine into the formal health sector; equity of access, given that efforts to "control" the quality of herbal preparations through biomedical research can dramatically alter costs, thereby undermining ease of access normally associated with traditional medicine; a need to re-examine underlining reasons for the current popularity of traditional medicine in Ghana and other African countries, given the fact that the introduction of user pay services may be forcing the poor to sometimes turn to obsolete therapeutic practices in the name of "traditional medicine"; and potential public health benefits accruing from better understanding of traditional African notions of illness causation and preventative health.

Adult↗
PubMed2003

Nursing staff mix models and outcomes.

BACKGROUND: Recently, restructuring of the nursing workforce has been undertaken in a number of countries in an effort to provide efficient and cost-effective services to users. This often takes the form of the introduction of unregulated workers to carry out support roles with registered nurses. However, these changes have not been evaluated for efficacy or impact on nurses, patients or the health care system. PURPOSE: The purpose of this study was to determine the relationship between staff mix models comprising regulated staff (Registered Nurses and Registered Practical Nurses) or regulated and unregulated staff (Registered Nurses and unregulated workers), and nursing and quality outcomes. METHODS: This comparative correlational study was conducted in a random sample of 30 adult, acute care patient units within eight hospitals located in Toronto, Canada. Registered Nurses employed on 30 randomly selected hospital units, grouped by the two staff mix models (15 units per group), were surveyed using previously validated instruments to measure role conflict, role ambiguity, job satisfaction, perceived effectiveness of care and perceived quality of care. RESULTS: Results indicated that Registered Nurses in this study experienced high levels of role conflict, regardless of the type of staff mix model within which they worked. Registered Nurses on units employing both Registered Nurses and unregulated workers reported higher levels of job satisfaction. On units employing both Registered Nurses and unregulated workers, Registered Nurses perceived that the quality of care was lower. CONCLUSIONS: Staff mix model was related to Registered Nurses' perceptions of the quality of patient care. It was also evident that other variables within the work environment might have more influence on the outcomes examined than the independent variable of staff mix.

Humans↗