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PubMed2006

[PIPEQ--a method for measurement of user satisfaction in mental health services].

BACKGROUND: This study describes the development and testing of the Psychiatric In-Patient Experiences Questionnaire (PIPEQ). MATERIAL AND METHODS: Questionnaire development was based on a literature review, qualitative interviews with patients, and expert opinion. The questionnaire was tested in a postal survey among inpatients at three community health centres affiliated with the psychiatric clinic of Stavanger University hospital during spring 2005. 244 patients received the questionnaire; either they got the questionnaire by mail after discharge or at the institution before discharge. RESULTS: 68 (28%) patients responded to the questionnaire. Items had low levels of missing data. Factor analysis showed that 11 widely applicable items contribute to a measure of overall experiences. Item-total correlations ranged from 0.55 to 0.82. Cronbach's alpha exceeded the criterion of 0.9. Construct validity was supported by comparisons with variables related to patient experience, including overall satisfaction, extent of patient say in the medication decision, necessity of coercion, and mental health status. INTERPRETATION: The PIPEQ is a brief instrument that covers important aspects of health care experience for psychiatric inpatients and has good evidence for internal reliability and construct validity.

Adult↗
PubMed2006

Design and implementation of a library-based information service in molecular biology and genetics at the University of Pittsburgh.

SETTING: In summer 2002, the Health Sciences Library System (HSLS) at the University of Pittsburgh initiated an information service in molecular biology and genetics to assist researchers with identifying and utilizing bioinformatics tools. PROGRAM COMPONENTS: This novel information service comprises hands-on training workshops and consultation on the use of bioinformatics tools. The HSLS also provides an electronic portal and networked access to public and commercial molecular biology databases and software packages. EVALUATION MECHANISMS: Researcher feedback gathered during the first three years of workshops and individual consultation indicate that the information service is meeting user needs. NEXT STEPS/FUTURE DIRECTIONS: The service's workshop offerings will expand to include emerging bioinformatics topics. A frequently asked questions database is also being developed to reuse advice on complex bioinformatics questions.

Computational Biology↗
PubMed2006

Integrated electronic health records management system.

Computer systems and communication technologies are making a strong and influential presence in the different fields of medicine. The cornerstone of a functional medical information system represents the electronic health records management system. Due to a very sensitive nature of medical information, such systems are faced with a number of stringent requirements, like security and confidentiality of patients' related data, different media type's management, diversity of medical data that need to be processed etc. At present most clinical software systems are closed with little or no operability between them, and the medical information are locked in a variety of different incompatible databases. As the result of these facts, it is very hard for the developers to provide the solution for an integrated health computing environment, which would considerably improve the quality of medical care in general. This paper presents the framework for a functional EHR management system that meets these demands, but also follows the initiative taken by the Next Generation Network (NGN) approach, which includes user mobility, service transparency and common communication platform for transferring and serving different types of information, services and media.

Computer Communication Networks↗
PubMed1991

[A study of falls experienced by the aged among users of preventive health examination services].

In order to determine what factors are related to falls and the effect on the aged, a study was conducted on subjects aged 60 years and over who had undergone preventive health examinations in the western region of Shizuoka Prefecture. Subjects (n = 305) had an average age of 64.4 +/- 3.8 years, and all were interviewed regardless of their history of falls. For the 66 cases who had experienced falls, further questions prepared in advance, were included. The following results were obtained: 1) There were 66 subjects (21.6% of the subjects) who had experienced falls with some experienced multiple falls for a total count of 91 falls. 2) The frequency of falls of female subjects was significantly higher than that of males. Further, with respect to the type of injuries suffered, in the case of many of the female subjects, these took the form of contusions. 3) The majority of subjects who experienced falls were engaged in farming and most of the falls were work-related. 4) Results of this study showed that, while not statistically significant, cerebrovascular diseases are closely connected to falls and increases the falls coefficient among the aged.

Accidental Falls↗
PubMedDate not supplied

[Structuring a clinical information system for hospital services: BASELINE].

Clinical database systems have been in use since 1972, but they still fail to meet most of the requirements they were aimed at. This includes not only the management of administrative tasks, but particularly the support of medical activities. Our study presents an experimental model of a clinical database system for general hospitals, mainly dedicated to the support of some basic, fundamental clinical activities, namely the management of baseline patient data. This model is based on a modular concept, and its core is represented by a Minimal Data Base Set designed to meet the specific requirements of each Department and of each distinct area within a Department. The system does not interfere with routine clinical work and tries to offer a high level of services to users. A number of utilitary programs simplify user interaction with the system, such as a menu-driven data-entry program, a semi-automatic codification program that follows the OMS/ICD-9-CM coding system, and a menu-driven program for data retrieval. Basically, this system can be helpful for the automatic edition of clinical reports and the retrieval of patient records meeting conditions specified by the clinician.

Hospital Information Systems↗
PubMed1976

Physical facilities of medical school libraries in the United States, 1966-1975: a statistical review.

This paper, based on information received from a questionnaire to which 107 of the present 114 medical school libraries in the U.S. responded, shows the vast growth and expansion of such libraries. The 86 libraries which have been built, expanded, under construction of planned during 1966-1975 represent the greatest expansion in the history of medical school libraries. This "decade of revolution" can be attributed to the evergrowing resources, primary users, and services discussed in this paper. The survey results can also be useful to those institutions planning or remodelling such library facilities in the near future.

Architecture↗
PubMedDate not supplied

Public health nursing clientele shared with social assistance: proportions, characteristics and policy implications.

This study was designed to determine (1) the extent to which public health nursing visits and social services income programs serve the same population (shared clientele), (2) whether shared and unshared clientele differ in their characteristics, and (3) whether those who use both these services are high users of other health and social services. A computerized record linkage showed that 17% of individual public health nursing clients were shared with social services. Shared clientele had more social, perinatal, emotional and mental health problems. It is these characteristics, rather than the simultaneous use of both services, that were associated with more public health nursing visits, days in care, and use of all other health providers. The trend away from in-home nursing visits may create a situation of unmet need. While health and social resources are expended on persons with children with greater risk circumstances, the question remains about the efficacy and efficiency of this mix of service for parents and children receiving social assistance.

Adolescent↗
PubMed1993

Family planning in the teen population.

As an increasing percentage of adolescents reach their sexual debut at younger ages, effective contraceptive methods, which will decrease the risks of unintended pregnancies and sexually transmitted diseases (STDs), become even more critical. Contraceptive methods which are less 'compliance-dependent', such as the implantable subdermal levonorgestrel and the injectable depot formulation of medroxyprogesterone acetate, are popular in adolescents but careful counseling before method selection and on-going counseling when side-effects are experienced are necessary and essential. The use of condoms to decrease the risks of STDs will continue to be important for adolescents, and it remains to be seen what impact the long-term methods will have on effective condom use. Adolescents' access to abortions when contraceptive methods fail, or when no method is used, is being challenged with state laws which mandate parental notification or permission. A greater knowledge about the option of emergency contraception could potentially lead to increased use of this method, particularly when the option of medications such as RU486 becomes available. The potential for a reduction in unintended pregnancies in adolescents, and a reduced need for abortions is a welcome prospect.

Abortion, Legal↗
PubMed1997

A new primary care rostering and capitation system in Norway: lessons for Canada?

Providing every patient with a personal primary care physician or, from the physician's perspective, establishing a stable roster or list of patients is currently being actively debated in Canada. Norway's system of primary care medicine, similar to Canada's, faces many of the same problems. In 1992 a trial rostering system with blended funding (capitation, fee-for-service and user fees) was established in 4 Norwegian municipalities. After 3 years of close monitoring, the results of system evaluations have attracted strong interest. This article reports on the benefits and problems encountered with the new rostering system in Norway. If Canada is moving in the same direction, some of the lessons learned may be helpful.

Canada↗
PubMed1997

Pulling together: multi-disciplinary training for mental health nursing.

In 1995 the Sainsbury Centre for Mental Health commissioned a major review of all specialist mental health training. The current, largely uni-disciplinary approach to training was felt to be failing to equip professionals with the necessary skills for today's multi-disciplinary, integrated, community-based service, where users and their carers expect an equal partnership and sharing of information. Kevin Gournay and Susannah Strong outline the findings and recommendations of the review, and its implications for mental health nurse education, which make a case for its separation from the rest of the nursing profession.

Certification↗
PubMed1997

[The evaluation of women's health promotion services: the internal client, the external client].

OBJECTIVES: To find the opinion of internal and external customers of the Women's Health Promotion Services; to obtain information about the perceptions and suggestions of both midwives and users of the service. DESIGN: An observational study of the qualitative evaluation of a service provided in Primary Health Care, through an open questionnaire to midwives and focus groups with users. SETTING: Health Area 4 in the Community of Valencia. PARTICIPANTS: 15 midwives from Health Area 4, 3 groups of women using the Pregnancy Follow-up Programme and 3 groups from the Programme of Integrated Care for climacteric women, coming from two Health Districts, one urban and one rural. MAIN RESULTS: For midwives, coordination with general practitioners was better in the urban setting, and with Family Planning Centres in the rural one. Absence of team work with gynaecologists, and gynaecologists' failure to value midwives' work, were identified as problems. CONCLUSIONS: Different patterns for the organisation and use of women's health promotion services were identified between the urban and rural setting. The problems of coordination identified by the midwives are not perceived as such by the service's users, who evaluated as satisfactory the Primary Care services received.

Adolescent↗
PubMed2003

Association between interruptions in medicaid coverage and use of inpatient psychiatric services.

OBJECTIVES: Persons with schizophrenia are heavy and persistent users of Medicaid services. Interruptions in their Medicaid coverage may have serious consequences for the mental health of these individuals and their subsequent use of mental health services. This study sought to determine the impact of interruptions in Medicaid coverage on the use of Medicaid-reimbursed inpatient psychiatric services over a four-year period. METHODS: Inpatient Medicaid claims and eligibility files for 1,830 Medicaid beneficiaries with schizophrenia in Utah from December 1990 to December 1994 were used to identify differences in hospital admissions and total number of days in a hospital associated with interrupted Medicaid coverage. Of the 1,830 Medicaid beneficiaries identified, 1,463 experienced continuous Medicaid eligibility, and 367 had interruptions in their eligibility. RESULTS: Interruptions in Medicaid coverage were associated with an average of.63 more psychiatric hospitalizations per beneficiary over the four-year period, representing an 86 percent higher hospital admission rate. This increase appeared to be largely due to a subset of persons who have much higher hospitalization rates after an interruption in Medicaid coverage. Interruptions in Medicaid coverage were associated with a mean of 8.3 more days of psychiatric hospitalization over the four-year period, representing 61 percent more hospital days. CONCLUSIONS: Medicaid beneficiaries who experience interruptions in coverage have, on average, a significantly greater use of inpatient psychiatric services while participating in Medicaid than beneficiaries with continuous Medicaid coverage. These findings suggest potential benefits of maintaining continuous Medicaid eligibility for beneficiaries with a severe mental illness.

Eligibility Determination↗
PubMed2007

Home-care programmes for older adults with disabilities in Canada: how can we assess the adequacy of services provided compared with the needs of users?

The need for home care will probably continue to increase over the next decade as one response to innovative health practices designed to help people receive services at home instead of in institutions. However, there are no data for determining whether home-care programmes can meet user needs. The objectives of the present study were to describe the functional autonomy profile of the users of public home-care programmes in Québec, Canada, and to compare the level of adequacy between required and provided services in public home-care programmes for older adults with disabilities. This study was based on a cross-sectional design from September to December 2002. The population studied consisted of all users of public home-care services in one administrative region in the province of Québec over this 3-month period. Each user was assessed with the Functional Autonomy Measurement System (SMAF) and then classified into one of the 14 Iso-SMAF profiles. The total number of hours of care required was determined using the median number of hours of nursing care, personal care and support services associated with each profile. For the sake of comparison with the services required, the services provided were calculated from an administrative databank that included statistics of the time spent by health professionals on caring for home-care users. The ratio of hours of services provided to the number of hours of services required by home-care users highlights a discrepancy between the services provided and user needs. The results of this study show the feasibility of describing users of public home-care programmes and the adequacy of services provided in relation to user needs. Based on these results, public home-care programmes in the province of Québec appear to be under-funded.

Aged↗
PubMed1989

Are people willing and able to pay for health services?

Following a nationwide increase in user fees for health services in Swaziland, this paper analyzes the effect of the fee increase on overall patient use of health services, on which types of services, curative vs preventive, were most affected, and on changes in utilization by higher paying and lower paying groups. Patient attendance data from a 71% sample of government and mission health facilities, suggests that the 'people are willing and able to pay for health services' assertion is not supported by the Swaziland case. Following the fee increase, average attendance decreased at government facilities by 32.4%, increased at mission facilities by 10.2%, leading to a combined decline of approx. 17%. Patient visits designed to protect against childhood diseases, BCG and DPT immunizations, or against dehydration in children, show average attendance declines of -16, -19, and -24%, respectively, while visits for musculoskeletal diseases, a less serious disease, declined 1.2%. The analysis also suggests that up to 34% of the overall decline in attendance was among patients who previously had paid the least for health care with part of this decline likely including fewer multiple visits.

Eswatini↗