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PubMed2006

[Impact of structure and context on utilization of socio-psychiatric services in Saxony--a multi-level-analysis].

OBJECTIVE: To analyse the influence of structural (service) aspects and context (catchment area) variables on the individual use of socio-psychiatric services in Saxony. METHOD: Data collected in 34 services were used. For the analysis of the variance components a multi-level model with random effects was computed using data at two levels ([1] client, and [2] service/catchment area). RESULTS: Service use was substantially influenced by structural/context factors which accounted for a proportion of 10 to 50 % of the variance depending on the (sub-)group of users included in the analysis. The impact of service structure and context on service use was particularly strong in the subgroup of service users with very high service utilisation.

Adult↗

PubMed2003

Comparing the use of health information/advice in Birmingham and Hull: a case study of digital health information delivered via the television.

Postal questionnaire surveys were carried out with users of two digital interactive television (DiTV) providers of health content to investigate the use made of each service and the users' reactions to service content and its usefulness to them. The research indicated that health information on DiTV was used and, on the whole, rated favourably. There was some evidence also that such information might be used by some people as a substitute for going to the doctor, though information from their general practitioner (GP) or practice nurse still carries more weight for most people than any other health information source. This study forms part of an ongoing research project which has, as part of its aim, the task of identifying particular users with the information sources that may be most appropriate for them.

Adult↗

PubMed2003

[The quality of outpatient services in health facilities in Hidalgo, Mexico, from the users' perspective].

OBJECTIVE: To identify and assess factors associated with the quality of health care in hospital outpatient services within the state of Hidalgo, Mexico, based on a user survey. METHODS: We performed a cross-sectional, comparative, analytical study of 15 public hospitals within the state of Hidalgo, Mexico. The sample, which was made up of 9 936 interviewees (power: 85%; significance level: 95%) was randomly selected among users of outpatient services between July 1999 and December 2000. We looked at the quality of care using a Likert-type scale. The statistical analysis consisted of inconditional logistic regression. RESULTS: The quality of care was perceived as being good by 71,37% of users surveyed and as bad by 28,63%. Poor quality was primarily perceived in institutions belonging to the social security system (39,41% vs. 19,42% in other institutions). Of those surveyed, 84,94% said they were satisfied with the care they received, and 49,2% said they expected to get better care. In all, 16% claimed they would return to the same hospital only because they had no other choice, and 2% said they would never return. A higher educational level and a better income showed a direct association with the perception of poor quality and discontent with the lenghty waiting period (odds ratio [OR]: 2,3; 95% CI: 2,02 to 2,82) and with the physician's discourteous attitude (OR: 4,22; 95% CI: 3,6-4,8). CONCLUSIONS: They main factors that determine poor quality in health care, according to users, are lengthy waiting times before being ushered in, incomplete physical examination and diagnosis, difficulty of getting an appointment, and poor treatment on the part of services staff.

Adult↗

PubMed2005

A survey of users and non-users of a UK teaching hospital library and information service.

BACKGROUND: The Lancashire Teaching Hospitals NHS Trust was formed in 2002 with the merger of two existing trusts. The library services unified to create a new expanded service with 11 staff. OBJECTIVES: The librarians wanted to test out users' opinions of the service, as a basis for a developmental strategy. They also wanted to find out to what extent they were offering a multi-disciplinary service, available to all staff. Therefore it was decided to include both users and non-users in the survey. METHODS: A twenty-question questionnaire was sent out to a 10% sample of registered users in all staff categories. The same questionnaire was sent out to a 10% sample of non-users, with the help of the Human Resources Department. RESULTS: The library staff and facilities were generally well regarded. The stock needed expansion in various areas, especially allied health and biomedical science. Non-users were in fact often occasional or remote users. Other non-users needed informing that they were entitled to use the service. CONCLUSIONS: Further research is required, especially concerning the information needs of allied health and scientific staff. There is a need for stock expansion. A marketing strategy is required to capture the interest of potential users.

Consumer Behavior↗

PubMed2004

Involving older people in intermediate care.

BACKGROUND: Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. AIM: This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. METHOD: The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. FINDINGS: The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. CONCLUSIONS: The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.

Aged↗

PubMed2002

Involving users in the delivery and evaluation of mental health services: systematic review.

OBJECTIVES: To identify evidence from comparative studies on the effects of involving users in the delivery and evaluation of mental health services. DATA SOURCES: English language articles published between January 1966 and October 2001 found by searching electronic databases. STUDY SELECTION: Systematic review of randomised controlled trials and other comparative studies of involving users in the delivery or evaluation of mental health services. DATA EXTRACTION: Patterns of delivery of services by employees who use or who used to use the service and professional employees and the effects on trainees, research, or clients of mental health services. RESULTS: Five randomised controlled trials and seven other comparative studies were identified. Half of the studies considered involving users in managing cases. Involving users as employees of mental health services led to clients having greater satisfaction with personal circumstances and less hospitalisation. Providers of services who had been trained by users had more positive attitudes toward users. Clients reported being less satisfied with services when interviewed by users. CONCLUSIONS: Users can be involved as employees, trainers, or researchers without detrimental effect. Involving users with severe mental disorders in the delivery and evaluation of services is feasible.

Delivery of Health Care↗

PubMed1999

The use of acute and preventative medical services by a general population: relationship to alcohol consumption.

AIMS: To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, but decreasing use of preventative, medical services among the general population. DESIGN AND PARTICIPANTS: Health and life-style survey of 41,000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, alcohol and tobacco usage and use of acute (A&E department and general practitioner) and preventative (dental, optician, mammography and cervical cytology) services: the response rate was 60%. MEASUREMENTS: Comparative use of acute and preventative health care services by patients with varying consumption of alcoholic beverages. This was estimated by the odds ratio for service use, after correcting for the following confounding variables; age, social class, ethnic group, employment status, whether lives with children or with other adults, whether is a career, limiting long-term illness, depression status, smoking habit and use of private health insurance. FINDINGS: There was increased use of accident and emergency services by the harmful and intermediate drinking groups compared with the safe drinking group. Male abstainers attended their A&E departments more frequently than 'safe limit' drinkers. With respect to preventative services, both male and female abstainers and harmful drinkers used dental services less than safe limit drinkers. For females, mammography and cervical cytology services were less frequently used by abstainers and by harmful drinkers. CONCLUSIONS: This study supports the generally held view that heavy alcohol consumers are disproportionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-users of acute services, but under-users of preventative services. These latter observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers.

Age Distribution↗

PubMedDate not supplied

Demystifying the injection drug user: willingness to participate in traditional drug treatment services among participants in a needle exchange program.

Injection drug users have been vilified in our culture as being wild-eyed and willing to do anything for the next hit. These individuals are typically seen as being unemployed, uneducated and completely disinterested in making any changes in their lives. Sixty-one participants in a syringe exchange program in Cleveland, Ohio were interviewed using the NIDA Risk Behavior Assessment. Fifty (81%) of the respondents were either in an abstinence-based program or reported a willingness to participate in such a program. Importantly, although the sample consisted of long-term daily users of injection drugs (m=19.95 years), the majority of the sample was employed (69%) and were high school graduates (51%). The results of this study suggest that injection drug users are willing to make changes in their use-related behaviors, involvement in a needle exchange program does not preclude involvement in abstinence-based programming, and needle exchange services may serve as an important component in a continuum of care when coupled with traditional abstinence-based services.

Adult↗

PubMed2004

The impact of employment counseling on substance user treatment participation and outcomes.

The nationally representative Alcohol and Drug Services Study (ADSS, 1996--1999) is used to examine employment counseling's impact on treatment participation and on postdischarge abstinence and employment. Employment counseling (EC) is among the more frequently received ancillary services in substance user treatment. The ADSS study sample showed it was received by 13% of all (N=988) nonmethadone outpatient clients, and 42% of the 297 clients with a need for it. Clients who received needed EC (met need) are compared to clients who did not receive needed EC (unmet need). Met-need clients had significantly longer treatment duration and greater likelihood of employment postdischarge than unmet-need clients. Both groups were as likely to complete treatment and be abstinent at follow-up. Implications are discussed. Future needed research and unresolved critical issues are also noted.

Adult↗

PubMed1982

Chiropractic use: a test of several hypotheses.

Several hypotheses concerning the use of chiropractic services were examined using data on health attitudes and health care utilization collected in central Wisconsin. The analyses indicate that the major differences between users and non-users of chiropractic services are that users are older, report more chronic health problems, have used physicians relatively frequently, but report difficulty in getting doctors' appointments. (Am J Public Health 1982; 72:727-730.)

Adolescent↗

PubMed2006

Crack/cocaine use in a rural county of England.

Crack/cocaine use is an increasing problem in the UK. This study is the first to ascertain the magnitude of the crack/cocaine problem in a rural county of the UK and to determine users' needs for treatment services. A questionnaire on drug dependence and risk behaviour was completed by 306 users of drug treatment services, and focus groups were conducted with 45 self-selected crack/cocaine users. It is estimated that 31% (95% C.I., 26% to 37%) of drug users in treatment services have moderate/severe dependence on crack/cocaine. Factors associated with severe crack/cocaine dependence are severe dependence on benzodiazepines, increasing number of drugs used, engaging in sex work and non-white ethnicity. Those with severe dependence have a higher prevalence of hepatitis B and C compared with those with moderate or no dependence. All focus group participants describe a frenzied drug life so when entering treatment they require additional support to give structure to their lives to prevent relapse. Current service provision appears not to provide help to crack/cocaine users. Given the lack of pharmacological treatment, programmes should incorporate a wide range of activities and interventions to provide structure to clients' lives. Learning from ex-users was perceived as an important component of treatment.

Adult↗

PubMed1990

Utilization of the Government dental service by Chinese civil servants in Hong Kong.

A sociological study was conducted in 1987 on a sample of 490 Hong Kong Chinese civil servants for the purpose of investigating factors which influenced their utilization of a freely available Government dental service. The proportions of regular, irregular and non-users of the dental service were 69, 18, and 13% respectively. Regular users had a higher educational standard and income level than the other two user-types. Most of the regular users attended the dental clinics for a check-up. The irregular users did not regularly utilize the service mainly because it took a long time to obtain an appointment. Non-users referred to the long waiting time to obtain an appointment and to their perception of not having dental problems when asked to give their main reasons for not utilizing the dental service. The majority of the user-types considered that shortening the waiting time and employing more dentists would increase the utilization of the Government dental service.

Adult↗

PubMed1988

Options and trends in the training of information professionals.

Professionals in the information field need a variety of up-to-date skills. Currently there are many options for learning and practicing these skills. Academic departments, professional societies, consultants, and various commercial organizations, all of whom offer courses, conferences, workshops, seminars, institutes and the like, compete with each other for training dollars. Other options for trainees include in-house training, how-to books and manuals, databases on CD-ROM, CAI and emulators, and videotapes. Major changes in training are taking place as a result of the rapidly increasing number of direct end users of information services and products. All potential trainees, whether end users or information professionals, must carefully assess the relative value of the training options available.

Computer User Training↗

PubMed1992

The economics of drug use and abuse.

The markets for drugs such as cocaine are characterized by much ignorance about the nature of trading relationships, in particular the volumes and prices exhibited by overlapping national and international networks of buyers and sellers (i.e. markets), and by severe regulation by the State. The regulation of illegal markets is expensive; for example, in 1988 in the UK, over 5000 Customs officers and 1800 CID and uniformed policemen were involved in enforcing the law at a cost of about 140 million pounds. The size of the markets can be only 'guesstimated': in 1989 just over 520 kg of cocaine was seized. If this is assumed to be 10% of the market, the total size of the cocaine market was somewhere in excess of 5000 kg. The 'cost-effectiveness' of both Customs and the police in enforcing the law may have declined in the late 1980s. What economic arguments are there for sustaining illegality and an expensive enforcement effort? Some arguments for State regulation are explored; for example, the drug user harms 'innocent' third parties, the drug user is less productive and reduces national income, the drug user will impose costs on the National Health Service, the drug user's behaviour is offensive, and the drug user should be protected from his own stupidity. Where do these arguments leave the case for maintaining public policy towards illicit drugs? Would it be cost effective to move towards the liberalization of these markets?

Cocaine↗

PubMed2001

How does drug and alcohol misuse develop among people with psychotic illness? A literature review.

BACKGROUND: There is little evidence contributing to the understanding of why people with schizophrenia and other psychotic illnesses use drugs and alcohol. METHOD: A comprehensive literature search for evidence relevant to each of the following questions was undertaken, each of which is relevant to understanding why individuals with schizophrenia and other functional psychotic illnesses use drugs and alcohol: (1) Is substance misuse more prevalent among those with psychotic illness than the general Population? (2) Which problem generally develops first in dual diagnosis? (3) Can substance misuse cause schizophrenia and other functional psychotic illnesses? (4) Does dual diagnosis have a neurobiological Basis? (5) Is personality disorder a mediating factor in the relationship between psychotic illnesses and substance misuse? (6) Do individuals with psychotic illness use substances as self-medication? (7) Have changes in the care and social circumstances of people with psychotic illness, particularly deinstitutionalisation, led to a rise in substance misuse in this Population? (8) Do the social situations and social difficulties of people with psychotic illness lead to substance misuse? and (9) Do individuals with psychotic illness tend to begin using drugs and alcohol within mental health service settings or in the company of other users of such services? RESULTS: There is some evidence to support the idea that people with schizophrenia and other psychotic disorders use substances to reduce general dysphoria, and possibly negative symptoms. Social environment and experiences are also likely to be factors in the development of substance misuse in this group, but there is a dearth of empirical evidence. CONCLUSIONS: There is a need for further research, especially concerning the social contexts of substance and alcohol misuse and the ways in which patterns of misuse develop among people with schizophrenia and other psychotic illnesses.

Alcoholism↗

PubMed2001

Prevention: developing a framework for conceptualizing and evaluating outcomes of preventive services for older people.

There is growing preoccupation among policy makers and commissioners in developing preventive strategies and services. There is simultaneous concern with evidence-based purchasing and provision, within health and social care. In social care the evidence base regarding prevention is neither extensive nor robust. As the review of recent policy documents indicates, the concept of prevention is extremely slippery. What preventive services are and whether they are effective depends on the specific policy context, the overall service objectives and the perspective on outcomes adopted (user, carer, professional, service). Focusing on older people, the paper seeks a way through the confusion, locating prevention within a theoretical model of successful ageing. This conceptualizes ageing as involving adaptation to the changing balance between gains and losses over the life course. Successful ageing is perceived as the attainment of valued goals, the minimisation of losses and maximization of gains through the linked processes of selective compensation and optimisation. The paper then identifies necessary elaborations of the model to take into account the wider cultural and socio-economic context. This shapes and constrains the goals pursued and the resources available in adopting particular adaptation strategies. Within this model, preventive services may be conceived as resources to be drawn upon to support compensatory strategies. Similarly, outcomes and effectiveness of services may be evaluated in terms of whether they facilitate/allow older people to achieve valued goals. In developing and evaluating preventive services in social care the question of interest is reformulated: what contribution do specific services make in optimising gains and compensating for the losses that accompany ageing? This framework is explored in respect of two substantive areas ripe for secondary prevention services and strategies - bereavement and instrumental support in the home.

Adaptation, Psychological↗

PubMed2001

Mapping as a method for analysing policy response in the management of health services.

Health services are susceptible to changes in health need, resource allocation, public-health debates and health policies. Service mapping is considered a useful tool for analysing complex issues, monitoring changes over time and facilitating change. It also enables one to describe pathways of care and the relationships between services. This article centres on two projects--a London-wide project 'Service networks for HIV Care' and a local survey 'Mapping of HIV-related services for illicit drug users'--and demonstrates the usefulness of mapping for both studies. Mapping of service networks allowed exploration of a variety of connections between treatment centres, and led to recommendations for a model of HIV service networks across London. The mapping of HIV-related services for illicit drug users confirmed that the service provision was balanced in time, space and target groups, but also identified gaps showing that services were not very successful in attracting women and members of ethnic minority groups. It is clear from both studies that mapping provides an overview of existing services, describing details of services, their target groups or links. It can assist to monitor changes over time, to reconfigure services according to need, and to target resources where need becomes apparent. Mapping exercises also can be useful in identifying new areas for collaboration and interagency work.

Community Health Planning↗

PubMed1999

The value of Web-based library services at Cedars-Sinai Health System.

Cedars-Sinai Medical Library/Information Center has maintained Web-based services since 1995 on the Cedars-Sinai Health System network. In that time, the librarians have found the provision of Web-based services to be a very worthwhile endeavor. Library users value the services that they access from their desktops because the services save time. They also appreciate being able to access services at their convenience, without restriction by the library's hours of operation. The library values its Web site because it brings increased visibility within the health system, and it enables library staff to expand services when budget restrictions have forced reduced hours of operation. In creating and maintaining the information center Web site, the librarians have learned the following lessons: consider the design carefully; offer what services you can, but weigh the advantages of providing the services against the time required to maintain them; make the content as accessible as possible; promote your Web site; and make friends in other departments, especially information services.

California↗