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The NHS Plan stipulates that health care in the 21st century should reflect the needs and expectations of local people, offer greater choice and involve patients in the planning and provision of services. This paper describes an initiative to involve users of cancer services in educating health-care professionals because patients are the experts on their condition.
There is growing concern that the indigent health care burden in the southwestern United States may be caused partly by Mexican residents who cross the border to use U.S. health services. This article describes the first attempt to measure the extent of this use by border residents. It also compares factors associated with their use of health care services in both the United States and Mexico. Data were obtained from a household survey conducted in Tijuana, Mexico, near the California border, using a random, stratified analytic sample of 660 households that included a total of 2,954 persons. The dependent variables--extent and volume of contacts with health professionals--were examined according to sociodemographic characteristics, insurance coverage, payment modality, type of visit, and health care setting. The results indicate that 40.3 percent of the Tijuana population used health services exclusively in Mexico during a 6-month period, compared with only 2.5 percent who used services in the United States. Of the Mexican users of U.S. services, the largest proportion appeared to be older people, lawful permanent residents or citizens of the United States who are living in Mexico, and persons from high- or middle-income sectors. In addition to the low level of use of U.S. health services, the findings show that more than 84 percent of the visits were to providers in the private sector and, for 59 percent of the visits, a fee for services was implied. Overall, this border population does not seem to be a drain on the U.S. public health system. The findings must remain tentative, given some methodological constraints of the study; they point to the need for further assessments of the demand for specific services by distinct segments of the border population. Furthermore,since health care financing is a critical issue for Mexico as well, more studies are needed that examine the behavior of U.S. residents who use Mexican health services.
In many parts of the United Kingdom the Community Dental Service (CDS) receives a consistently high level of referrals for general anaesthetic (GA) provision from general dental practitioners (GDPs), predominantly for the treatment of pain in young children. To provide a safe and effective service it is essential to have an appropriate and satisfactory referral process. As part of the established quality assurance programme in the East Kent CDS two surveys utilising self-complete postal questionnaires were conducted, the first to assess GDP's opinions and to examine their referral procedure, the second to gauge user satisfaction with the overall care provided by the CDS-GA service. The main findings suggested a lack of effective communication both between health professionals and with their patients. Over 80 per cent of the GDPs considered either the existing CDS referral guidelines needed clarification or did not even know such guidelines existed. Parents of referred children reported a high level of satisfaction with the service provided by the CDS, but some were critical of a lack of immediate access for children in pain. The finding of greatest concern was that 50 per cent of the parents stated their child's GDP did not explain the possible risks of general anaesthesia prior to referral and 70 per cent were offered no alternative form of treatment to a general anaesthetic. The results of this study should be fed into the continuing quality assurance programme to enable the effective and appropriate development of the CDS-GA service.
HEALTH ISSUES: While women are reported to be more frequent users of health services in Canada, differences in women's and men's health care utilization have not been fully explored. To provide an overview on women's healthcare utilization, we selected two key issues that are important for public policy purposes: access to care and patterns of utilization. These issues are examined using primarily data from the 1998/99 National Population Health Survey, complemented by the 2000 Canadian Community Health Survey and the 2001 Health Service Access Survey. KEY FINDINGS: * Women are twice as likely as men to report a regular family physician, but that proportion is very low (15.8%).* Women report significantly shorter specialist wait times (20.9 days) than men (55.4 days) for mental health, while the reverse is true for asthma and other breathing conditions (10.8 for men, 78.8 for women).* Reported mean wait times are significantly lower for men than for women pertaining to overall diagnostic tests: for MRI, 70.3 days for women compared to 29.1 days for men. DATA GAPS AND RECOMMENDATIONS: * Measurement of possible system bias and its implication for equitable and quality healthcare for women requires larger provincial samples of the national surveys, along with a longitudinal design.* Either a national database on preventive services, or better alignment of provincial databases pertaining to health promotion and preventive services, is needed to facilitate data linkage with national surveys to undertake longitudinal studies that support gender based analyses.en are reported to be more frequent users of health services in Canada, differences in women's and men's health care utilization have not been fully explored. To provide an overview on women's healthcare utilization, we selected two key issues that are important for public policy purposes: access to care and patterns of utilization. These issues are examined using primarily data from the 1998/99 National Population Health Survey, complemented by the 2000 Canadian Community Health Survey and the 2001 Health Service Access Survey. KEY FINDINGS: * Women are twice as likely as men to report a regular family physician, but that proportion is very low (15.8%).* Women report significantly shorter specialist wait times (20.9 days) than men (55.4 days) for mental health, while the reverse is true for asthma and other breathing conditions (10.8 for men, 78.8 for women).* Reported mean wait times are significantly lower for men than for women pertaining to overall diagnostic tests: for MRI, 70.3 days for women compared to 29.1 days for men. DATA GAPS AND RECOMMENDATIONS: * Measurement of possible system bias and its implication for equitable and quality healthcare for women requires larger provincial samples of the national surveys, along with a longitudinal design.* Either a national database on preventive services, or better alignment of provincial databases pertaining to health promotion and preventive services, is needed to facilitate data linkage with national surveys to undertake longitudinal studies that support gender based analyses.
The evaluation of health institutions performance in Mexico during 2004 was done using 29 indicators that describe intra-hospital mortality rates, productivity of health services, availability of health resources, quality of care, security, investment and costs of health care and the satisfaction level by users of health services. This exercise describes the efficiency and organization of health services provided by the different health institutions and allows comparing and balancing the performance of each institution. Results indicate the differences in availability of resources, inequity in the financing health care services, and inefficiency in the use of resources but also describe the level of efficacy of certain institutions and the satisfaction level that different users have of health services. The evaluation of the performance of the entire health institutions should provide the means to improve all the process of health care and to increase the quality of care in all health institutions in the country.
CONTEXT AND OBJECTIVE: Previous research on users of sexual health services has focused primarily on women. However, a focus on men also is needed to address sexual ill-health. This paper uses various data sources to describe the level of, and trends in, men's use of sexual health services in England. DATA SOURCES: Routine data are presented on clients of family planning clinics (FPCs), Brook Advisory Centres and attendances at genitourinary medicine (GUM) clinics. Cross-sectional surveys used include the National Survey of Sexual Attitudes and Lifestyles, Morbidity Statistics from General Practice and the National Gay Men's Sex Survey. RESULTS: The number of male clients attending FPCs has increased by 160% over the 1990s. Most of this increase is due to more men obtaining condoms. The ages of these clients are unknown, but data from Brook Advisory Centres show an increase among younger men. The one service for which male and female use is approximately equal is GUM. Male cases of sexually transmitted infections and other treatments have increased over the 1990s, although not at the same rate as female cases. Use of GUM clinics by homosexually active men is much greater than by all men. Recent data on men's use of general practice for sexual health are lacking. DISCUSSION AND CONCLUSIONS: While overall service use among men is still at a comparatively low level, it has increased over the 1990s for some services. Further in-depth research should question men's wants and demands from sexual health services.
User involvement in health care has received a high profile within the NHS Plan (Department of Health, 2000a), giving patients a greater say in their treatment and in the way that the NHS works. Older people, i.e. those over 65 years of age, as a group, are the highest users of hospital and community services (DH, 2001a). The national service framework (NSF) for older people (DH, 2001a) highlights the need to listen to older people, help them make informed choices and involve them in achieving a healthy lifestyle. While the NSF for older people rightly attempts to ensure fair and equitable access to health care services for older people, it is assumed that they want to be involved, and want to exercise their rights as users. This assumption needs to be tested. This study, presented as a series of four articles, sets out to explore if there is a consumerist ethic among older people in relation to health care. The first paper outlines some of the literature reviewed together with the methodology.
The aim of this study was to analyse the clinical dental health, use of dental services and socio-economic factors correlating with the subjective need for removable dentures in Finnish adults aged 30 years and older. A total of 2528 persons who had lost one or more natural teeth (wisdom teeth excluded) and who had not been provided with any dentures, were selected for this study. Subjects who had subjective need for prosthetic treatment had statistically significantly fewer teeth and fewer fillings, and more decayed teeth than others. Irregular users of dental services felt the need for a prosthesis more often than did regular users of those services. Irregular brushing of teeth was also associated with a greater need for prosthetic treatment. Men, older individuals and persons with less education and a smaller family income felt the need for prosthetic treatment more often than women, younger individuals and better educated persons. The factors differentiating between the two groups with and without a subjective prosthetic treatment need were analysed by discriminant analysis. The best differentiating factors were frequency of dental visits, caries score, frequency of brushing teeth, family income, number of fillings and sex.
INTRODUCTION: The characteristics of users of the Spanish public health system have been evaluated in multiple studies. However, these studies usually refer to users of primary care and emergency services and less frequently to users of specialized services. Some studies have described differences according to patients' geographical origin. OBJECTIVE: To analyze the demographic profile of patients attending our gastroenterology outpatient clinic over a prolonged period. PATIENTS AND METHOD: The geographical origin, age and sex of all patients referred for an initial consultation in the gastroenterology outpatient clinic from 2001-2003 were analyzed. RESULTS: Women accounted for 53.7% of all appointments but no significant differences in referral rates were observed in comparison with men. A total of 65.5% of patients were from urban areas and the referral rate was significantly higher in these patients than in those from rural areas, although attendance rates were equal between patients from the two types of area. Referral rates increased in direct proportion with age; a predominance of referrals was observed in women aged < 74 years and in men aged 75 years or older. Some discrepancies were found among the distinct years analyzed. CONCLUSIONS: In our catchment area, demand is greater in the urban population than in the rural population. No overall differences were found in sex but significant differences were found in age and length of follow-up.
Mental health services have been criticized for the lack of focus and response to people suffering from a serious mental illness (SMI). Assertive community treatment (ACT) offers the potential for greater partnership working between the user and provider of mental health services. The author describes one approach in developing ACT in the UK. Four criteria were developed to identify the most appropriate service users for ACT: those with SMI, illness instability, illness disability and risk to self or others. Fifty-five clients were identified using these criteria and tracked for their length of hospital stay and frequency of admission 2 years before acceptance to an ACT team and for 12 months after. Duration of hospital stay was unchanged although both the frequency and total numbers of bed days were reduced.
BACKGROUND: BPD is a serious mental illness in which psychotherapy has been shown to improve patient outcomes and reduce the use of health services. In most studies of psychotherapy, lower use of health services has been taken to imply lower health service costs. However, the costs of psychotherapy can offset any cost savings due to reduced use of other health services. AIMS OF THE STUDY: To estimate the net costs of health service use in a group of BPD patients receiving intensive psychotherapy. METHODS: Data on use of inpatient hospital, emergency hospital, ambulatory care, diagnostic tests and medications were collected for the twelve months before psychotherapy and the twelve months after the completion of treatment. Cost estimates were developed using standardised unit costs. RESULTS: There was a saving of approximately $670,000 in health service use over the thirty patients compared to a cost of $130,000 for psychotherapy, giving a net cost saving of $18,000 per patient. Most of this was due to reduced hospital admissions. Cost saving was higher in those patients who were high users of hospital services. Sensitivity analyses were performed; overall, the findings consistently show a reduction in the cost of health services used. DISCUSSION: The group studied consisted of 30 patients and comprised a before/after design. Therefore it does not overcome criticisms of other work in this area, that is of observational studies and small sample sizes. Nonetheless, the results were based on detailed costing of service use, using conservative assumptions and subject to sensitivity analysis. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The use of intensive psychotherapy in BPD patients who are high users of health services, particularly those who have had multiple hospital admissions, is probably warranted until more evidence is available. IMPLICATIONS FOR HEALTH POLICIES: There is little rigorous evidence on the effectiveness and cost-effectiveness of psychotherapy. BPD patients appear to generate high service costs so it is important to establish effective and cost-effective modes of treatment. IMPLICATIONS FOR FURTHER RESEARCH: Further research is warranted to establish accurate patterns of service use in BPD patients, and to identify those groups who will most benefit from intensive psychotherapy. erans.
BACKGROUND: To analyse the type of users that access an online Consultancy service. To understand what patient expectations are and how such a service can modify the physician/ patient relationship. METHODS EXPERIMENTAL DESIGN: retrospective investigation carried out by questionnaire which was sent out from 10/04/2001 to 05/06/2001. PARTICIPANTS: 65 users who had contacted the unit's online consultancy service. Of these 33 filled out the questionnaire. QUESTIONS: Each user was asked for anagraphic data, in full respect for his/her privacy, and an evaluation of the service. The data obtained, stored in a database, were then analysed and the percentages of each variable calculated. RESULTS: The typical user is resident in the centre-north, is aged an average of 32 with an average level of education. He chose online consultancy largely to obtain a medical opinion in a short time without leaving home and without the long waiting times usually necessary to obtain a further specialist opinion. He was generally fairly pleased with the replies received and therefore judged the system useful. CONCLUSIONS: The system is popular with users who access it to receive specific indications for treatment and to have more information about their condition. Given user expectations, it is necessary to guarantee the quality and reliability of the service and educate users in the correct use of these new technologies.
Do persons who utilize the services of the alternative therapist demonstrate a greater self-care response to illness? This cross-sectional study was done to compare the health perceptions and self-care response to minor illness among users of conventional medical care and alternative therapy. Data were collected with a pre-tested, self-administered questionnaire to 99 patients of medical practitioners and 74 of alternative therapists. Results indicated statistically significant differences in some health perceptions such as ways to improve general health and responsibility for personal health. For both groups there were similarities in socio-demographic characteristics and self-care responses to minor illness, such as headaches, constipation, diarrhoea, sinus congestion and colds or flu. Also, results reflected a common practice of self-management of minor illness and an overlap in attendance by patients to both groups of practitioners. Recommendations are made for the public to be guided in its practice of self-management of minor illness and that a regulatory body be set up to govern the practice of alternative therapy in Jamaica.
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BACKGROUND: Citizens advice can help clients avoid the worst consequences of poverty and hence has the potential to reduce inequalities in health. Previous studies of providing citizens advice from primary care have concentrated largely on older clients. AIM: To measure the benefits obtained by families with young children from a citizens advice service in primary care. METHOD: An advice worker was placed in three practices. Eligible families had a child less than 1 year of age. Quantitative analysis of data on benefits obtained by all families using the service was performed. Qualitative analysis of interviews with five users and five non-users of the service was undertaken. RESULTS: Out of 107 families recruited, 23 used the CAB service, seeking advice on 49 different problems and obtaining benefit on 32 of these, most frequently on welfare benefits, debt management and housing. One-off financial benefits totalled pound sterlings 17 857 with annual recurring payments of pound sterlings 6480. The interviews raised five general themes: (1) the stresses surrounding the birth of a child; (2) factors associated with uptake of the service; (3) the content and value of the advice received; (4) the benefits to their health of the advice; and (5) their perception of the links between health and financial adversity. CONCLUSIONS: Citizens advice offers considerable benefits to families with young children. It may have positive effects on maternal and child health. An advice service is a useful component of primary health care for young families.
Government services, including health departments, are insisting that consumers or users of health services be consulted. Linguistic diversity in communities can pose challenges to planners and policymakers in this communication and consultation agenda. This article presents rapid bilingual appraisal as a useful technique for health services to meet the requirements set by equity and access guidelines and legislation. This method was used in an area health service as part of an independent feasibility study. Health services should recognise the need for such consultation and allocate appropriate resources and time to conduct such consultations, and for skilled bilingual facilitators and qualified interpreters to be employed and developed as part of the team.
A group of 41 schizophrenic patients were followed up for a period of up to 8 1/2 years after their first admission to a general hospital psychiatric unit. During the follow-up period one third of the patients were not readmitted, and the remainder had between one and eight readmissions. Half of the patients spent less than 5 % of the follow-up period in hospital. Twenty-one patients remained in fairly close contact with at least one of the community services. A greater degree of clinical disturbance characterized high users, as compared with low users, of these services. At the end of the follow-up two patients were in hospital, half of the original cohort was considered clinically recovered and four-fifths socially recovered. The contribution of the general hospital and of the community services to the improved prognosis for schizophrenia is disucssed.
OBJECTIVE: The purpose of this study was to determine if the reduction in copayment amount by a large self-insured state employer increased utilization of adolescent services. Specifically, the study sought to discover if the number of unique adolescent users of substance use outpatient services increased as a result of reductions in cost-sharing arrangements. METHOD: The data utilized in this study were 31,585 records from administrative claims data on utilization of mental health and substance abuse services from members of a state indemnity plan fromJuly 1998 through December 2001, translating to 36 months of pre-intervention data and 6 months of postintervention data. Monthly longitudinal data before and after benefit design change were analyzed using a quasi-experimental time series design, using Box and Jenkins' autoregressive, integrated, moving-average time-series modeling methods. The primary outcome measure was the number of unique users of services. RESULTS: The hypothesis that service utilization would increase following the implementation of a reduction in copayment amount (the intervention) was supported in these analyses for adolescents' substance use service utilization. A significant increase in the number of unique adolescent users of substance use services was detected in the month following the intervention (p < .01). CONCLUSIONS: The results of this study suggest that a reduction in adolescents' substance use service copayment requirements to a level equal to those for general medical services may be a step toward assuring full parity between such types of services. These findings provide potentially important information regarding the possible effects of broader policy changes, as parity in benefit design is a common component of laws that attempt to ensure "full parity."