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PubMed1991

Audit of user satisfaction with the Leicestershire Breast Screening Service; women attending for assessment of abnormal mammograms.

Women returning for assessment of abnormal breast screens completed user satisfaction questionnaires: 103 at the clinic (100 per cent response) and 79 (87 per cent) of 91 without malignancies a week later. Women were satisfied with invitations' timing and with the information in one of three letter versions tested. A small group (11 per cent) had not discussed their invitations with anybody and also declined to do so with the Breast Care Sister. Twenty-nine per cent of women had to wait longer than 15 minutes (longer than expected for nine of them). Most women (69 per cent) described the staff as the best aspect of their visit, 55 per cent found nothing unpleasant and 96 per cent said they would attend again. Others mentioned waiting, the dressing gowns and the mammography as unpleasant. The audit allowed the service to be improved and provided invaluable feedback to staff working in a stressful environment. Similar audits will be repeated when screening other Leicestershire areas.

Anxiety↗

PubMed1997

Linking high-risk, low-income, pregnant women to public health services.

Utilization of public health services by high-risk pregnant women is contingent on women's awareness of those services. This article reports on an evaluation of public health promotional methods and compares high-risk pregnant women users of public health services to eligible nonusers. For women who used public health services, the two most frequently reported sources of information were a public health nurse or a friend. Users of services in contrast with nonusers tended to have had fewer pregnancies, lower income, and use WIC. They were also less likely to attend church and to have more contact with their child's school. These findings can assist agencies in planning outreach activities.

Adult↗

PubMed1999

Immunisation uptake, services required and government incentives for users of formal day care.

OBJECTIVES: To determine immunisation uptake in children attending formal day care prior to the introduction of certificates (state) and parent incentives (federal), and to document parent and child carers' attitudes to these strategies. METHOD: In 1997, 60 child care centres and 300 family day carers in suburban Melbourne were randomly sampled. Immunisation dates, service use and preference, and views on government incentives were obtained from parents of children under three years of age. RESULTS: From 2,454 eligible children, information was obtained for 1,779, of whom 84% (95% CI 82-86) were completely immunised. Low income (OR 1.8, 95% CI 1.2-1.9, p < or = 0.001) and larger family size (OR 1.8, 95% CI 1.2-2.7, p = 0.002) and only ever using a doctor (OR 1.6, 95% CI 1.1-2.3) was associated with incomplete immunisation. Main reasons for delaying immunisation were occurrence of minor illness and work commitments. Families would prefer immunisation services at Maternal and Child Health visits (39%), evening sessions (22%) and at day care (22%). Immunisation uptake could increase to 94% if those receiving Childcare Assistance (67%) immunised their children on time but would increase to 87% if these incentive only motivated those for whom Childcare Assistance was essential (15%). While 98% of day care co-ordinators and 71% of family day care co-ordinators documented immunisation status at commencement of child care, only 51% and 33% respectively regularly updated this information. CONCLUSION: Providing client-focused, flexible immunisation services and government incentives and legislation may work together to boost immunisation levels for those in formal child care.

Adult↗

PubMed1991

Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus.

BACKGROUND: Intravenous drug users (IVDUs) with human immunodeficiency virus (HIV) infection and AIDS often have no health insurance or rely on public programs to finance their health care. We examined the independent contributions of HIV serostatus, clinical symptoms, CD4 cell counts, and health insurance to utilization of health services among 1881 intravenous drug users in Baltimore, Maryland. METHODS: Participants in an ongoing natural history study of HIV were informed of HIV serostatus and seropositives were informed of CD4 cell counts; 6 months later, participants were administered a questionnaire concerning self-reported use of health services, insurance coverage, and HIV-related symptoms. RESULTS: Of 1881 participants, 67% had health insurance (including Medicaid), 48% had at least one outpatient visit, and 12% had at least one inpatient visit within the prior 6 months. The proportion of the study population that was HIV-1 seropositive was 32%. In multivariate analysis, the single most important predictor of health care utilization was the presence of two or more HIV-related clinical symptoms. HIV positive serostatus alone or known low CD4 counts were not significantly associated with use of health care services. CONCLUSIONS: These data suggest that HIV seropositive IVDUs are not receiving recommended preventive care. Additional efforts will be needed to ensure that HIV-seropositive drug users participate in currently recommended protocols for early treatment of asymptomatic HIV-1 infection.

Adult↗

PubMed1996

[Management control and operative budget at a radiology center].

The laws reforming the National Health Service (SSN) (DL 30.12.92 n. 502 converted into DL 7.12.93 n.517) strongly modify the operation rules of the local sociosanitary units (USL) and imply that the rules themselves be reorganized with flexible and agile organization systems, introducing, in addition, a budget system as a tool for programming and checking the results. The essential elements for management evaluation are: -an accurate accounting system for every department, based on a detailed analysis of the productive factors directly used; -a survey of the activity data with uniform and established indices. This work deals with a radiology department as a responsible unit belonging to Imola State Administration. It is an intermediate service as its activity is for both in- and outpatients. To calculate the cost of the service provided to users and to define the use of resources, inpatients and outpatients costs were included. This involves adding the cost of the examinations requested of the intermediate service, that is, the radiology department. The operative tool used to ascribe the cost of these demands to the departments needs a transfer cost system showing the increasing value of the number of services that the intermediate service gives the final user. To evaluate the activity of the radiology department, we tried to identify an index of respective complexity for every examination: a figure which allows us to express the use of resources according to the complexity of the services given and to turn the number of examinations into significant activity.

Budgets↗

PubMed1999

Not listening to patients--the use and misuse of patient satisfaction studies.

Demand for the development of health services that are responsive to the views of users has led to a growing interest in the measurement of patient satisfaction. Initial reluctance to seek the views of users of mental health services focused on a debate about whether or not mentally disordered patients were able to make 'valid' comments about their treatment. More recently the development of questionnaires that claim to 'reliably measure' the views of patients have coincided with a greater acceptance of the role that such studies can play. However, it is argued that the use of these quantitative and often simplistic methods underestimate the dissatisfaction of many patients. Further exploration of the differing expectations of users and providers of services and a degree of willingness in both parties to change is required if services are to be developed that better meet the needs of patients.

Health Care Surveys↗

PubMed1995

Health insurance status and the use of emergency and other outpatient services by adults with sickle cell disease.

STUDY OBJECTIVE: To evaluate insurance status and frequency of use of emergency services in adults with sickle cell disease. DESIGN: Retrospective analysis of visits. SETTING: Emergency department and outpatient clinics of an urban university hospital. PARTICIPANTS: One hundred seventy-two subjects, who made 771 visits to the ED during 1990. RESULTS: Of the 172 subjects, 31 were covered by commercial insurance, 32 were covered by Medicare, and 109 were covered by Medicaid or were uninsured. Insurance status and frequency of use of emergency services were independent (P > .05). On discriminant analysis, Medicaid-covered and uninsured subjects were correctly classified, but commercially insured and Medicare subjects were not. Medicaid and uninsured subjects were more likely to be younger and to live closer to the hospital (P < .00005). High-frequency users of emergency services were discriminated from low-frequency users. High-frequency users were more likely to be younger, to be users of primary-care services, and to live closer to the hospital (P = .0004). CONCLUSION: Provision of primary-care services or stable insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell disease in a group of patients selected from one urban academic ED.

Adult↗

PubMed2004

A family support service for homeless children and parents: users' perspectives and characteristics.

The objective of the present study was to establish the psychosocial characteristics and perspectives of 49 consecutive homeless families who received input from a new designated family support worker (FSW) post at a large statutory hostel for homeless parents and children. The FSW provided: assessment of social, educational and health needs; support and parent training; and liaison with and referral to specialist services. Measures included quantitative questionnaires (i.e. the Hospital Anxiety and Depression Scale, the Parenting Daily Hassles Scale, the Eyberg Child Behaviour Inventory, and the Health of the Nation Outcome Scales for Children and Adolescents), and a qualitative (semistructured) interview on service experiences and satisfaction. The psychosocial measures indicated high rates of parenting difficulties, mental health and related needs among children and their parents. Parenting difficulties were associated with child behaviour problems. Parents expressed satisfaction with the service whilst they were residents at the hostel, but they were often not clear about the objectives of agencies and interventions. Family support interventions have a key role in service provision for homeless and other vulnerable families by providing direct parenting interventions and ensuring that specialist agencies are appropriately involved. Family support worker involvement needs to continue when families are re-housed in the community.

Adult↗

PubMedDate not supplied

Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program.

The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.

Databases, Bibliographic↗

PubMed1994

Regional and supraregional biochemistry services in Scotland: a survey of hospital laboratory users.

AIM: To ascertain the views of Scottish hospital laboratory users on aspects of regional and supraregional biochemical services offered by the Institute of Biochemistry at Glasgow Royal Infirmary. METHODS: A questionnaire was circulated asking questions or inviting opinions under various headings, including current patterns of usage of the services provided, availability of information on specimen collection requirements and reference ranges, current arrangements for transport of specimens, turnaround times for delivery of reports, layout and content of request and report forms, quantity and quality of interpretive advice, potential changes in laboratory services, and overall impression of the services provided. Opportunities were provided for free text comment. The questionnaire was circulated in 1992 to heads of department in 23 Scottish hospital biochemistry laboratories. RESULTS: Twenty one replies were received. Services used widely included trace metals/vitamins (n = 20) and specialised endocrine tests (n = 19). Other services also used included specialised lipid tests (n = 13), toxicology (n = 12), thyroid function tests (n = nine), and tumour markers (n = eight). Fifteen laboratories used one or more of the services at least weekly. Most (n = 20) welcomed the idea of a handbook providing information on specimen collection and reference ranges. Nine identified loss of specimens as a problem. Other perceived problems included the absence of reference ranges from report forms, quantity and quality of interpretive advice, and turnaround times of some tests. Overall impressions of the service(s) offered were very good (n = 12); adequate (n = seven); poor (n = one). CONCLUSIONS: Useful information was obtained about patterns of use and transport arrangements. Areas identified as requiring follow up included provision of information, alternative ways of communicating reports, and improvement in quantity and quality of interpretive advice.

Attitude of Health Personnel↗

PubMedDate not supplied

An investigation of the impact of supplementary health benefits for low-income families in Saskatchewan.

OBJECTIVES: To examine the changes in health service use by recipients of Family Health Benefits, a supplementary benefits program that was introduced to lower-income, working families in Saskatchewan beginning in July 1998. These benefits reduced or eliminated fees for prescription drugs and for chiropractic, optometric and dental services. METHODS: The study population included program beneficiaries between July 1998 and January 2000. Administrative data maintained by Saskatchewan Health were used to capture information on changes in benefits coverage and use of hospital, physician, prescription drug, chiropractic and optometric services from 1997 to 2000. Demographic characteristics of the study population were described. Utilization rates were compared for periods prior to and following introduction of the program. RESULTS: Almost three quarters of Family Health Benefit beneficiaries had not had any form of prior supplementary health coverage in the previous year. A large proportion of these beneficiaries lived in rural Saskatchewan. Distinct demographic characteristics were observed for rural and urban beneficiaries. While utilization of physician and hospitalization services was lower following the introduction of the program, utilization of prescription drugs, and both chiropractic and optometric services increased. CONCLUSIONS: The reduction in user fees for non-insured services resulted in an increased use of these health services, suggesting that user fees can act as a barrier to the use of medical services by low-income families.

Family Health↗

PubMed2001

Standardized terminological services enabling semantic interoperability between distributed and heterogeneous systems.

The interconnection of heterogeneous computer applications in medicine raises the issue of semantic interoperability, going beyond traditional approaches of terminological standardization in basically three aspects. First, the variety of medical vocabularies that currently coexist in different domains is a major barrier for the integration of autonomously developed applications. Fortunately, with the Unified Medical Language System (UMLS) there are machine-readable terminological sources that cover and integrate most of the existing medical vocabularies. Second, the exchanged data need to be processed by a machine for different purposes like patient data integration, access to literature and knowledge bases as well as clinical audit and research. Medical vocabularies provided as passive dictionaries are no longer sufficient. Software system developers should take advantage of terminological services for refining user queries, for mapping the user's terms to appropriate medical vocabularies etc. Third, the services should be accessible uniformly and transparently. In the CORBAmed initiative a proposal for a standardized interface for querying and accessing computerized medical terminology resources was created. Based on the mentioned principles the MUSTANG system (Medical UMLS based Terminology Server for Authoring, Navigating and Guiding the Retrieval to Heterogeneous Knowledge Sources) has been developed. It is implemented on a Windows NT platform using the ORACLE database management and development software. The terminological services are accessible via multiple interfaces. The MUSTANG-System and the experiences with using terminological services in practice are described. Opposed to other levels of standardization like syntactical message standards there is much more a hesitation in the use of standardized terminology.

Humans↗

PubMed1998

[Home care service utilization by severely mentally and physically handicapped persons].

PURPOSE: To investigate the utilization of in-home services by severely mentally and physically handicapped persons at home in order to clarify the vital factors associated with the services. METHODS: Questionnaires were delivered to 174 severely mentally and physically handicapped persons who were registered with 8 institutions in Tokyo and Kanagawa prefecture through each institution. One hundred and thirteen respondents among them were the subjects of this study. As a conceptual model Andersen's model was adopted. RESULTS: (1) The age of subjects varied from 2 to 50. There were no subjects between the age of 7 to 17. The mean functional handicap severity score (SCORE) was 5.8 +/- 8.4 standard deviation. Ninety seven percent of main caregivers were mothers, even among the aged. (2) Over 1/2 of the subjects reported having utilized institutional services. On the other hand the percentage for visiting nurse service (VNS) and home help services were 28.3% and 7.7% respectively. (3) Subject who used V.N.S. had significantly higher SCORES and higher luck of health of caregivers. Caregivers utilized V.N.S. as a substitute to reduce their burden in activities care at home. On the other hand, users of institutional services showed high scores in difficulties with daily help and perceived difficulties with medical treatments: it showed that they sought institutional care to reduce there careburden. (4) Total number of used by each client for in-home service was explained only by both difficulties of daily help and SCORE from multiple regression analysis. CONCLUSION: Users of visiting nursing service expect highquality care based on current medical knowledge and also with the aim of caregiver's health. With the increasing age of caregivers it appears to be important to enhance visiting nurse services, reduce the caregiver burden, and provide active support of home care for the handicapped.

Activities of Daily Living↗

PubMed1994

[Poverty and disease: users of the primary care social services of a primary care center].

OBJECTIVES: To find the individual and socio-family characteristics of that sector of the population which uses Primary Care Social Services (PCSS) at the Primary Care Centre (PCC) and the social problems which occasion demand. DESIGN: A retrospective descriptive study, based on checking over social work case files. SETTING: A PCC situated in Barcelona's second industrial belt, serving a population with a low socio-economic level. PARTICIPANTS: The population group under study were the users with social work files open from January 1st 1985 to July 31st 1991 (a total of 690 case histories). A representative sample of 296 was selected. MEASUREMENTS AND MAIN RESULTS: In comparison with the population of the basic Health Area, the user population of the PCSS at the PCC was predominantly women, and had an older average age, a higher proportion of divorce/separation and widowhood, and, in the labour context, higher unemployment and retirement. A high proportion of one-parent families (12.8%) was found. Analysis of the work situation showed that 50% of the workers were temporary and 75% of the unemployed received no benefit. 51% of the retired people received the minimum pension and 11% received no pension. Monthly family income, recorded for 46.5% of the cases, was 75,362 pesetas (SD 37,643). The most common problems were those related to the "HEALTH" section (61%). CONCLUSIONS: The user population of the PCSS at the PCC is, in socio-economic terms, deteriorated, a condition closely related to the development of chronic illnesses. Tackling health inequalities from Primary Care is under discussion.

Adult↗

PubMed1984

Cost and usage of health sciences libraries: economic aspects.

A study of ninety-five health sciences libraries, obtaining nearly 24,000 user responses, provides estimates of the national cost of library services through the three principal services of circulation, reference, and in-house use; and for four types of users: persons interested in patient care, those interested in research, those involved in education, and others. Unit costs of the three principal services are reported and differences in their relative importance are described. National totals for nine classes of libraries are reported as well as costs by service, user, and function: patient care, research, education, or other. The national expenditure in 1982 was approximately $365 million. The study establishes a method for obtaining results that can be compared and combined across libraries.

California↗

PubMed2002

Medical service use and financial charges among opioid users at a public hospital.

We examined the prevalence of drug use related infectious complications among opioid using or dependent individuals and service charges associated with medical care received over a 2-year period at a public hospital. A computerized medical record review was used to identify 3147 individuals with diagnoses related to opioid use or dependence. Forty-nine percent of these patients were treated for bacterial infections and 30% presented for treatment of medical problems arising from the effects of the drugs themselves (e.g. drug withdrawal, overdoses, and drug-induced psychiatric symptoms). Mean charges were $13393 for these patients, nearly 2.5 times the average per patient charges for non-opioid using patients during the study period. Patients with diagnoses related to opioid use or dependence comprised 2% of the total patient population for this period, yet accounted for 5% of total charges. Homeless patients were less likely to have used ambulatory services and were more likely than non-homeless patients to have used emergency and inpatient services. Early detection of patients with opioid use or dependence problems, coupled with effective strategies to engage them in ambulatory preventive services, could allow interventions to reduce morbidity and associated charges in this patient population. The findings suggest that health care providers and policy makers consider policies that promote ambulatory care use among opioid users seeking medical care through the public health care system.

Adult↗

PubMed2007

Photo archiving, cephalometric analyses, and information sharing on the Internet.

The method we use to collect, store, and share dental records of our patients is rapidly becoming digital. Many programs have been designed to run on a single computer or local network to handle various tasks, including cephalometric analysis and orthodontic treatment planning. Selecting a system can be complex, requiring consideration of capital investment costs and subscription or update fees, as well as the ease (or difficulty) of installing the system and learning to use it. cephX (cephX, Inc, Las Vegas, Nev) is an Internet-based digital data storage and retrieval service for cephalometric analyses, photographic storage, and online data sharing. Users pay for services as they are used, eliminating the need to buy new hardware or software.

Cephalometry↗

PubMed2005

Depressive symptomatology at age 75 and subsequent use of health and social services.

It is well documented that elderly persons are the largest consumers of many health and social services. Consequently it is of interest to identify characteristics of users of those services. The purpose of this study is to examine whether depressive symptoms among men and women at age 75 are an independent determinant of incident hospitalization and use of home help 5 years later. Four hundred and ten men and women participated in a prospective study in Glostrup, Denmark, when they were 75 and 80 years old. Depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Use of health and social services was measured by asking the participants whether they had been hospitalized or used home help during the year before follow-up. Among women, depressive symptoms at age 75 were associated with subsequent use of home help at age 80 (odds ratio (OR) = 2.5; 95% confidence interval (CI): 1.2-5.0) and marginally associated with subsequent hospitalization (OR = 1.8; 95% CI: 0.96-3.5). None of these results were seen in men. Preventive services should take into account depressive symptoms among elderly women.

Activities of Daily Living↗