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At least 1,369 records · Page 76Linked to original sources
PubMed2003

Patterns of service use among persons with schizophrenia and other psychotic disorders.

OBJECTIVE: This study assessed 12-month service use patterns among people with psychotic disorders and sought to identify determinants of service use. METHODS: As part of a large two-phase Australian study of psychotic disorders, structured interviews were conducted with a stratified random sample of adults who screened positive for psychosis. Demographic characteristics, social functioning, symptoms, mental health diagnoses, and use of psychiatric and nonpsychiatric services were assessed. Data were analyzed for 858 persons who had an ICD-10 diagnosis of a psychotic disorder and who had been hospitalized for less than six months during the previous year. RESULTS: People with psychotic disorders had high levels of use of health services, both in absolute terms and relative to people with nonpsychotic disorders. Those with psychotic disorders were estimated to have an average of one contact with health services per week. Use of psychiatric inpatient services was associated with parenthood, higher symptom levels, recent attempts at suicide or self-harm, personal disability, medication status, and frequency of alcohol consumption. Services provided by general practitioners (family physicians) were more likely to be obtained by older people, women, people with greater availability of friends, those with fewer negative symptoms, and those whose service needs were unmet by other sources. People who were high users of health services also reported having more contact with a range of non-health agencies. CONCLUSIONS: The predictors of service use accounted for small proportions of the variance in overall use of health services. The role of general practitioners in providing and monitoring treatment programs and other psychosocial interventions needs to be acknowledged and enhanced.

Adolescent↗
PubMed1994

Usability and efficiency. The HELIOS approach to development of user interfaces.

This paper describes the user interface related services of the HELIOS project. The design and implementation of efficient user interfaces is a prerequisite for successful introduction of computer support in health care ward units. Design principles must be based on a basic understanding of cognitive aspects of human-computer interaction, as well as on detailed knowledge about the specific needs and requirements of the health care professionals. In the HELIOS project, a style guide for design of user interfaces has been developed. The style guide defines detailed design guide-lines together with a set of interface elements specified for the ward domain. Development tools for construction and implementation of user interfaces to ward applications have been developed and integrated into the HELIOS SEE. The tools are based on the TeleUSE product, which has been extended and adjusted to the HELIOS specifications. A set of new widgets, designed to implement health care interface elements, has been incorporated into the development tool.

Computer Communication Networks↗
PubMed2006

Service uptake and characteristics of injection drug users utilizing North America's first medically supervised safer injecting facility.

In 2003, the city of Vancouver, British Columbia, opened North America's first government-sanctioned safer injecting facility, where injection drug users (IDUs) can inject preobtained illicit drugs under the supervision of nurses. Use of the service by IDUs was followed by measurable reductions in public drug use and syringe sharing. IDUs who are frequently using the program tend to be high-intensity cocaine and heroin injectors and homeless individuals. The facility has provided high-risk IDUs a hygienic space where syringe sharing can be eliminated and the risk of fatal overdose reduced. Ongoing evaluation will be required to assess its impact on overdose rates and HIV infection levels, as well as its ability to improve IDU contact with medical care and addiction treatment.

Ambulatory Care Facilities↗
PubMed1999

Older people's use of ambulance services: a population based analysis.

OBJECTIVE: To investigate the use of emergency and non-urgent ambulance transport services by people aged 65 years and over. SETTING: The study was undertaken in Queensland where the Queensland Ambulance Services (QAS) is the sole provider of emergency pre-hospital and non-urgent ambulance services for the entire state. METHODS: The age and sex of 351,000 emergency and non-urgent cases treated and transported by the QAS from July 1995 to June 1996 were analysed. RESULTS: People aged 65 years and over who comprise 12% of the population utilise approximately one third of the emergency and two thirds of the non-urgent ambulance resources provided in Queensland. While the absolute number of occasions of service for females for emergency services is higher than for males, when the data are stratified for age and sex, males have higher rates of emergency ambulance service utilisation than females across every age group, and particularly in older age groups. Gender differences are also found for non-urgent ambulance usage. The absolute number of occasions of service for older females aged 65 and over using non-urgent ambulance transport is high, but utilisation patterns on stratified data reveal similar gender usage patterns across most age groupings, except at the older age groupings where male usage greatly exceeds female usage. CONCLUSIONS: As the aged are disproportionately high users of ambulance services, it will become increasingly important for ambulance services to plan for the projected increase in the aged population. Emergency pre-hospital care is one of the few health services along the continuum of care where male usage patterns are higher than those of females. More information needs to be obtained on the age and presenting characteristics of those people who are multiple users of the ambulance service. Such information will assist service planners.

Adolescent↗
PubMed1976

Introducing and implementing on-line bibliographic retrieval services in a scientific research and development organization.

The National Bureau of Standards Library recently implemented on-line bibliographic retrieval services. Methods are given to orient and aid users in availing themselves of the services. Results are presented, based on appraisal of the services by users: value to users; most used data bases; problems requiring search revision; reasons for unsatisfactory results; purposes for request and use of search results; impact on subsequent library use; and future searching requirements. On-line capability impacts on library financing as a whole and on the library role in the community are described.

Humans↗
PubMed1994

Establishment of a 900 telephone number at a university-based drug information service.

Effects of converting a free drug information service at a university medical center to a 900 telephone number are described. Calls to a university medical center drug information service had increased beyond the capacity of staff. A telephone survey to recent users of the service indicated that callers outside the institution would be willing to pay a fee for the service, so a 900 number was instituted for outside calls in January 1993. Staff recorded data on all questions they answered; data for 1993 were compared with those from 1992. Question volume decreased by 48% after the 900 number was instituted, with questions from outside the institution dropping by 55%, questions from outside health care professionals dropping by 72%, and questions from the lay public increasing slightly. One severe impediment to callers from local hospitals was that many hospitals block access to 900 numbers from their telephone systems. The average length of a call was three minutes and the average cost per call was $6. Net income during the first year of operation was $6698. The 900 number provided some income, but it did not completely offset operating costs. A 900 telephone number is a workable, but imperfect, method of providing drug information to outside callers. Early notification of users before implementing a 900 number is essential to allow time for them to arrange telephone access.

California↗
PubMed1999

High-resource hospital users in an integrated delivery system.

OBJECTIVES: With decreasing healthcare reimbursement, nurse administrators need to aggressively manage care for high-resource users of hospital services to ensure the viability of their healthcare organization. The objective of this study was to (1) investigate frequent Medicare inpatient admission and emergency department users, (2) investigate Medicare day outliers, and (3) examine Medicare reimbursement/charge ratios. BACKGROUND: Although much research has focused on patients who have been readmitted frequently to the hospital, little research has examined patients who are frequent users of both emergency departments and inpatient services. METHODS: In this study, all 4,920 elderly Medicare inpatient admissions and emergency department visits for 1 year in a 222-bed general hospital were included. Patient profiles of two categories of high resource users were created. RESULTS: Results showed the frequent high user group (n = 75), who had six or more combined emergency department and inpatient admissions per year, had cardiac, diabetic, and chronic respiratory conditions, and came to the hospital from their homes. The day outlier profile (n = 148) consisted of older patients who have neoplasms, and respiratory and circulatory diseases. The mean Medicare reimbursement/charge ratio varied for high volume diagnosis-related groups (DRGS.) IMPLICATIONS: From the study, implications include refining case management, monitoring high-resource patients by computer tracking, analyzing high-user trends by several different methods, incorporating many facets of an integrated healthcare delivery into their care, expanding patient, outpatient, and community support programs, and continually monitoring revenue for organizational viability.

Aged↗
PubMed2006

The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnea: a qualitative phase 1 study.

OBJECTIVE: Disabling breathlessness is the most common symptom of advanced cardiopulmonary disease. It is usually intractable, even when patients receive maximal medical therapy for their underlying condition. A pilot study was undertaken to evaluate a newly formed palliative Breathlessness Intervention Service (BIS). METHODS: The methodology followed the Medical Research Council's Framework for the Evaluation of Complex Interventions (Phase I). Qualitative interviews were completed with patients and relatives who had used the service and clinicians who had referred to it. The focus of the interviews was the participants' experience of using BIS. RESULTS: Patients valued the positive educational approach taken to breathlessness, emphasizing what was possible rather than what had been lost. Non-pharmacological strategies, especially the hand-held fan and exercises, were rated very helpful and new to patients. Participants reiterated that breathlessness was frightening and isolating, exacerbating the disability it caused: the easy access to advice and flexibility of BIS helped to alleviate this. Participants wanted a written record of the advice given. Carers welcomed the focus on their needs. Clinicians valued sharing the management of patients with an intractable problem. SIGNIFICANCE OF RESULTS: This Phase I study has helped to remodel the service rapidly by uncovering the aspects of BIS that users find most valuable and areas that need change or improvement. The BIS needs to provide written information, to reinforce and extend contacts with other agencies to build on support it already provides for patients and carers, and extend its flexibility and accessibility. Providing a "drop-in" service and continuing education after the initial program of contacts is completed could be a useful service development, warranting further evaluation. A qualitative methodology involving service users and referrers can help to shape service development rapidly.

Adult↗
PubMed1993

Utilization of medical services by drug abusers in detoxification.

To establish the extent of health services, including inpatient, emergency room, and outpatient care utilized by illicit drug users during the previous year, we surveyed 77 drug abusers, who were not known to be HIV-positive, entering a detoxification unit and a comparison group of 70 drug nonusers. Over the previous year, drug abusers had a greater number of visits to their usual source of care, to emergency rooms, and to other sites than drug nonusers. Drug abusers were significantly more likely to have been hospitalized during the past year. Using a logistic model including sociodemographic factors, drug abusers were 2.3 times as likely to use an emergency room and 6.7 times as likely to be hospitalized as drug nonusers. We conclude that drug abusers are heavy users of health services compared to a group of drug nonusers.

Ambulatory Care↗
PubMed2003

Swiss EMBnet node web server.

EMBnet is a consortium of collaborating bioinformatics groups located mainly within Europe (http://www.embnet.org). Each member country is represented by a 'node', a group responsible for the maintenance of local services for their users (e.g. education, training, software, database distribution, technical support, helpdesk). Among these services a web portal with links and access to locally developed and maintained software is essential and different for each node. Our web portal targets biomedical scientists in Switzerland and elsewhere, offering them access to a collection of important sequence analysis tools mirrored from other sites or developed locally. We describe here the Swiss EMBnet node web site (http://www.ch.embnet.org), which presents a number of original services not available anywhere else.

Databases, Protein↗
PubMed1990

Use of community support services by elderly patients discharged from general medical and geriatric medical wards.

This descriptive study examines the use of community support services by elderly persons discharged from general and geriatric medical wards of a large acute care British teaching hospital. A convenience sample of 40 patients were interviewed at 6-week intervals over a 3-month period about their need for and use of community support services. The type of ward from which patients were discharged did not influence the use of nursing, homemaker, physician, or warden/community visitor services, hospital day care, or meals-on-wheels. Patients who used the largest number of community services, and were the most frequent users of all available services, were those who, because of their fragility, died or were readmitted to hospital within 6 weeks of discharge. All families interviewed identified a need for more information about their elderly members' illnesses and prescribed medical regimes.

Aftercare↗
PubMed1995

User satisfaction with in-patient mental health services.

Although a wealth of literature regarding lay evaluation or satisfaction with health services exists, a paucity of literature is available about satisfaction with mental health services. Much of this literature is fraught with methodological problems. The study described, using both quantitative and qualitative methodology, investigated how users of in-patient mental health services evaluated these services with particular reference to the areas of the admission process, treatment, ward environment and safety. The findings confirmed the broad outcomes reported in the literature, in that they demonstrated the mismatch between quantitative and qualitative data. Global satisfaction ratings were generally positive; however, more specific questions yielded less positive outcomes. Semi-structured interviews reported some important areas of dissatisfaction, including a lack of information regarding treatment and services. Fears relating to safety were expressed equally by male and female users. Further work in this area is required with larger samples, and with specific reference to the experience of ethnic minorities and those detained under the Mental Health Act.

Female↗
PubMedDate not supplied

Design of RCSS: Resource Coordination Systems for Surgical Services using distributed communications.

The plans for Resource Coordination for Surgical Services system (RCSS) incorporate a distributed objectbase with a coordinating server. User-centered information screens are customized for each geographic location in surgical services. User interfaces are designed to mimic paper lists and worksheets used by health care providers. Patient-specific and site-specific data will be entered and maintained by providers at each geographic location, but also rebroadcast and displayed for all providers. Although RCSS is primarily a communications system, it will also support review of surgical utilization and operative scheduling.

Cost Control↗
PubMed2002

A needs assessment of the potential users of a South Pacific telehealth service.

Qualitative methods such as focus groups, individual interviews, case studies and participant observation were used to complete a needs assessment for a telehealth service in the South Pacific. Participants from the Cook Islands and Fiji were able to identify extensive uses for a telehealth service, but also identified barriers to its implementation. These included the extremely limited telecommunications and electrical infrastructure found in South Pacific countries, the high cost of Internet access and staffing shortages. The effective implementation of a telehealth site will probably require the use of clinician drivers with an interest in telehealth to encourage colleagues less enthusiastic to change their work practices. Telehealth in the South Pacific would improve services across a wide geographical area, but initial and continuing costs would be high due to the lack of infrastructure.

Attitude of Health Personnel↗
PubMed2006

[Violence and pregnancy in female users of Ministry of Health care services in highly deprived states in Mexico].

OBJECTIVE: To characterize intimate partner abuse and identify the main factors associated with violence in pregnancy in four highly deprived States in Mexico. MATERIAL AND METHODS: The data were taken from the National Survey on Violence against Women 2003 (ENVIM per its abbreviation in Spanish). Based on it a cross-sectional study was conducted on 1 949 women between 15 and 50 years of age, who were once pregnant and who utilized primary and secondary health care services from the Ministry of Health, Mexican Institute of Social Security, and the Institute for Social Security and Services for State Workers in Guerrero, Hidalgo, Oaxaca and Chiapas states, between November 2002 and March 2003. Logistic regression was used to assess the association between independent variables and violence during pregnancy. RESULTS: 250 women (13%) suffered a type of violence (physical, psychological, sexual or economical) during any of their pregnancies. Of these women 76 (30.40%) were battered on their abdomen. In most of these cases (91.39%) the husband was the aggressor. The variables significantly associated with violence in pregnancy were: woman's illiteracy (OR 2.2; CI 95:% .1,4.4); history of violence in childhood (OR 3.2; CI 95% 1.9, 5.4) as well as sexual abuse in her childhood (OR 2.4, CI 95% 1.3, 4.4) and her partner's daily alcohol consumption (OR 6.5; CI 95% 3.3, 12.9). CONCLUSIONS: The results show that violence during pregnancy is a regular event in the impoverished context and that its expression is more severe. These results point to the importance of continued study of the problem of violence against pregnant women in Mexico and the importance of identifying battered women in prenatal care.

Adolescent↗
PubMed2004

Effects of prescription drug user fees on drug and health services use and on health status in vulnerable populations: a systematic review of the evidence.

Rising pharmaceutical expenditures have led to the use of cost-sharing measures. The authors undertook a systematic review of the effects of cost sharing on vulnerable populations (the poor and those with chronic illnesses). Virtually every article reviewed supports the view that cost sharing decreases the use of prescription drugs in these populations. Copayments or a cap on the monthly number of subsidized prescriptions lower drug costs for the payer, but any savings may be offset by increases in other health care areas. Cost sharing also leads to patients foregoing essential medications and to a decline in health care status.

Chronic Disease↗