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PubMed1991

Developments in public policy in respect of tranquilizers: a case study of Britain.

The purpose of this paper is to highlight some of the social issues and policy developments which have set the "service provision agenda" for those who have experienced problems with tranquilizers. It covers three main areas: (1) key issues in considering the social context of tranquilizer use; (2) the development of services for drug misusers including tranquilizer users, and (3) the service response at the grass-roots level within a public health context. The implication of these discussions is that there is an urgent need to link policy with practice as well as resource management with service provision.

Anti-Anxiety Agents↗
PubMed2005

A framework supporting the development of a Grid portal for analysis based on ROI.

OBJECTIVES: In our research on brain function analysis, users require two different simultaneous types of processing: interactive processing to a specific part of data and high-performance batch processing to an entire dataset. The difference between these two types of processing is in whether or not the analysis is for data in the region of interest (ROI). In this study, we propose a Grid portal that has a mechanism to freely assign computing resources to the users on a Grid environment according to the users' two different types of processing requirements. METHODS: We constructed a Grid portal which integrates interactive processing and batch processing by the following two mechanisms. First, a job steering mechanism controls job execution based on user-tagged priority among organizations with heterogeneous computing resources. Interactive jobs are processed in preference to batch jobs by this mechanism. Second, a priority-based result delivery mechanism that administrates a rank of data significance. RESULTS: The portal ensures a turn-around time of interactive processing by the priority-based job controlling mechanism, and provides the users with quality of services (QoS) for interactive processing. The users can access the analysis results of interactive jobs in preference to the analysis results of batch jobs. The Grid portal has also achieved high-performance computation of MEG analysis with batch processing on the Grid environment. CONCLUSION: The priority-based job controlling mechanism has been realized to freely assign computing resources to the users' requirements. Furthermore the achievement of high-performance computation contributes greatly to the overall progress of brain science. The portal has thus made it possible for the users to flexibly include the large computational power in what they want to analyze.

Brain Diseases↗
PubMed1982

[Localization of emergency psychiatric services in Montréal.].

The validity of using a < > criterion as the organizing principle for the provision of emergency psychiatric services is examined both from the standpoint of the scientific literature on the subject and through a quantitative analysis of Montreal - based data. Given the lack of agreement as to the relative importance of distance between the consumer and the supply of services, the analysis attempts to test two hypotheses : 1) that there is a spatially structured response to the supply of emergency psychiatric services provided by Montreal hospitals and 2) the geographical distribution of the users of these services is linked to three variables of which the most important is the spatial distance between the patient and the closest emergency services. The study tends to confirm both hypotheses.

English Abstract↗
PubMed1989

Evaluation of an AIDS prevention education program for health service providers working with i.v. drug users.

A 12-hour training program was designed and pilot tested on 46 staff from three methadone maintenance and detoxification clinics. Also, 525 clients enrolled in a methadone clinic completed a questionnaire assessing their knowledge of AIDS and then participated in an AIDS education program. The staff and the patients had a high level of pretraining knowledge of AIDS. Both groups showed marginal improvement following education.

Acquired Immunodeficiency Syndrome↗
PubMed1989

User pays in the mental health service--256 discharges from Ashburn Hall.

A retrospective descriptive analysis was undertaken on all patients discharged from Ashburn Hall over a 14 month period. The sample of 256 patients was found to have a female to male ratio of 6:4 and contained 4.3% of individuals without school certificate (cf 48.3% national statistics) and 23% with a university degree or diploma (cf 13.2% in the general population). Seventy-four point six percent of the sample had some significant previous psychiatric history although for 68% of the sample this was their first admission to Ashburn Hall. A quarter of the sample came from the surrounding geographic area and patients were more likely to be referred by specialists rather than general practitioners as geographic distance increased from the hospital. Comparisons with the public system showed a predominance of patients with major affective disorder and less patients with a diagnosis of substance abuse and mental retardation.

Adult↗
PubMed1985

Survey of consumer users of a statewide drug information service.

A survey of consumers who had used a state-supported drug information center (DIC) was conducted to determine reasons for and frequency of use of the DIC and opinions about the services of the DIC. The Arizona Poison and Drug Information Center (APDIC) mailed questionnaires to 281 lay persons who had requested information about use of prescription or nonprescription drugs. The questionnaires were sent only to callers who responded affirmatively when asked to participate in the survey. Of 154 (54.8%) respondents (83.8% women), 40.9% were using no prescription drugs at the time of the survey and 83.8% purchased fewer than two nonprescription drugs per month. Approximately 44% said they tried to obtain drug information at least once per month. Pharmacists were named as the most frequent source of drug information for nonprescription drugs, but information about prescription drugs was sought more frequently from physicians and reference books. APDIC was mentioned most frequently as a source of information about all drugs (both prescription and nonprescription). Nearly all respondents said the information from APDIC was helpful and the service should be continued. Drug information consumers looked to this DIC to meet a demand not being met by pharmacists or physicians in the community. Consumers viewed the information as valuable and used this service because it was available and accessible.

Adult↗
PubMed2006

Configuration of services used by depressed older adults.

As a more comprehensive service use measure, this study identifies service use configurations based on the use of 17 services. Factors associated with service use configurations are examined guided by the Andersen and Network Episode models. Self-report data at admission and at six-month follow-up were collected, along with information from medical charts among 140 older adults hospitalized for major depression. The data document service access and levels of use in three sectors of care (psychiatric, medical, and psychosocial services) and assess need, predisposing, enabling, and social network factors associated with use. Three distinct service use configurations were identified with cluster analysis: (1) home care users; (2) moderate users of outpatient mental health services; and (3) heavy users of all formal services. Rather than psychiatric needs, post-acute service use was related to: (1) concurrent physical conditions; (2) the availability of formal and informal services; and (3) financial stability. No difference in psychiatric outcomes was found by service use configuration. It is important to understand service use patterns as a measure of service use, given the co-occurring medical, psychiatric, and psychosocial conditions of older adults and corresponding needs in multiple sectors of care.

Aftercare↗
PubMed2004

Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients.

BACKGROUND: Although present findings about frequent users of psychiatric inpatient services vary from study to study, some potentially important predictors of frequent use were extracted. The purpose of this study was to examine the potentially contributory factors of frequent use of psychiatric inpatient services by schizophrenia patients and to test the influence single factors have in an overall model. METHODS: A total of 307 schizophrenia patients were interviewed five times with intervals of 6 months. Data were collected about service receipt and health care costs, strength of primary diagnosis and comorbidities, as well as about patients' needs for care and satisfaction with care. Patients with three or more psychiatric admissions within a 30-month period were defined as frequent users. RESULTS: According to this criterion, 12% of the study population were frequent users. Compared with ordinary users, these patients accounted for significantly higher costs in hospital- and community-based care. Important predictors for frequent use of psychiatric inpatient services were the number of previous hospitalizations and current scores of psychopathology. In addition, a longitudinal analysis showed the importance of social factors for the use of psychiatric inpatient care. Therefore, a number of the frequent users' multiple admissions could also be caused by social problems. CONCLUSIONS: The mental health system should, thus, provide well-directed community-based resources, which give frequent users support to solve their social problems.

Adolescent↗
PubMed2003

Not virtual, but a real, live, online, interactive reference service.

In today's fast-paced environment, traditional medical reference services alone are not adequate to meet users' information needs. Efforts to find new ways to provide comprehensive service to users, where and when needed, have often included the use of new and developing technologies. This paper describes the experience of an academic health science library in developing and providing an online, real-time reference service. Issues discussed include selecting software, training librarians, staffing the service, and considering the future of the service. Use statistics, question type analysis, and feedback from users of the service and librarians who staff the service, are also presented.

California↗
PubMed2001

Increasing rates of suicide in Western Australian psychiatric patients: a record linkage study.

OBJECTIVE: To investigate the risk of suicide following contact with mental health services and whether it has changed over time. METHOD: Record linkage was used to obtain the records of previous hospital admissions and mental health service contacts for deaths due to suicide in the period 1980-98. Standardized incidence rates were calculated for the general population and for users of mental health services. Proportional hazards regression was used to assess risk factors within the cohort of people with mental health service contact. RESULTS: Suicide risk was significantly increased in users of mental health services (rate ratio 6.66 in males and 7.52 in females). Suicide risk was highest in the first 7 days after discharge from in-patient care, and decreased exponentially with time since discharge. Suicide risk in users of mental health services has increased over the study period. CONCLUSION: These results highlight the importance of adequate follow-up of patients discharged from in-patient services, and the need for adequate resources for community-based services.

Adult↗
PubMed2002

Acute care service utilisation and the possible impacts of a user-fee policy in Hong Kong.

OBJECTIVES: To examine the utilisation pattern of accident and emergency services and to study the possible impact of a user-fee policy on non-emergency attendances in Hong Kong. DESIGN: Retrospective study. METHODS: Four different scenarios are postulated to examine the impact on the number of accident and emergency attendances of a user-fee policy from 2000 to 2029. Patient volume data of accident and emergency attendances for 2000 were made available by the Hospital Authority of Hong Kong. RESULTS: Non-emergency use of the accident and emergency services is the main cause of over-utilisation and contributes to more than 70.0% of its use. Only 22.0% of patients attending accident and emergency departments were admitted to a ward for further treatment. By 2029, the number of accident and emergency attendances would increase by more than 47.0% if the present utilisation pattern prevails. However, if patients at triage levels 3, 4, and 5 were discouraged from using the accident and emergency services, the number of attendances would decrease by 76.4%. CONCLUSION: The proposed user-fee policy would act as a deterrent by preventing unnecessary use of accident and emergency services. However, the use of out-patient services may be increased as a result and attendance should be carefully monitored. Community health education and civic education relating to abuse of accident and emergency services would be effective in reducing over-utilisation of these services.

Accidents↗
PubMed2001

User satisfaction: measurement and interpretation.

Over the past 5 years there has been an increased interest in assessing users' satisfaction with health care services in England. Measuring and interpreting user satisfaction with reproductive and sexual health services can be complex, and efforts have met with varying degrees of success. This paper will summarise the methods that have been used to assess user satisfaction over the past 10 years, describe a different type of approach that has been recently used in England, and provide some suggestions for approaches that may be effective in improving clinical effectiveness in the new millennium.

Family Planning Services↗
PubMed1995

Service utilization and costs of care for severely mentally ill clients in an intensive case management program.

OBJECTIVE: The study evaluated the effects of an intensive case management model on clients' use of inpatient and outpatient psychiatric care and on the costs of care. METHODS: Ninety clients of a county mental health system who were frequent users of inpatient services were randomly assigned to either an intensive case management group, a traditional case management group, or a control group who received no particular services. Outcome variables measured over a two-year period were number of units used by clients and costs of inpatient care in county and private facilities and various types of outpatient care, including day treatment and use of an emergency psychiatric unit. RESULTS: Clients who received intensive case management had fewer inpatient days and reduced overall costs for mental health services. CONCLUSIONS: Assertive outreach and intensive case management can reduce hospitalizations of clients who are frequent users of inpatient care and can reduce overall mental health care costs. Mental health consumers employed as case management aides can play an important role in the delivery of mental health services, particularly with frequent users of inpatient care.

Adolescent↗