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Consumer responses to health care: women and maternity services.

The importance of understanding consumer perceptions of services is widely acknowledged. This is becoming more relevant in health care, as attempts to incorporate users' views into service development and evaluation are increasing. This study focused on women's responses to their recent experience of maternity care, and sought to gain insight into the service features they associated with negative and positive reactions. Postal questionnaires were sent to antenatal and postnatal women. Two open questions invited women to note if any aspects of their care had particularly impressed or bothered them. There was variation in the factors identified through the different phases of the service--antenatal, labour and postnatal care. However, staff attitudes were a main source of positive comments throughout the service, and lack of information and poor explanations were a consistent source of negative responses. Providing consumers with an opportunity to give feedback on their service experience should be based on issues which are relevant to them, not just on those which are measurable.

Female↗

Impact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program.

To examine the impact of the AIDS epidemic on morbidity and mortality in a defined population of intravenous drug users, we analyzed overall and cause-specific death rates, AIDS incidence, and acute medical hospitalizations among patients in a long-term methadone maintenance program in New York City for the years 1984 through 1987 (midyear population for each year 828 to 891; demographic characteristics did not differ). The number of deaths while in treatment increased from 11 (13.3/1000) in 1984 to 39 (44.2/1000) in 1987. Deaths from AIDS increased from 3.6/1000 to 14.7/1000, deaths due to bacterial pneumonia/sepsis from 3.6/1000 to 13.6/1000; deaths from cirrhosis, drug overdose, trauma, and other causes remained relatively stable. AIDS incidence rose from six cases/1000 in 1984 to 20.4.1000 in 1987. Hospitalizations for AIDS, pneumonia, tuberculosis, and endocarditis/sepsis increased from 84.9/1000 in 1986 to 144.8/1000 in 1987. These data suggest that the AIDS epidemic has had a profound effect on patterns of morbidity and mortality among intravenous drug users in this methadone program population. Drug treatment programs may be important sites for targeting clinical services for drug users with AIDS, although the increasing burden of AIDS-related disease will require expansion of existing funding and treatment resources.

Acquired Immunodeficiency Syndrome↗

[Quality perceived by two populations assigned to two health care centers in the province of Cuenca].

BACKGROUND: To render quality service, it is essential to know the opinion users have of the service in question. The purpose of this study is that of gauging and comparing the quality perceived by two populations assigned to two health care centers in the province of Cuenca. METHOD: This is a descriptive cross-sectional study. The Basic Health Care Districts studied were the Cardenete Health Care Center and the Motilla del Palancar Health Care Center, both within the Cuenca Health Care District. The source of information was personal health care card. A random sampling layered by age and gender percentages was taken. The perceived quality was gauged by means of a validated, reliable questionnaire used previously for similar purposes by the Ministry of Health and Consumer Affairs. RESULTS: A total of 295 surveys (147 males and 148 females) were analyzed. The average age was age 48.83 (SD: 18.77) for the Motilla Health Care Center and age 61.93 (SD: 15.17) for the Cardenete Health Care Center. The average monthly frequency of visits for the MP Health Care Center was 1.56 (SD: 1.91), this average having been 2.49 (SD: 4.27) for the Cardenete Health Care Center. The average weekly frequencies for the MP Health Care Center was 0.32 (SD: 0.66), having been 0.49 (SD: 1.03) for the Cardenete Health Care Center. The waiting time at the MP Health Care Center was 10.86 minutes (SD: 8.27), having been 7.88 (SD: 4.55) at the Cardenete Health Care Center. 83.4% of the users of the two Health Centers of are aware of the fact that they have the freedom to choose their primary care physician. CONCLUSION: Statistically significant differences were found in 11 of the 21 items studied regarding perceived quality of the which questionnaire is comprised. The results of the health care components according to the factorial analysis of the items of perceived quality are those coinciding with the perceived quality results. Of the two groups of users surveyed, those perceiving a higher degree of quality in the health care service they are rendered are those of the Cardenete Health Care Center.

Attitude to Health↗

[Drug advertising--users want information. Report of telephone survey conducted by North-Rhine Westphalia Public Health Service on the topic of drug advertising and drug information for users].

In Germany, drug advertising of non-prescription drugs is a controversial subject. On the one hand, consumer organisations plead for placing a ban on advertising or at least to offer a detailed description of medical risks in respect of protection. On the other hand, the pharmaceutical industry is keen on liberalizing the specific advertising law for drugs. A representative telephone survey among the population of North Rhine-Westphalia was conducted in April and May 1999. It showed consumer interest in advertising, the value of information on risks, the institution with maximum credibility in drug information for consumers, the importance of the now obligatory sentence after every advertisement: Regarding risks and side effects read the leaflet in the package and ask your physician or pharmacist, and to what extend the consumer would take advice from independent experts over the telephone about drugs. It was found that, in particular women, about 30% are occasionally interested in advertising, younger people are more open-minded about advertising than older people; and that doctors and pharmacists have the most credibility and are consulted for further information. It was also found that more than 80% of the population demanded precise information on the side effects of drugs. One-third of the consumers declared that the obligatory sentence (see above) led to greater demand for information from doctors or to read attentively the instruction leaflet. Nevertheless, there is a need for more information from more than half of the consumers, who would take advantage of an independent advice centre if this should exist.

Adult↗

[Comparative study of the needs of patients with schizophrenia by gender].

OBJECTIVES: To evaluate the gender differences in the needs of the people with schizophrenia who live in the community. METHOD: We randomly selected 231 patients with schizophrenia who were receiving treatment in one of the five mental health care centres that participated in the study. Patients were evaluated with a socio-demographic questionnaire, the Positive and Negative Syndromes Scale (PANSS) and Camberwell Assessment of Need (CAN) questionnaire. The CAN evaluate 22 needs, that we could be grouped into five subscales: service needs, basic needs, functioning need, health needs and social needs. All needs were evaluated by the professional and the user independently. RESULTS: Professionals detected more needs in men than in women, but users did not report such difference. Both professionals and users detected more service needs for women (p< 0.005) and more basic needs for men (p< 0,01-0.005). Only professionals detected more functioning needs in men (p< 0.05). CONCLUSIONS: Professionals detect more needs than users and detect more needs for men than for women. Women have less needs in food, personal care, home care, and daily activities. These gender differences should be taken into account when designing treatment programs for schizophrenia.

Adolescent↗

Linking radiology equipment service and medical physics survey databases.

During the performance of medical physics surveys on diagnostic imaging equipment, it is not unusual to find problems requiring service. In the work described in this article, two existing and separate databases, one for radiology equipment maintenance and the other for medical physics surveys were linked. By linking the two databases we have closed the loop in our documentation. The two databases are integrated so that when logging a survey, a single mouse click will allow the user to initiate a service call and link it to the survey. In addition, any survey linked to a service call permits the user to view the service record with a single mouse click. This allows us within the medical physics database to document the resolution of problems as well as to keep track of the status of service calls initiated as a result of medical physics surveys.

Calibration↗

Outreach interventions for the homeless mentally ill.

There has been a steady rise in the number of homeless mentally ill in Britain. This article reviews the scale of the problem and identifies the need for change within mental health services in order to address this challenge. It is argued that mainstream psychiatric services need to become more diverse and open in their approach to this potentially isolated group of users. The authors suggest that this could be achieved by embracing assertive outreach interventions. Innovative projects using a range of care providers, including voluntary workers, past users of the service and professional mental health workers, are discussed as an alternative framework to traditional services. In conclusion, the article highlights some of the professional and social implications for psychiatric nurses and mental health practice.

Community Mental Health Services↗

Family therapy in general practice: views of referrers and clients.

Family therapy is being used in a variety of settings, including general practice. To assess the views as to the effectiveness and acceptability of a family therapy clinic in a north London surgery, questionnaires were given to general practitioners referring patients, and to clients. Replies were received from seven doctors and 20 clients, representing 11 families. There was a high level of satisfaction among general practitioners referring patients. The clinic proved to be highly acceptable for clients, with 90% agreeing that it was easier to attend a clinic at the practice than at a hospital; and only one patient thought that knowing the general practitioner worked in the practice made it harder to talk openly. Eighty per cent of patients felt the problem had improved at the time of follow up. Where the problem had not improved, 60% felt that they were dealing with it better. Almost all of the patients felt that the family therapy clinic should become a permanent part of local services. The family therapy clinic in general practice has been shown to be effective and popular with users of the service.

Adolescent↗

[IMSS in numbers: demand of services in the emergency room, 2004].

The emergency room is one of the most productive services in any medical institution, where the demand of health services is diverse and complex in nature. Around 15 % of all the medical attentions provided at IMSS were done at the emergency room. There was an important increase in the number of consultations provided from 1995 to 2004; the death rate in the service also increased but the incapacity rate decreased. Adult and elderly women were among the most frequent users of emergency services. The main problems seen were respiratory infections (19.4%), trauma and poisoning (18.8%) and diarrheas (8%). Cholelithiasis, migraine, urinary infections and diabetes were more frequent in women, while trauma, accidents and conjunctivitis were more frequent in men. In relation to mortality, around 21% of all deaths registered at IMSS occurred in the emergency room. Diabetes and cardiovascular diseases appeared among the main death causes, especially in the adult and elderly population. Mortality was higher in men than in women.

Adolescent↗

Database search services as a basic service in academic health sciences libraries.

Mediated search services, usually offered for a fee, are commonplace in academic health sciences libraries. At the same time, users of these services have numerous self-service options available to them; for example, CD-ROMs and locally mounted databases. In keeping with its philosophy of access to rather than ownership of information, the University of Washington Health Sciences Library and Information Center (HSLIC) changed its policy from charging clients for mediated searching to offering mediated searches as an essential service of the library. By taking this step, HSLIC moved closer to becoming a true "library without walls." This paper describes HSLIC's experience with changing its policy and examines the issues surrounding use of the collection budget to subsidize access to online information in academic health sciences libraries.

CD-ROM↗

The impact of risk shifting and contracting on mental health service costs in California.

This paper identifies the impact of "program realignment," a 1991 California state policy that significantly enhanced local governments' financial risk and programmatic authority for public mental health services, on treatment costs per user, and on the mix of inpatient and outpatient service costs. The study employs a natural pre-realignment and post-realignment design using the 59 California local mental health authorities (LMHAs) as the unit of analysis over a seven-year period spanning policy implementation. Total treatment and inpatient cost per user decreases and outpatient cost per user increases after program realignment. Higher levels of contracting with private providers tend to enhance this trend, while risk for institutional services reduces user costs uniformly. Financial and programmatic decentralization can enhance cost efficiency in treatment, while promoting substitution of outpatient services for inpatient services. Local conditions such as risk and contracting determine the extent of the policy response.

Adolescent↗

Obstetric drug information service.

An obstetric drug information service in a 435-bed general hospital in Australia is described. The specialized service was established within a general drug information center after receiving a large percentage of calls on the use of drugs during pregnancy and lactation. The service decided to specialize in information on: (1) drugs excreted in breast milk, (2) drug effects on the fetus, (3) drug effects on the pregnant mother, and (4) drugs affecting sperm. An obstetrician is associated with the service to provide clinical judgments, assessments, and his expertise in the field. Monographs were prepared on 97 commonly prescribed drugs. The service provides oral replies and written replies that are checked by the director and deputy director of pharmaceutical services for their accuracy. Of the 1445 inquiries received during an 18-month period, 60% (863) were related to the use of drugs during pregnancy and lactation. The most frequent users of the service were physicians. Specific topics of the calls included inquiries on antibiotics (154 calls), psychotropic drugs (108), and analgesic and cold preparations (58). The center provided written replies for 51% of the calls. The specialized drug information center has received an increasing number of inquiries and positive feedback from its users.

Australia↗

Health service utilization and victimization among incarcerated female substance users.

Women represent the fastest growing population of prison inmates, which has increased dramatically in the past decade. Generally, women use more health services than men but with limited access to health care, incarcerated women tend to experience multiple problems, including problems with drugs, alcohol, and victimization. The purpose of this exploratory qualitative study was to identify specific factors related to health, mental health, drug use, and violence among incarcerated female substance users. Perspectives from 34 females who participated in focus groups in prison are discussed. Key findings indicate that drug use, victimization, and living in a rural area were barriers to accessing health services. In addition, implications for interventions targeting women are presented.

Adult↗

Utilization and morbidity: random or tandem?

Earlier studies have shown that one in eight children persist in being high users of health care services over long periods of time and, conversely, about the same proportion of children are consistently low users. As these studies failed to discover reasons for these persistent deviations from average, this study explored three possible explanations: persistent morbidity, mental health problem, and familial patterns of use. Although all three phenomena were associated with both persistence of high utilization of services as well as an overall large number of visits, the number of types of morbidity was the most significant correlate of high use. Children who were constantly low users of services were much more likely to have only a few types of morbidity whereas children who were constantly high users were much more likely to experience a wide variety of types of problems. These findings suggest that an understanding of the demand for health services requires an understanding of the interrelationships of illnesses within individuals rather than a focus on particular illnesses or particular types of illnesses.

Acute Disease↗

Use and effectiveness of tobacco telephone counseling and nicotine therapy in Maine.

BACKGROUND: Since 2001, the Maine Bureau of Health has offered free evidence-based treatment for tobacco dependence, including telephonic counseling and nicotine replacement therapy (NRT). This study examined the utilization of treatment services, evaluated quit outcomes, and estimated the population impact of treatment. METHODS: This is a descriptive study of tobacco users receiving treatment services from the Maine Tobacco HelpLine from January 2003 to December 2004. Demographics of callers were compared to adult smokers statewide, and NRT utilization was examined among callers eligible for therapy. Quit outcomes were assessed by telephone interview among a sample of callers registered November 15, 2003 to January 31, 2004 (n=535), 6 months after assistance. The population impact of treatment was estimated by applying intent-to-treat (30-day point prevalence) quit rates to services delivered in 2003 and 2004. Analyses were conducted in 2005. RESULTS: A total of 12,479 adult smokers (3% of smokers annually) utilized Maine's tobacco services during 2003 and 2004. Compared to smokers statewide, callers were more likely to be aged 45 to 64, female, or uninsured. A total of 82.3% of callers who were eligible for NRT and received counseling obtained free NRT. Intent-to-treat quit rates at 6 months were 12.3% (95% confidence interval [CI]=8.1-17.6) for counseling, and 22.5% (95% CI=19.1-26.3) for counseling plus NRT. An estimated 1864 smokers calling in 2003-2004 had successfully quit. CONCLUSIONS: The Maine Tobacco HelpLine and NRT programs have demonstrated effectiveness and population outreach, particularly to uninsured smokers. This study suggests that for quit lines to maximize their impact, tobacco medication access may be important.

Adolescent↗

[University-external sector linkage: a managerial strategy].

The University-External Sector vinculation is an increasing phenomenon in Latin America as in the rest of the world. The universities through its investigation processes actively participate in the creation and incorporation of science and technology to produce technological processes, to bring foreign technology into national reality, and also to create and transmit innovation for the productive sector. In those ways these institutions achieve bonds with the external sector which provide them with additional income and allows them to have certain relief for their tight teaching and investigation budgets. Several studies in university organizations have been made to identify the motivations and barriers for de adequate development of the interaction between the university and the external sector. The lack of vinculation between these institutions could be due in part to the lack of knowledge that the external sector has of the possibility to obtain services from the university, and also the lack of knowledge that the university has about the needs of potential users of their services. The goals achieved by public Venezuelan universities, in the last years, in their search of a vinculation with the external sector could grow and consolidate through an adequate strategic management plan that allows a mayor diffusion and promotion of the results of their investigations and services, to reach in a wider and more direct way, and to a greater number of potential clients.

Research↗

MultiLink--an intermediary system for multi-database access.

The design and implementation is described of MultiLink, a desktop system for direct enduser access to remote bibliographic information. The system is an application of a client-server technique based on a campuswide network, with the objective to assist end-users to accomplish the information--retrieval process by capturing knowledge and expertise for searches in query formulations. MultiLink, via intelligent interfaces, allows users to access several dozens of bibliographic databases. The application integrates regional, national and international resources, and brings library services to the user's desktop level.

Databases, Bibliographic↗

Women's health care services: an approach to exploring the market opportunity.

The market opportunity for women's health care programs is receiving increasing attention from hospitals since women are the major users of hospital services and the principal health care decision makers for the family. This article presents an approach to identifying and evaluating women's health care market opportunities so that those areas offering the greatest potential can be pursued, both responsibly and profitably.

Data Collection↗