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PubMed2003

Gaps in the drug-free and methadone treatment program response to Hepatitis C.

Drug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample (N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.

Health Care Surveys↗

PubMed1998

Substituting home care for hospitalization: the role of a quick response service for the elderly.

The purpose of the present study was to examine the role of a rapid access home-based service as a means for the elderly to avoid admission to an acute-care hospital. The setting for the study included emergency departments in three acute care hospitals and a home care program in a mid-size Canadian city. Multiple sources of information were obtained to evaluate the service. Hospital emergency department records and home care records were reviewed. Patients who participated in the service (n = 96) and physicians and nurses (n = 119) who had involvement with the service were surveyed appraising the service in terms of relevance, access, quality and coordination. Study results revealed that elderly women with multiple health problems who lived alone were the most frequent users of the service. The majority of the patients admitted to the service presented with problems of a functional nature that were the result of a fall or mobility problems. The results indicated that the service did avert hospital admissions and facilitated a process by which patients could avoid the intermediate step of hospitalization before placed in a higher level of care or returning to previous levels of functioning. Economic analysis indicated that the value of the service stemmed from the benefits to patients and caregivers rather than from cost savings offered to acute care hospitals.

Activities of Daily Living↗

PubMedDate not supplied

Shaping healthcare: developing a program evaluation questionnaire.

Healthcare delivery today emphasizes quality improvement in program management. The focus on consumer needs and satisfaction challenges us to develop effective tools to evaluate our services from the user's perspective. This article delineates the development, implementation, analysis, and outcomes of a program evaluation questionnaire that was designed to evaluate program staff and treatment services from the perspectives of both patients and families. The potential this type of consumer opinion gauge and tool has to shape healthcare delivery is outlined within the context of a rehabilitation program.

Aged↗

PubMed1997

Integrating primary care and methadone maintenance treatment: implementation issues.

Linking primary medical care with methadone maintenance treatment brings critical services to drug users, many with HIV/AIDS, tuberculosis and other illnesses. However, a variety of important philosophical, ethical, and systems issues may impede the process of implementing a "linked" service delivery model. Conflicting paradigms, such as the traditional "doctor-patient" relationship with its emphasis on continuity of care and the substance abuse treatment model of limit-setting and behavioral consequences, create tension in the treatment system. This article describes these tensions and uses clinical vignettes to demonstrate how to address these implementation issues. In conclusion, solutions are proposed for successfully integrating services for medically ill substance abusers.

Adult↗

PubMed1998

Interorganizational factors affecting the delivery of primary care to older Americans.

OBJECTIVE: To discuss different types and forms of interorganizational linkages involved in the provision of primary care to older Americans, along with their distinguishing characteristics. RESEARCH STRATEGY: To take advantage of these linkage characteristics. The strategy requires a partnership with health services organizations and providers actually involved in the provision of services along with a planned sequence of activities involving hypotheses and methods development, intervention trials, and finally, demonstration and implementation. CONCLUSION: Because older Americans are frequent users of health services, their need for continuity and access provides an opportunity to examine changes to the delivery system and to monitor the system's capability for meeting their healthcare needs.

Aged↗

PubMedDate not supplied

Technological developments and approaches to improving service quality.

In summary, major paradigm shifts in the health care industry are altering the way technology is maintained and supported. Service organizations are now responsible for maintaining a broader base of technology within the health care delivery network and must to this on an extremely rapid, efficient, and productive basis. A number of new technologies are coming on-line, which can allow a health care technology service organization to experience significant improvements in profitability, efficiency, and productivity. To realize maximum benefit from these technologies, service organizations may find themselves re-engineering their service processes. The author believes that this is a requirement for many service organizations, regardless of whether new technology is implemented. The traditional approaches to service delivery are ineffective in managing the new structural realities and service requirements of today's health care environment. New strategies and tactics are required for ensuring that these requirements are met. These approaches will no doubt improve the overall quality, productivity, and efficiency of service and are based on best practices utilized by leading OEMs and ISOs in the medical electronics and other high technology service industry such as information technology and telecommunications, where the service organization is responsible for supporting a broad array of the technology over a large geography with a densely populated installed base, not unlike the typical health care delivery service environment. Once operational improvements are made, a service organization can take advantage of the productivity and efficiency gains brought on by new technology. Organizations interested in doing so are urged to thoroughly research the current state-of-the-art and best practices, because there are numerous systems currently available off-the-shelf. The author believes that new technology will be a basic requirement for competing in the health care technology service marketplace, because it can significantly affect the profitability of service organizations. This technology will help level the playing field between ISOs, OEMs, and biomedical personnel. As our research suggests, efficiently operating biomedical personnel can achieve a significantly higher utilization and profitability than efficiently operating OEMs, due to the advantages of lower overhead and operating cost structure. In general, the process to improve service productivity and efficiency involves a review of current service operations and understanding of the customer environment perceptions as well as understanding of key service factors parameters. From there, service organizations should identify the current state-of-the-art service and infrastructure systems and technology. Based on this assessment, a service organization can evaluate best practices and identify new strategies and tactics for improving service delivery. Through better service management control and education of users on the improvement in service, which the new processes and technologies provide, the service organization can realize real, quantifiable improvements in service quality, productivity, and profitability.

Computer Simulation↗

PubMed2003

Does delivery matter? Users' perceptions of the significance of trust in the delivery of the Personal Advisor Service in the New Deal for Disabled Persons.

PURPOSE: In the context of welfare pluralism where government in the UK has been contracting a number of public services out to a range of private and voluntary sector organisations, the aim of this study is to explore the extent to which decisions to become involved in employment support programmes are affected by the users' perceptions of those delivering the service. METHOD: A qualitative design involving two focus groups of fourteen participants was employed to examine the attitudes and perceptions of participants in the government's New Deal for Disabled Persons. The study sample was purposefully selected from client records of Shaw Trust a national charity for disabled persons, one of the organisations who have been contracted by the government to provide this service. RESULTS: Two distinct but related themes of disillusionment with the government and the importance of trust emerged from the focus groups. Overall, the data suggests that the identity of those delivering the service significantly influences the decision to participate. As Shaw Trust is a voluntary organisation promoting the rights of disabled persons they were deemed to be trustworthy. The users were sceptical about the government's commitment to improving the lives of disabled people and were reluctant to engage with the state. CONCLUSIONS: Making the transition from dependency on disability benefits to paid employment is a quantum leap. For many the decision to put themselves forward for voluntary support schemes is affected by the extent to which they believe they can trust the agency delivering the service. It is imperative that the government listen to the service users who have been involved in these projects and learn from their experiences.

Adult↗

PubMed2000

Research, politics, and needle exchange.

We now have had 15 years of public discussion of and research on needle exchange programs. The data have shown these programs to be usually, but not always, effective in limiting HIV transmission among injection drug users. Needle exchange programs are conceptualized within a larger framework of providing ready availability of sterile injection equipment for injection drug users. Continuing research is clearly needed regarding how to maximize the availability of sterile injection equipment and how to integrate this with other needed health and social services for drug users. Many initial opponents of needle exchange programs have become supporters of the programs. The number of programs in the United States has been increasing by about 20% per year, and this can be considered substantial progress in reducing HIV infection among injection drug users. Important opposition remains, however, based primarily on the symbolic values expressed in government support for the programs. These value conflicts over needle exchange, which have existed since it was first considered in the United States, cannot be resolved with data. In the late 1980s, the value conflicts greatly hampered the collection of relevant data--there was no federal funding of research on needle exchange programs. Currently, there is considerable research on needle exchange, but many researchers are quite concerned about possible misuse of findings. This may be considered progress to an important but modest degree. Whether current and future research will be used to improve HIV prevention efforts remains to be seen.

Attitude to Health↗

PubMed2000

A library-based bioinformatics services program.

Support for molecular biology researchers has been limited to traditional library resources and services in most academic health sciences libraries. The University of Washington Health Sciences Libraries have been providing specialized services to this user community since 1995. The library recruited a Ph.D. biologist to assess the molecular biological information needs of researchers and design strategies to enhance library resources and services. A survey of laboratory research groups identified areas of greatest need and led to the development of a three-pronged program: consultation, education, and resource development. Outcomes of this program include bioinformatics consultation services, library-based and graduate level courses, networking of sequence analysis tools, and a biological research Web site. Bioinformatics clients are drawn from diverse departments and include clinical researchers in need of tools that are not readily available outside of basic sciences laboratories. Evaluation and usage statistics indicate that researchers, regardless of departmental affiliation or position, require support to access molecular biology and genetics resources. Centralizing such services in the library is a natural synergy of interests and enhances the provision of traditional library resources. Successful implementation of a library-based bioinformatics program requires both subject-specific and library and information technology expertise.

Computational Biology↗

PubMed2003

Implementation and evaluation of an virtual intelligent agent.

Reference librarians at the National Library of Medicine answer over 100,000 client questions annually. Although many answers are the NLM Web, clients may have difficulty finding them. Using intelligent virtual agent software, the NLM launched Cosmo, the Customer Service Owl (http://wwwns.nlm.nih.gov/). Cosmo uses natural language pattern matching to answer common questions. Early evaluation shows Cosmo can answer 25% of questions asked, but some users mistake the service for chat reference or a search engine.

Artificial Intelligence↗

PubMed1985

Community psychiatric nursing: a survey of patients and problems.

The work of a community psychiatric nursing service for acute psychiatric conditions was reviewed for the period 1980-82. Five community psychiatric nurses operated in 10 health centres. General practitioners were the most frequent users of the service and a wide range of psychiatric problems were encountered. The age structure of all referrals was found to be significantly related to sex, with the proportion of females in all age groups at least twice that for males. The most frequent reason for referral was mood/affect disturbance; female patients referred for the first time were predominant. Over half of all problems resolved within three months of referral and a limited number of patients were sent for further psychiatric investigation.

Community Health Nursing↗

PubMed1996

Tetanus: a rare but preventable cause of mortality among drug users and the elderly.

Forty deaths due to tetanus were reported in Lazio, Italy, during 1985-1994. Retired persons accounted for 48% of all deaths. Intravenous drug use was the most commonly identified risk factor among individuals aged less than 40 years. The frequent utilization of curative health services by drug users and the elderly should be used as an opportunity to update their immunization status.

Adult↗

PubMed1999

Shifting to capitation in primary care: what might the impact be in New Zealand?

Primary medical care in New Zealand has traditionally been delivered by general practitioners and funded by a mix of fee-for-service government subsidies, user part-charges and private payments. In 1998, New Zealand's national purchaser of publicly-funded health care, the Health Funding Authority, proposed to pay health service organisations capitation fees per enrolled patient, as well as fees-for-service for immunisations and some performance-related payments. This article considers the implications, drawing on theory and research from New Zealand and elsewhere, of different methods for paying general practitioners and other primary care professionals. The main focus is on whether giving a greater emphasis to capitation will lead to a fairer distribution of resources and better access to services for those groups of people who are not well served by the current system.

Adult↗

PubMed1993

Health services in the New England region and their relevance to Aboriginal people.

Public hospitals provide the vast majority of available health services in rural areas of Australia. These services reflect their clinical European origins in terms of organisation and delivery. This is one reason why they remain largely foreign and irrelevant to Aboriginal people, who are reluctant users of the services and facilities available. In this article we examine what is being done in the New England region of New South Wales to improve the relevance of existing health services for Aboriginal people; this is an important first step in improving the third world health status which they presently endure.

Attitude↗

PubMedDate not supplied

Determining the market for Family Nurse Practitioner services: the Seattle experience.

Using a stratified random sample of 239 Seattle residents, a telephone survey was conducted to investigate the relationships between consumer values and consumer intentions to use Family Nurse Practitioner (FNP) services. Applying marketing theories, this study indicated that 27.3% of the respondents intended to use FNP care. Stepwise discriminant analysis suggested that the best predictors of intention to use FNP services were age, family size, compatibility of services with individual and family norms, knowledge about FNPs, and the value attached to health education, which is part of FNP care. Evidence from this study suggests that potential users of FNP services are primarily women, who are relatively more affluent, better-educated, and younger than the general population. Analysis of the characteristics, values, and knowledge of this group provides valuable information for designing effective marketing strategies to reach this target market, meeting the needs of both consumers and providers of care.

Adolescent↗

PubMed1996

Systems approach to clothing for disabled users. Why is it difficult for disabled users to find suitable clothing.

Today's clothing market is not adapted for people with unusual body dimensions and/or different kinds of functional impairments. They will be referred to as disabled users. The method of user-oriented product development combined with the soft systems methodology has been applied in order to understand and possibly solve their problem. Sixty five disabled users were interviewed. The results show that the disabled users must be divided into subgroups. Their requirements are very much dependent on their impairment not only regarding the fit and function of the clothing, but also regarding shopping and service in the stores. The symbolic values of clothing are just as important as the functional values. However, it is essential not to focus on the end product only, but to look at the problem as a system consisting of: manufacturing, marketing and end use. A new method of taking three dimensional measurements from range images of the human body has been developed. In combination with other developments in information technology it will be possible to synthesise a new system where the manufacturers and retailers of clothing can co-operate in order to give service to disabled users.

Journal Article↗

PubMed2002

Youth reproductive health services in Bulawayo, Zimbabwe.

This study examines young people's access to reproductive healthcare services via an urban youth advisory centre in Bulawayo, Zimbabwe. The aim is to explain why teenagers do not always use existing health services. Data from exit questionnaires with users and focus groups with non-users are analysed to evaluate service accessibility. Analysis suggests that even where clinics are spatially accessible, barriers to access include temporal factors, lack of factual knowledge and stigmatisation. The paper concludes that spatial accessibility is not the only factor necessary to ensure equal access to health services. Recommendations are made towards tackling young people's unmet needs for reproductive healthcare services.

Adolescent↗

PubMed2006

The role of contact efficacy in evaluating sexual health promotion--evidence-based outreach work within a public sex environment.

BACKGROUND: This paper explores the role of contact efficacy in evidence-based health promotion by evaluating a public sex environment (PSE) based sexual health outreach program. The service operated in situ from a dedicated mobile unit to promote sexual health among PSE users. METHODS: A cross-sectional survey (response rate 56%) measured socio-demographics, sexual health behaviours and outreach-service use among men sampled within the PSE (n = 216). RESULTS: Most participants were aware of the service and two-thirds had contacted them. Men who had not completed hepatitis A vaccination (odds ratio (OR) = 2.02), who had ever received money for sex (OR = 2.07) or who reported a diagnosed mental health disorder(s) (OR = 2.38) were significantly more likely to have contacted the service. Although 89% of service users perceived the intervention positively, only 26% felt it had contributed to sexual behaviour changes. CONCLUSIONS: The 'mobile-unit' outreach model contacted a large proportion of PSE users, specifically men who had greater health needs. We advocate the adoption of this outreach model over traditional PSE-based outreach approaches. Contact efficacy evaluation is useful to assess ongoing health interventions. However, caution must be exerted when interpreting certain contact efficacy results. Since causality may not always be inferred, triangulation with other evaluative methodologies is recommended.

Adult↗