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PubMed2003

Emergency dental services: review of the Community Health NHS Trust Service in Birmingham between 1997 and 2000.

AIMS AND OBJECTIVES: To confirm the need for an emergency dental service in Birmingham and to review the emergency dental service run by the South Birmingham Community Health NHS Trust. DESIGN: A retrospective study of patients attending the emergency dental service from March 1997 to August 2000, using computerised patient records and a supplementary questionnaire for a nine-month period between August 1997 and April 1998. SETTING: Birmingham Dental Hospital. RESULTS: A review of the computerised records revealed that a total of 10,799 patients were seen during the study period. In the first year, on average five patients were seen on weekday evening sessions and 13 patients at weekends/public holidays. By the final year of the study, these figures increased to ten on weekday evenings and 16 at weekends/public holidays. Forty-three per cent of the attendees were in the 31-50 year age group and 33% in 19-30 year age group. Twenty-five per cent of patients required extractions, 20% received temporary dressings, 17% a prescription for antibiotics and 9% were treated for acute mucosal conditions such as pericoronitis. The remainder received other items of treatments, such as for dry sockets. The supplementary questionnaire revealed that during the period August 1997 to April 1998, 67% of the patients lived in Birmingham and the other 33% in the surrounding areas, and some 59% of patients claimed that they were registered with a dentist of whom 60% of patients were not exempt from NHS charges. CONCLUSIONS: The results indicate that the service was widely and increasingly used during the study period. A similar pattern of emergency dental care in dedicated clinics could be established throughout the United Kingdom. A profile of users of the service during its first three-and-a-half years has been established.

Adolescent↗

PubMed2005

Achievements and challenges of medicare in Canada: Are we there yet? Are we on course?

Health care policy in Canada is based on providing public funding for medically necessary physician and hospital-based services free at the point of delivery ("first-dollar public funding"). Studies consistently show that the introduction of public funding to support the provision of health care services free at the point of delivery is associated with increases in the proportionate share of services used by the poor and in population distributions of services that are independent of income. Claims about the success of Canada's health care policy tend to be based on these findings, without reference to medical necessity. This article adopts a needs-based perspective to reviewing the distribution of health care services. Despite the removal of user prices, significant barriers remain to services being distributed in accordance with need-the objective of needs-based access to services remains elusive. The increased fiscal pressures imposed on health care in the 1990s, together with the failure of health care policy to encompass the changing nature of health care delivery, seem to represent further departures from policy objectives. In addition, there is evidence of increasing public dissatisfaction with the performance of the system. A return to modest increases in public funding in the new millennium has not been sufficient to arrest these trends. Widespread support for first-dollar public funding needs to be accompanied by greater attention to the scope of the legislation and the adoption of a needs-based focus among health care policymakers.

Canada↗

PubMed2006

[Methodological design for the National Survey Violence Against Women in Mexico].

OBJECTIVE: To describe the methodology, the research designs used, the estimation and sample selection, variable definitions, collection instruments, and operative design and analytical procedures for the National Survey Violence Against Women in Mexico. MATERIAL AND METHODS: A complex (two-step) cross-sectional study was designed and the qualitative design was carried out using in-depth interviews and participant observation in health care units. RESULTS: We obtained for the quantitative study a total of 26 240 interviews in women users of health services and 2 636 questionnaires for health workers; the survey is representative of the 32 Mexican states. For the qualitative study 26 in-depth interviews were conducted with female users and 60 interviews with health workers in the States of Quintana Roo, Coahuila and the Federal District.

Battered Women↗

PubMed1999

Extending specialist palliative care to all?

How to extend palliative care services to all patients needing them is an issue currently exercising a range of bodies in contemporary Britain. This paper first considers the evidence regarding the needs of dying patients with long term conditions other than cancer and concludes that there is evidence to support their presumed need for palliative care. It then considers five potential barriers to extending specialist palliative care services to non-cancer patients in Britain. These are the skill base of current specialists in palliative care, difficulties in identifying candidates for specialist palliative care, the views of potential users of these services, resource implications and vested interests in present health service arrangements.

Clinical Competence↗

PubMed1998

Health care reform and quality initiatives in Brazil.

BACKGROUND: The pursuit of equity in health care and universal entitlement to access of services, as health care reform concerns, were addressed at a Brazilian national health conference in 1986, in a new constitution in 1988, and in subsequent legislative and administrative actions. However, in the early 1990s, economic policies affected the federal government's ability to fund the necessary services. QUALITY IMPROVEMENT (QI): In 1994 the Ministry of Health introduced a formal QI program, whose main purpose was to disseminate a culture of QI among health care providers, payers, and users of health services. The minister of health then established a national commission on QI, which played an important role in making QI activities an important activity. A NATIONAL ACCREDITATION PROGRAM: Efforts to create an accreditation program began in 1986. Since 1994 work has proceeded on organization of a nongovernmental accreditation agency, development of national standards and procedures for the accreditation of health services, and dissemination of methods and procedures for health care quality management. QI PROGRAMS: Examples of QI programs that have been successfully implemented include those at the State of Rio de Janeiro Blood Center and the National Institute of Cancer. Since 1996, many national societies have begun to produce consensus statements and guidelines. Progress has also been made in consumer rights and protection. CONCLUSIONS: The public, health care professionals, providers, and the government are increasingly aware of the need to strengthen and develop QI initiatives for health care in Brazil. Awareness of the opportunities for improvements in health care which outcomes trigger should help contribute to their application.

Accreditation↗

PubMed1991

Adding a competitive dimension to importance-performance analysis: an application to traditional health care systems.

This study introduced an extension of importance-performance analysis by further including the performance of competitors. It demonstrated its value by applying it to a national sample of fee-for-service health care users. This study found that inappropriate strategies may result from importance-performance analysis that excludes a dimension of competition. In particular, the two attributes, availability of both physicians and emergency services, were found to be "high" on importance and "good" on fee-for-service performance. From the basic classic importance-performance approach, a relatively passive strategy would be recommended for each of these attributes. When also considering competition, however, a more appropriate, vigorous strategy of head-to-head competition clearly emerges.

Consumer Behavior↗

PubMedDate not supplied

[CLSC's Info-Sante: an effective service?].

Satisfaction, self-care and cost savings resulting from the use of CLSC's Info-Santé service of the Québec region have been evaluated in the period 48-72 hours after the user's call to the service. Data have been collected by a telephone survey on a random sample of 394 users. Results show a very high rate of satisfaction with the majority of the 14 selected indicators. The waiting time until connection with a nurse was the main source of dissatisfaction. Approximately 91% of callers did not have to call back the service for the same problem. The majority of users (83%) carried out the actions recommended by the nurse, and 89% felt they would be able to handle the problem if it recurred. If Info-Santé did not exist, 76% of service users declared that they would have visited a doctor to solve their problem. If they had done so, it would have cost an estimated nearly two million dollars to the Québec Government.

Acute Disease↗

PubMed2001

Characteristics of repeated ambulance use in an urban emergency medical service system.

BACKGROUND AND PURPOSE: Although many studies have examined the reasons for repeated use of emergency medical service (EMS), little information is available concerning repeated ambulance use in Taiwan. This study evaluated the characteristics of repeated EMS ambulance use in an urban EMS system in Taiwan. METHODS: Data from a local EMS computerized database for the period from January 1996 through December 1998 were collected for analysis. All calls to the dispatch center that resulted in EMS transports were included. Repeat users were identified by matching the user name, sex, age, and home address. Transports were categorized according to how many times the patient was transported by ambulance during the 3-year period: single use, one time; repeated use, two or three times; or frequent use, more than three times. RESULTS: During the 36-month study period, there were 41,792 calls, with 13,076 non-transports (a non-transport rate of 31.3%). Of the 28,716 transports during the study period, 2,101 represented repeated or frequent use (7.3%); the rate of frequent use was 1.4% (406/28,716). The frequency of repeated use reached a daily first peak at 8:00 AM, with the second and third peaks at 1:00 PM and 7:00 PM. The mean age increased with increasing repeated use of transport (37.25 +/- 0.24 vs 41.55 +/- 1.03 vs 46.23 +/- 1.57 years, respectively; p < 0.001). The percentage of non-trauma missions increased with increasing repeated use of transport (26.3% vs 55.6% vs 73.2%; p < 0.001). Response time significantly increased for repeated use (analysis of variance [ANOVA], p < 0.001). The on-scene interval (time from arrival until departure) in the single-use group was shorter than in the repeated and frequent use groups (ANOVA, p < 0.005). CONCLUSIONS: The results of this study indicate that the characteristics of repeat users of EMS transport differ from those of single users. Characteristics of service time, reason for transport, and interval to each subsequent call varied among different groups of users. Studies of repeat use under a wider range of conditions such as in rural EMS systems and after implementation of a priority-dispatch system are needed to determine the implications of repeated ambulance use.

Ambulances↗

PubMed2003

User satisfaction survey and usage of an electronic desktop document delivery service at an academic medical library.

In June 2000, the Biomedical Library at the University of South Alabama introduced Prospero, an electronic desktop document delivery service. From June 2000 to November 2002, Prospero delivered 28% of interlibrary loan requests and 72% of document delivery requests. In November 2002, the library conducted a user satisfaction survey of the Prospero service. Forty-two surveys were used. Fifteen responses were received from affiliated faculty, staff, and students, who generally expressed satisfaction with the service. Twenty-seven responses were received from unaffiliated users, comprised of medical libraries, individual users, and businesses. Based on the survey results, the library deemed the Prospero service a success. To better support users, the library's Web page was updated to include hardware and software requirements for successful use of the Prospero service, as well as screen shots of the Prospero process.

Alabama↗

PubMed2000

Secure interoperability of patient data cards in health networks.

In the healthcare area, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. Dealing with sensitive personal medical information, shared care information systems have to provide appropriate security services, only authorized users allowing restricted rights to the patients' data according to the "need to know" principle. The DIABCARD project aims the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with Diabetes as an example. In co-operation with the EC-funded TrustHealth project, the communication and application security services needed are provided as strong authentication and the derived services like authorization, access control, accountability, confidentiality etc. The solution is based on Health Professional Cards and Trusted Third Party services. Besides the secure handling of the patient's chip cart in DIABCARD workstations, also the secure communication between these workstations and related departmental systems has been implemented. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.

Computer Communication Networks↗

PubMed2001

The promise and limits of private medicine: health policy dilemmas in Nigeria.

Developments in health are easily among the best known human development indicators. Comparisons of life expectancy, infant mortality, access to safe water and similar data indicate the positions of individual countries. The political and economic processes which these indices reflect, or which inform the nature of health policy, are often not as clear or visible. These structural factors are either frequently ignored or mentioned only in passing, as illustrated in a recent paper published in this journal on the private medical enterprise in Nigeria (Ogunbekun et al. 1999). According to the authors, the generally low quality of public health services and high user fees have combined to make private medicine the 'unavoidable choice' of Nigerians. They identify benefits of private medicine as higher technical efficiency and contributing to fill the gap created by inadequate public sector services and to medical training. This paper argues that these claims are exaggerated, and that the authors seem to ignore Nigeria's political and economic processes, the health seeking behaviour of Nigerians, as well as the prevailing causes of morbidity and mortality. It is suggested that whereas the contributions of private medicine are significant, there are also several limitations, some of which originate from its for-profit raison d'être. The ultimate aim of health development must include improved access to services and better health status for the majority of the people. Without any form of public supported programme of payments in Nigeria, these objectives are circumscribed, especially with high fees in the private system. It is concluded that while private medicine will continue to be available for those who can afford it, it is unlikely to provide solutions to Nigeria's morbidity and mortality problems, particularly in relation to epidemics such as the growing burden of HIV/AIDS.

Delivery of Health Care↗

PubMed2004

Factors associated with variations in older people's use of community-based continence services.

Many people who have urinary incontinence and who may benefit from healthcare and professional advice do not currently access UK National Health Service services, even though effective treatments are available in the community. Older people have an increased prevalence of incontinence and a correspondingly increased need for continence services. Therefore, increasing older people's access to continence services has the potential to reduce inequalities and improve quality of life. The present study aimed to identify older people with urinary incontinence living in the community, to describe and compare the characteristics of users and non-users of continence services, and to identify factors which prevent older people seeking help. A cross-sectional postal survey of patients aged over 65 years registered with four general practices in an urban area found an overall prevalence of 39% of older people with urinary incontinence, only 15% of whom had accessed services. Two-thirds of respondents who reported that they experienced urinary leakage several times per week to all the time, and up to two-thirds of those reporting leakage of moderate or large volumes of leakage had not accessed services. The majority of older people are in regular contact with health professionals, and the greatest single influence on use of services was that of being asked whether there were continence problems by a health professional. Being married or having a partner, experiencing less pain generally, and suffering relatively high frequency and volumes of urinary leakage also appeared to be associated independently with continence service use. In conclusion, there appears to be considerable unmet need for continence services. Health professionals should be aware that incontinence is an important health problem for older people, and by asking older people specifically about urinary leakage, they could reduce inequalities in use of services.

Aged↗

PubMed2006

Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran.

AIM: This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran. METHODS: Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU), non-injecting drug users (DU) and non-drug using patients were examined. RESULTS: 292 records were reviewed (34% IDU, 31% DU and 35% non-drug users). Eighty-three percent were males; all females were non-drug users. The mean age of the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%). Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%), heroin (13%) and hashish/ other cannabinoids (13%). Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7%) and 41% to have used drugs in prison. CONCLUSION: This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.

Journal Article↗

PubMedDate not supplied

Marketing on a shoestring.

Marketing includes the many steps taken to sell a product or service from its conception to its purchase or use. In healthcare, three cost-effective audiences to target are referring physicians and their staffs, local HMOs and PPOs, facility employees and patients. The potential users of such services--your target audience--should be made aware of new offerings such as the addition of special procedures, a new piece of equipment, or perhaps a new physician with special capabilities. To ensure a productive effort, a marketing attempt must follow two cardinal rules: first, the product or service offered must be of high quality and, second, the marketing effort must be carried out consistently. An effective marketing campaign should create an impression within the community about the facility by emphasizing those aspects of the department or facility that make it unique. Are its hours of operation adequate? Do its personnel project a professional attitude and demeanor? Does it have a specialty that makes it unique within the healthcare community? The most powerful marketing tool of all is word of mouth, which is based on the judgments clients make after visiting the facility-department or facility employees smile and greet visitors, they are polite and helpful on the telephone, their attitudes are professional, and so forth. Such impressions are worth millions in goodwill and can be used as a marketing tool. Last, an actual case study from my hospital explains how we determined the need for and marketed an open MRI system.

Cost-Benefit Analysis↗

PubMedDate not supplied

Public attitude toward pesticides. A random survey of pesticide use in Allegheny County, Pa.

Pesticide use was examined by means of a random survey in Allegheny County, Pa., in October and November 1973. The objectives included gaining insight into the need for a new community pesticide program and estimating its public acceptance. The 110 survey sites were grouped as single-family dwellings, commercial and recreational lawns, institutions, farms, rights-of-way, and wasteland. In the single-family dwellings, most householders (85 percent) used a pesticide in the previous 12 months, usually an aerosol insecticide (76 percent) or herbicide (55 percent). Their pesticide selections were most often based on advertisements of availabel products. A high percentage lacked either the interest or the knowledge of the information on the pesticide's label. No observation in this or any other study supports the need for a new special program in pesticides or indicates that a substantial segment of the public would use its services. The main users of "hard" pesticides were the golf courses, rights-of-way, and one farm-nursery. The rights-of-way used chemicals only for vegetation control. Utilities and railroads contracted with pesticide companies for this work. Municipal users applied pesticides recommended by dealers. The golf courses and a farm-nursery used a broad range of fungicides, insecticides, and herbicides, which they selected because of information received from the Pennsylvania Extension Service and professional organizations.

Aerosols↗

PubMed1995

Adults with a history of child sexual abuse: evaluation of a pilot therapy service.

OBJECTIVE: To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse. DESIGN: Questionnaire survey. SETTING: Specialised therapy unit, Breakfree, which offers care, therapy, and support. SUBJECTS: 116 clients presenting to the service who were offered therapy. MAIN OUTCOME MEASURES: Scores from three psychological questionnaires--the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory--and from questionnaires about the clients' abuse, previous use of health services, and opinion of the Breakfree service. RESULTS: Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon's matched pairs signed ranks test): social activities and distress scale, z = -3.3, P = 0.001; general health questionnaire, z = -5.8, P < 0.00001; delusions, symptoms, and states inventory, z = -4.8, P < 0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28/58 did so at the end of the study (only 17/35 among those who had finished therapy). CONCLUSIONS: This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.

Adult↗

PubMed2001

Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies.

OBJECTIVE: To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users. METHOD: Review instrument completed by pharmacist interviewing drug users and other pharmacy users. SETTING: Community pharmacists SAMPLING: All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129. KEY FINDINGS: The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users. CONCLUSIONS: Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.

Adolescent↗

PubMed2000

Intranet health clinic: Web-based medical support services employing XML.

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which operates in pilot form within the INTRANET HEALTH CLINIC project--a two-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different users. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system is designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current pilot implementations are under clinical evaluation and include oncological patients (Greece), Lupus Erythrematosis (Canada), Obstetrics (Belgium) and Chronic Obstructive Pulmonary disease (Spain).

Computer Communication Networks↗