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PubMed2003

Cross-sectional survey of users of Internet depression communities.

BACKGROUND: Internet-based depression communities provide a forum for individuals to communicate and share information and ideas. There has been little research into the health status and other characteristics of users of these communities. METHODS: Online cross-sectional survey of Internet depression communities to identify depressive morbidity among users of Internet depression communities in six European countries; to investigate whether users were in contact with health services and receiving treatment; and to identify user perceived effects of the communities. RESULTS: Major depression was highly prevalent among respondents (varying by country from 40% to 64%). Forty-nine percent of users meeting criteria for major depression were not receiving treatment, and 35% had no consultation with health services in the previous year. Thirty-six percent of repeat community users who had consulted a health professional in the previous year felt that the Internet community had been an important factor in deciding to seek professional help. CONCLUSIONS: There are high levels of untreated and undiagnosed depression in users of Internet depression communities. This group represents a target for intervention. Internet communities can provide information and support for stigmatizing conditions that inhibit more traditional modes of information seeking.

Adult↗

PubMed1999

[Utilization of prescribed drugs by HIV infected individuals: qualitative approach].

OBJECTIVE: The assessment, in its qualitative dimension, of the utilization--by HIV infected individuals--of selected prescribed drugs during the process of the search for and the obtaining of care in public health services in Belo Horizonte, Brazil. METHODS: Fifty two semi-structured interviews with patients, health care workers and non-governamental organizations volunteers were carried out and 1,079 medical records were reviewed. Data were obtained on the utilization of prescribed drugs by HIV infected individuals, whose first visit to one of the public services studied occurred between January 1989 and December 1992. Problems related to the use of anti-retroviral and/or opportunistic infection medication were identified and a qualitative description of their possible causes and consequences was commented on. RESULTS: Refusal to use, difficulty in obtaining and in complying with the prescription were the main problems related to anti-retroviral drug use. Causes for such problems included: fear or occurrence of side effects, large number of daily capsules/pills, insufficient and/or irregular distribution of drugs by the public health services and the high cost of anti-retroviral therapy. Based on the reports, the main consequences are likely to be no or late use of anti-retroviral drugs, an increase in resistance and a worsening of the clinical course of the infection. Other problems identified were: self-medication, difficulty in obtaining medications for associated pathologies and in complying with sulfa prescription. CONCLUSION: A better understanding of the main obstacles and difficulties experienced by the user of the services, from the moment of the prescription and throughout the treatment, may contribute to an improvement in compliance and the availability and adequate distribution of drugs.

Anti-HIV Agents↗

PubMed2001

Social work and health restructuring in Canada and Finland.

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.

Canada↗

PubMed2006

User charges in public health facilities in Tanzania: effect on revenues, quality of services and people's health-seeking behaviour for malaria illnesses in Korogwe district.

User charges in public health facilities are aimed at improving efficiency and quality of health services. In Africa, evidence about their effect on patient attendance and community health-seeking behaviour are mixed. This paper reports a study of the effect of user charges on revenue collection, quality of services and people's health-seeking behaviour in relation to malaria in Korogwe district, Tanzania. Data were collected through focus-group discussions with community members, interviewing community leaders and health workers, field observations and review of patient registers. Generally, there was no distinct difference in the trends of patient attendances before and after user fee introduction. Public awareness about cost-sharing policy was high, but had low appreciation in the administration of exemptions and waivers. Shortage of drugs, laboratory facilities, and inhospitality of nurses lowered their confidence in the user-fee system. Autonomy to collect and prioritize expenditure of user-fee revenue at the health-facility level was appreciated by community leaders and health workers who, however, had reservations with funds being held at the district level and delays by the DMO's office in approving budgets submitted in request for expenditure of such revenues. Thus, despite the potential of user charges for revenue mobilization, problems with their administration lowers public confidence in the user-fee system improving quality and accessibility of services to the poor.

Cross-Sectional Studies↗

PubMed2002

Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being.

The aim of this paper is to report the prevalence of 12-month comorbidity between DSM-IV alcohol use disorders (abuse or dependence) and anxiety, affective and drug use disorders in the adult Australian general population and to examine the disability and health service utilisation associated with this comorbidity. The study uses data from the National Survey of Mental Health and Well Being (NSMH&WB). The NSMH&WB is a cross-sectional survey of 10,641 Australian adults conducted in 1997 that measured the prevalence of DSM-IV mental disorders in the previous 12 months and associated disability and health service utilisation. Results show approximately one-third of respondents with an alcohol use disorder (abuse or dependence) met criteria for at least one comorbid mental disorder in the previous 12 months. They were 10 times more likely to have a drug use disorder, four times more likely to have an affective disorder and three times more likely to have an anxiety disorder. Respondents with an alcohol use disorder and a comorbid mental disorder were significantly more disabled and higher users of health services than respondents with an alcohol disorder and no comorbid mental disorders. These results reinforce the need for both mental health and drug and alcohol professionals to be provided with education to assist with appropriate identification, management and referral of clients presenting with this complex range of disorders.

Adolescent↗

PubMed1990

[Analysis of the use of an ambulatory unit of the Department of Health of the city of São Paulo, SP (Brazil)].

A working proposal for the integration of the activities of public health assistance is presented. Two health clinics in the city of S. Paulo, Brazil, were studied. Taking as a starting-point that all activity in the health sector depends on community participation, this study sought to discover how the population has received and used the geographically integrated health services. For this purpose, information was collected from the users of both of these services, by means of a questionnaire, as to the motive for the use of the service, the service's ability to meet the need, the degree of user-satisfaction, etc. The analysis of the above information as well as of the objective and the working method of these services, leads to the conclusion that they are used by the public in a selective way for the purpose of meeting immediate needs related to present illnesses.

Ambulatory Care Facilities↗

PubMed1997

Powered wheelchairs: are we enabling or disabling?

Following the unsuccessful issue of three powered indoor National Health Service (NHS) wheelchairs, a survey was carried out of 40 users in a London wheelchair service to identify the problems with issue and possible areas for improvement to practice. The survey identified improvements that were necessary both from the service and the manufacturers' booklets. The improvements include the issue of written instructions and information to complement verbal instruction given at handover. Such information should be as interesting to read as possible, make use of appropriate language and diagrams (especially in area where English is often not the first language), colour, text and print size to maximise comprehension to these severely disabled users and often their elderly relatives or carers. The importance of the role of the rehabilitation engineer in training the user, giving instruction at handover and annual review are highlighted to ensure that the equipment remains working, suitable and up to date for the individual's needs. Training in interpersonal and communication skills and the importance of recall should also be emphasised. The implementation of the findings should lead to increasing contact with the service by the user, reduction in repair and replacement costs, regular review, correct supply and will therefore enable users to increase their independence with appropriate equipment.

Persons with Disabilities↗

PubMed2004

The PredictProtein server.

PredictProtein (http://www.predictprotein.org) is an Internet service for sequence analysis and the prediction of protein structure and function. Users submit protein sequences or alignments; PredictProtein returns multiple sequence alignments, PROSITE sequence motifs, low-complexity regions (SEG), nuclear localization signals, regions lacking regular structure (NORS) and predictions of secondary structure, solvent accessibility, globular regions, transmembrane helices, coiled-coil regions, structural switch regions, disulfide-bonds, sub-cellular localization and functional annotations. Upon request fold recognition by prediction-based threading, CHOP domain assignments, predictions of transmembrane strands and inter-residue contacts are also available. For all services, users can submit their query either by electronic mail or interactively via the World Wide Web.

Internet↗

PubMed1993

The political process and its relationship to the psychotherapy of substance misusers: an historical perspective.

There are massive changes underway in the allocation of funds for health care in the United States which will impact upon services provided for users and misusers of intoxicating substances. Recent findings suggest that conditions in the marketplace and the development of professions have effected standards of care rather than a reasoned analysis of need and outcome. Psychologists question to what extent they will be involved in public policy issues including what is clinically and socially relevant. The goal of this paper was to determine if an historical perspective upon federal regulation of intoxicating substances (tobacco/alcohol/drugs) would enlighten the psychotherapy scientist in the pursuit of standards for service. The methodology included a review of the economic and social structure of colonial America which included tobacco plantations, breweries, and distilleries as well as a review of the formation of the federal government and political system in which men, women, and slaves were each assigned different performance standards/roles and economic rewards within the community. The implication is that potential for self-regulation and psychological development is based upon the legacy of our forefathers.

Alcohol Drinking↗

PubMed2003

Professional discourse and service cultures: an organisational typology developed from health and welfare services for people with learning disabilities.

This study focuses upon the effect of social policy upon a particular area of service provision. It is influenced by the Foucauldian concept of governmentality and the proposition by Lewis et al. that social policy needs to be understood in local contexts. Only through understanding the partial and fragmented impact of policy can we gain a clear insight into the outcomes for users. The study is undertaken through an exploration of the micro politics of organisations providing health and welfare services for people with learning disabilities. It involves an approach to discourse analysis that focuses upon text developed from interviews with service providers, which is brought into contact with published literature in an iterative process. The interpretation of the text produces four themes: power, trust, citizenship and managerialism. The development of these themes and a further holistic interpretation of the text suggest an emerging organisational typology. A typology based upon different articulations of the themes noted that work to produce particular outcomes for service users.

Community Health Services↗

PubMed1991

Best kept secrets ... First Coast Systems, Inc. (FCS).

The FCS/APaCS system is a viable option for small-to medium-size hospitals (up to 400 beds). The table-driven system takes full advantage of IBM AS/400 computer architecture. A comprehensive application set, provided in an integrated database environment, is adaptable to multi-facility environments. Price/performance appears to be competitive. Commitment to IBM AS/400 environment assures cost-effective hardware platforms backed by IBM support and resources. As an IBM Health Industry Business Partner, FCS (and its clients) benefits from IBM's well-known commitment to quality and service. Corporate emphasis on user involvement and satisfaction, along with a commitment to quality and service for the APaCS systems, assures clients of "leading edge" capabilities in this evolutionary healthcare delivery environment. FCS/APaCS will be a strong contender in selected marketing environments.

Computers↗

PubMed1990

Consistently high users of medical care among the elderly.

This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.

Aged↗

PubMed2002

[Heavy users of psychiatric care].

OBJECTIVE: This paper reviews findings and problems of heavy users research. METHODS: The German- and English language literature about "heavy users" and relevant border areas was analyzed. RESULTS: Heavy users are patients who consume a disproportionate share of medical services. The characteristics of heavy users are inhomogeneous. Social problems, denial of illness, non-compliance, comorbid personality disorders and substance misuse contribute significantly to heavy use. Future studies should define heavy use illness-related. More research is needed to clarify whether heavy use of special services is adequate to the patients situation. CONCLUSIONS: Heavy users should be identified early, in order to offer them alternative services, which better fulfil the patients specific conditions and prevent an inadequate heavy use of expensive services.

Case Management↗

PubMed2006

Quality of life in adults with an intellectual disability: the Evaluation of Quality of Life Instrument.

BACKGROUND: The construct of quality of life (QoL) has been the focus of a great deal of recent research and has been operationalized in the assessment of the effectiveness of biomedical and rehabilitative interventions. Consequently, the effective measurement of QoL has become a relevant issue. QoL assessment should take account of both objective life conditions and reported satisfaction with those conditions, and should recognize that QoL has multiple domains. There is also evidence to suggest that it is useful to supplement such assessments with the evaluations of significant others within a multidimensional assessment perspective. METHODS: The current study describes a further stage of testing and refinement of the Evaluation of Quality of Life Instrument (EQLI), which was designed to elicit from staff of health and social care services assessments of the level of satisfaction experienced by adults with an intellectual disability. Specifically, the EQLI's internal consistency, and construct, convergent and discriminant validity were analysed. RESULTS: The EQLI appears to be a psychometrically valid measure for collecting data on the levels of satisfaction which, according to health and social services staff, might be experienced by individuals with an intellectual disability who attend residential institutions and community-based day centres. The factor analyses supported a three-factor structure for the EQLI and reliability estimates of scores on the three factors were in the moderate to high range. The data collected supported convergent and discriminant validity. CONCLUSIONS: The results indicate that the EQLI is an effective measure for gaining staff perceptions of individuals who may be at risk of dissatisfaction with various QoL domains. The EQLI is as an instrument which, within a multidimensional assessment, could contribute to the identification of areas of user dissatisfaction with services.

Adolescent↗

PubMed2002

The provision of family planning services in the Caribbean.

This article examines the provision of family planning services in selected countries in the Caribbean. The potential impact of the funding shortfall resulting from the phasing out of funding by the International Planned Parenthood Federation (IPPF), and the strategies being adopted by the selected countries to cope with this, are considered. Stratified random sampling methods were employed to select eight Caribbean countries and a pre-designed questionnaire was administered to the agency responsible for family planning services in each country. The sample was stratified geographically to include countries from different parts of the Caribbean. The questionnaire was designed to collect information on the services provided, the name of the agency responsible for the provision of services and, where possible, the number of users of each type of service in 1998 and 1997. Vast disparities were found in the provision of family planning services in different Caribbean countries, in terms of the groups involved, the services available in each country, as well as methods of data collection and compilation. Anguilla and Bermuda were found to provide only limited family planning services, while Barbados, Jamaica and Grenada provide much more sophisticated services. A salient finding was the innovative approaches that various countries in the region have adopted to fund family planning programmes in anticipation of the phasing out of IPPF funding. The standpoint taken in the study is that countries such as Anguilla and Bermuda must strive to improve their provision of family planning services, and that they could learn from Barbados, Grenada and Jamaica, which provide much more comprehensive services. It is also concluded that, unless alternative funding sources are identified and accessed, the provision of family planning services in the Caribbean is likely to decline in the future.

Caribbean Region↗

PubMed2002

A network system of medical and welfare information service for the patients, their families, hospitals, local governments, and commercial companies in a medical service area.

A service information system using the Internet, which connected the various people who are related to medical treatment and nursing welfare, was constructed. An intractable neurological disease patient who lives in the Onga district, Fukuoka, Japan, and the people who are related to the service were chosen as test users in an experimental model. The communicated service information was divided into open-use data (electronic bulletin board, welfare service, medical care service, and link to private company service home page) and closed-use data (the individual patient's hysterics). The open data server was installed in an Internet service provider The open data could be accessed not only by the patient, but also by the family, information center, companies, hospitals, and nursing commodity store related to patient's nursing and medical treatment. Closed data server was installed in an information center (public health center). Only patient and information center staff can access the closed data. Patients should search and collect the service information of various medical and welfare services by themselves. Therefore, services prepared for the patient are difficult to know, and they cannot be sufficiently utilized. With the use of this information system, all usable service information became accessible, and patients could easily use it. The electronic bulletin board system (BBS) was used by patients for knowing each other or each others' family, and was used as a device for exchange of wisdom. Also, the questions for the specialist, such as doctor, dentist, teacher, physical therapist, care manager, welfare office staff member, and public health nurse, and the answers were shown on the BBS. By arranging data file, a reference of various patients in question and answer, which appeared in this BBS, was made as "advisory hints" and was added to the open data. The advisory hints became the new service information for the patients and their family. This BBS discovered the possibility of becoming an important information source for companies, hospital and, administration to know the requirements of patients and their families and the kind of services to be served. Although suppliers provide medical and welfare services for the patient, there is a tendency that the service information is sent by the suppliers at their own convenience. The information system in which various people participated was constructed in order to collect information for the patient, taking a patient-oriented approach. The result of the model test showed that this information system using Internet technology is a good system for both the service supplier and its receiver.

Access to Information↗

PubMed1996

[Household surveys as an evaluation tool for health services: a case study from the Southeast region of the Greater São Paulo Metropolitan Area, 1989-1990]

The increasing importance of health evaluation has raised the need of incorporating epidemiological methodology to assess both technologies and health services. Evaluation of health services performance requires population data to identify the unmet demand and patterns of health services utilization. Such data can be obtained through household surveys. A household survey in the Greater São Paulo Metropolitan Area identified the pattern of health services utilization by the local population. This pattern, which reflects current organization of health services, pointed to a low coverage level by local services, including public clinics, different profiles for users of private and public services, and a large demand for health services outside the area, mainly for childbirth. The information obtained through these surveys produces a "base line" for health planning and further evaluation and is central to the assessment of existing services. The advantages of household surveys in health services evaluation should be analyzed in relation to the potential use of such data and study costs, thereby designing the best cost-benefit relationship for each specific situation.

Journal Article↗

PubMed1998

User charges and the demand for acute paediatric traumatology services.

The city of Helsinki in 1991 introduced moderate patient charges for certain acute paediatric services. This provided the framework for a natural, partially controlled experiment on price elasticity of demand for acute paediatric trauma services. A cross-sectional time-series analysis of a partially controlled natural experiment was done for the period 1989-1994. The findings suggest that moderate user charges may reduce the demand for paediatric trauma services measurably. The effect was diagnosis-specific and, on average, stronger in older than in pre-school children. It probably had a negligible impact on long-term health.

Adolescent↗