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PubMed2004

Burden of allergic disease in the UK: secondary analyses of national databases.

BACKGROUND: Although allergy represents an important source of patient morbidity and healthcare utilization, there is little reliable information on the overall disease burden posed by allergic conditions in the UK. OBJECTIVES: Focusing on the following conditions: allergic rhinitis, anaphylaxis, asthma, conjunctivitis, eczema/dermatitis, food allergy and urticaria/angioedema, we sought to (i) describe the prevalence, incidence and outcomes of allergic disorders; (ii) describe the NHS healthcare burden posed by allergic disorders; (iii) estimate the costs of allergic disorders from a healthcare perspective. METHODS: Secondary analyses of data from the Health Survey for England, Scottish Health Survey, International Study of Allergies and Asthma in Childhood, European Community Respiratory Health Survey, Morbidity Statistics from General Practice 1991/1992, Royal College of General Practitioners Weekly Returns Service, Prescribing Analysis and Cost data, Hospital Episodes Statistics and national mortality data. RESULTS: Thirty-nine percent of children and 30% of adults have been diagnosed with one or more atopic conditions. Six percent of general practice consultations and 0.8% of hospital admissions are for allergic diseases. Treatments for asthma and other allergic disorders currently account for 10% of primary care prescribing costs. Direct NHS costs for managing allergic problems are estimated at over one billion UK pounds per annum. CONCLUSIONS: Allergic disorders are common throughout the UK, affecting males and females of all ages and peoples from all social classes and ethnic groups. They currently represent a substantial burden of morbidity and health service cost.

Adolescent↗
PubMed2002

Medicaid enrollment among elderly medicare beneficiaries: individual determinants, effects of state policy, and impact on service use.

OBJECTIVE: To better understand factors associated with Medicaid enrollment among low-income, community-dwelling elderly persons and to examine the effect of Medicaid enrollment on the use of health care services by elderly persons, taking into account selection in program participation. DATA SOURCES: 1996 Medicare Current Beneficiary Survey (MCBS) Access to Care and Cost and Use files. METHODS: Individual-level predictions of the probability of dual enrollment are obtained from equations that estimate jointly the residential status of Medicare beneficiaries (community versus institution) and the probability of Medicaid enrollment among community-dwelling eligible beneficiaries. Predicted values are then substituted into the service use equations, which are estimated via two-part models. PRINCIPAL FINDINGS: Less than half of all community-dwelling elderly persons with incomes at or below 100 percent of the Federal Poverty Level (FPL) were enrolled in Medicaid in 1996. Once selective enrollment was accounted for, there was limited evidence of a dual enrollment effect on service use. Although there were no effects of state Medicaid policy variables on the probability that beneficiaries lived in the community (as opposed to nursing homes), the effects of state's Medicaid generosity in home and community-based services had a sizeable and statistically significant effect on influencing the likelihood that eligible elderly persons enrolled in Medicaid. CONCLUSIONS: Our results provide compelling evidence that Medicaid participation can be influenced by state policy. The observation that "policy matters" provides new insights into how existing programs might reach a larger proportion of potentially eligible beneficiaries.

Aged↗
PubMedDate not supplied

One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery.

UNLABELLED: As intensive care nursery personnel increasingly seek to provide comprehensive care to families, there is a renewed emphasis on offering family support programs. PURPOSE: The purpose of this study was to identify parents' utilization and evaluation of a support program based in a newborn intensive care unit (NICU) that offered a combination of formats for support services: group support, one-to-one support, and telephone support. METHODS: Program records and a survey developed by the author documented parental use and evaluation of services. Data analysis consisted of descriptive statistics and qualitative content analysis of demographic data, survey results, and parental comments. RESULTS: Of the total 477 participants, 78% utilized 1 support service format exclusively. Eighteen percent utilized 2 support formats concurrently. A subsample of 48 parents completed an evaluation survey. Continuity of care was a critical component of the program overall. Group support offered more opportunities for families to problem-solve communication issues with nursery personnel and provide information that assisted parents' involvement in their babies' care. CONCLUSIONS: Parent support programs that utilize only one type of format may not be optimal for providing the range of support needed by many NICU families. Parent support programs offer an important mechanism to assess provider approaches to facilitate family-centered care.

Adult↗
PubMed1982

A program for infection surveillance utilizing an infection control liaison nurse.

Today's infection control programs require a practical, efficient, and effective surveillance system. The Epidemiology Section of a 650-bed, university-affiliated hospital has implemented a two-phase approach. Phase I is surveillance by service. Each service receives a minimum of 2 months' concentrated surveillance, with critical care units monitored each month. The entire hospital is covered within a year. Monthly statistics are issued for each surveyed service and the individual patient units within that service. Phase II involves the infection control liaison nurse (ICLN). An ICLN, established in each patient unit, monitors infection control practices and acts as a liaison between the unit and the epidemiology section. Selected candidates are trained by the epidemiology section. The ICLN aids in more immediate identification of problems and better monitoring of aseptic practices. This approach is effective and manageable. Better understanding of unit problems result in more relevant educational programs with time to conduct additional activities. Statistics have more meaning and support for infection control is improved.

Connecticut↗
PubMed1986

The cost-effectiveness of clinical pharmacist intervention on tobramycin prescribing.

The cost-effectiveness of clinical pharmacist intervention in reducing the use of tobramycin and in the pharmacokinetic monitoring of aminoglycoside therapy to prevent serious nephrotoxicity were evaluated. Prescribing practices for tobramycin were compared between two similar medical teams, one with clinical pharmacist services, the other without. A statistically significant difference was observed between the number of patients who received tobramycin in the two teams, and a cost saving of $5,072.85 was achieved in 3 months. The potential for hospitalwide cost savings is substantial if gentamicin can be substituted for tobramycin in selected circumstances and followed with appropriate monitoring.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Association of income with use of and access to health services in Spain at the beginning of the XXI century].

OBJECTIVE: To estimate the association of household income and provincial income with visits to general practitioners and specialists and with hospitalization and to determine whether waiting times to access these services vary with both economic variables. METHOD: Data from the 2001 National Health Survey were used. The association was estimated by sex- and age-adjusted odds ratios; in the case of per capita income, odds ratios were also adjusted for household income. Percentiles and the geometric mean of waiting times in each health service were estimated and the statistical significance of their association with both economic variables was evaluated. RESULTS: Subjects with the lowest household income showed the highest frequency of visits to general practitioners and hospitalization, although they waited longer for hospital admission. Subjects with the lowest household income also showed the lowest frequency of specialist visits: the odds ratio in the lowest income quartile with respect to the highest income quartile was 0.73 (95% CI: 0.62-0.87). However, when only visits to specialists working in the public system were analyzed, the lowest frequency of visits was observed in subjects with the highest household income. No differences were found in health services utilization or in waiting times according to provincial income. CONCLUSIONS: The frequency of specialist visits according to household income shows a different pattern from that observed for visits to general practitioners and hospitalizations. The longest waiting times for admission to hospital were observed in subjects with the lowest household income.

Adolescent↗
PubMed1983

[Various aspects of morbidity and the organization of neurologic services].

The author has carried out a statistical analysis of the incidence of nervous system diseases among the adult population of the city of Kamenets-Podolsky (the Ukraine). The analysis was based on the data presented by the central city hospital for a period of 5 years. The place of the nervous system diseases in tre structure of the general morbidity, as well as changes in the number of disease cases revealed for the first time are determined. Factors causing an increase or decrease of the incidence of some acute and chronic nervous diseases are shown. The importance of sanitary hygienic, therapeutic and prophylactic measures for the organization of the neurological aid to the city population, as wall as the effect of these measures on the decrease of the nervous disease incidence are demonstrated.

Humans↗
PubMed1998

The Nordic Comparative Study on Sectorized Psychiatry: patients who use only psychiatric in-patient care in comprehensive community-based services--a 1-year follow-up study.

In the present paper a sample of patients using psychiatric in-patient care only is characterized and analysed with regard to characteristics of the psychiatric services. This paper forms part of the Nordic Comparative Study on Sectorized Psychiatry, designed to investigate contact rates and use of psychiatric care by new patients in 7 catchment areas in 4 Nordic countries during a 1-year follow-up. One-year treated incidence cohorts were used. The logistic regression analysis revealed that the variable 'psychiatric service' was one of the statistically significant determinants of using only in-patient care during the follow-up. The diagnostic groups with the highest probability of using only in-patient care were dependencies and functional psychoses. The following factors were associated with a high risk of using only in-patient care: older age, being referred by another psychiatrist, having received previous psychiatric in-patient care, male sex, being retired, and not living with one's parents or a partner. Patients who used only in-patient care had fewer admissions and days in in-patient care than others during the 1-year follow-up period. Lack of 24-hour emergency services in out-patient care correlated positively with the use of only in-patient care.

Adult↗
PubMed2006

Using linguistic analysis to explore medicine counter assistants' communication during consultations for nonprescription medicines.

OBJECTIVE: The purpose of this study was to undertake linguistic analysis of consultations between medicine counter assistants (MCAs) and customers for the supply of nonprescription medicines. METHODS: The linguistic corpus comprised 168 recorded and transcribed consultations. Utterances were tagged as information eliciting, information or advice giving and other. The analysis focused on triads, beginning and ending with an MCA utterance (MCA(1)-->customer's response-->MCA(2)). The use of the mnemonic, WWHAM (Who for, What symptoms, How long, Any medicine tried, other Medication taken) was also analysed. RESULTS: A total of 505 triads were identified. Of the 773 utterances, 61% were information eliciting, 13% were information giving, 14% were advice giving and 11% were "other" or unclassifiable. No consultation involved WWHAM in its entirety. CONCLUSION: MCAs do not appear to have been made sufficiently aware of the ways in which their exchanges with customers during consultations for nonprescription medicines are crucially different from natural conversation. PRACTICE IMPLICATIONS: In order to help customers decide upon an appropriate nonprescription medicine, the MCA has the role of both informing and advising. Training should focus on informing and advising as distinct functions, and the potential problems caused by combining them.

Communication↗
PubMed2006

Regular health care use by lesbians: a path analysis of predictive factors.

BACKGROUND: Lesbians have more health risks than other women but access preventive medical care less frequently. OBJECTIVE: To test the influence of (i) provider inquiry about sexual orientation, (ii) perceived provider gay-positivity and (iii) patient disclosure of sexual orientation on regular health care use in a sample of Canadian lesbians. METHODS: A path analysis using community survey data from 489 lesbian respondents. RESULTS: 78.5% [95% confidence interval (CI): 74.7-82.0] of women reported regular health service use; 75.8% (95% CI: 72.2-79.8) of women had disclosed their sexual orientation to their provider; and 24.4% (95% CI: 20.6-28.2) of women had been asked about their sexual orientation by their provider. Of those women whose physicians had inquired about their sexual orientation, 100% (95% CI: 97.5-100.0) had disclosed. In the final path analysis, perceived provider gay-positivity and level of patient outness predicted disclosure, which, along with health status predicted regular health care use. All paths were significant at P < 0.05. CONCLUSIONS: Provider-related factors including perceived gay-positivity and inquiry about sexual orientation are strongly associated with disclosure of sexual orientation. Disclosure is associated with regular health care use. Minor changes to practice could improve access to health services for lesbians.

Adult↗
PubMed2002

Usual source of care and nonurgent emergency department use.

OBJECTIVE: To examine whether dissatisfaction with one's usual source of care (USC) and perceived access difficulties to one's USC were associated with nonurgent emergency department (ED) use. METHODS: Variables that measured USC satisfaction and access were identified in the 1996 cohort of the Medical Expenditure Panel Survey (MEPS), a nationally representative sample administered by the Agency for Healthcare Research and Quality. The main outcome measured was nonurgent ED use at least once during 1996. RESULTS: A total of 9,146 adults had a USC other than the ED, had at least one contact with the health care system or were unable to get needed care, and had complete data for all the variables in the final model. Dissatisfaction with the USC, dissatisfaction with the USC staff, lack of confidence in the USC's ability, difficulty scheduling an appointment, difficulty reaching the USC by phone, and long waiting times with an appointment were all associated with having a nonurgent ED visit in 1996 (all at p < 0.05). The positive associations between both dissatisfaction and perceived access barriers and nonurgent ED use persisted even in multiple logistic regression that adjusted for age, sex, race, education, health status, employment status, income, insurance, region of residence, and rural vs. urban residence. CONCLUSIONS: Patients who are dissatisfied with their USC or perceive access barriers to their USC are more likely to have a nonurgent ED visit.

Adolescent↗