[Incidence of neurological diseases and health services accessibility].
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In 1975, the 1972 survey by the DuPage County, Illinois, Health Department (Managan et al. 1974) was replicated in an eight-township area of Johnson County, Iowa, to compare and document areas of nursing needs for the nursing division of a rural health center and to determine if the Illinois findings were generalizable to a setting which included both similarities and differences. The DuPage County population was urban, while the Johnson County population had a strong farm background and the majority of the subjects still resided on a farm. The DuPage County sample of 1,466 represented approximately 5 percent of the elderly population. The sample size in the Johnson County study was only 82; however, it represented approximately 10 percent of the elderly in the eight townships of the study area. The method of interviewing in the resident's homes was replicated as was DuPage's method of statistical analysis. Comparison of data from the two counties showed striking similarities in all parameters: health condition, physical functioning accessibility of medical care, social isolation, and service needs. Both studies found need for additional health services. A multiple disciplinary service approach to health needs would assist the elderly to remain in their own homes longer and to improve the quality of their lives. In the Iowa study, four questions to determine satisfaction with present living facilities and with adequacy of income for needed medical and dental costs were added. When these answers were compared to two previous Iowa studies, findings were similar.
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The assumption that a centrally planned national health care system could match resources to needs has proved to be a chimera. Shortages are inherent in any system that is more or less "free at the point of access" while it still permits unlimited scientific innovation for its patients. Rationing by science is as unsatisfactory as is political or economic rationing: equality in health care cannot be in balance with uncontrolled technological innovation.
The therapeutic advantages and liabilities that accrue to the indigenous therapist (be he professional or paraprofessional) because of the indigenous state were explored, utilizing the five-year experience of ten indigenous therapists in Boston's North End. The current and historical proximity of therapists who live in the same neighborhood as their patients do provides both with increased access to, longitudinal knowledge about, and a blurred role concept of the other that may help or hinder the therapeutic process. Similarities in culture and values can foster alliance formation, differentiation of psychopathology, and therapeutic interventions, but also may interfere when therapy abuts culturally shared blind spots. These data are relevant to the private general psychiatrist as an indigenous therapist in non-metropolitan America.
The delivery of services has been receiving increased attention in recent years. Judicial action combined with budgetary constraints have focused on the need for greater scrutiny and accountability in service delivery. Although much is being written in this regard, there are at present few attempts to provide a conceptual base from which service delivery can be approached. Through this paper a framework will be provided from which various human services can be examined, with particular attention being directed to the need for separating the substance of service from the process of its delivery.
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Studies were made of the computed tomography (CT) scanning process at three hospitals. The data collected, while of interest to hospital administrators and radiologists, are particularly significant in view of the current structure of health planning guuielines. The data show clearly that the utilization potential of a particular CT scanner is a function of patient demand, scan time, the ratio of head to body procedures, and medical practice insofar as contrast medium administration is concerned. This paper summarizes the results of the hospital studies and documents the implications of the data for health planning guidelines.
Much research on utilization of hospital emergency departments has been published over the past 10 to 15 years. It has failed to yield a coherent view of why the volume of use has increased, however, because most of it has focused on users of one or more ERs, ignoring the nonusers, and has provided insufficient detail about the local context in which the ER operates. The result has been large quantities of data which, when compared, produce inconsistencies which cannot be resolved without additional data from different studies. Yet, a tentative explanation of ER growth can be presented if the question of why people use ERs, which is usually thought of as being similar to the question of why people use medical care services, is restated as, why do people who want to use medical care choose the ER as the site of care? That question can best be answered by paying greater attention to enabling and illness factors than to the predisposing demographic factors upon which much research has focused. A tentative explanation of the growth of ER utilization is offered. Then, the support from the literature for it is presented and the remaining questions are identified for future research.
During a two-month period in 1976, male patients scheduled to be discharged from two Veterans Administration Hospitals, who were aged 55 or older, chronically ill, able to communicate rationally, and had been hospitalized at least a week for the current illness, were interviewed prior to discharge. Information was sought regarding their feelings about admission and discharge, the availability of and their need for 13 related health-related services at home, and the informal support systems available to them in their local communities. Comparisons were made between patients from distinctly rural settings (communities with less than 5,000 population) and those from larger towns or cities. Both urban and rural patients were modest in assessment of their own health-related needs, especially their need for social and ancillary health services. In almost all instances, the perceived availability exceeded perceived needs. Rural dwellers reported somewhat less apprehension about entering the hospital; they also reported more social contact in their home communities despite the fact that in this sample the rural dwellers were more likely to be older, widowed, and living alone. Rural dwellers were slightly more likely to have their own family doctor.
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