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PubMed2004

The impact of quality on the demand for outpatient services in Cyprus.

Health policy reforms in a number of countries seek to improve provider quality by sharpening the incentives they face, for example by exposing them to greater competition. For this to succeed, patients must be responsive to quality in their choice of provider. This paper uses data from Cyprus to estimate the effect of quality on patients' choice between public and private outpatient care. It improves on the existing literature by using a more comprehensive set of quality attributes which allows the dimensions of quality that have the largest effect on patient choice of provider to be identified. We also introduce an innovative way of measuring patients' perceptions of quality in a household survey. We find that patients' choice of provider is sensitive to quality, and that interpersonal quality is more important than either technical quality or system-related factors.

Ambulatory Care↗
PubMed1993

Providing outpatient services to criminal procedure law patients: the clinician's perspective.

This presentation identifies a number of the elements involved in implementing an effective program for the care and treatment of the Conditionally Released CPL Patient. The component parts to be explored include: societal and agency issues, the identified patient and, issues relating to the clinician and the clinical treatment team. The outpatient clinician fulfills numerous role/task functions. The roles of therapist, educator, teacher, advocate, casemanager, and "parole officer" will be discussed. Techniques for identifying and working through the worker's own "blocks" will be discussed as a prelude to establishing a therapeutic alliance. Principles of utilizing authority and contracts as basic therapeutic techniques will also be noted. Recognizing that the patients who comprise the conditionally released CPL 330 category are heterogeneous and multiply disabled, techniques for active focused rehabilitation treatment will be explored.

Ambulatory Care↗
PubMed2000

A survey of hospital outpatient services for chronic diseases in Gauteng.

OBJECTIVES: The rapid evaluation of hospital-based services for chronic non-communicable diseases, in particular aspects of the organisation of services, and indirect indicators of patient care. DESIGN: A postal survey of services for asthma, epilepsy, diabetes and hypertension at nine hospitals. Assessment over 1 week of single blood pressure (BP) and blood glucose readings at the hypertension and diabetes clinics at one regional hospital. SETTING: Nine community and secondary hospitals in Gauteng. RESULTS: Eight hospitals responded. Most did not provide specific clinics for each condition. None of the professional staff had received additional training in chronic disease management, and 7 considered their services to be understaffed. On average, nurses managed 33 patients per day (range 19-50), and doctors 53 (20-80). Mean consultation time was 9 minutes (4-20 minutes). Management guidelines were used for all conditions in 5 hospitals. Modern routine assessments were seldom employed. Estimates of regular patient attendance ranged from 25% to 75%. At the single hospital surveyed, hypertension (N = 233) was controlled in 42.5% of patients using World Health Organisation criteria (BP < 160/95), but in only 24.5% of patients by The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC6) standards (BP < 140/90). Random blood glucose was satisfactory (< 10 mmol/l) in 45.2% of diabetic patients (N = 157) while hypertension (N = 100) was well controlled (< 140/90) in 10% of hypertensive diabetic patients. CONCLUSIONS: Services for chronic diseases at non-academic hospitals in Gauteng were characterised by perceived inadequate staff numbers and training, short consultation times, infrequent use of management guidelines and standard assessments, little patient education with regard to self care, and perceived low rates of regular attendance (and hence compliance with medication). At one hospital there was a low rate of hypertension control, and unsatisfactory rates of acceptable glycaemic and BP control among diabetic patients. There is an urgent need for restructuring of services for chronic diseases and for more detailed outcomes research.

Asthma↗