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PubMed1996

[Objective and subjective determinants in the benefits of home help services for the elderly].

In this paper, we analyze the factors related to the allocation of home help services, a main component for maintaining elderly at home. The study is based on a random sample of 889 people aged 65 and over, living at home in the areas of Lunel and Pézenas (Hérault, France). The factors taken into account were disabilities, income, social support, and subjective health assessed through the Nottingham Health Profile (NHP). A logistic model allowed to bring out the factors related to the delivery of home help services. Positive statistical correlations were found for age (OR = 1.6 per 10-year age groups), disabilities for instrumental activities of daily living (OR = 3.8) and for the notion of mobility assessed through the NHP (OR = 3.3); negative statistical correlations were found for the level of income (OR = 0.3), as well as for disabilities for activities of daily living (physical dependency) (OR = 0.5). These results show that the main criterion for allocating home help services is not severe disability and that subjective aspects play an important part. Accordingly, current practices should be modified to obtain a better targeting of home help services for disabled elderly at home.

Activities of Daily Living↗
PubMed1988

The evaluation of case management services with the chronically mentally ill.

This study reports the results of an experiment comparing a developmental-acquisition model of case management to usual case management services provided through a mental health center. This is the first study of case management with the chronically mentally ill to employ a true experimental design comparing two types of case management service. The statistically significant discriminant functions resulting from the analysis correctly classified 77% of the subjects based on the case manager's assessment of clients' socialization skills, assessment of community living skills by a significant other and the client, the client's tolerance of stress, use of leisure time, community behavior, and vocational training. Implications for research and service delivery are discussed.

Adult↗
PubMed2001

Work interest as a predictor of competitive employment: policy implications for psychiatric rehabilitation.

Consumers with serious mental illness (N = 166) enrolling in two community-based mental health programs, a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development (ICCD), were asked about their interest in work. About one third of the new enrollees expressed no interest in working. Equivalent supported employment services were then offered to all participants in each program. Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job. Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service. Once employed, these two groups held comparable jobs for the same length of time. These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness, and the viability of integrating these services into routine mental health care.

Adult↗
PubMed2003

African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities.

In the context of current concerns about health inequalities among minority ethnic groups in the UK, this paper addresses perceptions of mental health services among members of an African-Caribbean community in a South England town. Efforts to reduce health inequalities must take account of the views of local community members on the sources of those inequalities and on local health services. The statistical existence of inequalities in diagnosis and treatment of African-Caribbeans in the UK is well-established, supported by sociological explanations of these inequalities which centre on social exclusion in a variety of forms: institutional, cultural and socio-economic. However, detailed studies of the perspectives of local communities on mental health issues and services have received less attention. In this case study of community perceptions of mental health services, we find that social exclusion comprises an explanatory framework which is repeatedly invoked by community members in describing their interaction with mental health services. Interviewees assert that experience and expectation of racist mis-treatment by mental health services are key factors discouraging early accessing of mental health services, and thereby perpetuating mental health inequalities. We conclude that participation and partnership are vital means by which to generate both the objective and subjective inclusion that are requirements for an accessible and appropriate health service.

Humans↗
PubMedDate not supplied

Performing a program evaluation in a family case management program: determining outcomes for low birthweight deliveries.

Program evaluations have become an integral part of public health practice. To illustrate the program evaluation process, an evaluation of clinical outcomes for clients of the Family Case Management (FCM) program administered by the nursing division of the DuPage County Health Department, Wheaton, Illinois, is presented. Birth outcomes for 1996 clients of the program who had a previous low-birthweight (LBW) infant and a subsequent birth using the prenatal services of the FCM program were analyzed. A purposive sample of clients was selected from the FCM prenatal program. Birth outcomes including infant gestational age and birthweight, maternal weight gain, and other key variables were compared to provision of health department services. Descriptive statistical methods were used to explore the relationship between birth outcomes and prenatal care between the first pregnancy and the second pregnancy. Analysis of the data showed improvements in maternal weight gain, infant birthweight and gestational age, prenatal care access, public health nurse (PHN) contacts, and physician visits. A positive association was shown between the early entry and increased use of prenatal services to improved birth outcomes in the subsequent pregnancy.

Case Management↗
PubMed2006

Does distance affect utilization of substance abuse and mental health services in the presence of transportation services?

Long travel times have been identified as a significant barrier to accessing mental health and other critical services. This study examines whether distance to treatment was a barrier to receiving outpatient mental health and substance abuse care for HIV-positive persons when transportation was provided. Data from a cohort of HIV-positive persons who participated in a year-long substance abuse and mental health treatment programme were examined longitudinally. Transportation, which included buses, taxis, and mileage reimbursement for private transportation, was provided free of charge for participants who needed this assistance. Nearly three-quarters (74%) of participants utilized the transportation services. No statistically significant differences in retention in, or utilization of, the mental health and substance abuse treatment programme were identified by distance to the treatment site. This analysis demonstrated that increased distance to care did not decrease utilization of the treatment programme when transportation was provided to the client when necessary. These results provide preliminary evidence that distance to substance abuse and mental health services need not be a barrier to care for HIV-positive individuals when transportation is provided. Such options may need to be considered when trying to treat geographically dispersed individuals so that efficiencies in treatment can be attained.

Adult↗
PubMed2000

[Qualitative study of municipalities' maternal and child health promotion planning].

From 1997, basic maternal and child health services have been provided through municipalities. The ministry of Health and Welfare has requested all municipalities to publish a MCH promotion plan. We conducted a qualitative analysis of important contents of the plans using an evaluation index of original dichotomous variables. Out of 3,256 municipalities, 2,873 developed the plans for MCH promotion. Most of the plans present descriptions of the significance of MCH promotion planning, goals of the plans, problems of current MCH statistics and services, and plans of providing services. The proportion was low for plans which have needs assessment of target population, indicators of evaluation of plans, description of the relationship between objectives and services, importance of objectives, action plans, specific chapter or evaluation of the plan, monitoring of the plan, and plans for informing public of the MCH plan. Therefore, the MCH promotion plans have weaknesses in evaluation and action. The MCH promotion plans of middle sized cities were more likely to have these important contents. We will continue to analyze the processes for producing of excellent MCH promotion plans to extract universal promoting factors for producing MCH promotion plans.

Child Health Services↗
PubMed1990

The profession of maternity home care assistant and its significance for the Dutch midwifery profession.

Maternity home care assistants in the Netherlands assist the midwife (or GP) during the delivery, help and advise the new mother with the baby during the postnatal period at home. They are trained separately from nurses. Currently, more than three-quarters of mothers use this service. Birth statistics of deliveries attended by maternity home care assistants compare favourably with national statistics. The existence of this profession allows midwives to concentrate on midwifery tasks. It also enables pregnant women to consider giving birth at home or during a short-stay hospital delivery. These options are limited to certain groups in other industrialized countries.

Continuity of Patient Care↗
PubMed1980

Unemployment and the disabled.

An analysis of Employment Services Division statistics show a close relationship between the levels of unemployment in the disabled rehabilitated at the Employment Rehabilitation Centres (ERCs) and the rates of unemployment in the general population in the whole of Great Britain (r = 0.90) or in the local areas of the Centres (r = 0.66). There is also a significant association between the levels of unemployment in 749 rehabilitees passing through one ERC and the rates of unemployment in their home areas. The results have practical implications for both the employment and medical rehabilitation services.

Disability Evaluation↗
PubMed1996

Comparing the hospitalizations of transfer and non-transfer patients in an academic medical center.

BACKGROUND: By accepting and caring for patients transferred from other institutions, academic medical centers have been able to develop comprehensive training and research programs. Whether academic institutions can continue to do this in the future is questionable. To the extent that transfer patients are more complex and severely ill than non-transfer patients, they are likely to consume more resources, and in managed care payment systems, they could place accepting hospitals in financial jeopardy. METHOD: Between July 1989 and December 1993, the internal medicine, surgery, and pediatrics services of the 880-bed University Hospital of the University of Michigan accepted 8,740 patients from other hospitals. The hospitalizations of these patients were compared with those of the 76,047 non-transfer patients on these services. The statistical methods used were Student's t-test, chi-square, Cochran-Mantel-Haenszel chi-square, and analysis of variance. RESULTS: The hospitalizations of the transfer patients were more complex and resource-use intensive. The transfer patients were more likely (p<.0000) to be length-of-stay outliers as defined by Medicare standards (28% vs 10%) and to suffer in-hospital death (9.4% vs 2.5%). After case-mix adjustment and exclusion of length-of-stay outliers, transfer patients on the three services (surgery, medicine, and pediatrics) remained in the hospital 1.62, 1.15, and 0.84 days longer (p<.0001) than non-transfer patients. Ancillary-service resource use was assessed using a relative-value-unit (RVU) scale based on direct-cost dollars. The transfer patients' case-mix-adjusted resource use exceeded that of the non-transfer patients by 1,155,850 and 957 RVUs for surgery, pediatrics, and medicine (p<.0001). Although the transfer patients were more likely to have Medicaid insurance, the differences in lengths of stay and use of ancillary services persisted throughout all insurance groups. Indeed, transfer status, compared with age, sex, and insurance status, was the best predictor of high resource use. CONCLUSION: The transfer patients stayed longer and consumed more hospital resources than did the non-transfer patients. Age, sex, case-mix, and insurance status did not account for these differences. To limit the financial liability that transfer patients pose, academic medical centers could be forced to abandon their traditional role of caring for such patients. The consequences of this possibility should be explored.

Academic Medical Centers↗
PubMed1985

Use of statistics in the Journal of School Health 1979-1983: a content analysis.

A content analysis of the statistical methods employed in the research/evaluation articles published in Volumes 49-53 of the Journal of School Health (JOSH) was performed. Questions addressed included: To what extent does JOSH publish articles having a research/evaluation theme? Does knowledge of a few basic statistical techniques provide access to the statistical components of a high percentage of the research/evaluation reports published in JOSH? Which additional, but more complex techniques are used most often by authors? Results indicated that, to have access to the statistical content of about three-fourths of the research/evaluation reports published in JOSH, a reader would have to have learned descriptive statistics, analysis of contingency tables, analysis of variance, t-tests, and multiple comparison tests. Knowledge of these and other statistical procedures might assist school health practitioners read research/evaluation reports, and adapt the findings to their respective work settings. Moreover, content analyses can be tools for assessing the state-of-the-art of a profession, as well as helping to plan for practitioners' continuing education needs.

Periodicals as Topic↗
PubMed2006

Practices preventing rehospitalization of individuals with schizophrenia.

While psychosocial care approaches such as assertive community treatment or partial hospitalization can help prevent psychiatric inpatient stay, the ability of specific services to prevent admission is less clear (e.g., recognizing signs of impending relapse, promoting daily structure). Therefore, within 3 months of psychiatric hospital discharge, this study examined the extent to which inpatient readmission among 264 persons with schizophrenia was averted by interventions addressing medication education, symptom education, service continuity, social skills, daily living, daily structure, and family issues. After accounting for demographic characteristics in logistic regression equations, findings suggested that interventions addressing symptom education, service continuity, and daily structure were most effective in preventing inpatient stay among individuals with four or more prior hospitalizations. However, these services became statistically insignificant in preventing readmission among counterparts with fewer previous inpatient stays. While protective effects may differ among persons with varying hospitalization histories, results indicate that resource-poor outpatient centers could focus on these three interventions when care must be limited to rehospitalization prevention.

Activities of Daily Living↗