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Are you meeting the needs of your minority Medicaid members? Cultural competency is becoming an issue in managed Medicaid as minority populations grow, and states require plans to meet the needs of non-English-speaking members. But researchers find that plans don't offer much help to providers. Get some expert advice on how you can better meet the needs of a multicultural population.
This paper describes a survey of British Community Mental Health Centres (CMHCs). CMHCs are by far the most visible manifestation of the implementation of community mental health care policies of the 1980s. While these centres have demonstrated achievements in terms of accessibility, co-ordination and responsiveness to clients, they have also been bedevilled by ambiguity. The vast majority of CMHCs aim to serve the needs of all forms of mental illness within their catchment area, yet in practice, they have frequently failed to meet the needs of people with long term severe disorders and concentrate instead on providing assessment and counseling services for neurotic and transient situational disorders. It appears that this is a function of an early failure of multidisciplinary teams to delineate boundaries and priorities. If the British CMHC movement sharpens its focus and combines this with a determination to address the complexities involved in both rationing and enhancing choice, it could begin to improve upon rather than simply repeat the history of similar developments in America.
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The 5-year "Preventing Alcohol Trauma: A Community Trial" project in the United States was designed to reduce alcohol-involved injuries and death in three experimental communities. The project consisted of five mutually reinforcing components: (1) Community Mobilization Component to develop community organization and support, (2) Responsible Beverage Service Component to establish standards for servers and owner/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants, (3) Drinking and Driving Component to increase local DWI enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) Underage Drinking Component to reduce retail availability of alcohol to minors, and (5) Alcohol Access Component to use local zoning powers and other municipal controls of outlet number and density to reduce the availability of alcohol. This paper gives an overview of the rationale and causal model, the research design and outline of each intervention component for the entire prevention trial.
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The deinstitutionalization movement in the United States has traditionally neglected the rehabilitation potential of the seriously mentally ill elderly. With the proliferation of the elderly population, unique programs and community-based settings must be created and expanded to meet the mental health needs of this population in a cost-effective and humane manner. The mental health continuum presented is a model composed of programs that target the seriously mentally ill elderly in a variety of community placements including residential treatment facilities, nursing homes, retirement homes, and permanent housing.
BACKGROUND: The Perceived Need for Care Questionnaire (PNCQ) was designed for the Australian National Survey of Mental Health and Wellbeing. The PNCQ complemented collection of data on diagnosis and disability with the survey participants' perceptions of their needs for mental health care and the meeting of those needs. The four-stage design of the PNCQ mimics a conversational exploration of the topic of perceived needs. Five categories of perceived need are each assigned to one of four levels of perceived need (no need, unmet need, partially met need and met need). For unmet need and partially met need, information on barriers to care is collected. METHODS: Inter-rater reliabilities of perceived needs assessed by the PNCQ were examined in a study of 145 anxiety clinic attenders. Construct validity of these items was tested, using a multi-trait multi-method approach and hypotheses regarding extreme groups, in a study with a sample of 51 general practice and community psychiatric service patients. RESULTS: The instrument is brief to administer and has proved feasible for use in various settings. Inter-rater reliabilities for major categories, measured by the kappa statistic, exceeded 0.60 in most cases; for the summary category of all perceived needs, inter-rater reliability was 0.62. The multi-trait multi-method approach lent support to the construct validity of the instrument, as did findings in extreme groups. CONCLUSIONS: The PNCQ shows acceptable feasibility, reliability and validity, adding to the range of assessment tools available for epidemiological and health services research.
Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey. Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mother's education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.
As examples of nurse practitioners in primary care, Swedish district nurses have been shown, in several studies, to respond well to the general pressure to achieve higher productivity in health care. Yet they have less frequently been involved in studies of the detailed content of the service they provide. To maintain total service quality, change should not be brought about only for the sake of efficacy. This study is divided into an analysis of the basic service provided in district nursing by identifying a typical interaction with a patient; and an analysis of the daily dilemmas district nurses experience, their consequences, and possible measures for change. For the consultation study, data were collected from 40 videorecordings of office-hour consultations by a rural district nurse. Regarding the dilemma situations, a critical incident questionnaire was returned by 153 district nurses in a Swedish country. The analyses showed that the district nurse practises in an area between self-care on the one hand, and the intersection of the different specialties in health care, on the other. Both the consultation study and the study of dilemmas in practice showed that the district nurse has to approach the health care organisation from a viewpoint close to that of the patient, which implies that she can, and has to, maintain an overview of the patient's total interaction with social institutions. This focal localisation of the shared care and co-ordination aspects constitutes a critical target for change and development efforts. The conclusions are that, first, the role of the district nurse/nurse practitioner as co-ordinator and advocate in patient-centred care could be considered in central health services policies and planning. Second, the content of the district nurses' daily work could be taken into account in the implementation of quality programs. These measures together can lead to an integration between today's theoretical nursing models and the dynamically changing structures of health care organisations.
A primary health care community development programme was initiated in 1979 by people living in Saradidi, Kenya. The community was involved in planning, organization, setting of priorities and objectives, implementation, evaluation and benefits. This paper describes the developmental process that occurred including how the programme began, how it was organized and what it attempted to accomplish.
A model system was developed at the author's institution for providing toxicology and therapeutic drugs monitoring services. These services were expanded with chromatography instrumentation and the Syva EMIT-st Drug Detection System. An emergency screen for various drugs in urine takes about one hour. The drugs or drug families detected are opiates, barbiturates, benzodiazepines, amphetamines, phenothiazines, cocaine metabolite, acetaminophen, and ethyl alcohol. Confirmation and quantitation of drugs in serum can be done by either higher performance liquid chromatography, gas chromatography, or radioimmunoassay. Sample preparation takes from five to 15 minutes and chromatography requires about 15 minutes in most cases. While more than 60 drugs can be quantitated using these procedures, rarely are more than one or two drugs present in patient samples.
Cancer deaths occurring in Uruguay in the period 1988-1992 were classified by site, sex and residence according to the ninth version of the International Classification of Diseases (ICD-9), in order to analyze gradients of urbanization. For this purpose, Uruguayan counties were classified as rural, suburban and urban, using population density as an ordinal indicator of the degree of urbanization. Significant increasing trends with urban excess were observed for cancers of the colon, rectum, lung and female breast. In addition, this study showed significant urban deficits for esophageal, gastric and uterine cancers, contrasting with previous studies. These differences seem to be real rather than artifactual due to misclassification. The study thus provides interesting new findings concerning urban differences between developed communities and a partially developing country.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.