Service up, costs down in mail room.
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Centralized Hospital Services↗
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Drug information centre--analysis of activities of a regional centre.
Description and evaluation of a drug information centre's (DIC) professional activities one year after establishment are summarized. The aims of the centre are: to evaluate which problem areas are frequently requested, how frequently and by whom; which information sources are the most appropriate for the service and the approximate cost of such a service. We received 80 questions during the first 8 months. The questions were mainly asked by hospital physicians (32.5%) and pharmacists (32.5%), other health-care professionals were a minority; the scopes of most frequently asked questions include general properties of active substances (12.2%), contents of particular preparations (21%), dosage (11%), side effects (21%) and indications/contraindications (15%). Cost of the service included variable (mainly phone and mail charges, copy and print of the documents) and fixed costs (cost of software and salary of the staff).
Catchment Area, Health↗
Investment in mailroom services produces better communications.
A survey of mailroom practices at Providence Medical Center, Seattle, revealed inadequate working conditions and a lack of supervision. This article explains how careful planning and management enabled the mailroom to control copying costs and to improve services to patients, physicians, and hospital staff.
Copying Processes↗
Increasing response rates in telephone surveys: a randomized trial.
BACKGROUND: Sampling frames and mode of contact and administration of questionnaires are important factors contributing to response rates and selection bias in population-based research. The purpose of this paper is to evaluate whether contact by mail before contact by telephone increases response rate, and to assess the concurrent validity of telephone surveys for collecting health research and service data. METHODS: Two thousand households were randomly selected from electronic white pages. Half were randomly allocated to receive or not to receive an explanatory letter before telephone contact. Interviewers were blinded to whether a household received a letter. Respondents aged 18 years or over were randomly selected from within each household using a Kish grid and interviewed by telephone. RESULTS: The overall response rate was 68 per cent [confidence interval (CI) 66-70]. The response rate of those who received the letter was 76 per cent (CI 73-79), and of those who did not receive the letter was 60 per cent (CI 56-63). Use of the Kish grid to select randomly a respondent decreased the response rate by less than 10 per cent. The internal validity of the data was as follows: in a 10 per cent sub-sample, the Kish grid had been correctly applied in 93 per cent of households, and in 99 per cent of households the exclusion criteria had been correctly adhered to. The external validity was as follows: comparisons with data obtained from the same reference population using similar instruments administered face-to-face revealed no meaningful or significant differences in population estimates. CONCLUSIONS: Mail-out before telephone contact greatly increases response rates at low cost. Telephone surveys can yield valid, useful data for health research and service evaluation.
Adult↗
Impact of direct mail intervention on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction.
This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency.
Aged↗
Experiences in applying skills learned in a Mental Health First Aid training course: a qualitative study of participants' stories.
BACKGROUND: Given the high prevalence of mental disorders and the comparatively low rate of professional help-seeking, it is useful for members of the public to have some skills in how to assist people developing mental disorders. A Mental Health First Aid course has been developed to provide these skills. Two randomized controlled trials of this course have shown positive effects on participants' knowledge, attitudes and behavior. However, these trials have provided limited data on participants' subsequent experiences in providing first aid. To remedy this, a study was carried out gathering stories from participants in one of the trials, 19-21 months post-training. METHODS: Former course participants were contacted and sent a questionnaire either by post or via the internet. Responses were received from 94 out of the 131 trainees who were contacted. The questionnaire asked about whether the participant had experienced a post-training situation where someone appeared to have a mental health problem and, if so, asked questions about that experience. RESULTS: Post-training experiences were reported by 78% of respondents. Five key points emerged from the qualitative data: (1) the majority of respondents had had some direct experience of a situation where mental health issues were salient and the course enabled them to take steps that led to better effects than otherwise might have been the case; (2) positive effects were experienced in terms of increased empathy and confidence, as well as being better able to handle crises; (3) the positive effects were experienced by a wide range of people with varied expectations and needs; (4) there was no evidence of people over-reaching themselves because of over-confidence and (5) those who attended were able to identify quite specific benefits and many thought the course not only very useful, but were keen to see it repeated and extended. CONCLUSION: The qualitative data confirm that most members of the public who receive Mental Health First Aid training subsequently provide support to people with mental health problems and that this support generally has positive effects.
Adult↗
Mass mailing and staff experience in a total recruitment program for a clinical trial: the SHEP experience. Systolic Hypertension in the Elderly Program. Cooperative Research Group.
The Systolic Hypertension in the Elderly Program (SHEP) staff contacted 447,921 screenees, of whom 11,919 (2.7%) were originally eligible and 4,736 (1.1%) maintained eligibility and were randomized. The total number of participants enrolled at the 16 clinical centers ranged from 133 to 559. The low yield of screenees to randomizations resulted from the study design, not from low levels of agreement to participate, and required the employment of a variety of recruitment strategies in a prudent overall plan. SHEP was one of the first clinical trials to use mass mailing as a primary strategy of recruitment. The study used mailing lists from seven generic sources. More than 3.4 million letters of invitation were mailed; they yielded an overall response rate of 4.3%. Motor vehicle and voter registration lists provided the greatest numbers of names. Mailings to members of health maintenance organizations (HMOs) and registrants of the Health Care Finance Administration (HCFA) provided the greatest response rates. Considerable variability in response rates existed among clinical centers using generically similar mailing lists. Generally, the number of hours spent on recruitment showed a positive, but not statistically significant, association with randomization yields. The recruitment yield was statistically significantly higher in clinics with experienced recruitment coordinators than in clinics with inexperienced ones (p = 0.0008). From these findings we conclude that mass mailing is an important strategy in an overall recruitment program, that the involvement of experienced recruitment staff is important, and that although the total time spent by staff on recruitment may also improve results, it matters less than the staff's level of recruiting experience.
Aged↗
E-mail: what is e-mail?
This third part of the series explains what e-mail is and why it is the most widely used service on the internet. The principles behind sending and receiving e-mail messages are described. Also the various uses of e-mail are discussed.
Computer Communication Networks↗
Status of total quality management in Australian public health organisations.
Research suggests that there is some confusion among quality improvement managers about the differences between quality management and traditional quality assurance. This lack of understanding would appear to be the same among rural and urban health staff, although there is a higher percentage of staff engaged in multidisciplinary activities in the rural health services. Education of staff and commitment from top management would seem to be the factors inhibiting the health industry from incorporating quality management into their cultures.
Australia↗
Prevalence and correlates of depression among veterans with multiple sclerosis.
OBJECTIVES: To establish the prevalence of major depressive episode (MDE) in a large sample of veterans with multiple sclerosis (MS); to identify demographic characteristics, aspects of disease presentation, and perceptions of disability associated with greater concurrent risk for MDE; and to examine the relationship between MDE, service utilization, and activity participation. METHODS: Veterans with MS (n = 1,032) were identified via computer database and surveyed by mail; 451 (43.7%) responded. RESULTS: Twenty-two percent of the sample met criteria for current MDE. Low income, unemployment, presence of falls, younger age, absence of a marital partner, and high levels of perceived disability due to bowel functioning were independently associated with MDE. Disease subtype, disease duration, use of disease modifying therapies, and perceived disability due to mobility or bladder problems were unrelated to MDE. Current MDE was in turn associated with increased primary care visits and increased impact of disease upon activity participation. Similar correlates were associated with minor depressive episode. CONCLUSIONS: Unlike the general population, rates of depression in this predominantly male sample were similar to those found in predominantly female samples of persons with multiple sclerosis. Specific aspects of disability were differentially associated with depression, and depression was independently associated with increased service utilization and increased participation limitations.
Data Collection↗
Guidelines for defining and analyzing health care services areas.
The current health care environment demands well-informed health care planners. Toward that end, this article describes defining the service area by ZIP code areas and census tracts, obtaining and using data from the Bureau of the Census for demographic analysis, and presenting the results to the decision makers.
Catchment Area, Health↗
Barriers to adherence to preventive services reminder letters: the patient's perspective.
BACKGROUND: Despite an emerging consensus as to which preventive services are appropriate, a minority of patients receive them. Although adherence to recommendations for some interventions has increased, research studies have shown that adherence rates can be further improved through a better understanding of patient attitudes and motivations regarding preventive services. METHODS: Using components of the Patient Path Model, this study examined the response to patient reminder letters for cholesterol screening sent to 1077 adult patients between August and October 1990. The research strategy incorporated both quantitative and qualitative methods, including a telephone survey and focus group interviews of nonresponders to the reminder letter. RESULTS: Three hundred seven patients were surveyed by telephone to ascertain their reasons for nonresponse. One hundred fifty-four (50.2%) did not recall receiving the reminder letter, 84 (27.4%) recalled receiving the letter but did not recall its content, and 69 (22.5%) recalled both receiving the letter and its content. No consistent reason for nonadherence emerged among the 69 nonresponders who recalled the reminder. Twenty-seven of the nonresponders who did not recall receiving the cholesterol reminder participated in the focus groups. The participants stressed the importance of distinguishing the reminder letter from a bill, conveying a personally relevant message, and addressing logistical barriers to preventive services. CONCLUSIONS: Careful attention to the format and content of patient reminder letters is necessary to improve adherence to preventive services recommendations.
Adult↗
Physicians' attitudes toward health care rationing.
BACKGROUND: Optimal allocation of health care resources under a limited budget is controversial. Particularly important questions are whether rationing decisions should be based on efficiency considerations alone or in combination with equity considerations, and who should be in charge of such decisions. In this study, the authors sought to understand the position of Swiss physicians toward rationing using a previously developed rationing scenario. METHODS: The authors examined the acceptability of various scenarios implementing health care rationing in a mail survey of 1,184 physicians practicing in Geneva, Switzerland. Respondents were asked to choose between providing a suboptimal cancer screening test A to the whole population, which would save 1,000 lives, or selecting half of the population to receive a better but more expensive test B, which would save 1,100 lives. Physicians were randomly assigned to 3 versions of the scenario: Beneficiaries of test B could be chosen by lottery, on a first-come-first-served basis, or by medical associations. RESULTS: Only 26% of physicians chose the more effective selective rationing option; this proportion was lowest when test beneficiaries were selected by lottery (14%), intermediate for the first-come-first-served-scenario (26%), and highest when selection was left to medical associations (39%; P < 0.001). Hospital-based physicians and general practitioners were less likely to endorse selective rationing than community-based physicians and specialists. CONCLUSION: Swiss physicians appear to be more concerned about equal allocation of health services than about maximizing health in society, and they prefer physicians to be in charge of rationing decisions.
Adult↗
Errors in postcode to enumeration district mapping and their effect on small area analyses of health data.
BACKGROUND: Health research often seeks to associate individuals to their socio-economic circumstances by linking an individual's postcode to their Census enumeration district (ED). As part of a study into health visitor resource allocation the objective here is to quantify the errors that arise in attaching ED level deprivation scores to records and counts of records by ED when records are matched to EDs via their postcodes rather than their exact address. METHODS: The result of routine matching of postcodes to EDs was compared with the more accurate method of matching addresses to EDs. Townsend scores were then attributed to records according to the two different methods and the results compared. A sample of 4013 births registered in Sheffield in 1996 was used. RESULTS: The comparative work showed that the mismatching of individual addresses arising from matching postcodes to EDs was 16.4 per cent. (The 95 per cent confidence interval is 15.1-17.7 per cent.) Over one-third of mismatched records (about 6 per cent of the total records) were found to have Townsend scores greater than +/- 2 compared with the score obtained through the more accurate process of address matching. CONCLUSIONS: The evidence of the study is that it is important to recognize there are errors inherent in matching individual addresses to EDs via the address postcode. For problems involving resource allocation and for research into relationships between health outcomes or service uptake and deprivation it may be necessary to seek to quantify the level of error introduced through using postcode to ED matching.
Bias↗
Effectiveness and cost-effectiveness of a pharmacy-based screening programme for Chlamydia trachomatis in a high-risk health centre population in Amsterdam using mailed home-collected urine samples.
In order to increase case-detection of Chlamydia trachomatis (CT) in a multicultural, low-income and high-CT-prevalence neighbourhood, a novel approach was piloted in collaboration with the pharmacy of the health centre. During a two-year period, women aged 15-29 years who collected their contraceptives at the pharmacy were offered CT-test materials. Home-collected urine could be mailed to the laboratory and the general practitioner received the results. Nine percent of respondents were CT-positive (14% among 15-24 year-olds). There was a strong association with Surinamese/Antillean background. Uptake of the programme was low (27%). Net cost per pelvic inflammatory disease prevented ranged from cost-saving up to 3872 Euros in a low complication rate/high testing cost scenario. Faced with higher risk, but low participation rates, active case-detection of CT-infections in 'high-prevalence-areas' needs a concerted approach by different providers and community organizations, both in secondary and primary prevention. Pharmacists can contribute if proper liaison is made with primary care providers and/or public health services for (partner-)treatment, counselling and comprehensive sexual health care.
Adolescent↗
Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be 2-year outcomes.
OBJECTIVE: Evaluate effectiveness of weight-loss interventions in a managed care setting. METHODS: Three-arm randomized clinical trial: usual care, mail, and phone intervention. Participants were 1801 overweight managed care organization (MCO) members. Measures included baseline height, weight at baseline and 24 months, self-reported weight at 18 months. Intervention and participation in other weight-related programs was monitored across 24 months. RESULTS: Weight losses were 2.2, 2.4, and 1.9 kg at 18 months in the mail, phone, and usual care groups, respectively. Mail and phone group weight changes were not significantly different from usual care (P<0.35). Weight losses at 24 months did not differ by condition (0.7 kg mail, 1.0 kg phone, and 0.6 kg usual care, P=0.55). Despite treatment availability over 24 months, participation diminished after 6 months. Participation was a significant predictor of outcomes in the mail and phone groups at 18 months and the mail group at 24 months. Cost-effectiveness of phone counseling was $132 per 1 kg of weight loss with mail and usual care achieving similar cost-efficiency of $72 per 1 kg of weight loss. CONCLUSION: Although mail- and phone-based weight-loss programs are a reasonably efficient way to deliver weight-loss services, additional work is needed to enhance their short- and long-term efficacy.
Adult↗
Role of exercise for cancer rehabilitation in UK hospitals: a survey of oncology nurses.
A growing body of evidence indicates the potential benefits of exercise for cancer patients but little is known about exercise promotion within cancer services. A postal survey of oncology nurses in UK hospitals was conducted to ascertain the extent to which exercise has a role in cancer care. The survey design was based on the Total Design Method leading to a completed sample of 221 (62% response rate). Nineteen hospitals (9%) offered some kind of exercise programme or class for patients. In a further 17 (8%), there were other opportunities for exercise available (e.g. an exercise bicycle for inpatients). Sixty-five per cent of nurses were in favour of the notion of providing a specific exercise rehabilitation service for patients. Scarce resources and lack of awareness and expertise were identified as common barriers to establishing such a service. Fifty-eight per cent of nurses were unaware of, or unfamiliar with the published research on exercise for cancer rehabilitation and 33% reported receiving no training relating to exercise and health. The survey results indicate that some hospitals include exercise in the services offered to patients and that the majority of nurses favour adopting exercise as a rehabilitation intervention. However in general, the use of exercise within cancer care in the UK is currently rare.
Attitude of Health Personnel↗
The social recognition of repetition strain injuries: an Australian/American comparison.
In the mid 1980s the problem of occupational overuse injuries, particularly among keyboard operators, gained widespread recognition in Australia. The country appeared to be experiencing an epidemic, the like of which was unknown elsewhere in the world. Three explanations are canvassed in the paper: first, the psychiatric theory that it was a case of 'epidemic hysteria'; second the hypothesis that there really were more such injuries in Australia than elsewhere; and third, the hypothesis that the institutions of Australian society facilitated recognition of the problem, while those of other countries repress awareness of it. The paper focuses on this last hypothesis and seeks to demonstrate it by means of a comparison between Australia and the United States. It shows how, in particular, the system of workers' compensation in the Australian public service facilitated recognition of the problem, while the compensation system in the United States makes it very difficult for sufferers to have their disability acknowledged. Since workers' compensation is virtually the only source of injury statistics, this has led to the visibility of the problem in Australia and its invisibility in the United States.
Australia↗