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PubMed1989

Incarcerated adolescents. The need for the development of professional ethical standards for institutional health care providers.

Large numbers of children are incarcerated in juvenile correctional facilities each year in the United States. These children suffer from a wide range of physical and psychiatric illnesses and are in critical need of professional health care services. This article summarizes the health care needs of these children and documents the ethical problems faced by health care professionals who work in juvenile institutions. The adequacy of current ethical standards as a source of guidance and support for institutional health care professionals is reviewed and a series of recommendations for the development of comprehensive health care standards is set forth.

Adolescent↗
PubMed2001

Herbal products and conventional medicines used by community-residing older women.

There is a risk of interaction between herbal products and conventional medications, therefore, more needs to be known about the use of herbals by older persons. The purpose of this research was to explore the use of herbal products for medicinal purposes and to compare differences in the demographic characteristics and health status of herbal product users and nonusers among community-dwelling older women. In 1998, a random sample of 86 women aged 65 years and older who lived independently in a North Central Florida county was selected. Names were obtained from the Florida State Department of Highway Safety and Motor Vehicles. Structured interviews using questionnaires were completed for 86 subjects. The interview questionnaire addressed health status and the use of conventional medicines, use of herbal products, and demographic data. Findings indicated that herbal products were used by 45% of the sample in the previous 12 months. The average number of herbal products used by the 45% was 2.5. Herbal products were used to prevent health problems (41%), to treat illness (23%), and for both prevention and treatment (36%). The women reported using an average of 3.2 prescribed medicines and 3.8 nonprescribed medicines. No differences in demographic characteristics and health status were found for users and nonusers of herbal products except that herbal product users were more concerned with memory problems than nonusers. No difference in perceived seriousness of memory problems existed between the two groups. It is important for health care providers to be knowledgeable about the use of herbal products to provide comprehensive health care to older women.

Aged↗
PubMed1980

Humanistic geriatric health care: an innovation in medical education.

A geriatric health maintenance program, started in 1976 as a community medicine elective, has developed into an innovative model in humanistic health care. Junior and senior medical students act as live-in facilitators of comprehensive health care for the elderly tenants in publicly subsidized housing units. Students rotate emergency night and weekend calls and hold weekly health clinics at the housing units. Weekly seminars are given by faculty members during which case presentations by students and topics related to the complex problems of the elderly are discussed. Important aspects of this elective are experiential learning in humanistic health care, exposure to ambulatory well or stable elderly people, development of communication/interpersonal skills, and acceptance of responsibility. The program has been received enthusiastically by tenants, community physicians, students, and an increasing number of faculty members at the University of Oregon Health Sciences Center School of Medicine.

Aged↗
PubMed1995

Managed care: is it moral?. Interview by Cheryl Slagle King.

The expansion of managed care has raised a number of ethical and moral issues in the evolving health care marketplace. Health care providers have been highly concerned about the dominant shift from quality to cost in the health care marketplace. As a nation, a fundamental challenge we face is determining what comprehensive health care system can be implemented, enabling us to maximize dollars spent on health care while simultaneously improving quality and access. A parallel to the Hitlerian era is used to dramatically illustrate the importance of remembering lessons learned from the past.

Ethics, Nursing↗
PubMed1977

An analysis of standardized disease classification system for health care planning.

This paper deals with the development of the standardized disease classification system, which generates usable statistics for comprehensive health care planning. It is used by ARCH (a regional health planning agency) to obtain a measure of acute hospital utilization and regional health status. A sample of 35,000 patients discharged from 39 acute-care facilities in the St. Louis bistate region was examined and tested. The existing disease classification systems (three versions of ICD and SNDO) were converted into the standardized system. Its application results in a better conceptualization of current health problems. It aids in the formulation and monitoring of health problems.

Disease↗
PubMed2003

Dirigo Health--a universal health care coverage plan in Maine: implications for Massachusetts.

On June 18th, Maine governor John Baldacci signed into law a comprehensive health care initiative know as Dirigo Health. Dirigo is Latin for "I lead", the state motto. Dirigo is often referred to as Maine's new universal coverage law. The law seeks to achieve universal access to coverage by integrating access, cost, and quality initiatives. While Dirigo responds to and takes advantage of particular circumstances in Maine, it has naturally drawn a great deal of interest from other states seeking to deal with similar problems. This issue brief provides an overview of Dirigo Health and outlines areas that might inform the health policy debate in Massachusetts (and perhaps other states as well).

Cost Control↗
PubMed1983

The relative impact of status and health variables upon sick-role expectations.

This study deals with the relative impact of socioeconomic status and the level of physical and emotional health upon the sick-role concepts of the laymen in a comprehensive health care system. The selection of variables was guided by our recognition that Parsons' "deviation" model of the sick-role ignores the importance of environmental resources, in particular those that are required for coping with chronic illness and permanent handicaps. No significant differences were found across social classes with regard to serious acute illnesses. By contrast, significant differences between occupational groups were found for chronic illnesses, in which recovery and resumption of independent functioning depend more on the patient's own resources than on professional medical care. The lower the occupational status, the more dependency the patient was allowed. These differences are largely attributable to socioeconomic rather than to cultural resources and to the state of health.

Comprehensive Health Care↗
PubMed1979

Comparative approach to health maintenance: how will it work?

A prototype for the implementation of a comprehensive health maintenance program is described in which the expertise of veterinary medicine is brought to bear on preventive medicine and on special generic environmental disease factors as they impact on human health. For the sake of organization and the ease of presentation, certain specific activities have been divided into two overlapping categories: environmental health and health education. The implementation of a comprehensive health care delivery system will become a reality only when the full array of health resources is matched with health needs. It cannot be overemphasized that the delivery of health care services is not exclusively within the purview of any one profession; rather, interdependence and sharing of responsibilities and activities in a team approach are characteristics of the human health system.

Alabama↗
PubMed2001

Reform of the health care service system in Israel 1995-2000.

In January, 1995, a national health insurance law was enacted which allowed for the registration of every resident with one of the four public health funds. These funds provide medical services directly to their insured members, or purchase them from public or private hospitals or other health service providers. A basket of medical services was defined which guaranteed readily available comprehensive health care throughout the country. As part of the reform, a number of personal participation charges were established: a nominal fee for medications, and a service charge for a limited number of medical services (visits to specialist doctors, periodic fee for mother and child clinics, participation in the cost of chronic nursing hospitalization). In spite of the Government's commitment to finance the basket of services, the budget is not sufficient to cover costs, and there is an inherent shortfall deliberately introduced into the system by the Ministry of Finance. Since the introduction of the Law the sources for financing the basket of services have been eroded by 16%. Complementary health insurance programs are being developed by the health funds as well as by private insurance companies. The national expenditure on health is some 8.4% of GDP, with an average annual expenditure of $1,384 per person. 72% of health expenditures are public and 28% private. Life expectancy is continually rising, and stood at 75.9 years for men and 80.1 years for women in 1999. Infant mortality is decreasing: in 1996 the rate was 6.3 per 1,000 live births. There is an ever increasing use of new technologies, even though at the same time there seems to be somewhat of a decrease in customer satisfaction. The achievements of the reform are considerable, but there is need for improvement in the areas of budgeting, return of the employer parallel tax, and in other areas if these achievements are not to be undone.

Budgets↗
PubMed1997

The Union Health Center: a working model of clinical care linked to preventive occupational health services.

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings.

Ambulatory Care Facilities↗
PubMed1994

Hospital wage and price controls: lessons from the Economic Stabilization Program.

The Clinton Administration has implied that short-run failures to control health care costs may cause a reexamination of wage and price controls as elements of comprehensive health care reform. The most recent imposition of mandatory wage and price controls was the Economic Stabilization Program (ESP) of the early 1970s. We analyze trends in hospitals' economic behavior and utilization before, during, and after ESP. We also review the relevant literature to estimate ESP's impact, considering other factors that influence hospital behavior. Noting important changes in the hospital industry since the 1970s, we conclude that ESP had limited effect and that similar controls would have little effect today.

Cost Control↗
PubMed1990

The cost-effectiveness of nurse practitioners.

The use of nurse practitioners and other non-physician health care professionals is a cost-effective means of providing health care services. Since NPs, PAs, CNMs and others provide services comparable to physicians, their use in ambulatory care settings can also significantly increase the availability and accessibility to health care services, especially to low-income individuals and those requiring services in areas of physician shortage. While current obstacles such as reimbursement policies, legislative restrictions and prescriptive authority limit the use and effectiveness of non-physician health care providers, more physicians, hospitals, clinics, HMOs and public health care systems will view their use as a means of containing escalating health care costs. To the patient this will mean an increase in the availability of comprehensive health care services and the prevention and early detection of medical problems through wellness care. A discussion is presented regarding the ways in which use of NPs and other non-physician professionals can reduce costs and increase the quality and availability of health care services.

Attitude of Health Personnel↗
PubMed1995

Breast cancer: what the primary care provider needs to know.

Breast cancer is the most frequently encountered cancer in women today. It is estimated that more than 180,000 women will be diagnosed with breast cancer this year. However, somewhere between 900,000 and 1.8 million women will undergo breast biopsy. The primary care provider will most likely be the first to identify a local problem in the breast and is often the initial source of information regarding diagnosis and treatment. Hundreds of thousands of women are currently undergoing local, as well as systemic treatment for their breast cancer. In addition, a large number of women are living with breast cancer that has metastasized to other organs. It is estimated that the clinical courses for these women ranges from 5-40 years. During this long block of time, the women will work intimately with her oncology center, as well as her primary care provider. In order to provide knowledgeable, comprehensive health care to all women, primary care providers must possess a basic understanding of the risk factors, diagnosis, treatment, and natural history of breast cancer.

Adult↗
PubMed1977

Experience of a physician-nurse practitioner team in care of patients in skilled nursing facilities.

The use of a physician-nurse practitioner team is advocated as an approach to delivering better health care to patients in skilled nursing facilities. The application of this approach in a young community with an inadequate supply of primary physicians and 596 extended care beds is discussed. Patients derive benefit from more comprehensive health care delivered with greater attention to individual needs. Staffs of skilled nursing facilities enjoy improved communication with the medical team and better compliance with legal requirements. The team physician is able to use his time more effectively and provide medical supervision for a greater number of patients by sharing responsibilities with a nurse practitioner. Paper compliance, adherence to agency regulations, quality assurance, and payment are some of the problems encountered.

California↗
PubMed1988

Providing home care services in a for-profit environment.

It is no surprise that politics and ideology will determine the future of home health and long-term care. Those same forces will also dictate whether home care services will become more or less dependent upon federal support. At the moment the prospects are not promising. Over the last several years our national reimbursement policies have pointed toward more and more stringent use of Medicare home health care benefits, despite the assumptions (and the data) that prospective payment systems might legitimately increase their use. The implementation of tight cost limits, consolidation to ten regional fiscal intermediaries, and increased claim denials have signaled home care agencies that cost containment is the aim of the present conservative administration. Private insurance companies, however, have begun to examine the prospects for long-term care and home care policies. Presently, most home care benefits are available through employment-based policies, which, of course, are nearly useless to the elderly, the major users of home care services. But what if businesses provided more comprehensive health care policies so that their employees could have better protection in the case of long-term illnesses? What if the giant corporation such as IBM, Xerox, General Electric, General Motors, and so forth, established programs to underwrite the cost of long-term care? What if private insurance companies attempted to spread the risks among thousands of policy holders so that long-term care insurance premiums were affordable to most older Americans? Rather than new sources of funding, it is more reasonable to expect that the financing of home care services will be reshaped by innovative reimbursement strategies. The future will probably bring prospective, resource-sensitive, or capitated schemes. There are no easy remedies. We must secure the participation of all sectors of our country--both public and private--in a cooperative endeavor. And at the same time we are struggling to reshape the home care financing system, we must continue the effort to reshape the delivery system itself, because the two go hand-in-glove. It is only then that we can begin to allay one of the major deficiencies of our present health care system--the enormous gap in providing and paying for home health care.

Aged↗
PubMed1996

Physical and sexual abuse in a middle-class obstetric population.

To evaluate the prevalence of a history of physical and sexual abuse in pregnant, economically stable, middle-class women with access to comprehensive health care, we issued self-report questionnaires to prenatal orientation classes at Wilford Hall Medical Center from October 19, 1992, to March 15, 1993. After identifying women who had been physically or sexually abused, we identified the assailant, the number of occurrences, and injuries resulting from the abuse. Of the 563 women who responded, 100 (18%) reported previous physical or sexual abuse. Seven women (1%) stated that they were physically abused during the pregnancy. Women were more likely to be physically than sexually abused by a spouse or lover (46% versus 13%). To identify women who have a history of abuse and to address their needs, practitioners should incorporate taking a history of physical and sexual abuse during the routine new obstetric visit.

Adult↗