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The Care Programme Approach unifies and simplifies the organization of patients' aftercare and ongoing treatment. This article uses our experience in Barnet to highlight the strength of the Care Programme Approach, its limitations and some difficulties in implementation.
BACKGROUND: We examined the role of social networks and marijuana smoking in a community outbreak of infections due to Neisseria meningitidis. METHODS: We interviewed all patients and their contacts. Isolates were tested by pulsed field electrophoresis and multilocus enzyme electrophoresis. RESULTS: Nine cases of meningococcal disease occurred in the outbreak; isolates from seven cases with positive cultures were identical. Multiple overlapping social networks were found for case-patients and their contacts. All case-patients were linked by the marijuana-related activities of their contacts. CONCLUSION: Investigation of social networks and marijuana exposure might help identify close contacts of patients with meningococcal disease and help prevent secondary infections.
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The last half of the 20th Century has been witness to numerous changes in the delivery and financing of health care services. These changes have impacted the one-to-one doctor-patient relationship that may have existed in the past to become a complex of relationships. The contemporary physician collaborates with many other professionals to assist in the delivery, financing, and monitoring of health care services. These clinicians and other professionals require access to patient information to deliver care and secure payment. The patient understands this. Yet the patient has concerns about the widening circle of persons authorized to access his or her information. These concerns have been amplified by the development of community health information networks--(CHINs). This article focuses on CHINs, both patient concerns and the role physicians can take in developing them.
Health information professionals recognize the need to demonstrate that the benefits of health information technological (HIT) interventions outweigh their costs. However, such cost-benefit analyses are rarely conducted for HIT interventions, due in part to the lack of a standard methodology. In this study, we describe how the U.S. Public Health Service's guidelines for health economic analyses can be used to evaluate HIT interventions. This framework is described in the context of an economic analysis we are conducting for three HIT interventions to be implemented in a community-based health network caring for Medicaid beneficiaries in Durham County, North Carolina. At present, the 17,779 patients in our study cost Medicaid more than $5 million per month. In sensitivity analyses, we demonstrate that if our information intervention redirects just 10% of low-severity emergency room encounters to outpatient encounters, it will result in $12,523 of monthly savings to the local health system.
Although social networks has been extensively studied as independent, intervening, and moderating variables affecting health, little attention has been paid to social networks as dependent variables. The present research is a longitudinal study which focuses on social networks as the dependent variable. A sample of 3,559 poor, frail, elderly from California Multipurpose Senior Services Project (MSSP) were evaluated in six month intervals over an eighteen month period. The results indicate that life events, sex, ailments, mental functioning, and health habits are significant predictors of the elderly's social networks after six months, and that life events, sex, age, and health habits are significant predictors of the elderly's social networks after twelve months, as well as after eighteen months. Implications for intervention and for further research are discussed.
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The networking process involves the linkage of people, agencies, and community resources. This paper describes an application of networking and community involvement. The four authors, all occupational therapists, used their knowledge and skills to provide and extend health promotion services for disabled persons within their community. During this process, they extended the role of occupational therapy into nontraditional settings.
After reviewing the history of antitrust legislation and established zones of safety for providers and the application of antitrust laws to the healthcare industry in two earlier installments, the authors explore the consequences of the vigorous application of antitrust laws to physician networking, with an emphasis on rural communities. They review common exemptions to antitrust laws that maintain the uneven distribution of power in the evolving healthcare market. Acknowledging the tenuous ground that providers hold in the struggle for control of the healthcare industry, the authors argue for greater consideration of the unique circumstances and barriers that tend to prohibit the formation of strong, physician-sponsored, integrated healthcare networks. The authors have tested the climate for relief from the antitrust enforcement agencies in Washington, DC, and have found no easing of antitrust legislation forthcoming. However, following the resolution of several antitrust cases in recent months, barriers to physician-led organizations appear to be lessening. The authors close with a review of several strategies to minimize the risk of antitrust challenges.
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Louisiana Rural Health Access is part of a Robert Wood Johnson Foundation project to address primary and preventive medical care for indigent, uninsured people residing in underserved rural parishes. This 15-month grant funds the development of a pilot program to improve access to health care in Acadia, Evangeline, Iberia, Lafayette, St Landry, St Martin, St Mary, and Vermilion parishes. Led by representatives from the Department of Health and Hospitals and the Louisiana State University Health Sciences Center, team committees designed the program's innovative use of telemedicine, loan development, network integration, and community involvement. A benefit of the program will be to measure the outcomes of each objective in order to determine which intervention works best. This information will be invaluable for the design of a five-year rural health care development plan.