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PubMedDate not supplied

A randomized trial of a health care program for first-time adolescent mothers and their infants.

To test the effectiveness of a special health care program for adolescent mothers (17 years old or younger) and their infants, 243 mother-infant pairs were randomly assigned to one of two groups. All of the mothers were unwed, on Medicaid, and black. The control group received routine well-baby care. The experimental group received routine care and services that included rigorous follow-up, discussions with the mother about her plans for return to school and use of family planning methods, and extra health teaching. The dropout rate in the experimental group (60%) was significantly less after 18 months than the control group (82%). In spite of the high dropout rate, 91% of the mothers were located for the 18 month follow-up interview. The repeat pregnancy rate in the experimental group was 12% after 18 months, and 28% in the control group. There was no significant difference in the percentage returning to school. After 12 months, the infants in the experimental group were more likely to be fully immunized (33%) than the infants in the control group (18%). Mothers in the special care program who continued to attend clinic used the emergency room less than the mothers who continued to attend in the control group. These results suggest that a comprehensive health care program is one way to bring about better outcomes for both adolescent mothers and their infants.

Adolescent↗
PubMed1991

What should British consultation-liaison psychiatry be doing?

Despite increasing clinical interest and research consultation-liaison (C-L) services in the United Kingdom are mainly haphazard and unsatisfactory. Although the clinical problems are similar to those in other Western countries, the answers must reflect the British health care system. The national C-L organization must formulate and promote detailed policies for 1) clinical priorities; 2) staffing and other resources; 3) integration with other specialist psychiatric services for local populations and primary care; and 4) persuading other medical organizations to place greater emphasis on psychological skills, training requirements, and practice. Some of our conclusions are parochial, some are generally applicable; others are applicable only to countries with comprehensive health care.

Clinical Protocols↗
PubMedDate not supplied

Fostering health in the foster care maze.

The fastest growing population of children in foster care today is quite young, and many of these children have significant health care needs. The General Accounting Office (GAO) reported that children in foster care "are among the most vulnerable individuals in the welfare population" (GAO, 1995, p. 1). Poverty, increased homelessness, substance abuse, and a rise in the incidence of persons with HIV all contribute to the problems faced by these children. The Caring Communities for Children in Foster Care Project, funded by the Maternal Child Health Bureau Integrated Services Medical Home Initiative with the American Academy of Pediatrics (AAP), investigated the availability of comprehensive health care services for children in foster care. The AAP recommends that pediatricians serve as the primary health care provider for children in foster care and also as consultants to child welfare agencies. Pediatric nurses play a crucial role in providing health care services to children in foster care. With an increased understanding of the potential physical and mental health care needs of children in foster care and the important role of foster parents, pediatric nurses can increase the likelihood of positive health outcomes for children in foster care.

Adult↗
PubMed1977

The dietitian in primary health care.

This statement was prepared by The American Dietetic Association for use in a study on the development of an integrated manpower policy for primary care being conducted by the Institute of Medicine, National Academy of Sciences, Washington, D.C. Basically, it is concerned with the role of the dietetics profession in primary care. It is divided into the following sections: (a) Definition of the dietitian and her position regarding the importance of nutrition in all health and health-related programs; (b) present role of dietitians in both in- and out-patient settings; (c) barriers to carrying out the full potential of nutritional care in improving health; and (d) action recommended to maximize the positive influence nutritional services could have and to identify a nutrition component in any comprehensive health care program. Funding of nutrition services in health and medical programs for primary care would be expected to result in cost containment for total health care, as well as improvement in the health and quality of life of the population.

Adolescent↗
PubMed2002

A model of community-based interdisciplinary team training in the care of the frail elderly.

OBJECTIVE: It is widely recognized that interdisciplinary team care is essential for effective management of complex patients such as the frail elderly. Physicians need to understand the operational mechanisms that drive the team care model. While such concepts should be an integral part of medical education, teaching such a model of care that demonstrates effective provider communication, coordination of multiple services, and the provision of cost-effective health care can be difficult. The Program of All-inclusive Care of the Elderly (PACE) is a well-established, high-quality program that has been replicated nationally and can serve as an effective teaching model. Achieving the goals of the PACE program requires strong team leadership and communication, clear patient-oriented goal definition, an understanding and appreciation of roles among various disciplines, skillful negotiation, and shared responsibility for the patient. The PACE model offers medical and family practice residents a non-traditional clinical setting with educational opportunities not available in most hospital or ambulatory settings. DESCRIPTION: For several years the Fallon Healthcare System Elder Service Plan (ESP), one of 25 national PACE programs, has provided an educational setting for medical and family practice residents as a component of their clinical rotations in geriatrics. This training experience has been expanded to include additional residents in on-site interactive seminars that focus on effective communication using an interdisciplinary team approach to care. The ESP program provides comprehensive medical and social services to a frail, non-institutionalized nursing-home-eligible population. The aim of the program is to preserve the health and independence of its participants for as long as possible. The ESP team consists of physicians, nurse practitioners, nurses, nurse's aides, home health workers, social workers, therapists, nutritionists, and pharmacists. The seminar includes a slide and video presentation led by members of the ESP team using selected scenarios that portray both effective and poor team dynamics and communication. Definitions of a team, the process of establishing patient- and family-oriented goals, interdisciplinary role appreciation and responsibility, and the basics of financing a comprehensive health care delivery system for the frail elderly are discussed. Approximately half of each session is devoted to interactive discussion and critiquing of the scenarios by the residents and faculty, which is derived from the ESP team. DISCUSSION: For most of the medical and family practice residents, this experience represents their first exposures to this model of coordinated team care for the elderly. Preliminary evaluation results indicate that residents have generally been unaware of the services available to the elderly and of the opportunities for coordinated care using the expertise of multiple disciplines. There is a lack of knowledge of key non-physician professional roles. The expanded use of PACE models as training sites could be beneficial in preparing future health care professionals for interdisciplinary team care of the growing numbers of frail elderly.

Aged↗
PubMed1995

Where there is no family doctor: the development of family practice around the world.

Family physicians are generalists trained at the postgraduate level to address the majority of primary care needs of patients of all ages in communities they serve. Throughout the world there is a need for family physicians to serve as cornerstones of comprehensive health care systems that provide high-quality, cost-effective medical and public health services to the entire population. To meet this need, each country must value and adequately finance essential medical and public health services and must provide family physicians with a thorough education focused on the relevant health care problems of the population being served. The authors present an overview of the status of this training throughout the world, outline challenges to the development of such training, and suggest strategies for successful development accompanied by illustrative case studies from South Korea, Venezuela, and Pakistan.

Education, Medical↗
PubMed1996

[The US Health Care and the reform].

Securing access to medical services, controlling costs and improving quality are goals of health care system. Although they are all the same all over the country, each country has its own culture, health care system and health care problems. In the United States, employer-based and individual purchases of private health insurance coverage play a major role, although governmental programs such as Medicaid and Medicare exist for the poor and the elderly. Private health insurance had traditionally secured patients' freedom of choice of health care providers and physicians' professional freedom and had paid providers on a fee-for-service basis. Now, the U.S. has 40 million uninsured persons who do not have access to medical services, although it spends as much as its 14% of GNP on health care. In the early 1990s, this became a major political problem. President Clinton proposed the 'Health Security Act' which would enable any American to have access to comprehensive health care with managed competition to activate the health care market, but it was not enacted. Nevertheless, it is clear that managed care and managed competition will dominate and that traditional fee-for-service plan will be eroded in the health care market. Japan has a universal health care system. We do not have any uninsured or high medical costs. However, it is difficult to improve the quality of health care services within the present system. Japan can learn the system about disclosure of health care information from the managed care in the U.S.

Adolescent↗
PubMed2003

Family Support, Self-Rated Health, and Psychological Distress.

BACKGROUND: Comprehensive health care is becoming an important issue; however, little is known about the complex relationships between perceived family support, self-rated health, and psychological distress in mixed middle-aged/older primary care patient samples. METHOD: In this cross-sectional and predominantly male sample of 137 patients attending their appointments at a primary care clinic in a Department of Veterans Affairs Medical Center, participants completed several questionnaires including the Family Adaptation, Partnership, Growth, Affection, and Resolve; the General Health Questionnaire-12; the Symptom Checklist-10; and the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questionnaire and interview. Data were collected in 1998. Eighteen percent of the participants were diagnosed with a mood disorder, and 15% were diagnosed with an anxiety disorder (PRIME-MD diagnoses). RESULTS: Perceived family support and self-rated health were negatively associated with psychological symptoms and certain psychological disorders, while perceived family support and self-rated health were positively rated. In addition, the interaction between perceived family support and self-rated health was significant (p <.01) in relating to psychological symptoms such that psychological symptoms were most elevated in participants reporting dissatisfying family support combined with poor self-rated health. However, the cross-sectional nature of the study prevents causal conclusions from being made. CONCLUSIONS: Physicians and other health care professionals are encouraged to assess both the perceived family support and self-rated health in an effort to conceptualize their patients' problems in a more comprehensive manner.

Journal Article↗
PubMed1995

The treatment mapping survey; a descriptive study of drug and alcohol treatment responses in 23 countries.

This WHO key informant survey looked at services for the treatment of drug and alcohol problems in 23 different countries. Not surprisingly, there were many differences between treatment responses in the different countries. However, the survey also revealed many similarities in treatment responses. Most countries are confronted by problems of scarcity of resources for substance abuse treatment and many countries also noted the inadequate levels of staff training. Treatment was often primarily delivered in a non-residential setting (especially for alcohol problems). However, some countries treated drug and alcohol problems mainly in residential or inpatient settings. Psychiatrists were one of the professional groups most frequently involved in treatment, and the psychiatric hospital is one of the most common treatment locations. Most key informants reported a lack of basic information about the effectiveness of particular treatment interventions and treatment programmes. Drug services and alcohol treatment services were generally integrated in terms of staff, location, or treatment programmes and in some countries this integration was a feature of the national treatment system. Sometimes the integration of drug and alcohol treatment services was due to the scarcity of national treatment resources. Not all countries operated an integrated drug and alcohol treatment system. In several countries drug and alcohol treatment services were usually provided separately, and a number of countries expressed a preference for this independence. Countries also differed in the extent to which they provided drug or alcohol treatment in conjunction with other health care services with about half of the countries operating with close links with health care services and the other half operating largely independently.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholism↗
PubMedDate not supplied

Chemical hazards in health care workers.

A comprehensive occupational health program is essential in health care settings to minimize the risk of occupational injury and illness in chemically exposed workers. Careful exposure assessment is the framework on which such a program is built. Medical surveillance provides an additional check by allowing earlier identification of at-risk workers. Regular analyses of these data are needed to increase knowledge regarding occupational hazards for health care workers. Correlation of adverse health effects detected in medical surveillance with exposure level is a powerful, although underutilized, tool for advancing occupational health. Worker training is the other critical element in an effective occupational health program. Employees are better able to comply with workplace rules designed to protect health and safety if they understand their rationale.

Central Supply, Hospital↗
PubMed2005

Brazilian National Standard for Electronic Form Interchange among Private Health Plan and Healthcare Providers.

Since 1988 the Federal Constitution of Brazil declared health care as a public right to be provided as a duty of the state(1). Thus the Unique Public System ("Sistema Unico de Saúde-SUS"), Ministry of Health, a comprehensive health care system with full coverage, was created since then. But the private sector has nevertheless also been operating since 1960s but without any government regulation at all. It serves approximately twenty-five per cent of the Brazilian population (estimated at 180 million of people).The National Supplementary Health Agency - NSHA ("Agência Nacional de Saúde Suplementar- ANS") was created in 2000 and is in charge of regulating and assisting the private health plan organizations. The public sector has been structuring its information systems for almost 15 years, defining standard schemes, such as the National Health Card Project, in order to institute a national unique identifier health care and to construct a national repository of health records.The lack of widely common information standards in the private sector, however, and the difficulties involved in the complex information interchange among private health plan organizations and health providers have caused NSHA to work out a proposal for a national standard for electronic form interchange proposal, based on XML technology, known as the supplementary health information interchange (TISS - "Troca de Informação em Saúde Suplementar"). The TISS project aims integrating healthcare information nationwide; therefore it was developed in accordance with the National Health Card Project, using the same unique identifiers and others standard sets proposed by the Ministry of Health, such as unique identifiers of providers.NSHA has presented the TISS project successfully to all stakeholders and is going to introduce legislation to enforce the standards. There are more than two thousands private health plan organizations in the whole country and more than ten thousands hospitals and clinics. Private health practioners, including dentists, will also have to adopt the standard. As a matter of fact, the TISS project not only focuses on the patient billing but also on epidemiological information. And the TISS project is not only for health provider claims, but also to all kinds of events such as consultation and exams.

Brazil↗
PubMedDate not supplied

Planning community-oriented primary care in Israel.

The concept of primary care in the Kupat Holim Health Insurance Institution encompasses all the stages of health: the promotion of health, personal preventive care, curative care, and rehabilitation in the community. Primary care is, thus, the foundation of this nationwide comprehensive health insurance and health care delivery system; Kupat Holim covers 3.2 million people, close to 80 percent of Israel's total population in 1983. Primary care clinics in the community are the main focus of care and have undergone changes in the types of health care providers and functions as population characteristics change. In this system, the planning process allows constant review of changing needs and demands and the introduction of new functions. The main approaches to planning primary care that are presented deal with team members and the division of work in the community clinic, manpower training at undergraduate and postgraduate levels, and the content of primary care. Current trends include the extension of services provided to the patient in his home as well as the clinic and greater emphasis on preventive care. The interrelationship between policy and planning for primary care is strengthened by the linkage between financer, provider, and consumer in Kupat Holim. The planning process must make optimal use of this linkage to guide those responsible for health policy in implementing effective change.

Community Health Services↗
PubMedDate not supplied

Health care management in workers' compensation.

A high-performing, effective health care delivery system is critical to the recovery of injured workers within a workers' compensation insurance system. Timely and effective health care has the potential to minimize indemnity costs and therefore contribute to the insurer's financial state. While costs remain a concern to insurers, cost-containment initiatives within the health care arena have evolved from a strict "deep discount" approach to more sophisticated health care strategies that follow managed care-style models. In the future, health care strategies are likely to become more integrated within the business operations of workers' compensation insurance systems. The next evolution of health care strategy within workers' compensation will likely include consensus-based contracts with providers that stipulate the role and function of each party while reinforcing a continuous improvement mindset. It is probable that a component of this evolving system will include shared risk and reimbursement that is based on performance. Insurers who begin to evaluate the true impact of a comprehensive health care strategy will find it necessary and advantageous to modify their business relationship with health care providers. Those who are able to articulate a business strategy that capitalizes on the skills of the health care community are likely to gain a competitive advantage. Most importantly, this bridging of intellectual capacity across the insurance and health care domains will result in a delivery system that is valued by, and contributes to, its key participants--the employers and the injured workers.

Canada↗
PubMed1998

The influence of governmental policy on community health partnerships and community care networks: an analysis of three cases.

This is a comparative analysis of hospitals' efforts in three communities to pursue collaborative ventures to advance community health. The events occurred over a two-year period characterized by increasing market competition and national debate about comprehensive health care financing reform. The study objectives are to better understand factors that contributed to the initiation of the collaborative efforts, and factors that sustained, hindered, or thwarted these efforts. The study explores how the collaborative ventures in these three communities fared in the face of multiple and conflicting policies and the simultaneous creation of larger, competing health systems. A number of concluding generalizations address the impact of interorganizational dynamics and public policy initiatives on community health partnerships.

Community Health Planning↗
PubMed2005

Psychosocial problems among patients in neighborhood health centers: perspectives from health care providers.

Little is known about how health care professionals perceive and understand the psychosocial problems of individuals receiving services in neighborhood health centers (NHCs). We conducted interviews with health care professionals in NHCs in New York City. The respondents identified seven problems, including a lack of financial resources, unsafe housing, and emotional distress/depression as affecting large portions of their patient populations. Respondents reported that they are presently meeting many of the psychosocial needs of their clients, but they were pessimistic about their ability to continue to do so due to a lack of funding streams to support their provision of comprehensive health care that includes psychosocial services. The findings suggest that while NHCs may be "holding their own" in providing quality services to their clients, this will be harder to sustain in the future if the numbers of the uninsured served continues to increase, and the revenues generated continue to decrease.

Adult↗