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At least 523 records · Page 29Linked to original sources
PubMed1999

Emergency medical care: types, trends, and factors related to nonurgent visits.

OBJECTIVES: To describe and compare national trends in ED use by statistical analyses on data from the 1992 to 1996 National Hospital Ambulatory Medical Care Survey (NHAMCS) with a special interest in factors related to nonurgent visits. METHODS: The NHAMCS collects data for ED visits using a four-stage national probability sample. Data from 135,723 ED visits in 1992-1996 were analyzed using the chi-square test for proportions with logistic regression modeling for multivariate analysis. RESULTS: More than half of the ED visits were considered nonurgent. There was a decreasing trend for nonurgent ED visits over the first three years of the sample (54.0% to 52.1%, p < 0.05). The proportion of ED visits for nonurgent care bounced back in 1995 (54.7%) and 1996 (54.1%). Significant variation existed in the proportion of nonurgent care visit based on disease category, age, race, and insurance coverage status. Marked variation in nonurgent visits also existed among geographic regions and types of hospital ownership. CONCLUSIONS: Analyses of data from the NHAMCS identify trends in ED use. The study of nonurgent ED visits with this database has inherent methodologic problems such as retrospective coding and geographic coding inconsistency. Since the nonurgent visit is clearly linked to certain social-demographic factors, addressing these underlying issues by establishing a comprehensive health care system is a priority.

Adult↗
PubMed1986

Providing for the health needs of migrant children.

Migrant children frequently have health needs that go unmet due to fragmented care caused by their mobility, poverty, lack of medical and financial resources, language barriers, superstitions and poor education. Their common health problems primarily fall into four categories: 1) Diseases and conditions caused by overcrowded and poor living conditions and frequent moves to new climatic areas with different water supplies and native viruses; 2) nutritional problems; 3) congenital anomalies, inherited conditions and allergies; and 4) neglect and lack of adequate medical treatment. Migrant children present nurse practitioners with a unique challenge to provide the children and their families with comprehensive health care which includes 1) diagnosis and treatment of common illnesses, infections and infestations within the family's meager economic means; 2) referrals for congenital anomalies, chronic conditions and those conditions requiring additional or specialized health services; and 3) the adaptation of teaching programs for the child and his/her parents (including health education in hygiene, immunization status, growth and development, stimulation, nutrition, etc.). This article discusses migrant health problems and makes recommendations for providing health care and referrals for migrant children.

Child↗
PubMed1994

The role of the Society of Teachers of Family Medicine in health care reform: a membership survey.

BACKGROUND AND OBJECTIVES: We conducted a survey of STFM members to: 1) measure perceived knowledge of and support for four health care reform proposals, 2) rate the members' priorities about specific legislative activities relevant to STFM, health care reform, and STFM general activities, and 3) assess interest in STFM developing a monograph on health care reform. METHODS: A self-administered questionnaire was mailed to a 15% random sample (n = 470) of STFM members. Researchers were blinded to the identity of respondents. RESULTS: Three hundred seven members returned completed surveys (response rate = 65%). Members were largely divided in their support between the pay or play and the single payer plans, with 39% (95% confidence interval (CI) 33%-44%) preferring the former and 34% (95% CI = 31%-37%) preferring the latter. Employer mandate and tax credit plans were rated less favorably. Overall, members rated their perceived knowledge about these plans as fair to good. In terms of rating their priorities about STFM activities, members gave the highest ratings to STFM legislative activities specific to the needs of academic family medicine (eg, faculty development, reimbursement for clinical and teaching activities, and research). These specific legislative activities were rated higher than all of the general categories of STFM activities. CONCLUSION: STFM members want STFM to advocate for specific legislation pertinent to the development of academic family medicine. Although most members support comprehensive health care reform, no single plan is preferred by a majority of members.

Family Practice↗
PubMedDate not supplied

Hospital utilization patterns and costs for adult sickle cell patients in Illinois.

OBJECTIVES: To determine population size, demographic characteristics, hospital utilization patterns, the specialties of physicians providing care, and costs for hospitalized adult sickle cell patients in Illinois. METHODS: A statewide, administrative dataset for the two-year period from january 1992 through December 1993 was analyzed retrospectively. RESULTS: There were 8403 admissions among 1189 individual sickle cell patients for the two-year period. Eighty-five percent of patients resided in the Chicago metropolitan area. The median age of the 1189 patients was 29; two-thirds had Medicaid or Medicare coverage. Emergency departments were the primary source of admissions (85.7%). The most common admitting diagnosis was painful crisis (97.4%), and average length of stay was four days. The median number of admissions per patient was three; most patients (85%) used only one or two hospitals. A small group used more than four hospitals and accounted for 23% of statewide admissions. Primary care physicians cared for most patients, and total hospitalization charges were more than $59 million. CONCLUSIONS: In Illinois the adult sickle cell population is concentrated in major urban centers, primarily the Chicago metropolitan area. These patients accounted for approximately 8400 admissions and more than $59 million in hospital charges during the two-year study period. A small group of patients used multiple hospitals and accounted for more than 23% of total hospitalization charges. This study shows the necessity of and provides a useful framework for developing targeted programs for adult sickle cell patients as well as for training physicians to efficiently provide comprehensive health care services for this population.

Adolescent↗
PubMed1997

Pharmacoeconomic evaluation of antipsychotic therapy for schizophrenia.

Medications comprise a minor portion of the costs of schizophrenia, but may have a major impact on the likelihood of successful outcome of care. Novel antipsychotic medications which demonstrate superior symptom control, an improved safety profile, and benefits to quality-of-life may also reduce patients' need for medical services and the associated costs of these treatments. This report first considers key experimental design elements involved in integrating pharmacoeconomic and clinical objectives in studies of new drug therapies for schizophrenia. We briefly discuss the choice of therapies for comparison, randomization and blinding, sample size and composition, data collection, selection of the time frame for economic evaluation, and the importance of an intent-to-treat perspective. Second, as an example we present the design and selected results from a new economic clinical trial of the novel antipsychotic olanzapine. This trial utilized a randomized, double-blind design to compare the use of medical services and the cost of treatment for 817 schizophrenic patients from the United States treated with olanzapine or haloperidol. In comprehensive health care cost comparisons that incorporated the expenditures for study medications, the total cost of health care for olanzapine-treated patients was reduced by an average of $431 per month in comparison with haloperidol-treated patients during the initial 6 weeks of treatment. Among treatment responders receiving double-blind therapy for a maximum of 1 year, the total cost of care among olanzapine responders was reduced by an average of $345 per month in comparison with haloperidol responders. The results of this economic evaluation suggest that olanzapine's superior treatment profile may lead to reductions in the overall costs of medical care for patients with schizophrenia.

Antipsychotic Agents↗
PubMed1986

Sickle cell disease: implications for nursing care.

Abnormal haemoglobins produce a variety of anaemias which range in effect from being very mild to lethal. The most common of these are the sickle cell disorders and thalassaemias. In London, thalassaemia affects 3.5% of the Maltese population, 2.5% of the Italian population and 1.5% of the West Indian population respectively. Seventeen per cent of the Cypriot population carry a thalassaemia gene. Sickle cell disease occurs in 500:100,000 people in Britain's black population but is not exclusive to people of Afro-Caribbean origin. The gene is carried by 1 in 10 people. Sickle cell disease is statistically more prevalent among the host population than is phenylketonuria (10-12:100,000), hypothyroidism (20:100,000) and cystic fibrosis (62-63:100,000) in the general population. Although these diseases are routinely screened for at birth, there is no general strategy among district health authorities for sickle cell screening. It has been shown that of 76 health districts with a 3+% ethnic minority population, 30 of which have an ethnic minority population of 'over 10%', only 6 have a comprehensive health care policy for people with sickle cell disease.

Anemia, Sickle Cell↗
PubMed1987

Experience of a family clinic at Benghazi, Libya, and sociomedical aspects of its catchment population.

The article highlights the pioneering efforts towards establishment of a family clinic as a model for provision of primary health care to the community at family level in Libya. Home visits were undertaken by health teams to introduce the clinic and record demographic and sociomedical data. Families were invited to attend the clinic for a complete health examination. It was largely a young population with an average family size of 7.1. The houses were generally overcrowded. The majority of the heads of families had no formal education or skilled occupation but 98.1% had gainful employment. The vital statistics of the population, though comparable to the national figures, reflect a better health status. The infant mortality rate of the reference population was 25.9 per 1000 live births compared with 32.8 for the whole of Libya. Most reproductive age women (81.5%) breast fed their children for six months or more and 4% used contraceptives. The overall morbidity rate was 255 per 1000 population and the morbidity pattern, with a predominance of infections, was typical of a developing country. Each case diagnosed during the survey was appropriately treated and those with chronic diseases are being followed up. It is felt that such family based comprehensive health care units will go a long way in providing primary health care throughout Libya.

Adolescent↗
PubMed1997

Clinical dentistry in the 21st century.

What will oral health care be like in the 21st century? During the 20th century, American dental education evolved from freestanding and often proprietary schools to become an integral part of research-intensive university professional education. This evolution provided a formidable scientific basis for diagnosis, therapeutics, disease prevention, and health promotion. The development of clinical skills coupled with advanced dental materials and therapeutics has truly been remarkable. And now we approach the 21st century as a nation of changing demographics. By 2010, nearly 40 million Americans will be 65 years old or older. Expectations for "quality of life" now punctuate American values. In 1900, the human life span was 45 years, but today it approaches 80 years. Although in 1900, the primary causes of mortality and morbidity were acute infectious diseases, today our challenges include complex viral-infectious as well as neoplastic and chronic disabling diseases (e.g., chronic facial pain, musculoskeletal degeneration, osteoporosis, osteoarthritis, and cerebrovascular and coronary diseases and disorders). In fact, one American dies every hour from oral cancer. Changes in the practice of clinical dentistry in the 21st century will: (1) integrate dental practice into comprehensive health care; (2) become increasingly proactive for health promotion; (3) represent an increased knowledge-base and computer-assisted technology approach for diagnostics and therapeutics; and (4) use novel strategies for oral health care ranging from gene-mediated therapeutics to community-based health promotion.

Delivery of Health Care, Integrated↗
PubMed2000

Associations between community income and cancer incidence in Canada and the United States.

BACKGROUND: Associations between socioeconomic status (SES) and the incidence of cancer have been reported previously in the U.S. Canada has more comprehensive health care and social programs than the U.S. The purpose of this study was to compare the strength of associations between SES and cancer incidence in Canada and the U.S. METHODS: The regions studied were the Canadian province of Ontario and the areas of the U.S. covered by the Surveillance, Epidemiology, and End Results (SEER) program. The populations at risk were defined using the 1991 Canadian Census and the 1990 U.S. Census. The populations of Ontario and of the SEER areas of the U.S. were each divided into deciles on the basis of median household income. Population-based cancer registries were used to identify incident cases. Age-standardized incidence rates for all major groups of malignant diseases were calculated for each SES decile in Ontario and in the U.S. Income-associated incidence gradients observed in Ontario and the U.S. were compared. RESULTS: The incidence of most types of cancer was similar in Ontario and the U.S. In both countries, there were moderately strong, inverse associations between income level and the incidence of carcinomas of the cervix, the head and neck region, the lung, and the gastrointestinal tract. In both Ontario and the U.S., several of these diseases were twice as common in the bottom income decile than they were in the top decile. In contrast, carcinoma of the female breast and carcinoma of the prostate were more common among higher income communities in both countries, but the observed associations were weaker in Ontario. CONCLUSIONS: Despite Canada's universal health insurance and more comprehensive social security system, the association between lower socioeconomic status and the incidence of many common cancers is just as strong in Ontario as it is in the U.S. The mechanisms responsible for these associations require further investigation.

Age Factors↗
PubMed2006

Sensor, signal, and image informatics - state of the art and current topics.

OBJECTIVES: The number of articles published annually in the fields of biomedical signal and image acquisition and processing is increasing. Based on selected examples, this survey aims at comprehensively demonstrating the recent trends and developments. METHODS: Four articles are selected for biomedical data acquisition covering topics such as dose saving in CT, C-arm X-ray imaging systems for volume imaging, and the replacement of dose-intensive CT-based diagnostic with harmonic ultrasound imaging. Regarding biomedical signal analysis (BSA), the four selected articles discuss the equivalence of different time-frequency approaches for signal analysis, an application to Cochlea implants, where time-frequency analysis is applied for controlling the replacement system, recent trends for fusion of different modalities, and the role of BSA as part of a brain machine interfaces. To cover the broad spectrum of publications in the field of biomedical image processing, six papers are focused. Important topics are content-based image retrieval in medical applications, automatic classification of tongue photographs from traditional Chinese medicine, brain perfusion analysis in single photon emission computed tomography (SPECT), model-based visualization of vascular trees, and virtual surgery, where enhanced visualization and haptic feedback techniques are combined with a sphere-filled model of the organ. RESULTS: The selected papers emphasize the five fields forming the chain of biomedical data processing: (1) data acquisition, (2) data reconstruction and pre-processing, (3) data handling, (4) data analysis, and (5) data visualization. Fields 1 and 2 form the sensor informatics, while fields 2 to 5 form signal or image informatics with respect to the nature of the data considered. CONCLUSIONS: Biomedical data acquisition and pre-processing, as well as data handling, analysis and visualization aims at providing reliable tools for decision support that improve the quality of health care. Comprehensive evaluation of the processing methods and their reliable integration in routine applications are future challenges in the field of sensor, signal and image informatics.

Diagnostic Imaging↗
PubMed1999

Collecting psychiatric resources utilisation data to calculate costs of care: a comparison between a service receipt interview and a case register.

BACKGROUND: Economic assessment of interventions and policies is becoming increasingly common, in large measure because of the growing emphasis on cost containment within health care. Comprehensive and reliable outcome and cost data are required to advise policy makers and clinicians as to the best use of their limited resources. The process of costing can be broken down into three connected tasks: the collection of service receipt or utilisation data relative to individual clients or patients over a defined period; the costing of each of the services used; and the combination of these two sets of information in order to calculate individual costs. The aim of this study was to compare two methodologies of collecting data on individual service use - a customized interview schedule, ICAP, and the psychiatric case register (PCR) - and to calculate costs, testing the extent of agreement between them. METHOD: The agreement between the ICAP and the PCR costs measurement was evaluated using the concordance correlation coefficient rho(c). From all patients (n = 543) who had at least one contact with a psychiatrist or a psychologist during the period October-December 1996, 339 patients were interviewed using the ICAP. The overall number of patients in contact with the South-Verona CPS in the same period was 630. RESULTS: The agreement between the two sources was very different for each diagnostic group and each professional category. However, the overall agreement on total costs was satisfactory (rho(c) < 0.95). This result is probably due to the effect of the good agreement observed on more costly services: inpatient care and sheltered accommodation. CONCLUSION: The results suggested practical implications for the use of the service receipt interview: interviewers should be trained in order to avoid misinterpretation of the definitions given in the form; the sources of information should be clearly defined to tease out all the items of services provided for the users; the professionals (i.e. psychiatrists) could influence the reliability of data collection by underestimating services provided by different professionals (nurses, social workers, etc.). The findings confirm that it is possible to use this approach when the aim is to estimate the whole cost of the services; however, the importance of adopting adequate procedures for analysing the complexity of cost components should be pointed out. Only a trained interviewer who thoroughly knows each component of the health and social services provided could guarantee an accurate data collection.

Catchment Area, Health↗
PubMed1994

Comparison of laparoscopic and minilap cholecystectomy for acute cholecystitis.

The charts of all patients with acute cholecystitis undergoing either laparoscopic or minilap cholecystectomy at the Chinle Comprehensive Health Care Facility between October 1, 1991, and August 15, 1993, were retrospectively reviewed. During that period, 54 patients underwent laparoscopic cholecystectomy and 45 patients had minilap procedures. The two groups had similar mean age, sex distribution, temperature, leukocyte count, gallbladder wall thickness, and duration of preoperative symptoms. While laparoscopic cholecystectomy took an average of 16 min longer to perform than minilap cholecystectomy, patients who had laparoscopic cholecystectomy had less blood loss, reduced postoperative narcotic needs, and shorter hospital stays.

Acute Disease↗
PubMed1993

The competition vogue and its outcomes.

Social security and comprehensive health care financing were developed to protect all citizens and to redistribute money to cover costs. Their inspiration was social solidarity rather than pecuniary self-interest. The United States differed from other countries by continuing a private market in health, with many self-centred and competing providers and insurers; and its prevailing school of health economics deplored the national health insurance and national health services that were universal in other countries and recommended devices that would eliminate "market failure" in health. When health economics grew in Europe during the 1970s and 1980s, the reformers' first presumption was that the voluminous American market-oriented literature must offer answers; but much of it proved superfluous, since European health care systems still had much competition and consumer choice, and they worked better than the reality in the United States. The United States itself has paid a heavy price for turning over health financing policy to the devotees of microeconomics and free markets, and today its serious problems in health are unsolved. So powerful is the pro-competitive ideology that it has now been adopted by the Democratic Clinton Administration, contradicting the heritage of Roosevelt, Truman, and Johnson.

Economic Competition↗
PubMed1981

Team tension as a vital sign.

Current efforts to provide comprehensive health care have accentuated the need for new models that integrate the biological, psychological, and social fields. One approach to meeting this need has been the development of health care teams. However, the multidisciplinary perspectives of such teams often result in tension and discord. While this tension may be partly attributable to institutional or professional biases or lack of adequate decision-making techniques, it may also be an essential diagnostic tool for exploring and integrating the paradoxes of the patient's homeostatic system. This approach captures and bridges some of the inadequacies of our prevailing knowledge base. The team's tension can be experienced as an essential empathic connectedness to the patient's life situation. Resolution of the team's internalized conflict becomes a paradigm for the patient's reintegration of his or her own paradoxical or contradictory needs.

Conflict, Psychological↗
PubMed1989

Birth weight outcomes in a teenage pregnancy case management project.

While many comprehensive health care programs for pregnant adolescents are designed to improve the birth weights of the babies born, few provide statistical evidence that they were able to do so. In this study, information was gathered prospectively on 411 mothers in a Teenage Pregnancy and Parenting Program (TAPP) that coordinated medical, educational, and social services through individual case management and agency-level coordination, information on the mothers, their pregnancy, and services received. The low birth weight rate for TAPP participants was significantly lower than the rate for San Francisco teens prior to the establishment of the program (8.1% versus 12.0% p less than 0.05). The mean weights of babies born to teens in TAPP were significantly higher than those in San Francisco after controlling for differences in the race, infant gender, parity, and age (p less than 0.0001). Participation in the TAPP program prior to delivery was more strongly associated with better birth weight outcomes than was race, age, parity, or gender. Participation in the TAPP program was associated with significantly better birth weights independent of receiving a minimal number of prenatal medical visits adequate for the gestational age of the baby at birth. Our results provide evidence of better health outcomes for the babies of teens who had case management that included continuous individual counseling and coordination of health, education, psychosocial, and nutrition services.

Adolescent↗