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PubMed2001

Primary health care services provided by nurse practitioners and family physicians in shared practice.

BACKGROUND: Collaborative practice involving nurse practitioners (NPs) and family physicians (FPs) is undergoing a renaissance in Canada. However, it is not understood what services are delivered by FPs and NPs working collaboratively. One objective of this study was to determine what primary health care services are provided to patients by NPs and FPs working in the same rural practice setting. METHODS: Baseline data from 2 rural Ontario primary care practices that participated in a pilot study of an outreach intervention to improve structured collaborative practice between NPs and FPs were analyzed to compare service provision by NPs and FPs. A total of 2 NPs and 4 FPs participated in data collection for 400 unique patient encounters over a 2-month period; the data included reasons for the visit, services provided during the visit and recommendations for further care. Indices of service delivery and descriptive statistics were generated to compare service provision by NPs and FPs. RESULTS: We analzyed data from a total of 122 encounters involving NPs and 278 involving FPs. The most frequent reason for visiting an NP was to undergo a periodic health examination (27% of reasons for visit), whereas the most frequent reason for visiting an FP was cardiovascular disease other than hypertension (8%). Delivery of health promotion services was similar for NPs and FPs (11.3 v. 10.0 instances per full-time equivalent [FTE]). Delivery of curative services was lower for NPs than for FPs (18.8 v. 29.3 instances per FTE), as was provision of rehabilitative services (15.0 v. 63.7 instances per FTE). In contrast, NPs provided more services related to disease prevention (78.8 v. 55.7 instances per FTE) and more supportive services (43.8 v. 33.7 instances per FTE) than FPs. Of the 173 referrals made during encounters with FPs, follow-up with an FP was recommended in 132 (76%) cases and with an NP in 3 (2%). Of the 79 referrals made during encounters with NPs, follow-up with an NP was recommended in 47 (59%) cases and with an FP in 13 (16%) (p < 0.001). INTERPRETATION: For the practices in this study NPs were underutilized with regard to curative and rehabilitative care. Referral patterns indicate little evidence of bidirectional referral (a measure of shared care). Explanations for the findings include medicolegal issues related to shared responsibility, lack of interdisciplinary education and lack of familiarity with the scope of NP practice.

Cooperative Behavior↗
PubMed2006

Mental health: a cause or consequence of injury? A population-based matched cohort study.

BACKGROUND: While a number of studies report high prevalence of mental health problems among injured people, the temporal relationship between injury and mental health service use has not been established. This study aimed to quantify this relationship using 10 years of follow-up on a population-based cohort of hospitalised injured adults. METHODS: The Manitoba Injury Outcome Study is a retrospective population-based matched cohort study that utilised linked administrative data from Manitoba, Canada, to identify an inception cohort (1988-1991) of hospitalised injured cases (ICD-9-CM 800-995) aged 18-64 years (n = 21,032), which was matched to a non-injured population-based comparison group (n = 21,032). Pre-injury comorbidity and post-injury mental health data were obtained from hospital and physician claims records. Negative Binomial regression was used to estimate adjusted rate ratios (RRs) to measure associations between injury and mental health service use. RESULTS: Statistically significant differences in the rates of mental health service use were observed between the injured and non-injured, for the pre-injury year and every year of the follow-up period. The injured cohort had 6.56 times the rate of post-injury mental health hospitalisations (95% CI 5.87, 7.34) and 2.65 times the rate of post-injury mental health physician claims (95% CI 2.53, 2.77). Adjusting for comorbidities and pre-existing mental health service use reduced the hospitalisations RR to 3.24 (95% CI 2.92, 3.60) and the physician claims RR to 1.53 (95% CI 1.47, 1.59). CONCLUSION: These findings indicate the presence of pre-existing mental health conditions is a potential confounder when investigating injury as a risk factor for subsequent mental health problems. Collaboration with mental health professionals is important for injury prevention and care, with ongoing mental health support being a clearly indicated service need by injured people and their families. Public health policy relating to injury prevention and control needs to consider mental health strategies at the primary, secondary and tertiary level.

Adolescent↗
PubMed1987

Monitoring maternity services by postal questionnaires to mothers.

There are a number of gaps in existing statistics about maternity services and no systematic collection of data about women's views and experiences of maternity care. Much useful information could be obtained by regular surveys of random samples of mothers obtained from birth registration. Results from a series of studies carried out by the Institute for Social Studies in Medical Care show that this is a practical and useful proposition.

Consumer Behavior↗
PubMedDate not supplied

[Clinico-statistical data on the activities of the School Otiatric Service in the city of Parma during the period 1962-1973].

Statistics are given on the activity of the Parma Municipality Special School Ear Service over the period 1962-1973. The service is organised for two main tasks: 1) making hearing checks on children attending local schools, and 2) running a specialist out-patient clinic. Hearing checks carried out on 24,293 children revealed that 2.98 percent suffered from hearing defects; inadequate transmissive hearing accounted for 1.55 percent, perceptive defects 0.95 percent, and mixed forms 0.48 percent. Defects of medium severity were most common (1.63 percent), followed by slight defects (0.91 percent), with severe deafness making up the smallest category (0.44 percent). It is pointed out that partial deafness was observed in 5.59 percent of children examined from 1956-1959, dropping to 4.84 percent from 1959-1962, and to 2.98 percent from 1962-1973; the factors affecting this improvement are discussed. The out-patient clinic carried 6,049 examinations, and the main disorders encountered are listed. The Author expresses the hope that in the future partially deaf children will be admitted to the same classes as normal children, instead of being relegated to separate groups, and considers the psychological damage that may arise when deaf or partially deaf children are isolated.

Adolescent↗
PubMed2004

Waiting time information services: an evaluation of how well clearance time statistics can forecast a patient's wait.

Governments in some countries have created web-based information services so that patients requiring elective surgery can compare the waiting times of surgical units. This study investigated how accurately the waiting times of patients about to join a waiting list can be forecast by various clearance time statistics. It used 3 years of elective surgical activity data that covered 46 surgeons in 10 specialties within a public hospital. Six clearance time functions were tested, and the best function was compared with average waiting time statistics derived from census and throughput data. The forecast accuracy of the clearance time functions was found to be greatly affected by the characteristics and behaviour of a surgeon's waiting list. Although there was less difference in performance among the six functions, systematic differences between them were also found. The best of these performed better than the statistics derived from waiting time data, especially where waiting times exceeded 6 months. Yet, its accuracy was still poor. For each surgeon with an average waiting time of more than 6 months, at least 20% of patients waited more than 90 days beyond the clearance time forecast. Consequently, while waiting time information services should consider adopting the clearance time approach, they need to be explicit about its statistical limitations.

Elective Surgical Procedures↗
PubMed1976

Issues in the development of statistical and epidemiological data for mental health services research.

The planning of health services consists of a process that generally involves the following steps: (a) situational analysis, or the description, definition and statement of the problem, its characteristics and dimensions in relation to population and time; (b) the formulation of alternative tactical approaches to the handling and solution of the problem; (c) decision analysis or the selection of a plan; (d) discussion and implementation of the plan selected; (e) evaluation of the results achieved in relation to the problem, situations or populations concerned. This paper discusses the content of a programme of mental health services research for collecting and analysing the information needed to apply these processes to the planning of mental health services, monitoring the manner in which the plan is being implemented, and assessing its effectiveness in achieving short-term and intermediate objectives and long-term goals. Statistical and epidemiological information play an important role in these processes, particularly in the situational analysis and the evaluation processes. Illustrations have been provided of types of data that are produced in the national mental health statistics programme in the United States. Difficulties in using such data to answer questions concerning the needs for mental health services, and manpower requirements for delivering services to meet these needs are discussed. In many instances, currently available data are quite inadequate for answering key issues such as these, plus others related to living arrangements of the population, the effect of services on the persons who receive them, their families and the communities in which they live. Thus, much still remains to be done to develop systematic, comparative morbidity statistics on the incidence, duration and prevalence of mental disorders in the general population, on the needs for mental health services, and on the effectiveness of our efforts to prevent disorders that can be prevented, and to reduce the amount of disability and distress caused by those that cannot be prevented or terminated. A series of problems have been identified, the solutions to which would assist materially in providing data that would narrow gaps between available knowledge and that which is needed. The importance of establishing well-staffed research units at the catchment area level with stable funding to accomplish this is underscored. It is a matter of the greatest urgency that adequate resources--financial, manpower, scientific and administrative--be made available to solve these problems. If this is not done, then effordts to document quantitatively the effectiveness of programmes to prevent and control mental disorders will continue to suffer from many of the same shortcomings that have impeded our past and continue to impede current efforts to accomplish this.

Adolescent↗
PubMed1987

Laboratory performance and director qualifications.

Since 1971, federal laboratory regulations have required that directors of approved laboratories possess earned doctorates. Private accrediting agencies and some states also require doctoral directorship of accredited laboratories. No empirical studies have demonstrated that a director's earned doctorate is necessary to assure laboratory quality. Laboratories in physicians' offices (POLs) are exempt from federal regulation but receive federal reimbursement on the basis of the physicians' medical degree. No empirical studies have demonstrated that unregulated laboratories perform comparably with regulated laboratories. This investigation found no statistically discernible differences in quality when 1983 proficiency test data were used to compare statistically the performance of doctoral- and non-doctoral-directed Medicare-certified independent laboratories in California. When regulated non-doctoral-directed full-service laboratories were statistically compared with unregulated limited service POLs, regulated non-doctoral-directed laboratories consistently demonstrated superior per formance to POLs. Evidently a director's earned doctorate is neither a necessary nor a sufficient condition to assure laboratory performance. Government regulation appears to provide substantial quality assurance in the clinical laboratory field.

Accreditation↗