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PubMed1990

Models for the supply of pharmacists.

The BHPr (formerly Bureau of Health Professions) Supply Model for pharmacists is presented and analyzed. Recommendations are made for improvement of the supply model. Included are considerations of additional variables and improvement of tables of separation rates to more accurately reflect working patterns of male and female pharmacists. The supply model shares many features of supply models for other health professions such as nursing and medicine. The variables suggested for improvement of supply determinations parallel supply measures of other health professions also. The adoption of suggestions for improvement of the pharmacy supply model to other health professions' supply models is suggested.

Age Factors↗
PubMed1998

Evaluating predictors and concomitants of patient health visit satisfaction: an empirical study focusing on methodological aspects of satisfaction research.

We propose that the weak and conflicting results from various studies of satisfaction concomitants are due to the use of scales which sum scores from items that measure different types of satisfaction. The hypothesis is clearly supported, leading to the strong recommendation that different types of patient satisfaction be studied separately. Implications for studying and potentially increasing patient satisfaction are discussed.

Ambulatory Care Facilities↗
PubMed1994

A profile of the Medicare Current Beneficiary Survey.

This article presents the logic, methods, and capabilities of a major new source of data on the Medicare population, the Medicare Current Beneficiary Survey (MCBS). The survey originated from the need to provide valid estimates of various kinds of health care spending, such as long-term care spending or expenditures by different age groups, to describe the effects of the Medicare program on its beneficiaries, and to model the effects of proposed program changes. Presented here is an account of the MCBS sampling and data collection design and the analytic strengths of the resulting data. Of special interest are the use of Computer-Assisted Personal Interviewing (CAPI); sampling from Medicare enrollment files; design for both cross-sectional and longitudinal analysis; surveying both community and facility residents; and merging survey and administrative data.

Adolescent↗
PubMed1988

Health service performance indicators.

The development of statistical indicators for monitoring performance throughout the National Health Service began in 1981. In recent years, computer software packages containing performance indicators have been amended to include Health and Social Services Boards in Northern Ireland. Although this information is available to anyone with an interest in service provision, the main purpose of the indicator packages is to provide a framework and discipline for ensuring proper accountability to a higher tier authority.Efficiency and effectiveness are concepts central to performance appraisal. Most performance indicators are concerned with the input of resources or treatment activity rather than health outcome. Consequently the context within which the accountability review procedure operates is predetermined towards efficiency. The validity of the review process is limited by the accuracy of the indicators and the manner in which they are interpreted. The scale at which performance indicators function and the constraints associated with their use as an analytic tool are illustrated using data from a mental illness hospital in Northern Ireland.

Efficiency↗
PubMed1994

[Psychotherapeutic counseling and treatment of students within the scope of a psychotherapy counseling center].

The field of psychotherapeutic counseling in germany is rather heterogeneous and scientifically scarcely investigated. As an example the author describes the organisation and methods of a psychotherapeutic counseling service for students. Statistical material of the kind of complaints and disorders is given and first results of an evaluation study are reported.

Adaptation, Psychological↗
PubMed1992

Noise-induced low- and high-frequency hearing losses in Finnish conscripts.

Thirty-nine otologically healthy military conscripts were examined at the beginning and at the end of their 1-year service. On entry, they all showed normal findings during clinical otolaryngological examinations. The test battery included both conventional (0.25-8 kHz) and high-frequency "electric bone-conduction" (0.5-20 kHz) audiometry (EBC). The median pure-tone right ear thresholds at the end of service were 5 dB worse over the frequency range of 2-8 kHz compared with the thresholds at the beginning of the service. The difference was statistically highly significant (p = 0.00035). The median left ear pure-tone thresholds at frequencies of 0.25, 2, and 8 kHz were 5 dB worse at the end of the service compared to the thresholds at the beginning of the service. However, the difference was not statistically significant (p = 0.23). The median curves for the high-frequency (EBC) thresholds measured after the service showed worse thresholds over the whole frequency range compared to the median curves measured before the service. The greatest difference was seen in the highest frequencies (15-17 kHz) in both ears. The differences were statistically significant in both ears (p = 0.03 in the right ears; p = 0.01 in the left ears) when threshold values over the whole frequency range were analyzed. Since the otolaryngological history of these conscripts was uneventful during their service, the hearing deteriorations were considered to be caused by shooting practice.

Adolescent↗
PubMed1988

[Handicaps and maladjustment: evaluation of social policies].

This article examines various methods of assessing social policies with regard to the integration of handicapped or maladjusted children and adults in France. It begins with an account of the existing system of policies and services for handicapped or maladjusted children and adults in France today. By following the progress of an educationally retarded child (with minor mental handicap or retardation plus behavioural problems), noting the various instructions with which the child is involved, the reader will come to realise the limited nature of the facts available concerning the effectiveness of social integration schemes for the handicapped and maladjusted. The paper then examines the statistical data issued by the ministries of health and education as well as from separate institutions. These data indicate a lack of awareness of the various passages from childhood to adulthood, a bridge between institutions coinciding with the passage into adult life. Educational statistics are completely independent of other statistics on adult services. Measurements focus on institutional activity and often ignore the effects on the individual of the various measures taken. In 1975, France passed legislation concerning integration but little has been done to evaluate the effects of this law. Based on observations in one department of France, the author has found unequal development of the policy for educational integration on the one hand and vocational rehabilitation on the other. Such inequalities are producing increasing difficulties. Integration of physically handicapped children into an ordinary school environment has met with some success. However educational maladjustment, as manifested by children with minor mental handicap or retardation and those with behavioral problems, remains largely beyond the scope of legislation on educational integration. Increasingly, educationally maladjusted children are sent so special schools. Since job opportunities for the handicapped and maladjusted are in short supply, employment inequalities exist. As a result transitional measures or other programmes designed to occupy time have increased whereas employment in ordinary work settings has declined. More often than not, women are employed in "Centres d'Aide par le Travail" (Employment centres for the handicapped). Access to ordinary jobs tends to be mainly available to men whereas specialised employment is mainly for women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2005

Survey of academic pediatric emergency departments regarding use of evaluation and management codes.

OBJECTIVE: The aims of the study were to determine the frequency at which each emergency medicine evaluation and management (E/M) code is used, to identify factors associated with their use by academic pediatric emergency departments (PEDs), and to compare PED E/M code utilization rates with rates reported by Centers for Medicare and Medicaid Services for general emergency departments (EDs). METHOD: A 24-question survey was sent to 42 academic PED medical directors. Questions pertained to PED demographics, physician staff, records/documentation, billing education, and E/M coding data for 1 year. The general ED E/M code utilization rates were obtained from the published Centers for Medicare and Medicaid Services database. Descriptive statistics and odds ratios were used to report and compare the data. RESULTS: Twenty (48%) of the surveys were returned, and 9 (21%) completed the E/M coding data questions. From these 9 departments, the mean PED annual census was 46,065 (range, 23,531-92,910). The methods of PED medical record documentation were template (6), handwritten (2), and dictation/transcription (1). Charge documents were completed by the PED physician (3), professional service coders (4), and hospital coders (2). Coding/documentation in-services were provided to the physicians of 7 PEDs, and billing audits were performed in 5 PEDs. The total number of charges for the 9 PEDs was 325,129, 78.4% of the census. Multiple reasons were given for the discrepancy between census and charges. The percentage of each of the 5 levels of service billed was calculated for each of the 9 PEDs. The 2 lowest levels of service were used 38.3% of the time, whereas the 2 highest were used 19.2% of the time. The range for the highest level of service varied widely from 5.3% to 53.3%. Approximately 65% of E/M codes used by general EDs were for the 2 highest levels of service. The PED with the highest percentage of upper level charges (53.4%) was the only PED that used dictation/transcription for documentation. CONCLUSION: Although the response rate was low, and thus the validity of the results was limited, the findings may serve as a benchmark for E/M code utilization in PEDs. The large variation in use of the E/M codes among the PED in our study and the lower rate of using the highest E/M codes by the PEDs compared with the general EDs suggest potential opportunities for academic PEDs to improve billing practices.

Academic Medical Centers↗
PubMed1990

Development of an optically scanned consultation-liaison data base.

Every clinical service must record certain data about its patient care activities. In low-volume services, such as Psychiatric Inpatient Services, with perhaps 20-30 admissions per month, and an average patient stay of 2-4 weeks, a large amount of data on each patient can be obtained during the contact time with the patient. On the other hand, very large-volume psychiatric services, such as Emergency and Consultation-Liaison (C-L) Services, may not need or be able to gather such a large amount of data on every patient seen. This article describes the development of a brief, optically scannable, and computerized minimal data base form for patients seen by a very large division of C-L Psychiatry. The system is feasible and easily auditable for completeness and reliability. This data base has already served many important functions beyond providing an administrative statistical summary of services rendered. It is presented as a model for the development of similarly efficient data collection methods for other high-volume psychiatric services.

Computer Systems↗
PubMed2006

Improving preventive service delivery at adult complete health check-ups: the Preventive health Evidence-based Recommendation Form (PERFORM) cluster randomized controlled trial.

BACKGROUND: To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting. METHODS: A prospective cluster randomized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto. Preventive Care Checklist Forms were created to be used by family physicians at adult health check-ups over a five-month period. The sex-specific forms incorporate evidence-based recommendations on preventive health services and documentation space for routine procedures such as physical examination. The forms were used in two intervention clinics and two control clinics. Rates and relative risks (RR) of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to-date preventive health services delivered per patient were compared between the two groups. RESULTS: Randomly-selected charts were reviewed at baseline (n = 509) and post-intervention (n = 608). Baseline rates for provision of preventive health services ranged from 3% (fecal occult blood testing) to 93% (blood pressure measurement), similar to other settings. The percentage of up-to-date preventive health services delivered per patient at the end of the intervention was 48.9% in the control group and 71.7% in the intervention group. This is an overall 22.8% absolute increase (p = 0.0001), and 46.6% relative increase in the delivery of preventive health services per patient in the intervention group compared to controls. Eight of thirteen preventive health services showed a statistically significant change (p < 0.05) in favor of the intervention (adjusted RR (95% C.I.)): counseling on brushing/flossing teeth (9.2 (4.3-19.6)), folic acid counseling (7.5 (2.7-20.8)), fecal occult blood testing (6.7 (1.9-24.1)), smoking cessation counseling (3.9 (2.2-7.2)), tetanus immunization (3.0 (1.7-5.2)), history of alcohol intake (1.33 (1.2-1.5)), history of smoking habits (1.28 (1.2-1.4)) and blood pressure measurement (1.05 (1.00-1.10)). CONCLUSION: This simple, low cost, clinically relevant intervention improves the delivery of preventive health services by prompting physicians of evidence-based recommendations in a checklist format that incorporates existing practice patterns. Periodic updates of the Preventive Care Checklist Forms will allow a feasible and easy-to-use tool for primary care physicians to provide evidence-based preventive health services to adults at routine health check-ups. The forms can also be incorporated into an electronic health record. The Preventive Care Checklist Forms are accessible in English and French at the College of Family Physicians of Canada web site.

Adult↗
PubMed2004

Does equal availability of geographical and human resources guarantee access to family doctors in Estonia?

AIMS: To describe allocation of posts of trained family doctors geographically; to assess the patients' consultation rate and family doctors' workload geographically; and to evaluate comprehensiveness of the work of family doctors. METHODS: Data for the description of training in family medicine and the system of primary health care in Estonia were drawn from the health statistics of the Ministry of Social Affairs of Estonia and from data of the Estonian Health Insurance Fund. The comprehensiveness of work was expressed as the percentage of newborn babies on the practice lists of family doctors out of the total births in Estonia during 1999-2002. RESULTS: Altogether 979 doctors became family medicine specialists during 1991-2004, which corresponds to Estonia's need--one family doctor per 1,600+/-400 inhabitants. The rate of visits to family doctors has increased during recent years and in 2002 one inhabitant made 2.7 visits per year on average. Family doctors received an average of 22 visits per day throughout 2002. The number of home visits increased: in 2002 every fifth person and almost every second child in Estonia was visited by a doctor. According to the registration of newborns on family doctors lists, the comprehensiveness of family practice rose: in 2002, 83% of all newborns were registered with family doctors. CONCLUSION: The allocation of family doctors geographically according to population density ensures access to medical services in their localities. The registration of newborns with family doctors shows the comprehensiveness of the work of family doctors. Elaboration of the indicators for the analysis of accessibility of family doctors services, using national statistics, helps evaluate the development and further planning of the primary health care system.

Estonia↗
PubMedDate not supplied

[The epidemiologic situation of chronic obstructive lung diseases in the population in Croatia].

In the introduction the importance of epidemiologic studies of COPD is indicated, thus stressing the complexity of their realization and high cost of these projects. According to the data that are gathered through every day routine work of health service and health statistics the authors try to find out the place of COPD in the population of Croatia studying the year 1987. In general medicine 24.8% visits due to respiratory diseases have been registered, in occupational medicine 24.8%, school medicine 43.2%, pediatric health care 60.8%. In this number COPD are represented by 8.6% with 111.822 visits, occupational medicine by 3.8% with 18.445 visits, school medicine by 4.2% with 22.629 visits and pediatric health care by 5.5% with 40.961 visits. On the whole in this year in Croatia there were 4.214 visits on 100,000 population due to COPD. According to the data of pneumology service the incidence of COPD is 164 0/0000 and the prevalence 691,6 0/0000. In pneumology stationaries 6.207 patients with COPD or 21.5% were treated. In the proclaimed invalidity the COPD is to be found on the fourth place. In the mortality the respiratory diseases are found on the sixth place out of which half of them are COPD. By the follow-up of these data a lot of time and money is wasted without giving the adequate results. The method of analytically-specialistic register for COPD is explained as a simple, economic and efficient method for studying COPD in the population.

Humans↗
PubMed2006

Place and provision: mapping mental health advocacy services in London.

The National Health Service (NHS) Executive for London carried out an investigation in 2002 as part of their wider mental health strategy to establish whether existing mental health advocacy provision in the city was meeting need. The project took a two-part approach, with an emphasis on, (a) mapping the provision of advocacy services and, (b) cartographic mapping of service location and catchments. Data were collected through a detailed questionnaire with service providers in collaboration with the Greater London Mental Health Advocacy Network (GLMHAN) and additional health and government sources. The service mapping identified some key statistics on funding, caseloads and models of service provision with an additional emphasis on coverage, capacity, and funding stability. The questionnaire was augmented by interviews and focus groups with commissioners, service providers and service users and identified differing perspectives and problems, which informed the different perspectives of each of these groups. The cartographic mapping exercise demonstrated a spatially-even provision of mental health advocacy services across the city with each borough being served by at least one local service as well as by London wide specialist schemes. However, at local level, no one borough had the full range of specialist provision to match local demographic need. Ultimately the research assisted the Advisory Group in providing commissioning agencies with clear information on the current status of city-wide mental health advocacy services, and on gaps in existing advocacy provision alongside previously unconsidered geographical and service dimensions of that provision.

Focus Groups↗
PubMed2001

Use of health services and reported satisfaction among primary school adolescents in Arusha, Tanzania.

PURPOSE: To describe Tanzanian adolescents' utilization of health services, their satisfaction with the health services, and determinants of their satisfaction with these services. METHODS: A questionnaire was administered to 1279 seventh-grade school pupils, measuring use of health services in the past 2 years, reasons for seeking health services, and satisfaction with the health services provided during the last visit. Descriptive statistics were calculated on health service utilization and satisfaction variables, and univariate and multiple logistic regression analyses were performed to assess the factors associated with reported satisfaction with the health services. RESULTS: Seventy-five percent of the respondents reported using modern health services only, 1.2% used traditional services only, and 10% had used both during the past 2 years. Fever was the most common reason for seeking modern health services, followed by injury. The vast majority of the respondents reported being satisfied with the services provided during the last visit. Age was the only factor significantly associated with being very satisfied with traditional health services, whereas type of health facility and discussion of the issues of sexually transmitted diseases and AIDS were significantly associated with being very satisfied with modern health services during the last visit. CONCLUSION: Urban primary school adolescents report using modern health services, and the majority are satisfied with the services.

Adolescent↗