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PubMed1983

Millions of medical care dollars for indigents.

The medically indigent, a group traditionally underserved with health care, can obtain some needed free services from Hill-Burton facilities. These facilities (hospitals, nursing homes, clinics, and agencies) received Hill-Burton funds for their building programs and have, as a result, an obligation to provide a certain amount of uncompensated medical care to a defined medically indigent population. Health systems agencies (HSAS) or other interested agencies and groups can play an integral role in highlighting the Hill-Burton Program and helping the medically indigent obtain free care, This paper describes the Hill-Burton Program and explains how one HSA identified the Hill-Burton facilities in its area, determined the extent of their obligations, obtained allocation plans, and publicized and promoted the available health care services. From the interest shown by the community it was apparent that the HSA had provided a much needed and appreciated service that could be duplicated across the country by HSAS or other community groups.

Financing, Government↗
PubMed1986

AIDS risk-reduction guidelines: a review and analysis.

Until an effective treatment or vaccine for AIDS is developed, the principal strategy for controlling its spread will remain persuading at-risk and diseased populations to modify behaviors implicated in the transmission of the disease. In the case of homosexual and bisexual men the "risk-reduction" or "safe-sex" brochure has emerged as the most widely used public health intervention modality. While there has been a proliferation of such brochures, to date no systematic analysis of the content or potential efficacy of these materials has been undertaken. The authors carry out two kinds of analyses of a sample of risk-reduction brochures. First, these materials are characterized in terms of 13 characteristics related to their content, and style. Second, the extent to which they incorporate the elements of a standard model of health communication is assessed. Limitations of existing brochures are identified and the implications of the findings for the development of future materials are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Health promotion counseling in residency training.

This report describes health promotion counseling attitudes and practices in a family medicine residency that attempted to encourage such counseling. A patient "Health Habits Questionnaire" and matching patient education booklets were developed and distributed. Six grand rounds presentations on counseling were given. On three occasions, residency physicians completed questionnaires about counseling. Despite good personal health habits and positive attitudes toward counseling, the residency physicians had only moderate confidence in their counseling ability and infrequently documented counseling. The residents reported significant improvement in their ability to counsel patients about smoking cessation. Overall, the curriculum appeared to have a limited effect on health promotion.

Adult↗
PubMedDate not supplied

Will outpatients complete living wills? A comparison of two interventions.

OBJECTIVE: To test the efficacy of two intervention methods that aimed to increase the percentage of adult clinic patients who completed living wills and placed them on file with their physicians within a four-month period. DESIGN: There were one control and two intervention groups. Surveys were separated by age and gender categories and randomly selected for the final sample. SETTING: The internal medicine outpatient clinic of a large tertiary hospital. PARTICIPANTS: All patients who visited the clinic were asked whether they would be willing to fill out a survey. The final sample included 167 adult patients who comprised three study groups. INTERVENTIONS: The first intervention relied solely on a booklet that described the Minnesota Living Will Act, general information concerning advance directives, and medical interventions that could be considered extraordinary if used for a patient in a terminal condition. The second intervention relied on both the booklet and repeated physician-initiated discussions with the patient about the probable value of a living will. MAIN RESULTS: The booklet/physician intervention was found to be significantly more effective than either the booklet-only intervention or no intervention (p less than 0.05 and 0.01, respectively). CONCLUSIONS: The physician intervention used in this population could be undertaken in any primary care clinic. Time spent in discussion before a crisis may be significantly shorter and qualitatively better than time spent in discussion with families who must make decisions during a crisis.

Adult↗
PubMedDate not supplied

Impact of the informed consent process on patients' understanding of varicose veins and their treatment.

AIM: It is particularly important that patients have reasonable understanding of the risks, benefits and nature of elective surgery. This study sought to analyse this level of understanding in patients undergoing varicose vein surgery METHODS: Eighty two patients completed a questionnaire in the vascular outpatient clinic and were asked to complete a telephone questionnaire following the clinic. RESULTS: Pain (n = 46) was the primary reason patients considered varicose vein surgery followed by appearance (n = 32). Most patients felt that varicose veins placed them at high risk of leg ulcers (n = 46) and DVT (n = 41). A high level of expectation that surgery would significantly affect pain and flares was recorded. While the outpatient visit did not materially change these misconceptions, an educational leaflet significantly enhanced the recall of complications (p = 0.028) in patients who remembered receiving a leaflet. CONCLUSION: Patients attending varicose vein clinics have an unrealistic expectation of the benefits of surgery and fail to understand the benign nature of their condition. The outpatient process has little effect on patient-held beliefs.

Health Knowledge, Attitudes, Practice↗
PubMed2000

Briefing of orthodontic patients.

The aim of this study was to record the level of relevant knowledge among orthodontic patients and their parents in order to determine how they prepare for the first consultation and what level of orthodontic briefing is needed. The focus was on the response of young patients to briefing, with other objectives being to investigate what briefing media are used by orthodontists for patient motivation and improved compliance as well as the extent to which new briefing media are needed. Two hundred 9- to 12-year-old patients and their parents were interviewed, using a standardized questionnaire to record their knowledge and their need for information on orthodontic matters. In addition, 200 orthodontists were asked to fill in a questionnaire and to return it together with the briefing material used by them. The response rate was 62%.--To obtain an overview of the orthodontic briefing material available, various institutions (PR offices of health insurance companies, professional associations, specialist publishing houses, regional study groups) were approached with written requests for relevant material. Currently available children's books with dental or orthodontic subject matter were also scrutinized. 74% of children wanted to learn more about their orthodontic treatment and 40% expressed anxiety, in particular towards fixed appliances and impression-taking. 98% of orthodontists reported that the briefing interview was the main source of information. Despite being the person primarily in need of motivation, however, the child was not the focus of attention at the first consultation, even though that consultation was the preferred source of information for 51% of children. Other briefing media, consisting mainly of demonstration models and leaflets, were used primarily in the orthodontist's waiting room and surgery. Space-taking media (video films, computers) were rarely used, as were books. It is concluded that there is a clear-cut need for the orthodontic briefing process to be improved.

Audiovisual Aids↗
PubMed2000

The Internet as a source of medical information. Investigation in a mixed cohort of radiotherapy patients.

BACKGROUND: The widespread use of the internet has influenced patterns of medical information for tumor patients. The present study examines the use of various media and, in particular, the application of the internet, in a mixed cohort of radiotherapy patients. PATIENTS AND METHODS: All patients undergoing radiotherapy at the University of Würzburg were analyzed simultaneously in May of 2000 using a newly developed 9-item questionnaire. Questions related to the importance of various media for medical information (grading from 0 = unimportant to 2 = very important) and previous internet use. The data was correlated with clinical information from the patients' charts. RESULTS: In 95% of patients (n = 139) questionnaires were evaluable. Of 8 media, television (mean score 0.94), patient brochure (0.83) and newspaper (0.76) were considered most important for medical information while the internet ranged last (0.24). Whereas 61.2% knew the internet as a source of medical information, only 11.5% had searched the internet themselves and 15.1% had received internet information from family or friends. Only 24.1% from these 2 groups had discussed the information with their physician. The rates of internet use were substantially higher in subgroups with younger age, higher education and palliative treatment. CONCLUSION: The importance of the medium internet for the information of tumor patients is currently still low but likely to increase based on demographic factors.

Adult↗
PubMed2004

Written information for potential living kidney donors.

To meet the constantly growing demand for organs for transplantation the use of living related and unrelated donors continues to increase. Transplant units with a living-donor programme often provide written information to their potential kidney donors. We saw a need to assess the contents of these brochures. Written information for potential live kidney donors was requested from different Transplant units throughout the world. We obtained and analysed 16 different brochures from 14 countries. The general approach ranged from persuasive to almost deterring. Sixteen main themes were identified in the information material. Eight of those were considered paramount, namely voluntarism, medical suitability, short-term donor risks, long-term donor risks, risk of graft loss, outcome with and without a living donor, postoperative course, and financial conditions. Five brochures covered all these crucial matters. When mentioned, examples and interpretations of donor risks were very dissimilar. Furthermore, the conditions for donation were obviously very different in the various countries. This review points at essential issues to be included in the written information for living kidney donors. All transplant units with a living-donor programme should provide such information, thus enabling the potential donor to make a thorough decision.

Decision Making↗
PubMed2005

Does an educational leaflet improve self-reported adherence to therapy in osteoporosis? The OPTIMA study.

INTRODUCTION: Adherence to treatment in osteoporosis remains poor. The aim of this study was to evaluate the effects of an educational leaflet on adherence to medication and to assess the association between adherence and health-related quality of life (HRQOL). METHODS: A naturalistic, observational, multi-center, prospective study of 12 months' follow-up was performed. Consecutive post-menopausal women aged 50 years to 86 years starting treatment with raloxifene according to daily practice were enrolled from 126 primary care offices in Spain. The women were assigned to two study groups. Group A received an educational leaflet with general information about osteoporosis; group B followed current practice. To assess adherence to medication and HRQOL, the Morisky test and the EuroQoL questionnaire were administered. A total of 745 post-menopausal women (group A, n=366; group B n=379), with a mean age of 62 years, were included. RESULTS: Most patients in both study groups showed high adherence to raloxifene at the 3-month visit: 56.3% vs 62.7% for groups A and B, respectively; this proportion at the 12-month visit was 47.4% (P=0.15) and 52.5% (P=0.02), respectively. At baseline, "pain/discomfort" was the dimension showing the highest percentage of women reporting problems: 86.4% vs 83.2% in groups A and B, respectively (P=0.22). HRQOL improved in both groups throughout the study, with an overall mean increment in the EuroQoL visual analog scale (EQ VAS) of 9.2 at 12 months (P<0.01). Correlations between adherence and HRQOL were weak. After receiving an educational leaflet, young post-menopausal women suffering osteoporosis did not show improvement in adherence to therapy. HRQOL improved at 12-month follow-up under treatment. CONCLUSION: No consistent correlation between adherence and HRQOL was found.

Aged↗
PubMed2003

[Informing patients in the German Rheumaliga].

The German Rheuma-Liga as the largest patient organisation presents the different ways of informing patients. Patient- education-programs are presented, with a program focussing on social and psychological issues in particular.

Adaptation, Psychological↗
PubMed2006

Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain.

Despite dissuasive recommendations, intramuscular (i.m.) injections of NSAIDS are still a widespread treatment of acute pain in General Practice as well as among orthopaedic physicians. Most physicians argue that patients who are used to receive NSAIDS i.m. would insist on this application mode while being convinced of its therapeutic superiority for pain relief. Therefore, the aim of the study was to find out if patients' decision can be influenced towards an oral application by receiving a simple information leaflet. An information leaflet, providing information about the risks of NSAIDS particularly in case of i.m. application was provided to 161 patients with acute low back pain. Decision in favour or against i.m. application of NSAIDS was documented. Severity of disease was assessed by the Roland Morrison pain questionnaire and visual analogue scale (VAS) at the first visit and again 3-5 days later. From May to December 2004, 161 patients, visiting their GP (13 practices) with acute pain and demanding an injection were included in the study. After reading the information leaflet, 139 of the 161 (86.3%) patients decided for an oral application instead of receiving an injection of NSAIDS as in the past. This effect was statistically significant (P</=0.01). Of the initial 161 patients, 156 could be re-evaluated and no significant differences in the VAS and the Roland Morris Score between the patients with oral and i.m. application mode could be found. Only 2 patients of the 139 who decided for oral application indicated that they would opt for an i.m. injection next time. Our study demonstrates that patients' decision can be influenced even in case of severe pain by providing adequate information on a short information leaflet. The results should help to reduce physicians' fear of losing patients when not following their demand for i.m. injections and therefore enable a safer pain treatment.

Acute Disease↗
PubMed2006

The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression.

Post-operative management after lumbar surgery is inconsistent leading to uncertainty amongst surgeons and patients about post-operative restrictions, reactivation, and return to work. This study aimed to review the evidence on post-operative management, with a view to developing evidence-based messages for a patient booklet on post-operative management after lumbar discectomy or un-instrumented decompression. A systematic literature search produced a best-evidence synthesis of information and advice on post-operative restrictions, activation, rehabilitation, and expectations about outcomes. Evidence statements were extracted and developed into patient-centred messages for an educational booklet. The draft text was evaluated by peer and patient review. The literature review found little evidence for post-operative activity restrictions, and a strong case for an early active approach to post-operative management. The booklet was built around key messages derived from the literature review and aimed to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice on self-management. Feedback from the evaluations were favourable from both review groups, suggesting that this evidence-based approach to management is acceptable and it has clinical potential.

Decompression, Surgical↗
PubMed2005

[Preoperative information].

BACKGROUND: Many empirical studies have identified the quality and communication of patient information as a major weak point in the treatment process. Patient information can be made considerably more effective by multimedia communication of contents tailored to the patient's needs. Computer-based training (CBT) takes the multimedia presentation one step further. METHODS: Using the Macromedia Director 8.5 authoring software, a multimedia system for pre-operative patient information was developed on CD-ROM for a limited area of oral and maxillofacial surgery. This information system was evaluated for quality assurance on the basis of a random sample of 85 patients in a test lasting about 20 min. Impressions were determined with regard to design features, motivation, understanding, the subjective communication of knowledge, the newly acquired competence and acceptance compared with other media (information leaflets, Internet, conventional information). RESULTS: The analysis of the program test revealed a hugely positive assessment of the interactive program in respect of layout, functionality and design as well as in respect of structuring and the subjective understanding of the underlying complaint, therapy and potential complications. In a comparison with other information media such as information leaflets and the Internet, the program was rated just as good or better by over 70% of the respondents. Only conventional consultation with a doctor came off better in a direct comparison. CONCLUSION: It was shown that the quality of preoperative patient information can be improved through multimedia presentation and that it would be sensible to make use of modern media for the purposes of giving patients graphic information.

Adolescent↗
PubMed2005

[Health campaign for atherosclerosis prevention].

The goal of the campaign "plus leben", a project designed to run for at least 5 years, is to heighten the awareness of patients at risk of heart disease and to provide them with an appropriate prevention program. During the first two years of the campaign 20,000 visitors were registered on the homepage, 400,000 tests for risk of heart disease were distributed, and more than 3,000 health information brochures were requested. Thus, a survey of patients was designed to provide information on the extent to which preventive measures are effective. The survey, which was carried out by mail, had a response rate of 28%, or 230 participants. In the random sample, consisting of about 60% men and 40% women, only 16% are younger than 50 years of age. Thus the survey provides a representative picture of the affected target group. The test for risk of cardiac disease provided by "plus leben" led to an increase in awareness of preventive measures in more than two thirds of the respondents, and 60% also completed the test. Although only a fourth of the patients are regularly informed by their physician about preventive measures, the campaign has led about 90% of the respondents to make fundamental or at least partial changes in their lifestyle. In connection with the study it was shown that the media play an important role in providing information on preventive measures. Communication in the doctor's office as an important building block in raising consciousness about atherosclerosis prevention could be further improved.

Adult↗
PubMed2006

Project IMPACT: a report on barriers and facilitators to sustainability.

Project IMPACT is a collaborative care intervention to assist older adults suffering from major depressive disorder or dysthymia. Qualitative research methods were used to determine the barriers and facilitators to sustaining IMPACT in a primary care setting. Strong evidence supports the program's sustainability, but considerable variation exists in continuation strategies and operationalization across sites. Sustainability depended on the organizations' support of collaborative care models, the availability of staff trained in the intervention, and funding. The intervention's success was the most important sustainability factor, as documented by outcome data and through the "real world" experience of treating patients with this intervention.

Aged↗
PubMed2005

Patient perspectives on research recruitment through cancer registries.

OBJECTIVE: To gain preliminary insight into patients' levels of awareness and preferences about research recruitment through cancer registries. METHODS: We developed four questions about the North Carolina Central Cancer Registry's educational brochure and about patient preferences regarding physician involvement in research recruitment. These questions were included in the baseline interview conducted among 100 consecutively enrolled participants in the North Carolina Colorectal Cancer Care Outcomes Research Study, an ongoing observational study. RESULTS: Patients who read the Registry's educational brochure generally reported that it helped them understand that a researcher could contact them, but only about one-fourth of patients recalled receiving and reading the brochure. Over two-thirds of patients said they preferred that researchers contact them directly about their interest in research participation, rather than checking with their physician first. Among patients who wanted their physician involved, most preferred a physician notification rather than a physician permission approach. CONCLUSIONS: Registry policies about patient education and physician involvement can have an important impact on researchers' ability to conduct population-based studies. Understanding patient perspectives is key to developing balanced policies that protect patients' privacy, as well as facilitate their opportunities to make autonomous decisions about participating in research.

Age Factors↗