A feasible strategy for a health care package.
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Health Plan Implementation↗
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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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[Healthcare for adolescents: perceptions by physicians and nurses in family health teams].
This descriptive qualitative study was conducted in basic healthcare units to analyze the perceptions of physicians and nurses from family health teams concerning healthcare for adolescents, using content analysis with an emphasis on thematic analysis. The discourse of these health professionals showed that care exists for adolescents in the family health service, but that: it is not systematized because of other priorities; adolescents fail to use the service; the health professionals feel unprepared to draw adolescents to the service and treat them; and in order to implement a healthcare program for adolescents in the family health strategy it would be necessary to reorganize the service to train the existing team members and hire other professionals. Thus, the interviewees value differentiated care for adolescents, and even while recognizing their limitations and reporting not having been trained, they conduct joint actions with other areas beyond health, demonstrating that they transcend the limits of the health service and seek new ways of treating adolescents holistically.
Adolescent↗
[The new federal patient insurance regulation--initial experiences with implementation and preparation for 1996].
It is reported about the state of implementation of the new compensation system for inpatient care. Problems arise especially in determining flat "prices" for case and treatment categories (similar to diagnosis related groups). With regard to the obligatory introduction of the new system in 1996, hospitals have to make far-reaching internal changes, especially in accountancy and documentation. Obligations of hospitals to data transmission to the sickness funds and resulting administrative expenditure has to be confined to what is ultimately necessary.
Cost Control↗
[Medical risk management].
An error-control management (management of technical errors) is well established, tested and approved in sectors of high risk, such as aviation and nuclear industry. Although medical science likewise represents a sector of high risk, a similar region-wide control management is still missing. The reasons are multifaceted: by implementation of an error-control management, the negotiation of psychological obstacles and the investment of financial resources have to be faced. The profit from overcoming these obstacles is gained only in the long term. The intention of this survey is to give an overview of the current state of knowledge of errors in medical science as well as to give an introduction (adoption) of the basic principles of systemic error description, detection and prevention by evaluating the available studies.
Evidence-Based Medicine↗
Process evaluation of a tailored multifaceted approach to changing family physician practice patterns improving preventive care.
BACKGROUND: We conducted a process evaluation of a multifaceted outreach facilitation intervention to document the extent to which the intervention was implemented with fidelity. We also hoped to gain insight into how facilitation worked to improve preventive performance. METHODS: We used 5 data collection tools to evaluate the implementation of the intervention, and a combination of descriptive, quantitative, and qualitative analyses. Triangulation was used to attain a complete understanding of the quality of implementation. Twenty-two intervention practices with a total of 54 physicians participated in a randomized controlled trial that took place in Southwestern Ontario, Canada. The key measures of process were the frequency and time involved to deliver intervention components, the scope of the delivery and the utility of the components, and physician satisfaction with the intervention. RESULTS: Of the 7 components in the intervention model, prevention facilitators (PFs) visited the practice most often to deliver the audit and feedback, consensus building, and reminder system components. All the study practices received preventive performance audit and feedback, achieved consensus on a plan for improvement, and implemented a reminder system. Ninety percent of the practices implemented a customized flow sheet, and 10% used a computerized reminder system. Ninety-five percent of the intervention practices wanted critically appraised evidence for prevention, 82% participated in a workshop with opinion leaders in preventive care, and 100% received patient education materials in a binder. Content analysis of the physician interviews and bivariate analysis of physician self-reported changes between intervention and control group physicians revealed that the audit and feedback, consensus building, and development of reminder systems were the key intervention components. Ninety-five percent of the physicians were either satisfied or very satisfied with the intervention, and 90% would have been willing to have the PF continue working with their practice. CONCLUSIONS: Primary care practices in Ontario can implement significant changes in their practice environments that will improve preventive care activity with the assistance of a facilitator. The main components for creating change are audit and feedback of preventive performance, achieving consensus on a plan for improvement, and implementing a reminder system.
Family Practice↗
Organisation and implementation of neonatal hypothyroid screening programme in India--a primary health care approach.
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Health Plan Implementation↗
Health reform for children: the Egyptian experience with school health insurance.
In June 1992, the People's Assembly of Egypt passed Law 99 expanding health insurance to cover all school children. This was one of the most important initiatives undertaken in recent years by the Ministry of Health, and it effectively increased the number of beneficiaries covered by the Health Insurance Organization (HIO) from 3.75 million in 1988 to about 14 million in 1993. This paper first examines the policy processes for the introduction of this innovation in Egypt's health system. Next, the paper discusses the implementation and consequences of the new policy in terms of coverage, financing, benefits, and delivery of services, along with data on utilization and expenditures. Several important lessons derive from this analysis. First, major reform efforts are possible when there is a strong political commitment and the proposed program and solutions are acceptable to the key stakeholders. Second, compromises and trade-offs are essential to construct a politically feasible and ethically acceptable reform initiative. Third, while these trade-offs might yield short-term gains, the trade-offs in the long term may undermine the reform's capacity to achieve the anticipated equity enhancements and can potentially undermine the financial sustainability of the reform.
Adolescent↗
Toward a unified system of accreditation for professional preparation in health education: final report of the National Task Force on Accreditation in Health Education.
During the past 40 years, health education has taken significant steps toward improving quality assurance in professional preparation through individual certification and program approval and accreditation. Although the profession has begun to embrace individual certification, program accreditation in health education has been neither uniformly available nor universally accepted by institutions of higher education. To further strengthen professional preparation in health education, the Society for Public Health Education (SOPHE) and the American Association for Health Education (AAHE) established the National Task Force on Accreditation in Health Education in 2001. The 3-year Task Force was charged with developing a detailed plan for a coordinated accreditation system for undergraduate and graduate programs in health education. This article summarizes the Task Force's findings and recommendations, which have been approved by the SOPHE and AAHE boards, and, if implemented, promise to lay the foundation for the highest quality professional preparation and practice in health education.
Accreditation↗
The implementation of in vivo dosimetry in a small radiotherapy department.
PURPOSE: In vivo dosimetry has been shown in a number of evaluation studies, generally carried out in larger academic centres, to be a reliable method of checking the overall treatment accuracy. The object of this study was to investigate whether it was possible and useful to perform in vivo dosimetry in a small radiotherapy department and to detect if there were any systematic errors in the overall treatment set-up. MATERIALS AND METHODS: All patients were treated on a cobalt-60 unit equipped with a verification system. Six hundred fifty entrance dose measurements were performed with silicon diodes. RESULTS: The analysis showed a mean deviation of -1.3%. This negative deviation was mainly due to the mean deviation obtained in the treatment of head and neck (-1.6%) or breast (-2.5%) cancer patients. The results for pelvic or lung irradiation showed almost no deviation (-0.8 to 0.43%). Further investigation showed that the negative values for head and neck or breast irradiation were due to the irradiation technique; the lack of scattering material causes a reduction of the dose at the reference point, which is not taken into consideration by the treatment planning system. By performing in vivo dosimetry, we were also able to detect two large errors in 650 measurements and could prevent erroneous treatment. CONCLUSION: Even when the overall treatment set-up is very accurate, in vivo dosimetry is very useful in a small department since only a small effort can detect and prevent errors.
Cobalt Radioisotopes↗
Development of a vertically integrated program of services for persons with schizophrenia.
Economic pressures are changing the nature and quality of services available to individuals with chronic psychiatric disorders. Vertical integration of services has been proposed as a strategy for cost-effective merging of resources. This report describes the integration of inpatient, continuing day treatment, and ambulatory clinic services over an 18-month period into a service line for patients with schizophrenia. Key principles in implementing the integrated program included an open admission policy, continuity of care, use of criteria for level of care that were set by external review agencies, rapid transfers between services, and maintenance of the integrity of the treatment plan. Steps toward integration included evaluating and securing treatment resources, establishing core treatment approaches, fostering staff development, implementing outcomes assessment, and presenting the new program to clients, family members, and the community. The integrated program was 15 percent more productive than the combined services before integration, and inpatient length of stay dropped by 66 percent. Vertical integration of services is cost-effective and offers the potential for significant clinical benefits.
Continuity of Patient Care↗
A performance-based incentive program for influenza immunization in the elderly.
Our objective was to implement and evaluate performance-based reimbursement for influenza immunization of the elderly in physician offices. We performed a community-based quasi-experiment with historic and concurrent comparisons, using primary care physician offices in Monroe County, New York. Participants in the intervention group included 53 primary care physicians admitting to one hospital, and the comparison group included 82 primary care physicians admitting to other hospitals. All physicians participated in a Medicare-sponsored demonstration to increase influenza immunization rates, and, during the 1990-1991 immunization season, used a target-based poster to track immunization rates. Physicians in the intervention group were enrolled in a performance-based financial incentive program that rewarded immunization rates above 70%. A survey concerning influenza immunization practices and opinions was sent to all physicians. The average physician-specific immunization rate in the incentive group was 73.1% versus 55.7% in the comparison practices (P < .001). Eligibility for incentives, practice size, sex of physician, medical specialty, reminder postcards, and practice populations including medically indigent patients were associated with immunization level. Controlling for the above variables, we completed a regression analysis showing that eligibility for the incentive was still significant (P = .003). The survey responses were not predictive of performance or significantly different between the two groups, except for the negative influence of sending postcards. This study in a community setting suggests that linking reimbursement to performance may be a successful strategy to increase influenza immunization levels for the elderly.
Aged↗
Can it be done? Implementing adolescent clinical preventive services.
OBJECTIVE: To evaluate the implementation of an intervention to increase the delivery of adolescent preventive services within a large managed care organization. Target health areas were tobacco, alcohol, sexual behavior, and safety (seat belt and helmet use). DATA SOURCE/STUDY DESIGN: Adolescent reports of clinician screening and counseling were obtained from adolescents who attended well visits with their primary care providers. A prepost study design was used to evaluate the preventive services intervention. The intervention had three components: (1) 89 clinicians from three outpatient pediatric clinics attended a training to increase the delivery of preventive services; (2) customized adolescent screening and provider charting forms were integrated into the clinics; and (3) the resources of a health educator were provided to the clinics. DATA COLLECTION: Following a visit, adolescents completed surveys reporting on clinician screening and counseling for each of the target risk areas. Preimplementation (three months), 104 adolescents completed surveys. Postimplementation of the training, tools, and health educator intervention, 211 adolescents completed surveys (five months). For 18 months postimplementation clinicians delivered services and 998 adolescents completed surveys. PRINCIPAL FINDINGS: Chi-square analyses of changes in screening from preimplementation to postimplementation showed that screening increased in all areas (p < .000), with an average increase in screening rates from 47 percent to 94 percent. Postimplementation counseling in all areas also increased significantly, with an average increase in counseling rates from 39 percent to 91 percent. There were slight decreases in screening from postimplementation to follow-up. CONCLUSIONS: This study offers support for the efficacy of providing training, tools, and resources as a method for increasing preventive screening and counseling of adolescents across multiple risky health behaviors during a routine office visit.
Adolescent↗
Maryland's Medicaid reform: a provider's perspective.
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Attitude of Health Personnel↗
Maryland's Medicaid reform: Will the gain outweigh the pain?
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Cost Control↗
[For and against: the Integrated Plan of Treatment and Rehabilitation (IBRP) and the Conference on the Help Plan (HPK)].
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Community Health Planning↗
National Service Framework for long-term conditions--Quo vadis.
There is widespread dismay over the fate of the NSF for Long-term Conditions after all the efforts by so many people in securing its publication only one year ago in March 2005. In order to help to avoid its premature demise, the British Journal of Neurosurgery is pleased to provide a forum for the rapid publication of original papers and reviews that might help to catalyse the NSF's rational implementation. The first two of such papers are published in this Volume.
Delivery of Health Care↗
Risk selection and targeted interventions in community-based control of chlamydia.
PURPOSE OF REVIEW: To describe recent developments in the community-based approach of high-risk groups for Chlamydia trachomatis infection, and to discuss the assessment of impact of selective systematic screening on the transmission of C. trachomatis in the community. RECENT FINDINGS: Two large home-based screening programs in Europe have recently shown that systematic postal screening for C. trachomatis infection is feasible, but certain high-risk groups are poor participators. This underscores the need for risk selection and targeted approaches. A prediction rule has been developed which can assist in identifying high-risk groups and can be used as a tool for (self) selection for screening. The Internet has been shown to be a promising medium to promote chlamydia testing. School-based programs also succeed in including high-risk groups in screening programs. Recently developed dynamic simulation models, which take into account transmission of C. trachomatis, can assist in the development and evaluation of targeted screening strategies. SUMMARY: Chlamydia will not likely be controlled by one standard approach. Risk selection strategies need further development and different systematic approaches at the community level, including postal screening, school-based screening, and the Internet may produce the desired public health effect of decreasing morbidity and reducing the transmission of C. trachomatis in the community.
Chlamydia Infections↗
Lights, camera ... inaction? Trends in rural health care in Canada.
In summary, rural practice in Canada has had its image burnished in recent years and its model of practice (comprehensive, multi-tasking autonomous practice in multiple environments--"polyvalence" in good Québecois) increasingly recognized as an efficient model, which could apply to many settings. Where it thrives it has succeeded in distributing these tasks among enough individuals to allow itself room to breathe, and it has developed its skills and scope of practice in ways that support the self-reinforcing duality of competence and confidence. In short, it has made rural practice into "something someone would want to do." Whether this success will be repeated in enough places for it to be said that rural medicine is no longer in jeopardy remains to be seen.
Canada↗