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PubMed1976

Phasing out state hospitals -- a psychiatric dilemma.

Whether state hospitals have a role in caring for mentally ill persons has been intensely debated for the past decade. During this time the inpatient census of public mental hospitals has fallen dramatically from 490,000 to 215,000 owing to increasingly effective treatment programs for acutely and chronically psychotic patients. The vast majority of patients currently cared for in state hospitals could be adequately treated in the community if a comprehensive spectrum of psychiatric services and residential alternatives were established. The failure to establish this network of community services before the discharge of thousands of patients has discredited the deinstitutionalization programs in many states, including California and New York, and forced California to abandon its plan to phase out all its state hospitals. Thus, although phase out of state hospitals is clinically feasible, it is unlikely at present since the fiscal and ideologic commitment to shift to community-based treatment is lacking.

Acute Disease↗
PubMed1997

Coordinating rural divisions: the workforce window.

Divisions of General Practice have been established to alleviate the professional isolation which general practitioners face by being excluded from involvement in other parts of the health care system. Divisions facilitate the development of local communication networks and cooperative activities which improve the integration of general practice with other elements of the health system. Coordination of communication is one of the strengths of divisions at the local level and Rural Divisions Co-ordinating Units at the State level. This strength is being effectively utilised to target general practice workface issues. Given the significant proportion of general practitioners in the medical workforce, particularly in rural and remote areas, this has implications for broader medical workforce issues. Australia faces a maldistribution in its general practitioner workforce, with an excess supply in urban areas and a significant shortfall in rural and remote areas. Since 1995-96, the General Practice Rural Incentives Program, which targets the recruitment and retention of rural doctors, has devolved funding to the Rural Divisions Co-ordination Units to coordinate the statewide provision of practical assistance to rural general practitioners, through their divisions, in relation to continuing medical education and the provision of locums. There is potential to build on the success of these initiatives and also to work with urban divisions through the state-based organisational structures which are currently being developed.

Australia↗
PubMed1994

The elasticity of demand for health care in Burkina Faso: differences across age and income groups.

Like many other developing countries, Burkina Faso has been exploring how community resources can be tapped to co-finance health services. Although revenue generation is important for the viability of health services, effects on utilization and on equity of access to health care must also be considered. The authors present a logistic regression model to derive price elasticities of demand for health care based on cross-sectional survey data. While demand for health care appears inelastic overall (-0.79), subgroup analysis reveals differences in elasticity across age and income groups. Elasticities of demand for infants and children (-3.6 and -1.7) and for the lowest income quartile (-1.4) are substantially greater than overall elasticity. The method used is unusual in that it allows estimation of elasticities before the introduction of user fees. This increases the value of the information to policy makers.

Adolescent↗
PubMed1990

Undernutrition of children in Massachusetts.

Over the past 10 years, seven separate studies of children at risk from undernutrition in Massachusetts have been performed. The surveys have ranged from a statewide health center-based investigation to a house-to-house survey in a public housing project. All included children between 1 and 6 years of age. Chronic undernutrition was defined as a height-for-age less than the 5th percentile of the National Center for Health Statistics growth charts, and acute undernutrition was defined as a weight-for-height less than the 5th percentile. The prevalence of chronic undernutrition was greater than expected in four surveys, whereas no acute undernutrition was observed. The prevalence of obesity, defined as a weight for height greater than the 95th percentile, was increased in four of the seven surveys. These data suggest that chronic undernutrition is increased among children at risk in Massachusetts.

Body Height↗
PubMedDate not supplied

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need.

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Adolescent↗
PubMed1995

Utilization of nursing home resources.

The total use and cost of nursing homes in Manitoba, for the fiscal year 1991/1992 were analyzed using a population-based health information system. The use of hospital beds by elderly patients for stays of 60 days or more was also analyzed to see if long hospital stays were substituting for nursing home beds. More than one in ten Manitobans 75 years of age and older and one in three who were 85 years and older resided in a nursing home for some time during the study period. The nursing home sector is characterized by none of the marked differences previously found in hospital use across the southern regions of the province, whose residents are similar in health and need characteristics. A single entry system, combined with a population-based planning approach, appears to provide equitable access to care across the province.

Aged↗
PubMedDate not supplied

The New Hampshire public health network: creating local public health infrastructure through community-driven partnerships.

In 1997, under the auspices of the Turning Point program, New Hampshire's public health stakeholders convened a strategic planning process to transform the state public health system. What emerged was a fundamental vision that the public health system could only be improved by strengthening the capacity of local communities to address local health issues. A plan was developed to create regional public health structures, in areas with no local health departments, to deliver essential public health services at the local level. Seven years later, that plan has become the New Hampshire Public Health Network. The network now covers 67% of the New Hampshire population and includes 113 (48%) cities and towns. Pre- and postevaluations to assess local public health infrastructure at the inception of the program and following 2 years of funding and technical assistance showed significant improvement in local public health capacity and performance. This article describes the development of local public health structures in New Hampshire where none had previously existed.

Community Health Planning↗
PubMed1979

The public and private sector: a developing partnership in human services.

Historically, public and private providers of health and welfare services have functioned in separate, often incompatible, arenas. Drawing from the experience of a private child mental health center, the authors suggest that a more coordinated and collaborative approach would benefit both the public and private sectors, as well as their client populations.

Adult↗