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PubMed2003

Differences between physical and behavioral health benefits in the health plans of at-risk drinkers.

OBJECTIVE: The goal of this study was to describe the physical and behavioral health benefits of a representative community-based sample of at-risk drinkers potentially in need of behavioral health services. METHODS: A screening instrument for at-risk drinking was administered by telephone to a random community sample of more than 12,000 adults. A telephone interview was conducted with the health plans of 294 at-risk drinkers who were insured and who consented to the release of their insurance records to collect information about supply-side cost-containment strategies (for example, gatekeeping and restrictions on choice of provider), and demand-side cost-containment strategies (for example, deductibles, limits, coinsurance, and copayments). Information about health plan characteristics was successfully collected for 217 (72 percent) of the insured at-risk drinkers, representing 113 different health plans and 206 different policies. RESULTS: Both provider choice restrictions and gatekeeping were more likely to be used for behavioral health care than for physical health care. Greater cost-sharing for mental health than for physical health was most often achieved by using additional limits (83 percent) and higher coinsurance (66 percent) and less often achieved by using higher copayments (38 percent) and additional deductibles (13 percent). The greater cost-sharing for behavioral health amounted to a 30 percent ($42) difference in annual out-of-pocket costs for an average user of behavioral health services compared with full parity. CONCLUSIONS: The results provide information to advocacy groups and policy makers about how much equalization would have to occur in the insurance market before full parity could be achieved between physical health and behavioral health benefits for a population of individuals potentially in need of behavioral health services.

Adult↗

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↗

PubMed2005

The development of a new corporate specific health risk measurement instrument, and its use in investigating the relationship between health and well-being and employee productivity.

BACKGROUND: There is a growing body of evidence linking health and well-being to key business issues. Despite this, corporate uptake of workplace health promotion programmes has been slow outside the USA. One possible reason for this is the lack of a generally available health risk measure that is quick and easy to administer and produces data that is rich enough to inform and direct subsequent employee health promotional interventions. METHODS: We report on the development and validation of the health and well-being (HWB) assessment, a free to use health risk appraisal questionnaire that has been specifically developed for use in the corporate setting. The HWB assessment focuses upon modifiable health issues that directly impact upon business drivers. Development involved interviews with business leaders to ascertain their key areas of focus, scientific and general literature review to find evidence for health status having an impact upon these areas, and end user testing.Three UK-based organisations (insurance, telecommunications and consumer goods sectors) participated in the research. A total of 2224 employees completed the HWB assessment, the short-form 36 (SF-36) and the World Health Organisation Health and Work Performance questionnaire (WHO-HPQ) as part of the validation process. RESULTS: The HWB assessment is a twenty item questionnaire covering ten areas of health and well-being. Completion of the HWB assessment generates a global health risk score and ten sub-scores corresponding to the ten areas covered. It is easy to use and quick to complete (average completion time was eight minutes) and showed good internal consistency and test-retest reliability. Statistically significant correlations with similar SF-36 variables were observed. A significant negative correlation between HWB score and productivity decrement, as measured by the WHO-HPQ, was observed (r = -0.4). Individuals with HWB scores above the 25th percentile were more likely to achieve workplace productivity standards than those with scores below the 25th percentile (OR 3.62, 95% confidence limits 2.93 - 4.47). CONCLUSION: The HWB assessment generates reliable business focused health risk data that can be used to direct and target appropriate interventions within corporate populations. It may also be useful in quantifying the financial impact health status issues have upon organisations.

Adult↗

PubMed2002

Health governance--its introduction in Lanarkshire Health Board.

OBJECTIVE: To describe an approach to implementing the principles of clinical governance in a Health Board setting. DESIGN: Using guidance from the Scottish Executive and The Faculty of Public Health Medicine to set up a health governance structure at Health Board level. Auditing current work to identify areas that required to be progressed. SETTING: Lanarkshire Health Board. RESULTS: A Health Governance Committee and a Health Governance Advisory Group, to support the work of the main committee, were set up at Board level. The Scottish Executive Governance Monitoring Template has been adapted to cover the main public health functions. Topics considered in the first year include qualifications, registration and CPD activity of Consultants in Public Health Medicine, audit of public health advice on gastro-intestinal illness, audit of DPH Annual Report and audit of items of business on Health Board agenda. CONCLUSION: The model developed in Lanarkshire has a Health Governance Advisory Group which works in support of the main Health Governance Committee. This model works well in practice with much of the routine work being done by the Advisory Group. This has streamlined the work of the Health Governance Committee and facilitated its introduction.

Health Services Research↗

PubMed2005

Priorities for research for oral health in the 21st century--the approach of the WHO Global Oral Health Programme.

The World Health Organization (WHO) "World Oral Health Report 2003" emphasized that despite great improvements in the oral health status of populations across the world, problems persist. The major challenges of the future will be to translate existing knowledge and sound experiences of disease prevention and health promotion into action programmes, this is particularly the case with developing countries that have not yet benefited from advances in oral health science to the fullest extent possible. The WHO Oral Health programme gives priority to research helping correct the so called 10/90 gap which relates to the fact that only 10% of funding for global health research is allocated to health problems that affect 90% of the world population. As knowledge is a major vehicle for improving the health of the poor in particular, the WHO Oral Health Programme focuses on stimulating oral health research in the developed and developing world to reduce risk factors and the burden of oral disease, and to improve oral health systems and the effectiveness of community oral health programmes. Building and strengthening research capacity in public health are highly recommended by WHO for effective control of disease and the socioeconomic development of any given country.

Dental Caries↗

PubMed1977

Primary health care, policy makers and health education: some challenging goals.

A challenge to politicains and health administrators everywhere, and therefore to health education, is how to achieve a more equitable distribution of health care to the people. A new approach that may well be the answer is the use of primary health care, which is concerned with measures that will provide simple and effective health care to all people. The priniciples on which primary health care is based have much in common with those of health education, as spelled out over the past 20 years by WHO expert committees, namely: involving people in a working partnership respecting their values and beliefs, placing reliance on indigenous practitioners, etc. In both cases, "the focus is on people and action" and the primary health care context offers a challenging opportunity for health education to make a major contribution towards a fairer distribution of health services. Another area where health education has a particular challenge to meet concerns the education of politicians at all levels: health educators must do all they can to influence health and health-related policy away from those determined solely by political expediency and towards policies that benefit the people. They must also help bridge the gap between "deciding politicians" and the "consuming citizen" to help ensure that the decisions of the former meet the needs of the latter.

Health Education↗

PubMed1999

An oral health promotion module for the primary health care nursing course in Acornhoek, South Africa.

The severe personnel shortage in the health professions in most developing communities is well documented. This dearth of health workers and the widespread adoption of the primary health care approach (PHCA), requires that health professionals be trained to understand and effectively utilize the skills offered by other disciplines in the health care field. Nurses are expected to play active roles in the promotion of health including oral health, particularly in the rural under-served communities. There is a paucity of oral health education in nursing curricula. This article describes a 4-day module on oral health promotion developed and delivered to 36 nurses as part of a 12-month primary health care nursing (PHCN) training course. The module utilized a variety of educational methods and materials to facilitate and encourage both individual and group learning. The module was evaluated using both student academic attainment and perceptions as outcome measures. The evaluation and the experience of facilitating this module show that an oral health promotion module of short duration can sensitize nurses to the importance of oral health and increase oral health knowledge and skills.

Curriculum↗

PubMedDate not supplied

The mental health policy template: domains and elements for mental health policy formulation.

Mental disorders are a major and rising cause of disease burden in all countries. Even when resources are available, many countries do not have the policy and planning frameworks in place to identify and deliver effective interventions. The World Health Organization (WHO) and the World Bank have emphasized the need for ready access to the basic tools for mental health policy formulation, implementation and sustained development. The Analytical Studies on Mental Health Policy and Service Project, undertaken in 1999-2001 by the International Consortium for Mental Health Services and funded by the Global Forum for Health Research aims to address this need through the development of a template for mental health policy formulation. A mental health policy template has been developed based on an inventory of the key elements of a successful mental health policy. These elements have been validated against a review of international literature, a study of existing mental health policies and the results of extensive consultations with experts in the six WHO regions of the world. The Mental Health Policy Template has been revised and its applicability will be tested in a number of developing countries during 2001-2002. The Mental Health Policy Template and the work of the Consortium for Mental Health Services will be presented and the future role of the template in mental health policy development and reform in developing countries will be discussed.

Developed Countries↗

PubMed1998

Household health expenditures in Nepal: implications for health care financing reform.

His Majesty's Government of Nepal has embarked on an ambitious social welfare programme of increasing the accessibility of primary education and health care services in rural communities. The implications on the financing of health care services are substantial, as the number of health posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To strengthen health care financing, government policy-makers are considering a number of financing strategies that are likely to have a substantial impact on household health care expenditures. However, more needs to be known about the role of households in the current structure of the health economy before the government designs and implements policies that affect household welfare. This paper uses the Nepal Living Standards Survey, a rich, nationally-representative sample of households from 1996, to investigate level and distribution of household out-of-pocket health expenditures. Utilization and expenditures for different types of providers are presented by urban/rural status and by socioeconomic status. In addition, the sources of health sector funds are analyzed by contrasting household out-of-pocket expenditures with expenditures by the government and donors. The results indicate that households spend about 5.5% of total household expenditures on health care and that households account for 74% of the total level of funds used to finance the health economy. In addition, rural households are found to spend more on health care than urban households, after controlling for income status. Distributing health care expenditures by type of care utilized indicates that the wealthy, as well as the poor, rely heavily on services provided by the public sector. The results of this analysis are used to discuss the feasibility of implementing alternative health care financing policies.

Developing Countries↗

PubMed2000

Universal health care? The views of Negev Bedouin Arabs on health services.

BACKGROUND: This study examines health and health care attitudes, practices and utilization patterns among the Bedouin Arab minority in the south of Israel. Particular attention is given to the effects of the new National Insurance Law that provides universal coverage for the first time, and to the identification of critical issues for further research. METHODS: Focus groups, adapted to Bedouin culture, were the primary method of data collection. Twelve groups (158 participants) from throughout the Negev met for 3-7 sessions each, using specially trained local moderators and observers. Issues discussed and analyzed included experience and satisfaction with the current health system (both modern and traditional), health service availability/barriers, health care needs, influences of social change, and the National Insurance Law. RESULTS: Participants voice dissatisfaction with modern health services in the Bedouin sector and the state of health of Negev Bedouin. They place great emphasis on the connection between health and the rapid social and economic changes, which this traditionally nomadic group is undergoing. Traditional health care is felt to still exist, but its importance is waning. The National Insurance law is having a major impact on the Bedouin, particularly because it provides universal health insurance coverage where only partial coverage had been in effect. CONCLUSIONS: This study, one of the first of its kind in the Bedouin sector, showed that the focus group method, if properly modified to cultural norms, can be a valuable research tool in traditional communities and in health service research. The findings from this research can be used to direct efforts to improve health policy and health services for this group, as well as preparing the way for further qualitative or quantitative studies.

Arabs↗

PubMed1996

Building health promotion into health care reform in Russia.

The health care system of the former Soviet Union, despite serious flaws, did provide the basis for community health activities, and for mandatory immunization and periodic health examinations for which primary care physicians were responsible. Since 1991, a new system of mandatory health insurance has been put into place. Health care funding has decreased substantially, owing to economic conditions. However, there is not yet widespread acceptance either of the strong association between personal behaviour and health consequences, nor of the importance of individual responsibility for one's health. To summarize, efforts at health promotion and disease prevention in Russia face numerous barriers: severe financial constraints owing to the general economic situation; social upheaval with loss of previous constraints on behaviour; cultural characteristics that include fatalism and encouragement of heavy alcohol and tobacco consumption; lack of acceptance of individual responsibility for health; lack of role modelling by the medical community; lack of critical appraisal of benefit and cost-effectiveness for preventive interventions; low priority for health care, and for prevention specifically. Disease prevention and health education must be built into the reformed health care system, to promote health for the Russian population.

Community Health Services↗

PubMed2006

Sexual health education for people with mental health problems: what can we learn from the literature?

Research into sexual risk behaviour among people with 'severe' mental health problems suggested that they are likely to engage in high-risk sexual behaviour, for a number of reasons, putting them at risk of sexually transmitted diseases. The aim of this review is to describe approaches, content and outcomes of sexual health education programmes, developed and implemented for people with mental health problems. A literature review from 1980 to 2005 was carried out using the electronic databases CINAHL, PsycINFO, British Nursing Index, Pubmed and Medline, and the Cochrane library was also searched. The literature search was confined to papers written in English. The keywords 'sexuality', 'sexual health education', 'sexual health promotion', 'HIV', 'sexually transmitted disease' were combined with 'mental illness', 'chronic mental illness''severe mental illness''persistent mental illness''psychiatry', 'mental disorder', 'education interventions' and 'evaluation'. A vast amount of literature was recovered on sexual risk behaviour in people with severe mental health problems, and sexual dysfunction as a result of prescribed medication. As the focus of the review was on sexual health education, this literature was omitted. Although the literature on sexual health education for people experiencing mental health problems was sparse, 14 studies were located that either described or evaluated sexual health education programmes. Most sex education programmes focused on topics such as HIV and other sexually transmitted diseases, negotiating safe sex and skill development in condom use. Findings suggested that the people who attended benefited from sexual health education programmes, facilitated in a sensitive and supportive manner. Education tended to produce a reduction in sexual risk behaviour as opposed to complete cessation. Nevertheless, it is appropriate to consider integrating such education with service provision. The results of the review provide guidance to service providers and mental health nurses wishing to develop and evaluate sexual health education programmes for service users. Areas for future research are also identified.

Attitude to Health↗

PubMed1996

Lost in the market? A survey of senior public health service managers in New Zealand's 'reforming' health system.

In 1993, New Zealand implemented radical health sector reform, separating purchaser from provider and creating a competitive market. This paper reports on a 1994 survey of senior managers' perceptions of how well public health services were adapting to this more commercial environment. An initial questionnaire to chief executive officers of Crown health enterprises, the main providers of public health, as well as secondary treatment services, was followed by a telephone survey of managers of public health services. Chief executives expressed generally positive views about the importance of public health, especially health promotion, within their organisations. Public health managers indicated a wide range of negative and positive views about the new system. They were concerned especially about service fragmentation, diminished information-sharing and decreased collaboration, especially with Maori and general practice providers. Questions were raised about the compatibility of competition with the need for collaboration in public health. The major issue was the inefficient, costly, conflicting and fragmented purchasing arrangements for public health. Managers wanted united systems and fewer purchasers. More positive views were expressed on an improved focus on outputs and clearer directions, and none wanted to return to the former era of an entirely separate system for public health services. The abolition of the Public Health Commission during 1995 should lead to increased integration of purchasing and policy making, but important questions remain about the place of public health services, especially in their links with primary care.

Administrative Personnel↗

PubMed2000

Youth health promotion and health promoting schools: what should be the aims?

The school plays a very important role in health education and promotion at the crucial stage of childhood and adolescence. It develops personal character, skills, attitude and physique, in addition to imparting knowledge. To sustain the concerted effort to address inter-wined social, educational, psychological and health needs of children, training and ongoing reinforcement must be given to teachers. A task force made up of parents, teachers, administrators, students and health professionals must be formed to develop core values, visions, goals and activities; and to provide new direction for health education and promotion. The 'Health Promoting Schools' Programme of the CUHK was launched in 1999 with the aim to promote physical, emotional and intellectual development of students through healthy and hygienic practices. The programme has also conducted researches on health of students, prioritise and evaluate relevant programmes. Recent research studies revealed that students in higher grades had more physical and psychological health problems, probably due to heavy workload and less emphasis on health education in their formal curriculum. Another research study has shown the lack of concrete school policies in health education. It is therefore important to develop policies, practices and structures, as well as regular curricular reviews to promote health of the school children. The "Health Promoting Schools' Programme has already initiated several district based health promotion programmes to pave the way for the formation of local task force on youth health promotion.

Adolescent↗

PubMedDate not supplied

Beyond access: who reports that health care is not being received when needed in a publicly-funded health care system?

OBJECTIVES: To examine the relationship between reporting that health care was not received when needed in Canada's publicly-funded health care system and contact with the health care system, and to explore whether there is a differential impact of specific chronic conditions. METHODS: Analyses were carried out on the 2000/2001 Canadian Community Health Survey. The proportion of survey respondents who reported that they had not received health care when it was needed was determined overall, and for individuals with selected socio-demographic, health status, and health care utilization characteristics, as well as stratified by various chronic conditions. Multivariate logistic regression was then employed to examine possible predictors of having reported that health care was not received when it was needed during the previous year. RESULTS: Approximately 13% of Canadians reported that health care was not received when they felt it was needed during the previous year. These individuals reported higher rates of health care utilization, worse health status, were more likely to have chronic health conditions (particularly conditions such as fibromyalgia, Crohn's disease, and chronic bronchitis for which there is no effective treatment), and were more likely to be female, younger, white, have higher education and lower income. CONCLUSION: Reporting that health care was not received when it was needed may not be related to accessibility but rather to a perceived failure of the system to meet the individual's needs.

Adolescent↗

PubMedDate not supplied

Inequalities in health and health services delivery: a multilevel study of primary care and hypertension control.

Delivery of health services is an important determinant of health. Restricted availability and access may result in health inequalities. To determine the extent of geographic variation in the delivery of health services and its effect on the health of community residents in terms of under-diagnosis and under-treatment of hypertension, we carried out a multilevel study of participants in the 1995 Nova Scotia Heart Health Survey (n = 3,094). We used individual level survey data and health status measurements linked to geographical level information to examine the importance of adequate delivery of health services to the diagnosis and treatment of hypertension in the universal health care setting of the province of Nova Scotia. The delivery of primary care services across Nova Scotia varied moderately with physician visit rates ranging from 3.3 to 5.5 visits per resident per year. There were neither substantial nor statistically significant differences in the diagnosis and treatment of hypertension among residents of communities varying in the delivery of health services. We concluded that a geographic variation in the delivery of primary care services is a public health concern that is not consistent with the objectives of universal coverage of health services; however, it was not confirmed to result in health inequalities.

Adult↗

PubMed2005

Perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders.

Caregiving and its consequences are major concerns for nurses. Many studies have examined health-promoting behaviors in general (Duffy, 1993; Walker, Volkan, Sechrist, & Pender, 1988), but few studies have explored health-promoting behaviors of caregivers. The purpose of this study was to examine the effects of age, gender, race, and length of caregiving on perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders. Data from a larger study was used to examine a conceptual model linking perceived health status and health-promoting behavior. A sample of 136 (n = 136) African-American and 257 (n = 257) White caregivers was recruited from northeastern Ohio through random digit dialing and interviewed face to face. English-speaking caregivers were selected for study who provided unpaid assistance or care for a minimum of five hours a week to an impaired person 60 years of age or older living in the community. The Health-Promoting Behavior Questionnaire, perceived health status, and a demographic profile were used to measure the study variables. Data were analyzed using hierarchical multiple regression. Findings from this study suggest that the overall fit of the conceptual model was significant, and that moreover, the relationship found between perceived health status and health-promoting behaviors supported Pender's model of health promotion (Pender, 1987). The relationship between perceived health status and health-promoting behaviors has not been documented in prior studies of caregivers, or in studies comparing the two racial groups of African-Americans and Whites.

Adult↗

PubMedDate not supplied

Training and education for public health: the role of the U.S. Public Health Service.

In 1993 Assistant Secretary for Health Philip R. Lee commissioned an evaluation of U.S. Public Health Service (USPHS) activities in training and education for public health (TEPH). Findings revealed significant shortages of professionals and academic faculty in the public health fields of epidemiology, biostatistics, environmental and occupational health, public health nutrition, public health nursing, and preventive medicine. An inventory of PHS activities showed that about $217 million was spent on 151 public health and prevention training programs serving over 141,000 persons in fiscal year 1993. The $217 million amounted to about 18% of the total reported PHS training expenditures of $1.2 billion and about 1% of the total spending of $19.4 billion in fiscal year 1993. The National Institutes of Health (NIH) and Health Resources and Services Administration (HRSA) had the largest training expenditures of $655 and $445 million respectively, but spent only about 7% and 17% on public health and prevention training. Other PHS agencies had larger proportional investments in prevention, but the amounts were smaller. Priority recommendations were provided to Dr. Lee in seven key areas: advanced technology, core public health functions, policy and financing, academic-practice links, educational research, research training, and coordination. Together, these could dramatically increase the PHS proportional investment in TEPH. The PHS has a rich variety of resources for TEPH, but a lack of prioritization, coordination, and planning is causing opportunities to be missed. Medical Subject Headings (MeSH): public health, training, education.

Curriculum↗