Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Accessibility”

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed1993

Progress in childhood cancer care in Florida. 1970-1992.

Pediatric cancer has been a priority in Florida since 1970. That year physicians established a statewide network of children's tumor programs, the Florida Association of Pediatric Tumor Programs (FAPTP), which has grown from the initial two programs to 10 in 1992 and now maintains a registry with follow-up to monitor incidence and other indicators. State-of-the-art care is provided through affiliation with the Pediatric Oncology Group. The incidence of pediatric cancer in Florida is equivalent to national rates, but the number of children followed in 1991 had grown to approximately 2,000. The number receiving care has increased an average of 13% annually since 1981. Services for these patients should be reviewed on a continuing basis to assure access to specialized programs.

Adolescent↗
PubMed2006

Injecting drug users who are (un)aware of their HIV serostatus: findings from the multi-center study AjUDE-Brasil II.

This study aimed to characterize the profiles of injecting drug users (IDUs) who were unaware of their HIV serostatus, given the importance of this information for prevention strategies, especially in this vulnerable population, key to the HIV/AIDS dynamic. As part of a cross-sectional multi-city survey, IDUs were interviewed and HIV-tested by the ELISA technique. IDUs were categorized according to knowledge of their own HIV status as either aware or unaware. Means, averages, and proportions were compared between the groups using bi- and multivariate analyses. Of 857 IDUs interviewed, 34.2% were unaware of their HIV serostatus. Those who were unaware were more likely: to have been recruited at sites where the HIV prevalence rate was considered medium (> 10 to 50%; odds ratio = 8.0) or high (> 50%; 4.0); to be illiterate (OR = 4.54); to have no prior HIV test (OR = 2.22); to be male (OR = 1.81); and to have been enrolled more recently in syringe-exchange programs (OR = 1.69). HIV prevention programs should target both individuals at risk and HIV-positive individuals. Programs to expand access to HIV testing are pivotal and should be tailored to specific contexts and populations.

Brazil↗
PubMed1995

Gender differences in factors affecting health care administration career development.

At first glance, a woman's prospects for a career in health administration seem encouraging. More than half of the recent graduates of health administration master's programs are female, and initially post-master's salaries are comparable with those of male graduates. Unfortunately, opportunities for promotion and financial benefits seem to decrease for women and expand for men as their respective careers progress. This study found that, with the same educational background, men earned an average of $51,491 annually, compared to $50,839 for women, in health care administration. We examined gender differences in organizational and individual factors that have been modeled as influences on career development. These factors include financial and nonfinancial benefits, access to training programs, success factors, demographics, and motivating factors underlying education, employment, and career choices. Some evidence of gender differences in the organizational and individual factors affecting career development is provided. Academic and professional strategies addressing these differences are suggested for consideration by both professional and university administrators.

Attitude of Health Personnel↗
PubMedDate not supplied

A comparison of prostate knowledge of African-American and Caucasian men: changes from prescreening baseline to postintervention.

PURPOSE: This study was undertaken to determine if a community screening program designed to overcome key barriers (lack of awareness, cost of program, ease of access to care) could successfully impact on African-American males' knowledge, attitudes, and behaviors regarding prostate cancer screening. The focus of this report is knowledge. To date, there are no reported studies that examine differences in knowledge from a prescreening baseline to a postintervention level for minority participants. PATIENTS AND METHODS: A total of 944 men were enrolled in the study in a 20-month period. Prostate screening and education were offered as a new service at an existing senior health clinic. In addition, mass screenings were offered approximately monthly at various locations in the community (including senior community centers, senior apartment complexes, and some public housing projects). Screening included both the digital rectal examination and the prostate specific antigen test. A brief questionnaire was administered during client intake (the pretest) and repeated after the education and screening participation (the posttest). Test items targeted three constructs: (1) etiology, (2) risk status, and (3) clinical factors. RESULTS: The largest difference on pretest scores between the racial groups resulted from clinical factor knowledge. African-American men were significantly less likely than Caucasian men to correctly identify early symptoms of prostate cancer and the basic components of a prostate checkup. Although scores were initially significantly lower for African-American participants, these differences were not evident after program involvement. There was a significant increase in knowledge level for all men when comparing pretest and posttest scores. Significant improvement was noted for each test item, with the exception of one key item. Even after participation in the program, African-American men were still more likely to believe that "pain" was the first symptom of prostate cancer. DISCUSSION: An item-by-item analysis revealed that there was only one test item in which program participation did not "correct" knowledge. African-American men were still more likely to believe that pain was the first symptom that would alert them to the presence of cancer. The screening program included information (both printed and oral content) that emphasized the importance of routine screening to detect cancer at an early stage, because most men would experience no symptoms. The only other reported study that examined knowledge documented similar findings with respect to an understanding of symptomology. These findings can be used to direct or guide the educational component of future screening programs that hope to target African-American men.

Black or African American↗
PubMed1988

An evaluation of Utah's primary care case management program for Medicaid recipients.

One of the first case management (CM) programs for limiting Medicaid enrollees' freedom of choice of provider was established by Utah. By assigning enrollees to specific providers responsible for arranging all nonemergency care, Utah intended both to improve access and to reduce program costs. State officials expected the program to increase recipients' use of primary-care providers, while reducing their use of specialists, prescription drugs, and hospital outpatient services. Savings from reductions in unnecessary use were expected to more than offset increases in outlays arising from access enhancements, resulting in lower program expenditures. This study investigated the extent to which the state Medicaid program achieved these goals. The analysis was based on a two-part multivariate model of usage, estimated from data created from claims-level information provided by Utah. The findings revealed that the use of primary-care physician services increased significantly. However, the program also raised the use of specialists' services and prescription drugs. In contrast, the use of hospital outpatient services was lowered. Overall, CM apparently achieved the objective of increased access, but failed to attain the cost-containment goal. The findings indicated that expected costs for ambulatory care rose by 25% in the early years as a result of case management.

Cost Control↗
PubMed1990

Access to health care in the United States: barriers for neurologic patients, challenges for neurologic physicians.

Approximately 34 million people in the United States have no health insurance. Up to 80 million people have insurance inadequate to provide care for severe or long-term illness (the underinsured). In 1986, an estimated 1 million persons in the US could not obtain needed health care for financial reasons, and another 18.8 million had difficulty obtaining care. There probably are 3.2 million people with neurologic disorders among the 34 million uninsured, and more among the underinsured. Those patients probably have difficulty obtaining health care, including neurologic consultations, laboratory tests, and radiologic procedures. Congress and many state legislatures are considering various proposals to address the problems of the un- and underinsured. Several national medical professional societies have developed programs to improve access to care for their patients. The American Academy of Neurology Task Force on Access to Health Care is studying access to care for neurologic patients and will recommend a course of action to the Academy. The Task Force welcomes suggestions concerning appropriate steps to improve access to health care for patients with neurologic disorders.

Delivery of Health Care↗
PubMed2001

Mathematical models of eye movements in reading: a possible role for autonomous saccades.

An efficient method for the exact numerical simulation of semi-Markov processes is used to study minimal models of the control of eye movements in reading. When we read a text, typical sequences of fixations form a rather complicated trajectory - almost like a random walk. Mathematical models of eye movement control can account for this behavior using stochastic transition rules between few discrete internal states, which represent combinations of certain stages of lexical access and saccade programs. We show that experimentally observed fixation durations can be explained by residence-time-dependent transition probabilities. Stochastic processes with this property are known as semi-Markov processes. For our numerical simulations we use the minimal process method (Gillespie algorithm), which is an exact and efficient simulation algorithm for this class of stochastic processes. Within this mathematical framework, we study different forms of coupling between eye movements and shifts of covert attention in reading. Our model lends support to the existence of autonomous saccades, i.e., the hypothesis that initiations of saccades are not completely determined by lexical access processes.

Algorithms↗
PubMed2004

A management-orientated comparative analysis of urban and rural anglers living in a metropolis (Berlin, Germany).

Increased efforts to analyze the human dimensions of anglers are necessary to improve freshwater fisheries management. This paper is a comparative analysis of urban and rural anglers living in a metropolis, based on n = 1061 anglers responding to a mail survey in the German capital of Berlin. More than two thirds of the anglers (71%) had spent most (>50%) of their effort outside the city borders of Berlin and thus were categorized as rural anglers. Compared to the rural anglers, urban anglers (>/=50% of total effort spent inside the city) were younger and less educated. Urban anglers were more avid and committed, less mobile, and more frequently fished from boats and during weekdays. Rural anglers were more experienced, fished for longer times per trip, fished more often at weekends and on holidays, were more often members of angling clubs, and more frequently caught higher valued fish species. The achievement and fish quantity aspects of the angling experience were more important for urban than for rural anglers. Concerning management options, urban anglers more frequently suggested constraining other stakeholders and reducing regulations, whereas rural anglers more often proposed improving physical access to angling sites. Future urban fishing programs should offer ease of access, connection to public transportation, moderate prices, and diverse piscivorous fish stocks. In contrast to rural fisheries, the provision of high ecological and aesthetical quality of the angling waters can be regarded as of minor importance in urban fisheries. Rural fisheries managers need to consider the needs of stakeholders living in Berlin to minimize impacts on the less degraded rural water bodies and potential user conflicts with resident anglers. Ecosystem-based management approaches should guide rural fisheries policy.

Berlin↗
PubMed1993

Randomization tests: application to single-cell and other single-unit neuroscience experiments.

The application of randomization tests for statistical determination of the significance of experimental manipulations on single cells and other types of single units in neuroscience is described. Applications of standard parametric tests like analysis of variance (ANOVA) and t tests to data from single-subject experiments have been severely criticized for lack of validity and those criticisms are relevant to parametric statistical tests for data from other types of single-unit experiments. A broad class of statistical tests known as randomization tests, on the other hand, has been free of such criticism. Randomization tests have been applied to data from various types of single units in neuroscience, where their validity in the absence of random sampling makes them especially valuable. Until the advent of computers, the computational requirements of randomization tests rendered them impractical. Randomization test computer programs are now readily available. Procedures for access to a public domain program are given in the text.

Analysis of Variance↗
PubMed2007

The current role of medical simulation in american urological residency training programs: an assessment by program directors.

PURPOSE: Although medical simulation opportunities are increasingly available, resident training to date has involved primarily hands-on, subjective assessments. The role of simulation and computer based training for urology residents remains unknown. We evaluated the current status of medical simulation among urological training programs in the United States. MATERIALS AND METHODS: An anonymous questionnaire was developed and mailed to the program director at the 119 Accreditation Council for Graduate Medical Education accredited United States urology training programs, and consisted of 17 questions documenting the prior experience of the responder to medical simulation as well as the current status of simulation at their institution. An additional 14 questions sought the responders' opinion of medical simulation in urology training programs. RESULTS: The questionnaire was returned by 41 program directors (35%). Among respondents, access to a laparoscopy simulator was 76%. In comparison, reported access to cystoscopy, ureteroscopy, transurethral resection and percutaneous access simulators was 16%, 21%, 8% and 12%, respectively. Respondents indicated that these simulators were good educational tools, realistic and easy to use. Unanimous agreement was reported for simulation training in residency and that simulators allow practice in a controlled environment. Disagreement was reported about the cost effectiveness, validity and ability of simulators to replace hands-on instruction in the operating room. CONCLUSIONS: Among responders a high level of access to laparoscopic simulators for urology residents is coupled with low levels of access to other endoscopic trainers. Urology residency program directors unanimously recognize a role for simulation training in residency, although the extent to which they may be incorporated remains to be resolved.

Computer Simulation↗
PubMedDate not supplied

Factors influencing acceptance of mammography: implications for enhancing worksite cancer control.

PURPOSE: The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. SEARCH METHODS: We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. SUMMARY OF IMPORTANT FINDINGS: A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. MAJOR CONCLUSIONS: Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening.

Adult↗
PubMed2000

Commercial managed care plans leaving the Medicaid managed care program in New York State: impact on quality and access.

UNLABELLED: To develop sufficient managed care capacity to accomplish the goal of transitioning Medicaid recipients into managed care, state policymakers have relied on commercial health maintenance organizations to open their panels of providers to the Medicaid population. However, while commercial health maintenance organization involvement in Medicaid managed care was high initially, since 1996 New York State has had 14 commercial plans leave the New York State Medicaid Managed Care Program. It has been speculated that the exodus of these commercial plans would have a negative impact on Medicaid enrollees' access and quality of care. This paper attempts to evaluate the impact of this departure from the perspective of quality and access measures and plan audit performance. Univariate and multivariate analyses were performed to evaluation the effect of commercial managed care plans leaving the Medicaid program. The overall performance of plans that remained in the program was compared to that of the plans that chose to leave for the two time periods 1996-1997 and 1998-2000. Access to care, quality of care, and annual audit performance data were analyzed. The departure of commercial health plans from the New York State Medicaid Managed Care Program has not had a statistically significant negative effect on the quality of care provided to Medicaid recipients as evaluated by standardized performance measures. In addition, there were no instances when there was a negative impact of the exit of the commercial plans on access to care. Managed care plans that chose to remain in Medicaid passed the Quality Assurance Reporting Requirements audit at a significantly (P < .01) higher rate than plans that chose to leave. CONCLUSIONS: A program consisting of health plans voluntarily participating and committed to Medicaid managed care can provide Medicaid recipients with appropriate access to high-quality health care. The exodus of commercial health plans from New York's Medicaid Managed Care Program during the time periods studied did not result in a detectable adverse impact on the quality of care for enrollees.

Adolescent↗
PubMed2005

Impact of a decline in Colorado Medicaid managed care enrollment on access and quality of preventive primary care services.

BACKGROUND: Beginning in 1997 the Colorado Medicaid program de-emphasized managed care and shifted children from enrollment in a health maintenance organization (HMO), which required an enrollee to have an assigned primary care physician, to either the unassigned fee-for-service (UFFS) program in which the enrollee was not required to have a primary care physician (PCP) or to the primary care physician program (PCPP) in which the enrollee was required to select a participating PCP if one was available. The proportion of Medicaid enrollee-months in HMOs dropped from 75.4% in 1997 to 29% in 2003, whereas the proportion of enrollee-months in UFFS programs during this time period increased from 18.6% to 45.6%, and the proportion in the PCPP increased from 5.5% to 25.3%. This shift of children from HMO managed care to the UFFS program provided a natural experiment to assess the impact of not having an assigned PCP on pediatric primary care services. OBJECTIVE: We sought to assess whether an elective shift of children from Medicaid HMO managed care plans with an assigned PCP to the UFFS program without an assigned PCP restricted access to a primary care medical home, recommended health supervision visits, and age-appropriate immunizations. METHODS: Published Colorado Health Plan Employer Data and Information Set (HEDIS) data for 1999-2003 were reviewed to determine if Colorado children enrolled in Medicaid managed care programs with an assigned PCP (HMO and PCPP) compared with the UFFS program were more likely to have any type of visit with a PCP, to have recommended health supervision visits, and to be fully immunized. In the analysis, "HMO total" refers to the average of all children participating in HMO plans. Kaiser Permanente was considered a benchmark because it had the highest immunization rates of all HMOs. "Total Colorado" refers to the average of all children enrolled in Medicaid including the managed care and UFFS options. For 2-year-olds, the 4:3:2:1:1 combination immunization included 4 diphtheria-tetanus-acellular pertussis vaccines, 3 oral poliovirus vaccines or inactivated polio vaccines, 2 hepatitis B vaccines, 1 Haemophilus influenzae type b vaccine, and 1 measles-mumps-rubella vaccine. RESULTS: In 1999 the percentages of children 12 to 24 months of age having any type of visit with a PCP were >80% for the PCPP, Kaiser Permanente, and UFFS programs. However, although the proportion with any visit remained >85% in 2001 for children enrolled in the PCPP and Kaiser Permanente program, the percentage dropped 13.9% to 66.2% for children in the UFFS program. In 2001 the percentage of children with any type of PCP visit enrolled in the UFFS program (66.2%) was significantly lower than the total Colorado (73.6%) as well as the PCPP (85.7%) and Kaiser Permanente program (97.7%). Children 12 to 24 months of age enrolled in the PCPP in 2001 were 1.3 times more likely to have any type of visit with a PCP compared with those enrolled in the UFFS program. Children in the PCPP in 2001, 2002, and 2003 were 1.4, 1.9, and 2.6 times more likely, respectively, to have all 6 of the recommended health supervision visits compared with children enrolled in the UFFS program. Children 3 to 6 years old in the PCPP in 2001, 2002, and 2003 were 1.3, 1.5, and 1.4 times more likely, respectively, to have an annual health supervision visit compared with children enrolled in the UFFS program. In 1999, 2001, 2002, and 2003 2-year-old children enrolled in the PCPP were 2.0, 1.4, 1.5, and 1.8 times more likely, respectively, to be up-to-date with 4:3:2:1:1 vaccines compared with children enrolled in the UFFS program. In 1999, 2001, 2002, and 2003 adolescents enrolled in the PCPP were 1.8, 1.6, 1.3, and 1.6 times more likely, respectively, to be up-to-date with 2 measles-mumps-rubella vaccines compared with children enrolled in the UFFS program. CONCLUSIONS: This study documents the diminishing ability of the Colorado Medicaid program to provide children access to the benefits of a medical home, including visits with PCPs, recommended health supervision visits, and immunizations as care was shifted to the UFFS program from HMO managed care. The high up-to-date immunization rates achieved by Kaiser Permanente suggest that differences in immunization rates reflect the effectiveness of the care processes rather than the characteristics of the Medicaid population.

Child↗
PubMed2001

Pramwalking as postnatal exercise and support: an evaluation of the Stroll Your Way To Well-Being program and supporting resources in terms of individual participation rates and community group formation.

Stroll Your Way To Well Being is a community pramwalking program designed to increase access by mothers to sociable postnatal exercise. This study evaluated the program in terms of long-term adherence rates by mothers to walking, and the effectiveness of kits distributed to providers in assisting them to set up their own groups. Approximately one quarter of information kit recipients established a pramwalking group. Reasons for non-initiation included lack of time or a perceived lack of priority. Mothers reported program benefits to be the opportunity to exercise, socialize and share information about baby issues. 70% of mothers were still walking 16 months after the program's commencement. Reasons for mothers ceasing participation in pramwalking included lack of interest, no group leader available or their baby was too old. Future studies need to focus on the prevention and treatment of postnatal depression through exercise.

Community Networks↗
PubMed2006

Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency.

BACKGROUND: The provision and maintenance of vascular access remains a major cost to end-stage renal failure programs. In addition, vascular access occlusion, results in significant morbidity in hemodialysis patients. Age, gender, diabetes mellitus, malignancy, smoking habits, administration of heparin per hemodialysis session, previous dialysis catheter insertion, number of hemodialysis sessions and location of the fistula may be associated with survival of the primary arteriovenous fistula. We examined the effects of various factors on fistulas in 412 chronic renal insufficiency patients. METHODS: From 1995 to 2004, 412 arteriovenous fistulas were created by the Department of Cardiovascular Surgery at the Medical Faculty of Atatürk University for hemodialysis. The mean age of the patients was 45 years (range 6 to 62 years). We evaluated the effects of various factors for patency rates in the patients who had primary arteriovenous fistulas. Primary patency was defined as the duration of fistula patency without revision. Twenty-eight patients (6.7%) with ischemic cardiac disease did not require surgical interference. Analyzed data were age, gender, smoking habits, diabetes mellitus, malignant neoplasm, previous dialysis catheter insertion, number of hemodialysis sessions, and fistula location. RESULTS: In 298 patients, where lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively, in the other 114 patients, where upper-arm fistulas were created, these rates were 84.0%, 72.2%, 53.3%, 39.8%, and 12.3%, respectively. There was no significantly difference between the upper-arm fistulas and the lower-arm fistulas statistically (p = 0.069). Factors affecting the primary patency of arteriovenous fistulas were diabetes mellitus (p = 0.0001), hemodialysis counts > or =3 per week (p < 0.0005), presence of malignancy (p < 0.0005), previous catheter insertion (p < 0.0007), and administration of heparin per hemodialysis session (p = 0.0008). CONCLUSION: While primary arteriovenous fistula patency was shortened in chronic renal insufficiency patients with diabetes mellitus, presence of malignancy, and previous catheter insertion, patency was longer in patients with heparin used for hemodialysis and hemodialysis count per week (> or =3).

Adolescent↗
PubMed1989

Monitoring patient outcome following discharge: a computerized geriatric case-management system.

Many political, economic, and social factors are influencing health care providers to consider case-management programs. The authors describe a computer-supported, hospital-based case management program for elderly patients and report on the benefits and drawbacks of the program. Primary benefits include access to better client data, improved discharge planning capabilities, and greater program efficiency. Drawbacks chiefly are related to the difficulties inherent in introducing computerization into a human service setting. Overall, the program is a beneficial addition to patient care efforts and is a valuable tool for tracking high-risk patients in acute-care settings.

Aged↗
PubMed1975

Cost analysis of regionalized versus decentralized abortion programs.

A detailed cost analysis has examined the fiscal benefits from regionalizing abortion services. Benefits were found to be virtually insignificant and not to outweigh problems of program visibility and patient accessibility incurred in such regionalization. The study covered 14 hospitals' abortion programs providing both first trimester and second trimester abortions and analyzed each program's total cost and six component costs for first trimester and second trimester procedures separately. The results of this study were employed for program planning by the New York City Health and Hospitals Corporation in its operation of abortion services.

Abortion, Induced↗