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Results for “Program Acceptability”

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PubMed1991

A quality-control program for colposcopic practice.

Quality control is accepted as an integral part of the cytology laboratory's activities. However, provision of similar safeguards for colposcopic practice in assessing patients with abnormal cervical cytology has been an elusive problem. This report describes the quality-control program for colposcopy that is used province-wide in British Columbia for 21 hospital-based clinics staffed by 35 colposcopists. Copies of the results of all colposcopic examinations performed are sent to the Central Cytology Laboratory where the program is coordinated and the data are collated, analyzed, and evaluated. These data are used to set standards against which each colposcopist's performance and activity can be measured. One of the quality-control indicators used is a comparison between the colposcopic impression of the lesion and the corresponding direct biopsy diagnosis. Correlation within one histologic degree occurred in 86% of patients examined; this information was used to set a performance standard of 80% as the quality-control index for this particular indicator. Three colposcopists had scores below this standard. Comparisons were also made between presenting cytology, directed biopsy results, initial colposcopic impression, and final colposcopic evaluation (the clinical working diagnosis). The other major aspect of the quality-control program consists of an analysis of all cases of diagnosed invasive cervical cancer in the province in a given year to determine whether any colposcopically related errors occurred in the investigation and management of these cases. This system helps to identify individuals who may benefit from additional training.

Biopsy↗
PubMed1990

Computer aided interpretation of acid-base disorders.

This paper describes an expert system for the interpretation of acid-base disorders. The target users are residents in training in internal medicine, anaesthesia and intensive care medicine. The program is written in PROLOG and runs on a SUN 3/160 minicomputer. Evaluation of a learning set (N = 202) and a test set (N = 194) has proved that the system's accuracy is acceptable. As a result, the program has recently been put in routine clinical practice.

Acid-Base Imbalance↗
PubMed1997

Flexible sigmoidoscopy screening: patient acceptance.

Although compelling evidence is available that screening can reduce the risk of death from colon cancer, patient compliance with screening in the United States is poor. The objective of this study is to describe a program that uses patient education to improve patient acceptance of flexible sigmoidoscopy screening. Our program provides multiple opportunities for patients to ask questions and to receive information. Preliminary data show that this approach has resulted in a procedure acceptance rate of 81% of those referred in the first year of the program. Future research needs to focus on evaluating factors associated with noncompliance in colorectal cancer screening programs.

Appointments and Schedules↗
PubMedDate not supplied

Promoting participation in a population screening program for breast and cervical cancer: a randomized trial of different invitation strategies.

AIMS AND BACKGROUND: Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer. METHODS: Women eligible for invitation--8385 for cervical and 8069 for breast cancer screening--listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A--letter signed by the GP, with a prefixed appointment; Group B--open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C--letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D--extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP). RESULTS: Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08). CONCLUSIONS: Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.

Adult↗
PubMed2005

A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a World Health Organization collaborative study.

OBJECTIVE: This study examines the impact of marketing strategies on the dissemination of a brief alcohol intervention program to general practitioners (GPs). The marketing strategy was tested to determine the most effective way to promote awareness about and consideration of a brief alcohol intervention program. The study also examines the impact of training and support strategies to promote the program's implementation in routine primary care. METHOD: A pragmatic trial was carried out in Australia, Belgium (Flanders), Denmark, England, New Zealand and Spain (Catalonia) in which GPs were randomly allocated into one of three marketing conditions (direct mail, telemarketing and academic detailing [personal visits]). The GPs who requested a brief intervention program and agreed to use it were stratified by previous marketing condition and randomly allocated into one of three implementation strategy groups: written guidance, outreach training and outreach training plus ongoing telephone support. RESULTS: Acceptance of the brief intervention program was more effective with use of telemarketing (65%) and academic detailing (67%) than with direct mail (32%) for promoting awareness about and consideration of a brief alcohol intervention program. The median proportion of patients screened was higher for trained GPs (6%) and supported GPs (9%) than for control GPs (1%), who received only written guidance on how to conduct brief intervention. Similarly, the median rate for giving advice to at-risk patients was higher for trained GPs (3%) and supported GPs (3%) than for control GPs (0%). CONCLUSIONS: The adoption of more direct approaches for disseminating evidence-based intervention programs to GPs is a necessary first step for changing practice behavior. However, outreach training was required to promote actual use of a new procedure in routine practice.

Adult↗
PubMed2004

Effects of food attributes and feeding environment on acceptance, consumption and body weight: lessons learned in a twenty-year program of military ration research US Army Research (Part 2).

Twenty years of testing in the field has consistently revealed that food intake is inadequate when packaged military rations are fed as the sole source of food. Food intake is much lower and there is a loss of body weight. Conversely when these rations are fed to students or military personnel for periods ranging from 3 to 42 days in a cafeteria-like setting, food intake is comparable to levels of a control group provided with freshly prepared food. Under these conditions, body weight is maintained. In this review, the consumption pattern is considered in terms of characteristics of the food (acceptability, variety, portion size, beverages, serving temperature, appropriateness for time of day, monotony, and novelty) and the eating milieu (social interactions, time, ease of preparing and consuming a meal). The twenty-year program of military ration research has led us to conclude that both the food and the context must be considered in understanding and controlling food intake.

Eating↗
PubMed2006

Does familiarity breed acceptance? The influence of policy on physicians' attitudes toward newborn screening programs.

OBJECTIVE: As newborn screening (NBS) programs expand to include conditions that challenge traditional public health criteria, little is known about what influences physicians' attitudes toward screening. We examined the effect of state policy and perceived state policy on pediatricians' attitudes toward screening. METHODS: Six hundred pediatricians from the American Academy of Pediatrics who practiced in Wisconsin, Colorado, Florida, or Illinois were queried about (1) testing high-risk infants and (2) universal NBS for cystic fibrosis (CF), glucose-6-phosphate dehydrogenase deficiency (G6PD), and type 1 diabetes. RESULTS: A total of 225 (41%) of 548 eligible pediatricians returned 223 surveys with usable data. The majority were supportive of NBS for CF (n = 188 [84%]) and G6PD (n = 130 [58%]), whereas only 25% (n = 55) supported type 1 diabetes screening. Pediatricians who lived in states that screen for a condition were more likely to support screening than those who lived in states that did not (CF: 117 of 119 [98%] vs 71 of 89 [80%]; type 1 diabetes: 32 of 88 [36%] vs 23 of 109 [21%]). Physicians also were more likely to support NBS when they believed that it was offered in their state versus when they believed that it was not (CF: 117 of 119 [98%] vs 52 of 65 [80%]; G6PD: 28 of 32 [88%] vs 75 of 108 [69%]; type 1 diabetes: 7 of 14 [50%] vs 25 of 102 [25%]). CONCLUSIONS: Most pediatricians are supportive of NBS for CF and G6PD but not type 1 diabetes. Pediatricians who live in states that screen or believe that their states screen are more likely to support screening.

Attitude of Health Personnel↗
PubMed1986

Medical student attitudes to computer-assisted learning in anaesthesia.

Two methods of data entry for computer-assisted learning (CAL) programs were assessed and the acceptability of two forms of CAL to 100 medical students determined. Sixty-two per cent preferred keyboard entry of data compared with 26% who preferred the light-pen. There was not preference for dynamic simulation programs over patient management programs. The majority of the students preferred using CAL in groups with a supervisor to provide further explanation when required. Ninety-three per cent of students favoured more teaching using this method.

Anesthesiology↗
PubMedDate not supplied

[E-mail in psychotherapy--an aftercare model via electronic mail for psychotherapy inpatients].

We introduce an aftercare program for psychotherapy inpatients, which is based on regular communication via E-mail. The organizational and operational structure of the program are described within the context of computer mediated communication. First results on utilization and acceptance are reported. In comparison to patients who did not participate in either aftercare program of the clinic, the E-mail participants are younger and higher educated. Inpatient treatment of the participants was three days shorter in duration than that of non participants. Both groups were similar with regard to symptom distress at discharge from hospital. A low dropout rate of 8%, the high activity and satisfaction emphasize the positive acceptance of the program. Therapists' E-mail activity turned out to be important for the participants. Neither age, internet experience or symptom related variables nor the own E-mail activity were associated with participants' evaluation of the new service. Based on these first positive experiences the perspectives of using E-mail in psychotherapy will be discussed.

Adult↗
PubMed1984

Results of the peer assessment program of the College of Physicians and Surgeons of Ontario.

This paper describes the experience of the College of Physicians and Surgeons of Ontario in developing and conducting a program for the peer assessment of physicians' office practices that would allow the standards of medical practice to be reviewed and assessed. Following two pilot projects in 1978 and 1979 that demonstrated the need, the feasibility and the acceptance of a peer assessment program the office practices of 391 randomly selected physicians were reviewed in 1981 and 1982. Included in the sample were 255 general/family practitioners and 136 specialists in seven fields. Serious deficiencies were found in the medical records of or in the care provided by 30 of the general/family practitioners and 3 of the specialists, accounting for 8% of the practices studied. The difference between the two groups of physicians was statistically significant (p less than 0.01). No predictors of significance were demonstrated in the general/family practitioner group. When follow-up assessments were done most of the physicians were found to have made the improvements that had been recommended.

Ambulatory Care↗
PubMed2002

Benchmarks of support in internal medicine residency training programs.

PURPOSE: To identify benchmarks of financial and staff support in internal medicine residency training programs and their correlation with indicators of quality. METHOD: A survey instrument to determine characteristics of support of residency training programs was mailed to each member program of the Association of Program Directors of Internal Medicine. Results were correlated with the three-year running average of the pass rates on the American Board of Internal Medicine certifying examination using bivariate and multivariate analyses. RESULTS: Of 394 surveys, 287 (73%) were completed: 74% of respondents were program directors and 20% were both chair and program director. The mean duration as program director was 7.5 years (median = 5), but it was significantly lower for women than for men (4.9 versus 8.1; p =.001). Respondents spent 62% of their time in educational and administrative duties, 30% in clinical activities, 5% in research, and 2% in other activities. Most chief residents were PGY4s, with 72% receiving compensation additional to base salary. On average, there was one associate program director for every 33 residents, one chief resident for every 27 residents, and one staff person for every 21 residents. Most programs provided trainees with incremental educational stipends, meals while oncall, travel and meeting expenses, and parking. Support from pharmaceutical companies was used for meals, books, and meeting expenses. Almost all programs provided meals for applicants, with 15% providing travel allowances and 37% providing lodging. The programs' board pass rates significantly correlated with the numbers of faculty fulltime equivalents (FTEs), the numbers of resident FTEs per office staff FTEs, and the numbers of categorical and preliminary applications received and ranked by the programs in 1998 and 1999. Regression analyses demonstrated three independent predictors of the programs' board pass rates: number of faculty (a positive predictor), percentage of clinical work performed by the program director (a negative predictor), and financial support from pharmaceutical companies (also a negative predictor). CONCLUSIONS: These results identify benchmarks of financial and staff support provided to internal medicine residency programs. Some of these benchmarks are correlated with board pass rate, an accepted indicator of quality in residency training. Program directors and chairs can use this information to identify areas that may benefit from enhanced financial and administrative support.

Benchmarking↗
PubMed1981

Creating an appropriate climate for drug use review.

Methods of establishing an appropriate climate for drug use review (DUR) programs are discussed. Characteristics of DUR programs proposed as essential for their initial acceptance and eventual continuity include objectivity, neutrality, and confidentiality. A retrospective DUR program is used as an illustrative model. The need to establish positive interpersonal peer relations is stressed.

Drug Utilization↗
PubMed1969

Mass Chemotherapy In The Control Of Paragonimiasis.

Among 11,005 inhabitants(61% of total population) surveyed in 13 villages of Che Ju Island in 1964, were identified as paragonimiasis patients, of these 1,355 were treated with 40 mg/kg body weight of bithionol for 10~15 doses. The purpose of the study was to test whether mass chemotherapy of the human host may provie an answer for the control of paragonimiasis in an area where the human host is main source of infection to the intermediate hosts. The efficacy of the mass chemotherapy as control program was measured by the acceptance of the survey and treatment by the inhabitants, the efficacy and the toxicity of the drug applied, and the influence of the infection rates of the intermediate hosts. The acceptance of the survey and the treatment was not entirely satisfactory: an estimate based on data suggests that only fifty to sixty percent of all cases infected were detected, and 93% of detected cases were treated in the primary program. All cases detected during the follow up survey, which could not cover whole population, were treated. The efficacy of bithionol was excellent when the treatment was completed. 40 mg/kg body weight for 10~15 doses was sufficient to turn the sputum egg-negative except in a few cases infected heavily that needed 20 doses. Side reactions were generally mild; the most frequent reaction was gastrointestinal; which spontaneously subsided within a few to several days. The infection rate of intermediate hosts started to decrease from the third year of the mass treatment with a pattern of gradual drop. Follow up studies on general population in three and four years of the mass treatment also showed markedly decreased prevalence of paragonimiasis by intradermal test and sputum examination. It is concluded that a complete mass chemotherapy with bithionol in an area where human is the main source of infection to the intermediate hosts can be the answer for control of paragonimiasis.

Journal Article↗
PubMed1998

Suicidal behavior in a bicultural society: a review of gender and cultural differences in adolescents and young persons of Aotearoa/New Zealand.

During the 1990s, Aotearoa/New Zealand has experienced an alarming increase in youth suicide in the Maori and non-Maori populations. Among 23 Organization for Economic Cooperation and Development countries surveyed by the World Health Organization's (1995) World Health Statistics Annual, New Zealand ranks first for fatal suicidal behavior, in males 15-24 years of age, and third for fatal suicidal behavior in females. A United Nations Children's Fund (UNICEF, 1996) survey of 32 countries places New Zealand males as third highest for fatal suicidal behavior, and females as eighth highest in the age group 15-24 years. New Zealand has recently undergone a number of social and economic changes that have created dramatic social and cultural shifts. Given the rapidity of these changes, the shock on such a small country has been difficult to absorb. These shifts have placed tremendous pressures on families and service support systems, such as health and mental health services, to develop programs that are relevant and acceptable for a bicultural society. This article focuses on these changes and the effect they have had on cultural narratives of gender and suicidal behavior, the different cultural etiologies that underlie these statistics, and recommendations for intervention and prevention program development.

Adolescent↗
PubMed2002

Disparate views of community in primary health care: understanding how perceptions influence success.

The importance of community in primary health care (PHC) is evident in the role of community participation and in the types of programs that are routinely implemented (community health-worker [CHW] programs, community clinics, community-based disease-control programs). Few health care providers and program administrators, however, have considered the meaning of community. Instead, they frequently impose their own definition of community and assume that it corresponds to local realities. This is problematic because target populations may have different ideas about what a community is and how it functions. When disparate ideas of community exist, they can affect the implementation of PHC programs, leading to low rates of acceptance, participation, and utilization. Using two examples, a community clinic in El Alto, Bolivia, and a CHW program in Rio Branco, Brazil, this article discusses some of the problems that arise when local definitions of community do not correspond to programmatic definitions.

Bolivia↗
PubMed1999

The impact of Medicaid managed care on community clinics in Sacramento County, California.

OBJECTIVES: The purpose of this study was to determine the impact of countywide Medicaid managed care on service use at community clinics. METHODS: Clinic use before and after introduction of Medicaid plans in one county was compared with that in a group of comparable counties without such plans. RESULTS: There were significant declines of 40% to 45% in the volumes of Medicaid clients, encounters, and revenues at clinics with the introduction of Medicaid plans. Declines of 23% in uninsured clients and encounters did not differ significantly. CONCLUSIONS: The introduction of Medicaid managed care with multiple commercial plans can have significant negative effects on nonprofit community clinics.

Analysis of Variance↗
PubMed2005

Is a computer questionnaire of childhood asthma acceptable in general practice?

OBJECTIVES: To determine whether a previously-validated touch screen computer program of symptoms and management of childhood asthma is acceptable to parents who accompany their children to consult a GP, and to examine whether any parent characteristics are associated with acceptability. METHODS: Conducted in general practice in Newcastle, NSW, Australia. A cross sectional pen and paper survey was given to parents of children consulting a GP after completing the computer questionnaire on childhood asthma in the waiting room. Measurements were frequencies of Likert scale responses to statements concerning the computer questionnaire, compared with demographic and personal characteristics. RESULTS: High levels of acceptability of the asthma computer questionnaire were reported by the 198 respondents, with most being willing to do the same program once or twice a year (87%), or to do similar programs on other topics (91%). Most respondents (81%) agreed that the computer program was enjoyable, and very few (8%) would have preferred to answer the asthma questions by pen and paper rather than by computer. Two or more children accompanying the parent was the characteristic most associated with less positive responses. CONCLUSIONS: Overall the high acceptability of this questionnaire suggests that this computerised format is an appropriate method of screening children for asthma and determining their current management. As a large component of underdiagnosis of asthma is lack of reporting to the doctor, this valid and acceptable diagnostic aid has the potential to improve detection of unreported asthma, and also to identify high-risk individuals.

Adolescent↗