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PubMedDate not supplied

Managed care and women's health: access, preventive services, and satisfaction.

This paper examines insured women's access to health care, receipt of preventive services, and satisfaction with care by the types of health plans in which they are enrolled. Three types of plans are compared: managed care (HMOs and PPOs), fee-for-service with utilization controls, and traditional fee-for-service. For women who have been enrolled in their plans for at least one year, we find the same or better access to care in managed care plans as compared with other plans; receipt of more gender-specific clinical preventive services in managed care plans, but no differences among types of plans for non-gender-specific preventive services or counseling services; and lower satisfaction with care in managed care plans. The implications for practice and policy are discussed.

Adult↗
PubMed1999

[Family health services and preventive strategies].

Health promotion is effective if it is based on the active offer of preventive measures to the target population. The active offer must be sustained by non standardised communication procedures, with the aim of producing empowerment of involved people. People, who are socially deprived and therefore at high risk, are hard to reach. They need special attention and resources. Prevention services and, in particular, those devoted to women, children and adolescents must be sufficiently diffused among the population. They must change from being dependent on demand to being based on active offer of preventive measures.

Adolescent↗
PubMed2000

Receipt of preventive health care services by lesbians.

BACKGROUND: We measured receipt of age-appropriate preventive health services by lesbians and assessed whether provider and individual characteristics, including disclosure of sexual orientation, are independently associated with receipt of these services. METHODS: A questionnaire was printed in a national biweekly gay, lesbian, and bisexual news magazine, and self-identified lesbians living in all U. S. states (N =6935) responded to the survey. Main outcome variables were receipt of a Pap smear within the preceding 1 and 2 years and, for women aged > or= 50, receipt of a mammogram within the past 1 and 2 years. RESULTS: Fifty-four percent had Pap smears within 1 year and 71% within 2 years, with increasing rates among older and more educated respondents. Seventy percent of respondents aged > or = 50 had a mammogram in the past year, and 83% within 2 years; rates did not vary significantly controlling for education. Sixty percent had disclosed their sexual orientation to their regular health care provider. Controlling for patient and provider characteristics, disclosure was independently associated with receipt of Pap smears, but not mammograms. CONCLUSIONS: It is important for providers to identify their lesbian patients' unmet needs for preventive health care. Additionally, it is important for providers to provide complete and appropriate preventive health care for their lesbian patients. Further research is needed to determine why lesbians are not receiving Pap smears at the recommended rate and whether this disparity is reflective of aspects of cervical cancer screening or indicates a more general problem with access to health care including receipt of preventive services.

Adolescent↗
PubMed1993

The relationship between dental utilization and preventive participation among a well-elderly sample.

Previous studies have shown that dental utilization by older people is lower than for the general population. This study hypothesizes that an elder's tendency toward participating in preventive health activities may be an important factor in explaining the likelihood of accessing the dentist. Subjects included 1,911 older individuals who enrolled in the UCLA Medicare Screening and Health Promotion Trial. All were interviewed about their utilization of preventive health services and participation in preventive behaviors. A recent dental visit was positively associated with all sociodemographic variables examined except age and sex. It was also related to health status questions and utilization of the preventive health services and health behaviors studied. Logistic regression analysis showed that both summary preventive health behavior and preventive service utilization variables were important factors in explaining a recent dental visit (model chi-square = 221.4, P = .001) along with income, not having a removable prosthesis, and perceiving the need for dental care. This study showed that dental utilization is related to older people's participation in other preventive activities. When in contact with older people, health care professionals should consider current oral and general preventive health status and encourage appropriate referral for preventive activities.

Age Factors↗
PubMed1989

[Possibilities and limits of preventive sports medicine examination by the Essen public health service].

Prevention is mainly based on combatting the well-known risk factors, one of them being insufficient movement and mobility exercise, by no means an unimportant factor. The knowledge that regular sports activities are important and relevant, is steadily growing, but it also entails uncertainties. Persons who have been inactive for years do not know what they can cope with and which kind of sports would be most appropriate. The Public Health Office in Essen offers a detailed medical examination by a sports physician coupled with counselling on further training for all who are interested in sports activities.

Adolescent↗
PubMed1995

The health services of Sri Lanka present and future.

1) Sri Lanka has achieved a high human development status; 2) The health sector, and particularly the government health sector, has played an important role in this achievement. 3) The health transition is going to increase the burden of disease and the demand for health services; 4) The government health services have been underfunded and the provincial health services have been more underfunded; 5) The most cost efficient health services, anywhere in the world, are government funded; 6) Therefore, it is our duty to lobby government to increase government funding for health services; 7) The preventive health service should continue to be funded fully by government. Prevention of non-communicable diseases should come within this orbit. Staff in preventive health services should be better remunerated; 8) The essential clinical package in the periphery must be improved to reduce by-passing and underutilization; 9) Management of tertiary health care facilities have to be strengthened. They should be given responsibility and autonomy; 10) A powerful unit should be established in the Ministry to study and implement cost recovery and cost containment in tertiary care institutions; 11) Senior doctors should take an active part in the management of the tertiary care institutions to make them more efficient. 12) Private hospitals should be supervised by the Ministry in order to ensure quality of care and to contain national health care costs:

Delivery of Health Care↗
PubMed1999

[Alcohol abuse prevention in health care services: screening methods and motivational counseling].

Health service prevention of alcohol problems is based on screening and primarily involves motivational counselling. Screening may take the form of routine enquiries about drinking habits. Motivational counselling consists in two parts, assessment of readiness to change, and counselling adapted to the readiness to change. Alcohol problems do not generally require intervention by a specialist, but rather by an observer who suggests a change. Doctors and health care authorities alike should pursue the prevention of alcohol problems by such methods as a matter of policy, as this is a demonstrably effective approach which would enable both the need and costs of health care to be reduced.

Alcohol Drinking↗
PubMedDate not supplied

Longitudinal effects of preventive services on health behaviors among an elderly cohort.

This study examines the longitudinal (48 months) effects of a preventive services intervention trial with Medicare beneficiaries. The health promotion intervention incorporated a series of workshops and targeted individualized counseling dealing primarily with nutrition and exercise. All subjects completed a health risk appraisal (HRA) questionnaire, which served as a dependent measure. Results show significant, positive changes in intervention subjects in two activity outcomes, aerobic activity and stretching exercises. Although previous research on this cohort found significant positive changes in nutrition behaviors at 12-month follow-up, these differences were not sustained over the three-year follow-up period. The results offer encouragement that continued research on health promotion will eventually produce protocols for select activities that will improve the status of seniors' health.

Aged↗
PubMed2006

[Opinion: prevention and health services research from the point of view of the German Forum on Disease Prevention and Health Promotion].

The article presents the point of view of the German Forum on Disease Prevention and Health Promotion that health promotion and prevention and health care research are not only similar as to their self-concept, structure and future tasks, but that health promotion and prevention need the systematic support of health care research to improve its policy impact. Furthermore, the article informs about the latest developments and the current state of disease prevention in Germany, presents a survey of the structure and work of the German Forum on Disease Prevention and Health Promotion and lists desirable topics for future studies in the field of health services research.

Biomedical Research↗
PubMed2006

Surveillance for certain health behaviors among states and selected local areas--behavioral risk factor surveillance system, United States, 2004.

PROBLEM: Continuous monitoring of behaviors that increase the risk for chronic diseases and use of preventive practices are essential for the development, implementation, and evaluation of health promotion programs and policies, and other intervention strategies to prevent morbidity and mortality. Data from states/territories, selected metropolitan and micropolitan statistical areas (MMSAs), and counties provide the impetus for policymakers and other stakeholders to develop and promote the improvement of their community's overall health status. REPORTING PERIOD COVERED: Data in this report were collected during January 1-December 31, 2004, from states/territories, MMSAs, and counties that participated in the 2004 Behavioral Risk Factor Surveillance System (BRFSS). DESCRIPTION OF THE SYSTEM: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey that employs a multistage cluster design. BRFSS collects information on health risk behaviors and preventive health practices related to the leading causes of death from the U.S. civilian, noninstitutionalized population aged > or =18 years. During 2004, a total of 49 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands participated in BRFSS. Among these states and territories, completed surveys were collected from a selection of 134 MMSAs and 199 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of specific medical conditions, screening for certain cancers, and use of preventive health services varied substantially by state/territory, MMSA, and county. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied by state/territory, MMSA, and county. In 2004, HP 2010 objectives for 100% health-care coverage and vaccination for pneumonia and influenza among persons aged > or =65 years were not achieved by any state/territory, MMSA, or county. Twelve states/territories, 47 MMSAs, and 74 counties achieved the HP 2010 objective of < or =20% of adults engaged in no leisure-time physical activity or exercise. The HP 2010 objective to reduce the proportion of adults who currently smoke cigarettes to < or =12% was achieved by two states/territories, four MMSAs, and six counties. One MMSA and one county achieved the HP 2010 target of < or =6% who engage in binge drinking during the month preceding the survey. The HP 2010 target of < or =15% of adults who are obese was obtained by one MMSA and eight counties. The HP 2010 objective to reduce the proportion to <20% for older adults who have had all of their natural teeth extracted was achieved by 23 states/territories, 51 MMSAs, and 45 counties. The HP 2010 target for adults aged > or =50 years who have ever received a sigmoidoscopy is 50%. BRFSS measured both sigmoidoscopy and colonoscopy. Using this measure, 38 states, 110 MMSAs, and 154 counties achieved the 50% goal. Four counties achieved the HP 2010 objective of 50% for adults who received a blood stool test within the previous 2 years. The HP 2010 objective to increase the proportion of women aged > or =18 years who had a Papanicolaou (Pap) test within the preceding 3 years is 90%. Twenty-four MMSAs and 49 counties achieved this objective. The HP 2010 objective for women aged > or =40 years who have received a mammogram within the preceding 2 years is 70%. Thirty-nine states, 112 MMSAs, and 168 counties achieved the objective. This report includes several risk behaviors and conditions that, although not included in HP 2010 goals, are important public health problems. These include self-reported fair-to-poor health status, heavy alcohol consumption, asthma, diabetes, and prostate cancer screening. The 2004 BRFSS data indicate great variability in the prevalence of self-reported fair-to-poor health status (5.7%-34.8%) and use of prostate cancer screening (34.7%-65.2%) by states/territories, MMSAs, and counties. Among these areas, the prevalence of current asthma ranged from 4.1% to 12.4%, and the prevalence of diabetes ranged from 3.2% to 12.5%. INTERPRETATION: The findings in this report indicate variations in health risk behaviors and use of preventive health screenings and health services among adults at the state, local, and county levels. These variations substantiate the continued need for public health surveillance in designing, implementing, monitoring, and evaluating public health policies and health-care use programs to reduce morbidity and mortality from the effect of high-risk health behaviors and subsequent chronic disease outcomes. PUBLIC HEALTH ACTION: Data from BRFSS are essential for monitoring prevalence of high-risk health behaviors, specific diseases, and use of preventive health services; dictating the design, focus, implementation, and evaluation of prevention health programs and strategies; and monitoring progress toward obtaining local, state, and national health objectives. Data from the 2004 BRFSS indicate a continual necessity to initiate and implement health promotion strategies for identifying specific health risk behaviors and practices and for assessing progress toward achieving disease prevention and health promotion objectives at state and local levels throughout the United States.

Behavioral Risk Factor Surveillance System↗