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PubMed1997

[The Stimulation Program Health Research. X. Evaluation of the program section 'Psychogeriatrics'].

In the programme section 'Psychogeriatrics' of the SGO Health Research Promotion Programme a longitudinal study was carried out in Amsterdam from 1989 until 1994, concerning the course of mild cognitive decline in elderly people (the AMSTEL project). The scientific aims were the development of diagnostical instruments for the early diagnosis of dementia, the development of criteria which predict the course of mild cognitive impairment and the expansion of knowledge on the relationship between somatic and psychiatric pathology and dementia. The programme also had aims regarding medical education and patient care. The results include the following: in order to diagnose dementia in general practice questions regarding orientation and short-term memory are helpful. Risk factors for cognitive deterioration in elderly people include hippocampal atrophy on the MRI scan, a low level of education and subjective complaints regarding memory. Subjective complaints regarding memory are not primarily caused by a depressive mood, as is often thought, but are important as correct self-observations of cognitive deterioration, and go with an increased risk of developing dementia. Besides the AMSTEL project a feasibility study was carried out concerning a psychogeriatric case register in Amsterdam.

Aged↗
PubMed1998

[R. N. Braun diagnostic programs: what prevents the general practitioner from using them? Results of a 1-year-study of indications, acceptance and failure to apply diagnostic programs].

In General Practice, a global measure for quality control has not yet been established. Procedures in this field of health care are usually not evidence based but rely on personal experience. In 1976, the "Diagnostic Protocols" (DP) had been introduced by Robert N. Braun to cover the most frequent and most important uncharacteristic complaints presented to the General Practitioner by the patient. In this study, the authors are showing how often the usage of DP may be useful in the management of cases in General Practice. Additionally, reasons are demonstrated that may lead the Family Physician not to apply DP in certain cases. In 2,084 new cases presented to a General Practitioner within one year (1-12/1994), 19 of 82 existing protocols were used. In every sixth new case (16%), the patient's history and physical examination were analyzed with the help of Diagnostic Protocols. However, their usage would have been beneficial in one of four cases (24.6%). Reasons for declining DP included "No need for further diagnostic investigation" and "Other diagnostic strategy chosen". Shortness of time only played a minor role.

Attitude of Health Personnel↗
PubMed1998

[The role of the medical corps in a mass screening program for cervical cancer. The program "Female Health Action in 3 urban districts of Lyons].

A pilot study of cervical cancer screening has been initiated in three districts of Lyons suburbs. This campaign aims to increase women participation, specially for high risk groups, helped by an intensive collaboration of general practitioners and gynecologists. Despite several campaign of information, a low rate of participation (13%) was noted. A survey has been performed on the medical population, notably for their participation, eventual changes, encountered problems and perception of such a screening. At time of survey, only half of the general practitioners and 75% of gynecologist still participated. Complexity of administrative procedures, involvement in an epidemiologic survey, lack of time or non-gynecological practice were important obstacles. Volunteer practitioners, enhanced value of public health and university formation of doctors could be necessary in the future for such mass screening.

Adult↗
PubMed2000

State scholarship, loan forgiveness, and related programs: the unheralded safety net.

CONTEXT: In the mid-1980s, states expanded their initiatives of scholarships, loan repayment programs, and similar incentives to recruit primary care practitioners into underserved areas. With no national coordination or mandate to publicize these efforts, little is known about these state programs and their recent growth. OBJECTIVES: To identify and describe state programs that provide financial support to physicians and midlevel practitioners in exchange for a period of service in underserved areas, and to begin to assess the magnitude of the contributions of these programs to the US health care safety net. DESIGN: Cross-sectional, descriptive study of data collected by telephone, mail questionnaires, and through other available documents, (eg, program brochures, Web sites). SETTING AND PARTICIPANTS: All state programs operating in 1996 that provided financial support in exchange for service in defined underserved areas to student, resident, and practicing physicians; nurse practitioners; physician assistants; and nurse midwives. We excluded local community initiatives and programs that received federal support, including that from the National Health Service Corps. MAIN OUTCOME MEASURES: Number and types of state support-for-service programs in 1996; trends in program types and numbers since 1990; distribution of programs across states; numbers of participating physicians and other practitioners in 1996; numbers in state programs relative to federal programs; and basic features of state programs. RESULTS: In 1996, there were 82 eligible programs operating in 41 states, including 29 loan repayment programs, 29 scholarship programs, 11 loan programs, 8 direct financial incentive programs, and 5 resident support programs. Programs more than doubled in number between 1990 (n = 39) and 1996 (n = 82). In 1996, an estimated 1306 physicians and 370 midlevel practitioners were serving obligations to these state programs, a number comparable with those in federal programs. Common features of state programs were a mission to influence the distribution of the health care workforce within their states' borders, an emphasis on primary care, and reliance on annual state appropriations and other public funding mechanisms. CONCLUSIONS: In 1996, states fielded an obligated primary care workforce comparable in size to the better-known federal programs. These state programs constitute a major portion of the US health care safety net, and their activities should be monitored, coordinated, and evaluated. State programs should not be omitted from listings of safety-net initiatives or overlooked in future plans to further improve health care access. JAMA. 2000;284:2084-2092.

Cross-Sectional Studies↗
PubMedDate not supplied

Tri-State Regional Pulmonary Rehabilitation Survey. Program characteristics and practices.

PURPOSE: This report summarizes the pulmonary rehabilitation characteristics found in the 1991 survey of programs in the Pennsylvania, New Jersey, and Delaware region. METHODS: A listing of 111 potential Tri-state regional programs with pulmonary rehabilitation was compiled. A 34-item questionnaire was developed. Using multiple mailings and phone-call follow-up, 59 programs of 100 the active programs in the region returned the questionnaires. Programs that were providing services to patients with pulmonary disease were compared to those focusing on patients with cardiac and/or pulmonary disease. RESULTS: A third of all programs (31%) used combined cardiopulmonary services. Pulmonary-only programs averaged 1.7 hours per day, and cardiopulmonary programs averaged 1.1 hours per day (P < .01). Both types of programs averaged 2.4 days per week. Average duration of pulmonary-only programs was 8.7 weeks, and duration of cardiopulmonary programs was 10.6 weeks (P < .05). Most programs (85%) required referral from the patients' primary physician. Many programs (64%) reported that local physicians other than the program's medical director referred a majority of the patients. Almost all programs (92%) performed exercise testing before initiating pulmonary rehabilitation. Post-rehabilitation discharge planning seemed to be based in many programs on performance measures taken during the final rehabilitation sessions or from a final 6- or 12-minute walk. Educational sessions were provided by 95% of the programs. Maintenance sessions were not offered by 39% of the programs. Seventy-three percent of the pulmonary-only programs and 44% of the cardiopulmonary programs offered support groups (P < .05). The pulmonary-only program coordinator's specialty was mostly respiratory therapy (70%), whereas in cardiopulmonary programs, coordinators tended to be nurses (39%) or from other nonrespiratory specialties (28%). No respiratory staff were used by 38% of the cardiopulmonary programs. CONCLUSIONS: The type of rehabilitation program, either pulmonary-only or cardiopulmonary, appears to influence many program characteristics (e.g., hours per day, weeks in duration, coordinator's specialty, and staffing).

Analysis of Variance↗