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At least 1,603 records · Page 89Linked to original sources
PubMed1995

Multicenter study of case finding in elderly emergency department patients.

OBJECTIVES: To assess the feasibility of a brief comprehensive case-finding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have. METHODS: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case-finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17-item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one-month follow-up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed. RESULTS: Patient acceptance of the case-finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow-up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 +/- 10.2 minutes was required to complete the screen. CONCLUSIONS: A brief comprehensive case-finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.

Activities of Daily Living↗
PubMedDate not supplied

Risk-rated health insurance programs: a review of designs and important issues.

PURPOSE OF THE REVIEW. The purpose of this review is to assist those who work in the field of health promotion when considering the implementation of an individually risk-rated health insurance plan. It does so by introducing the reader to the concept of individually risk-rating health insurance; uncritically reviewing selected risk-rated health insurance plans; and exploring several issues related to plan implementation, administration, and appropriateness. SEARCH METHODS USED. The review is based on the authors' awareness of the literature in the fields of preventive medicine, health promotion, and employee benefits. The six individually risk-rated health insurance programs that are reviewed were chosen because they demonstrate how aspects of the National Association of Insurance Commissioners' Model have been implemented using various combinations of administrative procedures, verification strategies, and types of economic incentives or disincentives. This review is not intended to be a comprehensive review of the literature. SUMMARY OF IMPORTANT FINDINGS. Individually risk-rated health insurance programs have been established using a variety of administrative procedures, verification strategies, and types of economic incentives or disincentives. The frequency with which these programs are being established is increasing. As the number of risk-rated programs grows, it will be increasingly important to address the many issues that implementing such plans generate: How should lifestyle behaviors be verified? Will healthy lifestyles save money? Can employees fully control their risk factors? Is risk-rating socially responsible? MAJOR CONCLUSIONS. As risk-rating becomes more widespread, there will be a continuing need to address the business, medical, ethical, and legal issues these programs create and to refine them accordingly. The health promotion community has both an opportunity and obligation to see to it that individually risk-rated health insurance programs are implemented in a socially acceptable manner and that the outcomes they generate are cost-beneficial.

Employee Incentive Plans↗
PubMed1995

Insecticide-impregnated bed nets for malaria control: varying experiences from Ecuador, Colombia, and Peru concerning acceptability and effectiveness.

Between 1991 and 1994, an intervention program with permethrin- and lambdacyhalothrin-impregnated bed nets was carried out over a period of nine months in each of five endemic, malarious areas of Ecuador, Peru, and Colombia. This program was evaluated through household surveys, blood sampling, in-depth longitudinal studies, and entomologic analysis. Eighty-four communities (including approximately 35,000 individuals) were paired according to malaria incidence, size, and coverage with bed nets and then randomly allocated to intervention and control groups. The results showed that peoples' acceptance of the measure was related to their perception of an immediate protective effect against insects. The effectiveness of the bed nets, measured as a reduction of malaria incidence in intervention communities as against control communities, showed large variations between and within the study areas. The protective efficacy varied between 0% and 70% when looking only at the postintervention differences between intervention and control groups. The average protection was 40.8% when considering a four-month incidence of clinical malaria attacks and 28.3% when considering a two-week malaria incidence. Important factors for the success of the bed net program were insect susceptibility to pyrethroids, high coverage with impregnated bed nets, high malaria incidence, good community participation, high mosquito densities when people go to bed, and a high proportion of Plasmodium falciparum. In one area, where DDT spraying in the control communities was executed, the effectiveness of bed net impregnation was slightly better than that of spraying.

Adolescent↗
PubMed2002

Patient characteristics determine differences in the influenza vaccination rate more so than practice features.

BACKGROUND: World-wide each year 30-55% of the target population is vaccinated against influenza. Determinants of successful vaccination programs are not clear. This study was aimed at identifying practice- and patient-related factors that determine differences in vaccination rates. METHODS: Data on patients of the target population were extracted from the computerized medical record systems of 48 family practices. Information about organizational factors was collected by a questionnaire for GP's. Multilevel logistic regression analyses were used to assess the determinants. RESULTS: Of all patients at risk (42,426), 76% were vaccinated. The vaccination rate for patients above age 65 was 15% higher when a medical indication was present. Patients with cardiac diseases or diabetes mellitus attained a relatively higher vaccination rate than other groups at risk. Special hours for vaccination led to significantly higher vaccination rates for the elderly and cardiac patients. Patients below 65 years of age were particularly influenced by special information pamphlets. CONCLUSION: Explanations of differences in uptake rates were found at the patient level. All practices in this study were well organized; nevertheless, subgroup analyses showed that special vaccination hours for elderly people and information pamphlets for young people could improve results further.

Adolescent↗
PubMedDate not supplied

Pediatric dentists' participation in the California Medicaid program.

PURPOSE: The purpose of this study was to determine pediatric dentists' participation in the California Medicaid program and investigate barriers to participation. METHODS: A 24-question mail-in survey with a follow-up was sent to all pediatric dentists in California with questions including demographics, Medicaid participation, and barriers to participation. Data were analyzed using descriptive statistics, chi-square tests, bivariate analysis, and multivariate logistic regression. RESULTS: Pediatric dentists returned 364 useable mail-in surveys for a response rate of 70%. Forty-five percent participated in the Medicaid program, one third of which would accept all patients and two thirds of which placed some restriction on their participation. Twenty-five percent of respondents had at least 10% Medicaid patients in their practice, and 25% accepted 6 or more new Medicaid patients per month. Dentists in rural areas were significantly more likely than those in urban or suburban areas to accept a new Medicaid patient (P < .05). Eighty-nine percent of all respondents reported low fees and 82% reported broken appointments as important reasons for not participating or limiting participation. CONCLUSIONS: Participation of California pediatric dentists in Medicaid is low compared to other states that have participation studies. Pediatric dentists in rural areas are most likely to participate. Among the reasons that contribute to California dentists not participating in the Medicaid program, the major ones appear to be low fees, broken appointments, and denial of payment.

Adult↗
PubMed1983

Occupationally-sponsored, community-provided hypertension control.

A hypertension control program established by the Massachusetts Mutual Life Insurance Company in 1977 included education, on-site case finding, and referral to community physicians with a company-based follow-up system facilitated by assumption of all costs by the company. Ninety-eight percent (2, 463) of the employees were screened; 11% (277) had hypertension. Of these, 59% were in treatment and 36% were controlled at entry. More than 84% of the hypertensives accepted referral to care and 79% fulfilled all program requirements. By the fifth program years, 70% had achieved blood pressure control. Mean blood pressure declined from 150/93 to 142/88 mm Hg. Absenteeism for all hypertensives averaged 4.7 in the three years before and 5.7 during the four years of the program. Employees active in the program had fewer average days of absenteeism (4.7) than inactive participants (6.8). Modest cost and a favorable employee/physician response has made this a highly acceptable as well as an effective company health program.

Absenteeism↗
PubMed1999

WVU--community partnership that provides science and math enrichment for underrepresented high school students.

In response to the need to help West Virginia secondary school students overcome educational and economic barriers and to increase the number of health professionals in the state, the Health Sciences and Technology Academy (hereafter, "the Academy") was established in 1994. The Academy is a partnership between West Virginia University (WVU)--including the Robert C. Byrd Health Sciences Center, Eberly College of Arts and Sciences, and the College of Human Resources and Education--and members of the community, including secondary-school teachers, health care professionals, and other community leaders. The Academy targets students from underrepresented groups (mainly African Americans and financially disadvantaged whites) in grades nine through 12. By November 1997, 290 students (69% girls and 33% African American) from 17 counties were Academy participants. Funding is from the W. K. Kellogg Foundation, Howard Hughes Medical Institute, the National Institutes of Health, the Coca-Cola Foundation, and other sources. Academy programs are an on-campus summer institute and community-based clubs, where students engage in activities for science and math enrichment, leadership development, and health careers awareness. In the Academy's clubs, students carry out extended investigations of problems related to human health and local communities. Most students report that the Academy has increased their interest in health care careers, and almost all who have continued to participate in Academy programs through their senior year have been accepted into college.

Adolescent↗
PubMed1990

Training residents in clinical teaching skills: a resident-managed program.

A resident-managed program to improve teaching skills and examine residents' perceptions of teaching was conducted for internal medicine residents at Maine Medical Center. A modification of the Fewett (1982) teaching model was applied as an adjunct to an ongoing resident teaching program. Twenty-six of 29 residents voluntarily participated in a series of workshops over a 6 month period. A low attrition rate and high level of acceptance of the format were observed. Teaching programs are manageable by a senior resident and can be of potential benefit.

Clinical Competence↗
PubMed1993

Continuing medical education for AIDS: an organizational response.

The Management of the Southern California Kaiser-Permanente Medical Group mandated a day-long program of continuing medical education on AIDS for all staff physicians at one facility. Presentations dealt with cognitive (transmission/diagnosis), skills (risk factors, history taking), and affective (discomfort/attitudes) domains. All physicians participated in 2 small-group workshops on sexual history taking and ethical issues. An evaluation compared primary care physicians' attitudes and practices before and after the program at the experimental site (Medical Center), a comparison site (written materials only), and a "no-treatment" facility. A sample of new patients (N = 2,689) seen by study physicians (N = 253) before and after the educational intervention were telephoned to determine if sexual history questions were asked by their physicians. There was a significant increase in the frequency of sexual history questions asked by internists at the experimental site. Over 95% of all patients were accepting of sexual history questions. This program has since been repeated at 11 medical centers involving over 3,500 Kaiser-Permanente physicians throughout Southern California.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Controlled trial of a Preterm Labor Detection program: efficacy and costs.

Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.

Clinical Trials as Topic↗
PubMed2006

Promising strategies for obesity prevention and treatment within American Indian communities.

In the United States, obesity prevention and treatment programs are dominated by individual-focused strategies. Yet epidemic proportions of obesity and high failure and dropout rates of conventional efforts prompt consideration of alternate approaches. A nonsystematic review of American Indian (AI) health promotion programs highlights a group-focused approach using three primary and two supportive strategies. These strategies are outlined as: (a) build and reinforce social cohesion and collective efficacy, (b) use the motivating force of friendly competition, and (c) aspire to change local norms and policies through assuring high visibility of alternate behaviors and engaging formal and informal leaders. Although evidence to demonstrate the impact of these efforts is limited and not currently available to public health audiences, AI communities' sustained acceptance and continued involvement in the programs suggest that these strategies are worthy of review and consideration by public health practitioners addressing obesity on a national level.

Group Processes↗
PubMedDate not supplied

A total heart/lung bypass simulator.

The often overlooked role of device design is the need to teach the optimal use of the device. A mathematical model was used in the development of the Sarns/3M SMO oxygenator, as presented at the 1985 ASAIO meeting. This model accepts inlet saturation, hemoglobin levels, and other variables, and returns output saturation, and has been verified in over 100 clinical cases. A patient oxygen consumption model including oxygen stores was developed, using clinical data based on size, temperature, and a term called "anesthesia level." This interesting factor accounts for differences between institutions. The two models were integrated with a heat exchanger model and a patient temperature model to allow accurate predictions of cooling and heating, and a hemoconcentrator model. The combination was programmed for IBM compatible computers to create a bypass simulator. A potential user can put a patient on bypass starting with any selected patient variables, track progress on a minute by minute basis, and adjust the circuit variables as dictated by his technique. The program runs in accelerated time, and accepts defaults to continue without changes as long as desired. Such a simulator is valuable for the initial introduction of the new device to experienced perfusionists, the training of potential new perfusionists, study of unusual or complex cases, the design of new devices, and even as a "track along" system during an actual clinical case.

Blood Flow Velocity↗
PubMed1998

Care process and satisfaction analysis of a transmural home care program.

This study investigated both professional caregiver workload as well as the patients' and caregivers' satisfaction with a transmural home care program. Seventy-nine patients were included in the intervention program. The specialist nurse coordinator, general practitioner, community nurse providing 'intensive' community care, community nurses providing 'standard' community care, and the home helper spent in total an average of 7.5, 4.4, 55.6, 55.0, and 112.3 h, respectively, on each patient during the care process (mean survival of the 79 patients was 101.2 days). The 24 h telephone service and transmural home team were contacted in total 100 and 8 times, respectively. Patient and caregiver satisfaction with the care provided scored (very) high. Considering this acceptable workload and given that the program did not interfere with existing standard health care structures, it can be concluded that such care may easily be introduced by other hospitals and related primary care teams.

Attitude of Health Personnel↗
PubMed2006

Acceptance of Web-based personalized feedback: user ratings of an alcohol misuse prevention program targeting U.S. Marines.

The use of Web-based programs for a variety of health education, risk reduction, and health promotion purposes can be a valuable tool in the effort to improve the health of a population. Providing theory-based personalized feedback through such a method can be particularly useful in alcohol misuse prevention efforts. A brief alcohol use feedback program was developed for members of the U.S. Marine Corps, and user-satisfaction ratings were collected from 167 participants. Approximately 44% of the sample found the program to be useful or very useful, and 46% of the sample reported that they were likely or very likely to recommend the Web site to others. The Web-based format with tailored responses was preferred by 85% of respondents over other more traditional methods of alcohol training, and 80% of participants felt that the feedback was appropriate for Marines in their community. Significantly higher usefulness, likelihood of recommending the program to others, and overall ratings of the program were reported among younger and nonheavy-drinking participants (p < .05). Results indicate that this computerized assessment and feedback program is a promising mechanism with which to provide personalized alcohol misuse prevention information.

Adult↗
PubMed2001

The place of guidelines and their means of dissemination.

INTRODUCTION: The literature shows that physicians do not change their patterns of practice quickly. With thousands of conflicting guidelines available, many disseminated by print, there has been little measurable impact of new guidelines on physician prescribing patterns. METHODS: A series of interventions designed to improve physician uptake of guidelines is described. Interventions evaluated in a series of trials include mail dissemination, small group continuing medical education sessions, academic detailing by both academic detailers and pharmaceutical detailers, and a whole community program known as the Program for Appropriate Anti-Infective Community Therapy. RESULTS: Only the whole community intervention had significant impact on physician prescribing patterns. The changes involved a significant reduction in anti-infective use and a significant change from the use of second- and third-line drugs to first-line drugs, as specified in the Ontario Anti-Infective Guidelines. CONCLUSIONS: Acceptable guidelines disseminated by a multidisciplinary community program can have a positive impact on physician prescribing patterns. To increase the acceptability of guidelines for whole community dissemination, a new innovation (Guideline Advisory Committee) that scores the quality of guidelines and selects the most objectively produced guideline is described.

Attitude of Health Personnel↗
PubMed1978

An addiction treatment program in Laos: the first year's experience.

In late 1972 a treatment program for narcotic addicts was begun in Vientiane, Laos. Medical and social treatment modalities were emphasized: withdrawal from narcotic drugs, care for chronic health problems, a highly structured milieu program with explicit rules, and careful discharge planning with family counseling. Patients were accepted on a voluntary basis only. The first year's patient population were mostly married, employed, addicted to opium, and from rural areas. They comprised a diversity of ethnic groups. A smaller group of young, single, male heroin addicts (a type of addict new to Laos) also appeared in this group of patients. This treatment program proved highly acceptable to a large number of addicted people from various age groups and ethnic backgrounds. It was successfully undertaken by medical personnel who had minimal or no experience in the addiction field prior to work at this facility. Among opium addicts, twice-a-day methadone dosage for withdrawal treatment was superior to once-a-day dosage. Opium addicts required a longer detoxification regimen than did heroin addicts.

Adult↗