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PubMed1988

Information management through integration of distributed resources.

Duke University Medical Center conducted a strategic planning process focused on information management needs beginning in 1983 and ending in 1985. That effort concluded that the institution was ready to establish an Integrated Academic Information Management System (IAIMS). A model was proposed in which information management was to be achieved through integrated distributed resources. The elements of the IAIMS model are ongoing policy development and planning; communications; an electronic library or resource inventory; coordination of the development or selection of the end-user function; user support; and ongoing evaluation. This model is being tested to determine its effectiveness in meeting the administrative, patient care, research, and educational needs of a basic science department and a clinical science department at Duke University.

Academic Medical Centers↗
PubMed1986

Pediatrician participation in Medicaid--findings of a five-year-follow-up study in California and elsewhere.

Medi-Cal-California's Medicaid program-underwent significant changes during the period 1978 through 1983. Most notable were the imposition of new copayments, reductions in physician reimbursement and selective contracting for hospital services. The state-funded medically indigent program was transferred to the counties and the state began to experiment with bulk purchasing of drugs and supplies, a lock-in for overutilizers and primary care case management. How have these changes affected primary care providers' participation in Medi-Cal? Surveys of California pediatricians in 1978 and 1983 suggest that while most continue to participate, the level of limited participation in Medi-Cal increased from 23% to 51%. Most pediatricians express discontent with the level of Medicaid payments and there is a growing sentiment that Medicaid regulations interfere with the provision of high quality medical care. Future Medi-Cal policy developments, such as contracting for physician services, should be structured in ways that maximize participation of primary care providers in the program.

Attitude of Health Personnel↗
PubMed1987

Determinants of VA utilization. The 1983 survey of aging veterans.

By the end of the decade, fully one half of American males aged 65 years and over will be veterans. In anticipation of the increased demand for medical services, the Veterans Administration recently commissioned a survey of the needs of aging veterans. From a national probability sample, approximately 34,500 households were screened to yield interviews with 3,013 veterans aged 55 years and over. Using multivariate regression analyses, the present study employed this data set for two purposes: 1) to identify covariates of past and present service utilization in the VA system, and 2) to identify the conditions under which veterans will declare an intention to use VA services in the future. Independent variables included medical diagnoses, ADLs, demographic and background characteristics, convenience and proximity to VA facilities, alternative forms of insurance coverage, VA eligibility, and attitudes about the quality of VA care. The results suggest markedly different predictors for current use versus likelihood of future use; however, income was related to both current and intended future utilization. The implications of these findings for policy development and utilization projections are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Adoptive pregnancy: legal and social work issues.

Medicine's recent advance in aiding reproduction, "adoptive pregnancy," is spawning a host of legal, ethical, and policy questions. Policies developed to cope with problems that have arisen in more traditional adoptions, including "the right to know" and access to genetic information, may provide a starting point for finding answers to some of the new dilemmas.

Adoption↗
PubMedDate not supplied

Determining the market for nurse practitioner services: the New Haven experience.

This study examined factors associated with the intent to use nurse practitioner (NP) services among 331 residents of the New Haven, Connecticut, urban area. Using a stratified random sample, a telephone survey was conducted to investigate the significance of selected socio-economic, attitudinal, cognitive, and health care use characteristics known to influence consumers' choices about health care providers and services. Applying marketing concepts, these findings indicated that 62% of the respondents would use NP services. Chi-square analysis and stepwise logistic regression indicated that dissatisfaction with present health care, family size, and age were the best predictors of intent to use NP services. Respondents believed that NP services were not different from physician services; they were concerned about issues of availability and cost of care. Consumers would seek NP care if it were covered by health insurance and if it cost less than physician care. Implications for designing effective marketing strategies and policy development are discussed.

Adult↗
PubMed1985

Competition and cost in graduate medical education. Should we train unsalaried residents and fellows?

In 1985, a total of 6,080 applicants to the National Resident Matching Program (Match) were unable to match with residency positions. The majority of unmatched applicants were graduates of foreign medical schools. In addition, many US and foreign medical graduate applicants did not find positions in their preferred choice of specialties. As a result, teaching hospitals are increasingly receiving offers from would-be residents who are willing to work without financial support to gain the experience and credentials required for medical licensure. Teaching hospitals that consider accepting unsalaried house staff must begin to develop policies and guidelines that ensure fair and equitable treatment of all residents and fellows and that standards of quality are not compromised.

Costs and Cost Analysis↗
PubMed1984

Controlling financial variables--changing prescribing patterns.

Techniques of formulary management, pharmacy and therapeutics committee intervention, and the use of clinical pharmacy services to change prescribing patterns and contain costs in hospital pharmacy departments are reviewed. Methods of using the formulary to contain costs include deletion of generic and therapeutic equivalents, inclusion of therapeutic categories and cost codes, and regular reviews and updates of its contents. Drug monographs for formulary evaluation prepared for the P & T committee should include a comparative review of other drugs in the therapeutic category and a cost impact statement. The P & T committee can help contain costs by developing policies for automatic stop orders and restricted drug use. Clinical pharmacy activities that can result in cost savings include physician education (focused on prescribing), target drug programs, target disease programs, pharmacist participation on TPN and i.v. therapy teams, and patient training programs for home care. A matrix for evaluating cost-containment activities is presented. By tailoring the described methods to departmental personnel resources and hospital needs, the pharmacy can be effective in controlling costs.

Drug Utilization↗
PubMed1984

Combined services of a community hospital and clinic to provide antineoplastic drugs for outpatients.

An outpatient antineoplastic drug service that uses the services of a community hospital and clinic is described. The hospital pharmacy department assumed responsibility for preparing doses of antineoplastic drugs for use in a local medical clinic; previously, clinic nursing staff prepared the doses on a countertop. To provide this service, the hospital purchased a vertical laminar-flow safety cabinet, developed policies and procedures, and devised standard dilution protocols. The pharmacy maintains patient profiles for all outpatients. Each physician order is telephoned to the pharmacy from the clinic followed by delivery of the written order to the pharmacy via a courier service. After review of the written order by a pharmacist, the courier delivers the medication to the clinic. Since beginning the service December 1982, the pharmacy has prepared an average of three doses of antineoplastic drugs per day; about one hour of pharmacist time per day is devoted exclusively to this service. Revenue from the service has covered start-up costs and has generated profit. By using the combined resources of health professionals in the community, quality care is provided to outpatients receiving cancer chemotherapy.

Antineoplastic Agents↗
PubMed1983

Pharmacist liability for suicide by drug overdose.

Conditions that affect pharmacist liability for suicide by drug overdose are discussed. Traditionally, courts have refused to find liability on the part of a pharmacist who negligently dispenses medication to a patient who then commits suicide with the medication. The rationale has been that the act of suicide is not reasonably foreseeable to the pharmacist, and therefore it is an independent intervening act that breaks the chain of causation between the pharmacist's negligent act and the death of the patient. This legal precedent was followed in a recent case involving hospital pharmacists in Dallas, Texas. Analysis of the facts in the Dallas case shows that the pharmacists could reasonably have foreseen the patient's suicide, and the court's reliance on precedent might have been misplaced. This case and review exemplifies a pharmacolegal situation in which practitioners cannot strictly rely on reported case law to guide their actions. Pharmacies should develop policies and procedures to prevent patients from accumulating medications with which suicide can be consummated.

Humans↗
PubMed1981

Compliance with federal regulations for pharmaceutical services in skilled nursing facilities.

The extent of consultant pharmacist compliance with federal regulations for pharmaceutical services in skilled nursing facilities is reported. Twenty geriatric nursing facilities in Indiana were surveyed over a five-month period. The performance of consultant pharmacists was rated with regard to their facility and patient monitoring functions and their administrative (policy development) activities. Their facility monitoring functions and their patient monitoring functions consisted of both clinical and supervisory responsibilities. Performance was rated on a 4-point scale with a ranking of less than 75% considered unsatisfactory. Eighty percent of the pharmacists were performing their facility monitoring clinical activities at or above an 80% performance level. Ninety-five percent of the pharmacists were performing their facility monitoring supervisory functions at or above an 80% performance level. The supervisory components of patient monitoring were being performed at a mean level of 89%, in contrast to a level of 62% found for the clinical components of patient monitoring. The patient monitoring functions were being performed below the satisfactory level of 75% of the consultant pharmacists. The younger pharmacist (ages 25-28) were performing the patient monitoring clinical functions at a significantly higher level (p less than 0.01) that the pharmacists in the older age group. Seventy percent of the pharmacists were performing their administrative functions at a satisfactory level.

Consultants↗
PubMed1981

Containing cost through competition: the new wave.

The enormous increases in outlays for federal health care program beneficiaries have prompted national policy developers to look for effective means to contain health care expenditures. Past attempts to do so through Federal regulation have not worked because they were not directed at creating incentives to contain cost. In the Reagan Administration, the most talked-about alternative is a comprehensive reform of health care financing and delivery through instituting a competitive model. The plan will be discussed extensively in the 97th Congress; the outcome of that debate can have profound effects on the methods by which Americans receive and pay for health services.

Cost Control↗
PubMed1995

When is it right to die?

Advances in technology and the increased awareness and activism of health care consumers have brought a heightened focus to the ethical questions associated with end-of-life decision-making in health care. This attention is manifested in increased discussion, both in the literature and informally, of end-of-life issues; in increased numbers of advanced directives; and, recently in Canada, in the formation of the Senate Committee on Euthanasia and Assisted Suicide whose charge was to develop policy on these issues. Nurses have valuable perspectives to add to this discourse.

Advance Directives↗
PubMed1995

African American families, religion, and disability: a conceptual framework.

In recent years, there has been considerable discussion of the impact of factors such as religion and ethnicity on the adjustment of families who have a child with disabilities. The role of religion is particularly relevant for African American families because of its historic influence on basic social and cultural values of this ethnic group. In this paper we explored issues of religion, disability, and ethnicity, with emphasis on how these factors relate to adjustment for families, particularly African American families. Findings gathered from diverse literature sources are reflected in a proposed framework to guide future research and policy development.

Adaptation, Psychological↗
PubMed1995

Developing a health sciences library Gopher: more involved than meets the eye.

The purpose of this paper is to discuss the development of the Health Sciences Library Gopher at St. Louis University (SLU) Health Sciences Center. The authors will outline university criteria from the Office of Computing and Information Services, library selection criteria, bibliographical access, reference and instructional implications, data entry and maintenance, and the role of the library's Internet Committee. All libraries have been awed by the tremendous amount of resources available through the Internet; the challenge is to not be intimidated but to be innovative in designing systems that can present these resources to the library client in the most easily understandable approaches possible. The Internet Committee in the SLU Health Sciences Center Library has designed a framework for the construction of "menus" to lead the client to selected Internet resources. Some of the issues confronted include relating the Internet resources to the library's Collection Development Policy, coordination of Internet resources to other bibliographic sources (Journal Holdings List, Intelligent Catalog), and educating staff and clients to manage a wide range of new resources as well as traditional ones in electronic formats.

Computer Communication Networks↗
PubMed1995

Evolution of safety in anesthesia.

The evolution of anesthesia safety has paralleled the evolution of anesthesia over the last several hundred years. This article describes the introduction of safer practices of anesthesia and the impetus for these changes in practice that improved patient safety. It discusses both the role of technology in the advancement of safety and the policies developed by professional organizations of anesthesia care providers.

Anesthesia↗
PubMedDate not supplied

A continuing education preference survey of public health graduates.

Continuing education (CE) is a vital component in strengthening the public health work force, and its importance has been emphasized by the Institute of Medicine and the Council for Education in Public Health. A CE preference survey was undertaken of alumni of the University of California, Berkeley, School of Public Health (UCB-SPH). Questionnaires were mailed to a one-third random sample of 1,500 graduates from 1981-1992 who currently reside in U.S. Department of Health and Human Services (HHS) Region IX. A response rate of 57% was achieved. Results of the survey show that CE activities are highly desired among respondents. Overall, 58% of respondents prefer a half-day to one-day seminar format during regular business hours, as opposed to night classes. They prefer a traditional didactic classroom presentation that is within one hour's automobile travel. The optimal setting for CE courses would be at the University of California, Berkeley, or in-house at their institution. Subject areas of interest noted by respondents are health policy development, communication in public health, community involvement, and research. Schools of public health may respond to the CE needs of their alumni through a variety of channels, including the mainstreaming of CE as part of a school's teaching responsibility, special seminars or institutes, extension courses through the larger university system, distance-based learning, and through a separately funded for-profit CE activity.

Adult↗
PubMed1995

Alternative medicine and general practitioners. Opinions and behaviour.

OBJECTIVE: To describe general practitioners' opinions and behaviour regarding alternative medicine. DESIGN: Cross-sectional survey of a random sample of Ontario and Alberta general practitioners. SETTING: General practices in Ontario and Alberta. PARTICIPANTS: A questionnaire was mailed to 400 general practitioners. Of the 384 eligible physicians, 200 completed the questionnaire. MAIN OUTCOME MEASURES: Reported beliefs and practices concerning alternative medicine. RESULTS: Acupuncture, chiropractic, and hypnosis were considered most useful and reflexology, naturopathy, and homeopathy least useful. Results showed 56% of general practitioners believed that alternative medicine has ideas and methods from which conventional medicine could benefit, 54% referred to alternative practitioners, and 16% practised some form of alternative medicine. Province of practice, place of graduation, training in alternative approaches, number of alternative approaches perceived useful, and attitude toward alternative medicine were clearly related to referring to alternative practitioners. Sex, age, type of practice, training in alternative medicine, referring to alternative practitioners, number of alternative approaches perceived useful, and attitude toward alternative medicine were related to practicing alternative medicine. CONCLUSION: Although acceptance and integration of alternative medicine extend only to certain approaches, alternative medicine cannot be discounted in general practice. A study encompassing all Canadian provinces could help in planning medical education and developing policies to guide physician behaviour.

Adult↗
PubMed1995

Towards a rational cervical cytology screening strategy. Case study of a peri-urban settlement.

OBJECTIVES: To assess cervical cytology screening activity in a peri-urban settlement near Cape Town, with a view to informing rational policy development. METHOD: Total and age-specific prevalence rates of women who had been screened, relative prevalence by age group of women who had not been screened, and yield of screening were estimated from cytopathology laboratory records and available demographic data. Age-specific prevalence rates among women who had been screened were compared with age at presentation with cervical cancer at the referral hospital. Attendance for colposcopy follow-up was assessed from colposcopy clinic records. RESULTS: The number of smears taken and the prevalence of women who had been screened peaked in the 20 - 24-year age group, and declined to low levels in those over the age of 40 years. The relative prevalence of those who had not had a smear exceeded 9 in all age groups over 39 years, compared with women of 20 - 24 years. Smears which showed signs of CIN III, malignancy or possible malignancy comprised 0.13%. Thirty-six per cent of women booked for colposcopy did not attend. CONCLUSIONS: Efficiency of screening could be improved by emphasising coverage of higher-risk age groups, e.g. women over the age of 30 years, and better follow-up.

Adolescent↗