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Access Issues (access + issues)
Selected AbstractsWhy patients attend emergency departments for conditions potentially appropriate for primary care: Reasons given by patients and clinicians differEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Malcolm Masso Abstract Objectives: To compare reasons identified by clinical staff for potential primary care attendances to the ED with those previously identified by patients. Methods: Survey of staff and primary care patients in five ED in New South Wales, Australia using questionnaire based on reasons identified in published studies. Results: Clinicians in the survey identify a broader spectrum of reasons for potential primary care cases presenting to the ED than the patients themselves report. Doctors reported on average 4.1 very important reasons and nurses 4.8 compared with patients 2.4 very important reasons. The main reasons identified by both doctors and nurses were similar and quite different to those identified by patients. Clinicians were more likely to emphasize cost and access issues rather than acuity and complexity issues. There was no difference within the clinician group between doctors and nurses nor by varying levels of experience. Furthermore doctors with significant experience in both primary care and emergency medicine did not differ from the overall clinicians' pattern. Conclusions: These data confirm that clinician perspectives on reasons for potential primary care patients' use of ED differ quite markedly from the perspectives of patients themselves. Those differences do not necessarily represent a punitive or blaming philosophy but will stem from the very different paradigms from which the two protagonists approach the interactions, reflecting the standard tension in a provider , consumer relationship. If policy is to be developed to improve system use and access, it must take both perspectives into account with respect to redesign, expectations and education. [source] Evaluation of the Personal Dental Services (Wave 1) for Lambeth, Southwark and Lewisham Primary Care Trusts , Part 1: Retrospective analyses of registration data and access issuesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005Helen Best BDS MDS PhD Abstract Aim/objective, The purpose of the study was to undertake analyses of registration data for the personal dental services (PDS) of Lambeth, Southwark and Lewisham primary care trusts and relate the analyses to the PDS goal ,of ,increasing ,uptake ,of ,dental services. Method, Secondary analyses of registration statistics provided by the Dental Practice Board were undertaken for both 1 years pre-PDS (October 1997 to September 1998) and post-PDS (October 1998 to March 2003) periods. Three sets of analyses were undertaken to consider different aspects of changing registrations: (1) Absolute numbers of patients registered at each time interval; (2) Rates of change in numbers of patients registered for the entire period after the introduction of PDS; and (3) Rates of change in numbers of patients registered ,for ,the ,most recent 3 years of available data. Results, There was a significant increase in the numbers of children registered under capitation, post-PDS as compared to the pre-PDS level (all ages and both genders combined). Post-PDS, the rate of increase for the children was approximately one additional child per practice per month (0.96, 95% CI 0.41,1.52). Similarly there was a significant trend for increasing adults registrations over time of about two and a half adults per practice per month (2.42, 95% CI 0.90,3.95). There was no evidence of a change in registrations for children or adults in total over the most recent period of 3 years. Conclusions, The analysis of the absolute numbers of registered patients each month indicated that the PDS practices had more children registered than before the implementation of the PDS scheme, but not adults. Overall post-implementation there was a trend for increasing registrations in both children and adults, but the most recent data indicated a plateau effect. Further consideration of facilitators to achieve PDS goals of improved uptake of services is required, particularly as they relate to local contexts. [source] Eating disorders in adults with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2000S. Gravestock Abstract There is an increasing focus on the nutrition of people with intellectual disability (ID), but less interest in the range of eating disorders (EDs) that they may exhibit and the bio-psycho-social impact of these conditions. Despite diagnostic and methodological difficulties, psychopathology and ED research studies suggest that 3,42% of institutionalized adults with ID and 1,19% of adults with ID in the community have diagnosable EDs. Weight surveys indicate that 2,35% of adults with ID are obese and 5,43% are significantly underweight, but the contribution of diagnosable EDs is unknown. Such data and case reports suggest that EDs are associated with considerable physical, behavioural, psychiatric and social comorbidity. Review papers have focused on the aetiology and treatment of pica, rumination, regurgitation, psychogenic vomiting and food faddiness/refusal. Emerging clinical issues are the development of appropriate diagnostic criteria, multimodal assessment and clinically effective treatment approaches. Key service issues include staff training to improve awareness, addressing comorbidity and access issues, and maintaining support for adults with ID and EDs, and their carers. Research should confirm the multifaceted aetiology and comorbidity of EDs. Then multicomponent assessment and treatment models for EDs can be developed and evaluated. [source] Promoting ecologic health resilience for minority youth: Enhancing health care access through the school health centerPSYCHOLOGY IN THE SCHOOLS, Issue 3 2003Caroline C.C. Clauss-Ehlers Ethnic minority youth experience problems in access to healthcare, yet little is known about how to enhance utilization. This article will discuss the demographic realities of children of color in the United States, with a focus on health care needs and access issues that have an enormous influence on health status. The article will consider health policy as it describes the considerable barriers to quality health care for minority youth such as a lack of a usual source of care and limited health insurance. An ecologic model is presented that incorporates cultural values and community structures into the school health center. Enhancing access and utilization through the school setting is viewed as promoting ecologic resilience in youth. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 265,278, 2003. [source] Rural Bioethical Issues of the Elderly: How Do They Differ From Urban Ones?THE JOURNAL OF RURAL HEALTH, Issue 4 2001Jacqueline J. Glover Ph.D. ABSTRACT: Typical ethical issues in health care for the elderly include decision making for elderly patients with and without capacity, advance directives, the use of life-sustaining technologies, and questions of access to services and justice. Obviously the same issues are relevant for elderly patients in rural settings. But the unique features of rural living add another dimension to ethical discourse and the care of patients, namely the primary importance of relationships. Rural bioethics is based on an ethic of familiarity, which alters our attention to such issues as confidentiality, multiple relationships, scope of practice, and access issues. The following article briefly outlines the unique features of rural bioethics and provides a case analysis. [source] Public dental service utilization among adults in South AustraliaAUSTRALIAN DENTAL JOURNAL, Issue 2 2009L Luzzi Abstract Background:, Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3½-year period were examined. Methods:, Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3½ years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits. Results:, Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline. Conclusions:, Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care. [source] Health behaviours of young, rural residents: A case studyAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2009Lisa Bourke Abstract Objective:,To analyse self-reported health behaviours of young people from a rural community and the factors influencing their behaviours. Methods:,Interviews were conducted with 19 young people, 11 parents and 10 key informants from a small rural Victorian community, asking about teenage health behaviours and the factors influencing these behaviours. Results:,Young people ate both healthy and unhealthy foods, most participated in physical activity, few smoked and most drank alcohol. The study found that community level factors, including community norms, peers, access issues and geographic isolation, were particularly powerful in shaping health behaviours, especially alcohol consumption. Smoking was influenced by social participation in the community and national media health campaigns. Diet and exercise behaviour were influenced by access and availability, convenience, family, peers and local and non-local cultural influences. Conclusion and implications:,The rural context, including less access to and choice of facilities and services, lower incomes, lack of transport and local social patterns (including community norms and acceptance), impact significantly on young people's health behaviours. Although national health promotion campaigns are useful aspects of behaviour modification, much greater focus on the role and importance of the local contexts in shaping health decisions of young rural people is required. [source] | ||||||||||