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Adequate Coverage (adequate + coverage)
Selected AbstractsAre clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] Erosion and Nutrient Loss on Sloping Land under Intense Cultivation in Southern VietnamGEOGRAPHICAL RESEARCH, Issue 1 2008NGUYEN VAN DE Abstract To help improve the well-being of the local people, a joint Vietnamese-UK team set out to establish a way of estimating soil and nutrient losses under different land management scenarios, using field data extrapolated through remote sensing and GIS, to obtain catchment-wide estimates of the impact of land cover change. Immigration from remote provinces to the Dong Phu District of Binh Phuóc Province, about 120 km north of Ho Chi Minh City, has led to disruption of soil surface stability on easily eroded clayey sandstones, creating rapid nutrient depletion that affects crop yields and siltation in the channel of the Rach Rat river downstream. The poor farmers of the areas see crop yields drop dramatically after two or three years of cultivation due to the fertility decline. Soil loss varies dramatically between wet season and dry season and with ground cover. Erosion bridge measurements showed a mean loss of 85.2 t ha,1 y,1 under cassava saplings with cashew nuts, 43.3 t ha,1 y,1 on uncultivated land and 41.7 t ha,1 y,1 under mature cassava. The rates of erosion were higher than those reported in many other parts of Vietnam, reflecting the high erodibility of the friable sandy soils on the steep side-slopes of the Rach Rat catchment. However, although the actual measurements provide better soil loss data than estimates based on the parameters of soil loss equations, a large number of measurement sites is needed to provide adequate coverage of the crop and slope combinations in this dissected terrain for good prediction using GIS and remote sensing. [source] Spatial sampling requirements for monitoring upper-air climate change with radiosondesINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 8 2008Mark P. McCarthy Abstract The global climate observing system upper air network (GUAN) was established to provide a network of high quality radiosonde stations with sufficient historical data records, and a commitment to future observing, in support of the needs of the climate research community. An assessment of the spatial sampling requirements for such a network in order to monitor large-scale climate changes has been conducted. The GUAN provides adequate coverage for monitoring global, tropical and hemispheric mean climate. Priority stations within the GUAN have been identified based upon their unique contribution to the network. Further sampling improvements to the GUAN may be possible by utilizing radiosonde stations located in India, Africa and northern polar regions. To keep sampling-related trend error below 0.05 K/decade in the troposphere, and 0.1 K/decade in the stratosphere, requires a radiosonde station to be located approximately every 30° longitude and 15° latitude north of 30°N. The inhomogeneous distribution of radiosonde stations in the tropics and southern hemisphere place a stronger requirement of 20° longitude and 10° latitude south of 30°N. The radiosonde network is inadequate for monitoring humidity except in the northern mid-latitudes. © Crown Copyright 2007. Reproduced with the permission of the Controller of HMSO. Published by John Wiley & Sons, Ltd [source] Consultants' opinion on a new practice-based assessment programme for first-year residents in anaesthesiologyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2002C. Ringsted Background: Assessment in postgraduate education is moving towards using a broad spectrum of practice-based assessment methods. This approach was recently introduced in first-year residency in anaesthesiology in Denmark. The new assessment programme covers: clinical skills, communication skills, organizational skills and collaborative skills, scholarly proficiencies and professionalism. Eighteen out of a total of 21 assessment instruments were used for pass/fail decisions. The aim of this study was to survey consultants' opinions of the programme in terms of the representativeness of competencies tested, the suitability of the programme as a basis for pass/fail decisions and the relevance and sufficiency of the content of the different assessment instruments. Methods: A description of the assessment programme and a questionnaire were sent to all consultants of anaesthesiology in Denmark. The questionnaire consisted of items, to be answered on a five-point scale, asking the consultants' opinions about representativeness, suitability and content of the programme. Results: The response rate was 251/382 (66%). More than 75% of the respondents agreed that the assessment programme offered adequate coverage of the competencies of a first-year resident and was appropriate for making pass/fail decisions. There was strong agreement that the content of the 18 tests used for pass/fail decisions was relevant and sufficient for pass/fail decisions. Conclusion: Judging from the consultants' opinions, the assessment programme for first-year residency in anaesthesiology appears to be appropriate regarding the range of competencies assessed, the appropriateness as a basis for pass/fail decisions, and regarding the content of the tests used for pass/fail decisions. Further studies are needed to assess the feasibility and acceptability of the programme in practice. [source] The Quality of Health Insurance Service Delivery for Kidney Transplant Recipients: A Patient PerspectiveAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010E. J. Gordon Increased attention has been devoted to improving quality care in kidney transplantation. The discourse on quality care has focused on transplant center metrics and other clinical parameters. However, there has been little discussion on the quality of health insurance service delivery, which may be critical to kidney recipients' access to transplantation and immunosuppression. This paper describes and provides a framework for characterizing kidney transplant recipients' positive and negative interactions with their insurers. A consecutive cohort of kidney recipients (n = 87) participated in semistructured interviews on their interactions with insurance agencies. Patients reported negative (37%) and/or neutral or positive (79%) interactions with their insurer (a subset [16%] reported both). Perceived negative experiences included: poor service, logistical difficulties with confusing and time-consuming paperwork, poor communication, rude behavior and concerns about adequate coverage. Positive experiences related to: having good coverage, a simple application process, straightforward transactions and helpful communication. Findings suggest that even when patients have insurance coverage, difficult interactions with insurers and limited skills in navigating insurance options may limit their access to needed medications and health services. Future research is needed to test this hypothesis in a larger population. [source] | ||||||||||