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Improving Access (improving + access)
Selected AbstractsIMPROVING ACCESS TO OPIATE ADDICTION TREATMENT FOR PRISONERSADDICTION, Issue 7 2010AMY NUNN No abstract is available for this article. [source] Improving Access to and Participation in Adult Learning in OECD Countries,EUROPEAN JOURNAL OF EDUCATION, Issue 1 2004Beatriz Pont First page of article [source] Improving access to the international coverage of reports of controlled trials in electronic databases: a search of the Australasian Medical IndexHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 1 2002Steve McDonald Introduction: Locating reports of trials from journals not indexed in the major databases presents difficulties to systematic reviewers, and may be a factor in improving the reliability of the reviews. Objectives: To identify and make available reports of controlled trials from the Australasian Medical Index (AMI). To measure the quality of indexing of trials in AMI. Methods: Using a highly sensitive search strategy consisting of methodology indexing and free-text terms, records from AMI were read for reports of controlled trials. Trials meeting the criteria were submitted for inclusion in The Cochrane Controlled Trials Register (CCTR) and assessed for the quality of their indexing. Results: 3621 records were downloaded, of which 512 were identified as reports of controlled trials (317 RCTs; 195 CCTs) and submitted to CCTR. The precision of methodology indexing terms was 60%, but sensitivity just 18%. The quality of indexing of trials was generally poor with only 50 tagged with the RCT/CCT publication type term. 453 reports (88%) were not previously available in CCTR. Conclusions: The large proportion of trials found to be unique to the AMI database increases the pool of studies available to systematic reviewers, and helps ensure CCTR remains the most comprehensive source of trials. [source] Mental health nurse practitioners in Australia: Improving access to quality mental health careINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2005Jacklin E. Fisher ABSTRACT:, Under The Nurses Amendment (Nurse Practitioners) Act 1998, New South Wales became the first state in Australia to legislate for nurse practitioners. Mental health was identified as a priority ,area of practice' for nurse practitioners. Issues surrounding the implementation of the nurse practitioner role in Australia and the potential for the role to address the current crisis in mental health nursing and the mental health sector will be discussed. The potential for partnerships with other health-care providers, in particular medical practitioners, will demonstrate how successful implementation of the role can fulfil consumer demand for primary prevention counselling, improve access to mental health services and early intervention, and provide mental health services that better reflect national priorities. This examination of the Australian context will be contrasted with a review of the overseas literature on mental health nurse practitioners. [source] Catastrophic payments for health care among households in urban Tamil Nadu, IndiaJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 2 2009Salem Deenadayalan Vaishnavi Abstract Urban residents in India face important health problems due to unhygienic conditions, excessive crowding and lack of proper sanitation. The private sector has started occupying the centre stage of the health system and households are burdened with increasing levels of health expenditure. This paper aims to study out-of-pocket expenditure (OOPE) and the extent of catastrophic payments for health care among households in a highly urbanised state, Tamil Nadu. The study used data on morbidity and health care for the year 2004 collected by the National Sample Survey Organization, India. Care was sought for 84 per cent of illness episodes in urban areas, and the majority used private sector providers (67 per cent for inpatients and 78 per cent for outpatients). Mean OOPE for inpatients and outpatients was higher for households with higher income. The average cost burden per visit was higher among those who sought care from private providers for inpatient services (29 per cent of household consumption expenditure) and outpatient services (20% of household consumption expenditure) compared with the burden associated with public health service use (3,4 per cent of consumption expenditure). About 60 per cent of households which used private health services faced catastrophic payments at the 10 per cent threshold level. To avoid catastrophic expenditure, greater use of the public sector which is providing services at an affordable cost is needed. Improving access to public health services, better gate-keeping systems, stronger controls on drug prices and increasing the quality of services are required to reduce the incidence of catastrophic expenditure both on inpatients and outpatients. Greater use of risk pooling mechanisms would encourage the poor to seek health care and also to protect households from all socio-economic groups from catastrophic expenditure. Copyright © 2009 John Wiley & Sons, Ltd. [source] Improving access to diabetes servicesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2003Eileen Emptage No abstract is available for this article. [source] Projections of US prevalence of arthritis and associated activity limitationsARTHRITIS & RHEUMATISM, Issue 1 2006Jennifer M. Hootman Objective To update the projected prevalence of self-reported, doctor-diagnosed arthritis and arthritis-attributable activity limitations among US adults ages 18 years and older from 2005 through 2030. Methods Baseline age- and sex-specific prevalence rates of arthritis and activity limitation, using the latest surveillance case definitions, were estimated from the 2003 National Health Interview Survey, which is an annual, cross-sectional, population-based health interview survey of ,31,000 adults. These estimates were used to calculate projected arthritis prevalence and activity limitations for 2005,2030 using future population projections obtained from the US Census Bureau. Results The prevalence of self-reported, doctor-diagnosed arthritis is projected to increase from 47.8 million in 2005 to nearly 67 million by 2030 (25% of the adult population). By 2030, 25 million (9.3% of the adult population) are projected to report arthritis-attributable activity limitations. In 2030, >50% of arthritis cases will be among adults older than age 65 years. However, working-age adults (45,64 years) will account for almost one-third of cases. Conclusion By 2030, the number of US adults with arthritis and its associated activity limitation is expected to increase substantially, resulting in a large impact on individuals, the health care system, and society in general. The growing epidemic of obesity may also significantly contribute to the future burden of arthritis. Improving access and availability of current clinical and public health interventions aimed at improving quality of life among persons with arthritis through lifestyle changes and disease self-management may help lessen the long-term impact. [source] HEALTH ISSUES AMONG FILIPINO WOMEN IN REMOTE QUEENSLANDAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2001Margaret Kelaher ABSTRACT: This paper discusses health issues among Filipinas (women born in the Philippines) living in remote and rural environments in Queensland. The sample was recruited as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health (ALSWH). Most of the women lived in an urban or semi-urban area (391), whereas 90 lived in rural or remote areas. Community perceptions had a much greater impact on health service utilisation in rural and remote areas than in urban areas. The transition between newcomer and old-timer is more difficult for Filipinas than for other rural women because they are visibly different from other members of the community and suffer from stigmatisation associated with perceptions of Filipinas as mail order brides. For these women, concerns about confidentiality and a reluctance to ask for support are major barriers to health service utilisation. The area of greatest concern is mental health, particularly in relation to parenting issues. Improving access may involve providing a greater awareness of what services are available and allowing women to access services in a way that does not require them to label themselves or be labelled by others. [source] Pathways to care for patients with bipolar disorderBIPOLAR DISORDERS, Issue 3 2005Dinesh Bhugra Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely ,filtering' of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided. [source] TRIPs and Public Health: The Doha Declaration and AfricaDEVELOPMENT POLICY REVIEW, Issue 1 2007Stine Jessen Haakonsson The Doha Declaration on the TRIPs Agreement and Public Health (2001), aimed at improving access to medicines, especially for HIV/AIDS, malaria and tuberculosis in developing and least developed countries, has not yet been used for compulsory licences to import generic medicines or for expanding production for export to poor countries. By analysing HIV/AIDS treatment in Uganda, this article discusses the variety of TRIPs-related channels for ensuring drugs for domestic treatment, and argues that emphasising the restrictive nature of TRIPs provisions fails to grasp the scale of the obstacles involved. Lack of domestic resources leaves African countries dependent on donor financing, which in turn constrains their ability to exploit international trade provisions. [source] Night watchman, extractive, or developmental states?ECONOMIC HISTORY REVIEW, Issue 2 2007Some evidence from late colonial south-east Asia The article examines aspects of government policy in different parts of colonial south-east Asia, and in nominally independent Siam (Thailand) in the first four decades of the twentieth century. The emphasis is on taxation and expenditure policies, and their implications for the development of infrastructure and also for the welfare of indigenous populations. Attention is also given to the impact of government regulation of both factor and product markets. On the basis of the empirical evidence, the article argues that the traditional view of the colonial state as a ,night watchman' was not applicable to most parts of south-east Asia after 1900. Governments were increasingly involved in implementing policies that today would be considered developmental, including building infrastructure and improving access to secular education and modern health care for the indigenous populations. But given the resources that they had, or had the potential to mobilize, more could have been achieved. [source] The Contribution of Bioenergy to a New Energy ParadigmEUROCHOICES, Issue 3 2005Daniel De La Torre Ugarte Biomass is a widely available resource that is receiving increased consideration as a renewable substitute for fossil fuels. Developed sustainably and used efficiently, it can induce growth in developing countries, reduce oil demand, and address environmental problems. The potential benefits include: reduction of greenhouse gases, recuperation of soil productivity and degraded land, economic benefits from adding value to agricultural activities and improving access to and quality of energy services. The production of bioenergy involves a range of technologies, including solid combustion, gasification, and fermentation. These technologies produce energy from a diverse set of biological resources - traditional crops, crop residues, energy-dedicated crops, dung, and the organic component of urban waste. The results are bioenergy products that provide multiple energy services: cooking fuel, heat, electricity and transportation fuels. It is this very diversity that holds the potential of a win-win-win for the environment, social and economic development. Bioenergy has to be viewed not as a replacement for oil, but as an element of a portfolio of renewable sources of energy. Coherent and mutually supportive environmental and economic policies may be needed to encourage the emergence of a globally dispersed bioenergy industry that will pursue a path of sustainable development. La biomasse est une resource largement répandue, qui commence à retenir l'attention comme substitut renouvelable aux énergies fossiles. En l'utilisant de façon efficace et durable, on peut accélérer la croissance des pays en voie de développement, réduire la demandepour le pétrole et résoudre certains problèmes d'environnement. Au nombre des bénéfices potentiels il faut mettre : la réduction des émissions de gaz à effet de serre, la reconstitution de la fertilité dessols et des terres dégradées, les avantages économiques liés à l'accroissement de la production agricole et à l'amélioration des services énergétiques, tant en qualité qu'en accessibilité. La production de bioénergie met en oeuvre un large éventail de techniques parmi lesquelles la combustionde produits solides, la gazéification et la fermentation. Elles produisent de l'énergie à partir d'une grande variété de sources biologiques : cultures traditionnelles, résidus de cultures, cultures spécialisées, fumiers et déchets organiques urbains. Les produits bio-énergétiques qui en résultent couvrent une grande variété d'usages : énergie de cuisson, chauffage, électricité et transports. C'est précisément sur cette diversité que repose l'espoir de gains dans toutes les directions, sociales, environnementales et économiques. Il ne faut pas voir la bioénergie comme un simple substitut au pétrole, mais comme un portefeuille de ressources renouvelables. Pour encourager l'émergence d'une industrie bioénergétique largement répandue et susceptible de contribuer au développement durable, il faudra sans doute élaborer des politiques économiques et environnementales cohérentes, capables de se soutenir mutuellement. Bei Biomasse handelt es sich umeine weithin verfügbare Ressource, welche zunehmend als erneuerbarer Ersatz für fossile Brennstoffe in Betracht gezogen wird. Sie kann bei nachhaltiger Entwicklung und effizienter Nutzung zu Wachstum in den Entwicklungsländern führen, die Nachfrage nach Öl senken und dazu beitragen, die Umweltprobleme in den Griff zu bekommen. Zu den potenziellen Nutzen gehÖren: Verringerung der Treibhausgase, Wiederherstellung von Bodenproduktivität sowie von erodiertem Land, wirtschaftlicher Nutzen durch zusätzliche Wertschöpfung aus landwirtschaftlicher Aktivität und besserer Zugang zu und Qualität in der Energieversorgung. Bei der Erzeugungvon Bioenergie kommen eine Reihe von verschiedenen Technologien zur Anwendung, z.B. Verbrennung fester Brennstoffe, Vergasung sowie Gärung. Diese Technologien erzeugen Energie mittels unterschiedlicher biologischer Ressourcen , traditionelle Feldfrüchte und deren Rückstände, spezielle Energiepflanzen, Mist sowie der organische Anteil städtischer Abfälle. Die daraus erzeugte Bioenergie kann zum Kochen, zum Heizen, als Elektrizität oder als Treibstoff genutzt werden. Gerade in dieser Vielfalt liegt der potenzielle Gewinn für die Umwelt und die soziale sowie die wirtschaftliche Entwicklung. Bioenergie sollte nicht als ein Ersatz für Öl, sondern als Bestandteil des Portfolios erneuerbarer Energiequellen angesehen werden. Kohärente und sich gegenseitig unterstützende ökologische und Ökonomische Politikmaßnahmen könntenerforderlich sein, um die Entstehung einer global verbreiteten Bioenergieindustrie zu begünstigen, welche eine nachhaltige Entwicklung verfolgt. [source] Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insuranceHEALTH ECONOMICS, Issue 3 2001Winnie Yip Abstract Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme. Copyright © 2001 John Wiley & Sons, Ltd. [source] Depression Treatment in a Sample of 1,801 Depressed Older Adults in Primary CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2003Jürgen Unützer MD OBJECTIVES: To examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patients DESIGN: Cross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial. SETTING: Eighteen primary care clinics belonging to eight organizations in five states. PARTICIPANTS: One thousand eight hundred one clinic users aged 60 and older who met diagnostic criteria for major depression or dysthymia. MEASUREMENTS: Lifetime depression treatment was defined as ever having received a prescription medication, counseling, or psychotherapy for depression. Potentially effective recent depression treatment was defined as 2 or more months of antidepressant medications or four or more sessions of counseling or psychotherapy for depression in the past 3 months. RESULTS: The mean age ± standard deviation was 71.2 ± 7.5; 65% of subjects were women. Twenty-three percent of the sample came from ethnic minority groups (12% were African American, 8% were Latino, and 3% belonged to other ethnic minorities). The median household income was $23,000. Most study participants (83%) reported depressive symptoms for 2 or more years, and most (71%) reported two or more prior depressive episodes. About 65% reported any lifetime depression treatment, and 46% reported some depression treatment in the past 3 months, although only 29% reported potentially effective recent depression treatment. Most of the treatment provided consisted of antidepressant medications, with newer antidepressants such as selective serotonin reuptake inhibitors constituting the majority (78%) of antidepressants used. Most participants indicated a preference for counseling or psychotherapy over antidepressant medications, but only 8% had received such treatment in the past 3 months, and only 1% reported four or more sessions of counseling. Men, African Americans, Latinos, those without two or more prior episodes of depression, and those who preferred counseling to antidepressant medications reported significantly lower rates of depression care. CONCLUSION: The findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants. [source] The use of psychiatric medications to treat depressive disorders in African American womenJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2006Allesa P. Jackson Review of the current literature confirms that African American women as a group are underdiagnosed and undertreated for psychiatric disorders. Hence, much effort is targeted towards awareness, screening, and improving access to health care for this population. However, once an African American woman is diagnosed with a major mental health disorder, determining the optimal course of treatment is a process that must be approached carefully because of gender and racial/ethnic differences in response and metabolism of psychiatric medications. African American women fall into both of these understudied categories. Given the small numbers of African American women represented in the clinical trials on which clinical practice is based, one must consider the limitations of current knowledge regarding psychoactive medications in this population. Culturally based attitudes or resistance to pharmacotherapy can complicate the use of psychoactive medicines, often a first-line approach in primary care clinics. Communication with patients is key, as well as openness to patient concerns and tolerance of these medications. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 793,800, 2006. [source] The Financial Impact of Ambulance Diversion on Inpatient Hospital Revenues and ProfitsACADEMIC EMERGENCY MEDICINE, Issue 1 2009Daniel A. Handel MD Abstract Objectives:, The objective was to study the association between ambulance diversion and weekly inpatient hospital revenues and profits. Methods:, This was a retrospective review of administrative data from one academic medical center from July 1, 2003, to December 31, 2006. Given the high amount of daily variability, inpatient hospital revenues and profits were collapsed by week and evaluated in four categories: no diversion, mild diversion (from >0 and <10 hours), moderate diversion (>10 and <20 hours), and high diversion (>20 hours). Revenues and profits for two categories of patients admitted to the hospital were calculated: 1) patients admitted from the emergency department (ED; i.e., those arriving by ambulance and by other means) and 2) electively admitted patients. Results:, A total of 166,460 ED patients were included in the analysis. Inpatient hospital revenues were included from 85,111 patients, 28,665 of which were admissions from the ED (33.7%). For patients admitted from the ED, the average weekly revenues during periods of high diversion were $265K higher than periods of no diversion. For patients admitted on an elective basis, revenues were significantly higher when comparing periods of mild divert to high diversion (an additional $415K weekly). The overall increase in profitability was significant for periods of severe divert compared to no divert ($119K per week). Conclusions:, Periods of greater diversion are associated with higher inpatient revenues and profits for ED, electively admitted patients, and the overall inpatient hospital population. Therefore, no financial disincentive exists from an inpatient perspective for the boarding of admitted patients in the ED and increasing periods of diversion. Efforts to decrease ambulance diversion must therefore be based on other rationales, like patient safety, quality of care, and improving access to care, or new models of reimbursement that reward hospitals for reducing ambulance diversion. [source] On-site mental health care: a route to improving access to mental health services in an inner-city, adolescent medicine clinicCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2006A. Lieberman First page of article [source] | |||||||||||||