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Kinds of Healthcare Providers Selected AbstractsTHE ETHICS OF INTERCOUNTRY ADOPTION: WHY IT MATTERS TO HEALTHCARE PROVIDERS AND BIOETHICISTSBIOETHICS, Issue 7 2010SARAH JONES ABSTRACT The goal of this paper is both modest and ambitious. The modest goal is to show that intercountry adoption should be considered by ethicists and healthcare providers. The more ambitious goal is to introduce the many ethical issues that intercountry adoption raises. Intercountry adoption is an alternative to medical, assisted reproduction option such as in vitro fertilization (IVF), intracytoplasmic sperm injection, third party egg and sperm donation and surrogacy. Health care providers working with assisted reproduction are in a unique position to introduce their clients to intercountry adoption; however, providers should only do so if intercountry adoption is ethically equal or superior to the alternatives. This paper first presents a brief history of intercountry adoption. The second section compares intercountry adoption with medical alternatives. The third section examines the unique ethical challenges that are not shared by other medical alternatives. The final section concludes that it is simplistic for a healthcare provider to promote intercountry adoption unconditionally; however, in situation where intercountry adoption is practiced conscientiously it poses no greater ethical concern than several medical alternatives. This conclusion is preliminary and is intended as a start for further discussion. [source] The Relationship between Patients' Perception of Care and Measures of Hospital Quality and SafetyHEALTH SERVICES RESEARCH, Issue 4 2010Thomas Isaac Background. The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. Methods. We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates. Results. The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations ,0.17 to ,0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care. Conclusions. Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care. [source] Language and Regional Differences in Evaluations of Medicare Managed Care by HispanicsHEALTH SERVICES RESEARCH, Issue 2 2008Robert Weech-Maldonado Objectives. This study uses the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) survey to examine the experiences of Hispanics enrolled in Medicare managed care. Evaluations of care are examined in relationship to primary language (English or Spanish) and region of the country. Data Sources. CAHPS 3.0 Medicare managed care survey data collected in 2002. Study Design. The dependent variables consist of five CAHPS multi-item scales measuring timeliness of care, provider communication, office staff helpfulness, getting needed care, and health plan customer service. The main independent variables are Hispanic primary language (English or Spanish) and region (California, Florida, New York/New Jersey, and other states). Ordinary least squares regression is used to model the effect of Hispanic primary language and region on CAHPS scales, controlling for age, gender, education, and self-rated health. Data Collection/Extraction Methods. The analytic sample consists of 125,369 respondents (82 percent response rate) enrolled in 181 Medicare managed care plans across the U.S. Of the 125,369 respondents, 8,463 (7 percent) were self-identified as Hispanic. The survey was made available in English and Spanish, and 1,353 Hispanics completed one in Spanish. Principal Findings. Hispanic English speakers had less favorable reports of care than whites for all dimensions of care except provider communication. Hispanic Spanish speakers reported more negative experiences than whites with timeliness of care, provider communication, and office staff helpfulness, but better reports of care for getting needed care. Spanish speakers in all regions except Florida had less favorable scores than English-speaking Hispanics for provider communication and office staff helpfulness, but more positive assessments for getting needed care. There were greater regional variations in CAHPS scores among Hispanic Spanish speakers than among Hispanic English speakers. Spanish speakers in Florida had more positive experiences than Spanish speakers in other regions for most dimensions of care. Conclusions. Hispanics in Medicare managed care face barriers to care; however, their experiences with care vary by language and region. Spanish speakers (except FL) have less favorable experiences with provider communication and office staff helpfulness than their English-speaking counterparts, suggesting language barriers in the clinical encounter. On the other hand, Spanish speakers reported more favorable experiences than their English-speaking counterparts with the managed care aspects of their care (getting needed care and plan customer service). Medicare managed care plans need to address the observed disparities in patient experiences among Hispanics as part of their quality improvement efforts. Plans can work with their network providers to address issues related to timeliness of care and office staff helpfulness. In addition, plans can provide incentives for language services, which have the potential to improve communication with providers and staff among Spanish speakers. Finally, health plans can reduce the access barriers faced by Hispanics, especially among English speakers. [source] Case-Mix Adjustment of the CAHPS® Hospital SurveyHEALTH SERVICES RESEARCH, Issue 6p2 2005A. James O'Malley Objectives: To develop a model for case-mix adjustment of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospital survey responses, and to assess the impact of adjustment on comparisons of hospital quality. Data Sources: Survey of 19,720 patients discharged from 132 hospitals. Methods: We analyzed CAHPS Hospital survey data to assess the extent to which patient characteristics predict patient ratings ("predictive power") and the heterogeneity of the characteristics across hospitals. We combined the measures to estimate the impact of each predictor ("impact factor") and selected high impact variables for adjusting ratings from the CAHPS Hospital survey. Principle Findings: The most important case-mix variables are: hospital service (surgery, obstetric, medical), age, race (non-Hispanic black), education, general health status (GHS), speaking Spanish at home, having a circulatory disorder, and interactions of each of these variables with service. Adjustment for GHS and education affected scores in each of the three services, while age and being non-Hispanic black had important impacts for those receiving surgery or medical services. Circulatory disorder, Spanish language, and Hispanic affected scores for those treated on surgery, obstetrics, and medical services, respectively. Of the 20 medical conditions we tested, only circulatory problems had an important impact within any of the services. Results were consistent for the overall ratings of nurse, doctor, and hospital. Although the overall impact of case-mix adjustment is modest, the rankings of some hospitals may be substantially affected. Conclusions: Case-mix adjustment has a small impact on hospital ratings, but can lead to important reductions in the bias in comparisons between hospitals. [source] A Study of Midlife Women's Reasons for Changing Healthcare ProvidersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2005FACNM, Holly Powell Kennedy CNM Purpose The purpose of this study was to examine the reasons midlife women report for changing healthcare providers and to determine if there were any differences in reasons given for the change based on gender or ethnicity. Data sources This was an analysis of data collected from a healthy community-based sample of midlife women as part of a longitudinal 5-year study of changes in health outcomes during transition to menopause. Women were queried about their experience in changing healthcare providers. Conclusions Over 42% indicated that they had changed health providers because of dissatisfaction with care. The component accounting for the majority of the variance was related to communication issues. There were no significant differences across ethnic groups in decision to change providers or in reasons for their dissatisfaction with care. However, their reports of experiencing racism in the healthcare system were troubling. Implications for practice The ability of the provider to communicate with women may have implications in women's choices in health care later in life. [source] The ISTSS/Rand Guidelines on Mental Health Training of Primary Healthcare Providers for Trauma-Exposed Populations in Conflict-Affected Countries,,JOURNAL OF TRAUMATIC STRESS, Issue 1 2006David Eisenman Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations. [source] Cancer risk from diagnostic radiology in a deliberate self-harm patientACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010L. J. Norelli Norelli LJ, Coates AD, Kovasznay BM. Cancer risk from diagnostic radiology in a deliberate self-harm patient. Objective:, Patients who engage in recurrent deliberate self-harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. Method:, Case presentation and discussion. Results:, A 29-year-old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient's calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. Conclusion:, Patients with recurrent self-injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH. [source] Oral self-care habits of dental and healthcare providersINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 4 2008Y Zadik Abstract:, Objective:, To evaluate the self-care level of dental and healthcare providers regarding prevention of oral diseases Methods:, Healthcare providers (dental assistants and surgeons, laboratory personnel, biologists, medics, paramedics, corpsmen, nurses, pharmacists, physicians, physiotherapists, psychologists, social workers, speech therapists, X-ray technicians) and non-health care providing adults (the general population) were asked to respond to a questionnaire regarding their routine measures for maintaining oral health Results:, Three hundred and twenty-six healthcare providers and 95 non-healthcare providers participated in the study. Regarding toothbrushing, flossing, undergoing periodic dental examinations and professional scaling/polishing, dental practitioners have better, but not perfect, maintenance habits than other healthcare providers. Non-dental healthcare providers have better dental habits than the general population, and nurses and medical practitioners have better dental habits than medics, paramedics, corpsmen and para-medical professionals. Among non-dental healthcare providers, nurses have a relatively high frequency of toothbrushing and flossing but a low frequency of periodic examinations and scaling/polishing. Generally, females reported significantly higher frequencies of toothbrushing and flossing than males did. The toothpaste selection of the participants was primarily influenced by dentists' recommendations, the flavour of the toothpaste, and its anti-malodour effect were the most dominant factors. Conclusion:, The compliance of health professionals, especially dental practitioners, with appropriate oral health measures is relatively high. However, the dental team cannot always assume that the dental patient, who also happens to be a healthcare provider, has meticulous oral habits. The dental hygienist and surgeon have to educate and motivate their patients, especially healthcare providers because of the influence of the latter on their own patients. [source] Assessing Emergency Preparedness of Families Caring for Young Children With Diabetes and Other Chronic IllnessesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2006Lynda G. Stallwood PURPOSE.,To help children with chronic illnesses and their caregivers assess emergency preparedness. CONCLUSIONS.,Little work has been done to ascertain patient adherence levels to these recommendations. Additionally, little is known about the seeking patterns of healthcare providers and/or changes in interventions based on certain elements of emergency preparedness, such as the presence of medical alert identification and an emergency kit. PRACTICE IMPLICATIONS.,,Healthcare providers must discover their patients' level of emergency preparedness and facilitate the acquisition and implementation of elements of emergency preparedness that meet their patients' needs. [source] Burnout and its correlates among nursing staff: questionnaire surveyJOURNAL OF ADVANCED NURSING, Issue 1 2008Mustafa N., lhan Abstract Title.,Burnout and its correlates among nursing staff: questionnaire survey Aim., This paper is a report of a study to determine the burnout level and its correlates in nurses. Background., Healthcare providers and especially nurses are generally considered a high risk group regarding work stress and burnout and this syndrome has been a major concern in the field of occupational health. Method., The study was carried out at a university hospital in Turkey during May,June 2005. A total of 418 nurses from the 474 working at the hospital at the time (88·2%) answered a self-administered questionnaire including the Maslach Burnout Inventory. Findings., All the nurses were female, with a mean age of 30·6 (5·4) and a median age of 29 years. The mean score was 17·99(6·35) for the Emotional Exhaustion subscale, 5·72 (3·87) for the Depersonalization subscale and 19·83 (4·66) for the Personal Accomplishment subscale. Emotional Exhaustion decreased with increasing age (P < 0·05). Total time in the job, weekly working hours, shift-working and the unit where employed influenced burnout scores (P < 0·05). Not being happy with relations with superiors, not finding the job suitable, feeling anxious about the future, perceived poor health, problems with personal life and financial difficulties were also factors influencing burnout scale scores (P < 0·05). Conclusion., It is necessary to consider nurses having the characteristics shown as the correlates of burnout in this study as a target group, to screen periodically the burnout status and improve their working conditions, especially relationships with colleagues. [source] Sleep disturbance experiences among perimenopausal women in TaiwanJOURNAL OF CLINICAL NURSING, Issue 15 2009Hsiu-Chin Hsu Aim., To generate a descriptive theory framework regarding the experiences of sleep disturbances among perimenopausal women in Taiwan. Background., Although studies show that some perimenopausal women are troubled by sleep problems, little information was found about the subjective experiences of sleep disturbances among these women. Research is required to explore women's feelings or perceptions in dealing with their sleep problems. These understandings will be important to help alleviate perimenopausal women's sleep problems. Design., A grounded theory research design was applied. Method., Twenty-one Taiwanese sleep disturbed women, aged 46,57 years, participated in in-depth interviews. Results., ,Getting back a good night's sleep' was the core theme for describing and guiding the process of the women's sleep disturbance experiences. During the process, ,disturbed sleep' was identified as the antecedent condition that included subcategories: easy awakening, difficulty falling asleep, inner worries, physical discomfort and genetic and bodily constitution. Analyses showed five categories (some with subcategories) of the sleep disturbed women: (i) worsening health status , physical exhaustion, impaired social interactions, emotional swings and decreased work performance; (ii) living with lonely nights , self-help and endurance; (iii) a search for resources to relieve sleep difficulties , doctor shopping, trying alternative therapies, exercising and seeking support; (iv) vicious cycle and (v) acceptance of insomnia. Conclusions., Women expected to relieve their sleep disturbance by finding comprehensive counselling or by their body constitution responding to treatment. Healthcare providers need to value women's individual concerns and subjective voices. Providers must seek out sleep counselling instead of simply prescribing drugs for their sleep difficulties. Relevance to clinical practice., It is crucial to integrate perimenopausal sleep care by implementing a multidimensional approach such as sleep assessment laboratories, sleep counselling, complementary alternative medicine, sleep strategies and support groups. [source] Prevalence of pigmentary disorders and their impact on quality of life: a prospective cohort studyJOURNAL OF COSMETIC DERMATOLOGY, Issue 3 2008Anne Taylor PA-S Summary Background, Pigmentary disorders are commonly seen in dermatology practice and can have a negative psychosocial impact on patients. Objective, This study aims to examine the prevalence of pigmentary disorders and their level of psychological and physical impact on patients. Methods, A prospective cohort study involved a sample of 140 patients undergoing skin exams at a private dermatology practice in North Carolina. Patient demographics and pigmentary diagnoses were obtained, and participants were asked to fill out a skin discoloration impact evaluation questionnaire. Descriptive and frequency analyses were performed. Results, Around 80% of the participants were diagnosed with one or more pigmentary disorders. About 47.3% of patients admitted of feeling self-conscious about their skin to some degree, 21.8% felt others focused on their skin, 32.7% felt unattractive because of their skin, 32.7% put effort into hiding pigment changes, and 23.6% felt their skin affected their activities. A limitation was the lack of diversity in the population studied (gender and skin type). Conclusions, Pigmentary disorders such as melasma, vitiligo, and lentigo pose significant negative impact on a person's health-related quality of life. Hence, there is a need for effective treatments of pigmentary disorders based on their prevalence and effect on quality of life. Healthcare providers should consider the impact of pigmentary disorders on health-related quality of life and educate patients on possible treatments. [source] Barriers to the self-care of type 2 diabetes from both patients' and providers' perspectives: literature reviewJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2009Sandra PY Pun MHA Aim., To review systematically the literature about barriers to diabetes self-care from both patients' and healthcare providers' perspectives. Background., Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self-care in order to promote successfully self-care behaviours. Methods., A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986,2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search. Results., A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed-method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors. Conclusions., Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care. Relevance to clinical practice., Understanding barriers to diabetes self-care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes. [source] A primary care provider's guide to preventive and acute care management of adults and children with sickle cell diseaseJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 5 2009Ardie Pack-Mabien RNC, CRNP (Clinical Nurse Practitioner & Nurse Manager) Abstract Purpose: To familiarize primary care providers (PCPs) with the pathophysiological processes, diagnostic evaluation, and medical management of sickle hemoglobinopathies and their complications. Current standards of care, clinical research advances, and new treatment options will also be addressed to assist PCPs in the management of sickle cell disease (SCD). Data sources: A selective search and review of the current literature on SCD and the authors' experience. Conclusions: Management of individuals with SCD is very complex, requiring a multidisciplinary approach that includes the patient or parent, PCP, specialist, nurse, and social worker. More patients living with SCD are relying on PCPs in nonspecialty practices for comprehensive disease management. Implications for practice: Newborn screening detects new cases of SCD annually. The median life expectancy has more than doubled for individuals with sickle cell anemia. Healthcare providers are now in an era of increased routine screening, assessment, and management of chronic complications from this illness not previously seen in the care of adults with SCD. [source] Partner violence prevalence among women attending a Maori health provider clinicAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2007Jane Koziol-McLain Abstract Objective: To determine partner violence rates among women attending a general practice in Aotearoa, New Zealand. Methods: This descriptive study was conducted in a hauora (Maori health provider general practice clinic) in one South Auckland community. Non-acute, English-speaking women who entered the huaora during 30 randomly selected clinic sessions in a five-week period in 2003 were eligible to participate. Research assistants (RAs) verbally administered a structured, brief questionnaire that included a partner violence screen (past 12 months), assessment of high danger risk, and lifetime prevalence. Of 148 women approached, 109 participated. Participants generally self-identified as Maori (74%) or New Zealand European (18%) and ranged in age from 17 to 82 years (mean 38.8). Results: Twenty-three per cent (95% CI 15,31) of women screened positive for partner violence. Among the 25 women who screened positive, six (24%) had one or more high danger risk factors and 24 (96%) reported one or more children living in the household. Seventy-eight per cent (95% CI 70,86) of women reported a history of partner violence. Conclusions: In this sample of mostly Maori women, direct partner violence questioning in a general practice setting yielded a high disclosure rate. Three out of four women disclosed violence by a partner; nearly one out of four disclosed violence by a partner in the past year. Implications: Healthcare providers have the opportunity to identify and provide services to women and their children experiencing partner violence. Health care providers and the health care system also have a responsibility to join with the community in calling for non-tolerance of family violence. [source] Balancing Acts: Dynamics of a Union Coalition in a Labor Management PartnershipINDUSTRIAL RELATIONS, Issue 1 2008ADRIENNE E. EATON This paper analyzes the experience of a set of unions that formed a coalition to engage in coordinated bargaining and to build and sustain a labor management partnership with Kaiser Permanente, a large healthcare provider and insurer. We use qualitative and quantitative data, including member and leader surveys, to explore the experience of the coalition in confronting five key challenges identified through theory and prior research on such partnerships. We find that the coalition has been remarkably successful, under difficult circumstances, in achieving institutional growth for its member unions and in balancing traditional and new union roles and communicating with members. The unions have been less successful in increasing member involvement. [source] Diagnosis and management of erectile dysfunction in the primary care settingINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2007M. T. Rosenberg Summary Recent advances in the management of erectile dysfunction (ED) involve the use of oral phosphodiesterase type-5 (PDE-5) inhibitor therapies which have transformed the perception of ED for both the patient and the healthcare provider. Recent treatment guidelines, including the American Urological Association (AUA) 2005 guidelines, promote a goal-oriented approach to therapy and emphasise that PDE-5 therapy should be offered to patients with ED as a first-line treatment option, unless contraindicated. Evidence-based studies have identified an association between ED and the presence of risk factors for cardiovascular and other vascular diseases, implicating ED as a marker for other vascular conditions. Therefore, the importance of screening and diagnosis in the primary care setting is paramount in the diagnosis and management of ED-associated comorbidities. This review provides an update on ED screening and management focusing on the use of PDE-5 inhibitor therapy in the primary care setting and also discusses clinical efficacy parameters with regard to recent results from clinical trials. [source] Oral self-care habits of dental and healthcare providersINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 4 2008Y Zadik Abstract:, Objective:, To evaluate the self-care level of dental and healthcare providers regarding prevention of oral diseases Methods:, Healthcare providers (dental assistants and surgeons, laboratory personnel, biologists, medics, paramedics, corpsmen, nurses, pharmacists, physicians, physiotherapists, psychologists, social workers, speech therapists, X-ray technicians) and non-health care providing adults (the general population) were asked to respond to a questionnaire regarding their routine measures for maintaining oral health Results:, Three hundred and twenty-six healthcare providers and 95 non-healthcare providers participated in the study. Regarding toothbrushing, flossing, undergoing periodic dental examinations and professional scaling/polishing, dental practitioners have better, but not perfect, maintenance habits than other healthcare providers. Non-dental healthcare providers have better dental habits than the general population, and nurses and medical practitioners have better dental habits than medics, paramedics, corpsmen and para-medical professionals. Among non-dental healthcare providers, nurses have a relatively high frequency of toothbrushing and flossing but a low frequency of periodic examinations and scaling/polishing. Generally, females reported significantly higher frequencies of toothbrushing and flossing than males did. The toothpaste selection of the participants was primarily influenced by dentists' recommendations, the flavour of the toothpaste, and its anti-malodour effect were the most dominant factors. Conclusion:, The compliance of health professionals, especially dental practitioners, with appropriate oral health measures is relatively high. However, the dental team cannot always assume that the dental patient, who also happens to be a healthcare provider, has meticulous oral habits. The dental hygienist and surgeon have to educate and motivate their patients, especially healthcare providers because of the influence of the latter on their own patients. [source] Application of activity-based costing (ABC) for a Peruvian NGO healthcare providerINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2001Dr. Hugh Waters Abstract This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries. Copyright © 2001 John Wiley & Sons, Ltd. [source] Role of the Clinical Breast Examination in Breast Cancer ScreeningJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2001Does This Patient Have Breast Cancer? QUESTION: The authors, in an article for the JAMA section on the rational clinical examination, consider the evidence on whether and how to use clinical breast examination as a cancer screening technique. BACKGROUND: Breast cancer is a common disease, particularly in older women. The authors note that by age 70 the annual incidence of breast cancer is one in 200 women. Breast cancer survival is strongly influenced by the stage of the disease at the time of diagnosis. As a result, it is important to consider how best to screen for this disease. In recent years there has been considerable attention in the clinical literature and in the popular media paid to the screening strategies of breast self-examination and of screening mammography, but somewhat less to the potential role of the breast examination by the healthcare provider. In actual clinical practice, the same woman may be the recipient of any, none, or all of these screening modalities. The best way to combine these screening strategies, particularly in the case of the older woman, remains a subject of some uncertainty and controversy. DATA SOURCES: Data were obtained from a MEDLINE search of the English-language literature for 1966 through 1997 and additional articles as identified by the authors. STUDY SELECTION CRITERIA: In their evaluation of the effectiveness of clinical breast examination, the authors included both controlled trials and case-controlled studies in which clinical breast examination was used as a component of the screening. Study of breast examination technique considered both clinical studies and studies using silicone breast models. DATA EXTRACTION: The combined data from the trials included information on approximately 200,000 women who received a breast cancer screening intervention (mammography and/or clinical breast examination). However, none of the studies made the direct comparison of a group receiving clinical breast examination as a sole intervention with a control group that did not receive any screening. Data on the utility of clinical breast examination were partially derived from studies where that screening modality was used in combination with mammography. MAIN RESULTS: A number of trials of cancer screening have demonstrated a reduction in mortality from the use of mammography and clinical breast examination as combined screening strategies compared with no screening, with the inference that the reduction in mortality comes from the earlier detection of breast cancer. The percentage of the detected cancers that are detected in the trials by clinical breast examination despite having been missed on mammography varies across the trials from a low of 3% of the detected cancers to a high of 45%. It is speculative whether the marginal contribution of clinical breast examination to the mortality reduction in these screening trials corresponds to the percentage of cancers detected by clinical breast examination alone. In most of the clinical trials, the technique of breast examination reportedly was not well described. It is unclear therefore how much the technique of breast examination used varied within and among the clinical trials. Data from studies using examinations of breast models made of silicone demonstrated that test performance accuracy correlated with a lengthier breast examination, better breast examination technique, and perhaps with examiner experience. The report includes data from six comparator studies and from two demonstration projects. Of the six comparator studies, four compared a screened population with an unscreened population and two compared different intensities of screening strategies. None of the eight clinical trials was directed to a geriatric population and in fact older women were excluded by upper age entry criteria from the six comparator studies. (The upper age limit for study entry in the six comparator studies varied from 49 to 64.) CONCLUSION: The authors drew on the pooled results of these eight studies to conclude that clinical breast examination has a sensitivity of 54% (95% confidence interval, 48.3,59.8) and a specificity of 94% (95% confidence interval, 90.2,96.9). The authors conclude that screening clinical breast examination should be done for women age older than 40. [source] Living with chronic illness: A phenomenological study of the health effects of the patient,provider relationshipJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2008Associate Professor of Nursing), CNS (Psychiatric, Mental Health Clinical Specialist, Sylvia Fox PhD Abstract Purpose: To understand the patient,healthcare provider (HCP) relationship from the lived experience of women with chronic disease and determine how this relationship affects women's health. Data sources: Narrative accounts of 25 women's relationships with HCPs in repeated group and individual interviews were audio-taped and transcribed verbatim. Interpretive phenomenology was used to explore the data using three interconnected modes of paradigm cases, exemplars, and themes. Conclusions: Women with chronic disease believed their health was significantly affected by their relationships with HCPs. They experienced a greater sense of well-being and security in connected relationships and had more confidence and motivation to manage their illness. Implications for practice: This research suggests that for women with chronic disease, relationships with HCPs that are connected, and characterized by partnership, and personableness result in the women feeling better in many dimensions. The context of today's healthcare system often pushes the nurse practitioner (NP) to provide care more attuned to medical issues, leaving little time for the development of connected relationships. In spite of this pressure, NPs need to strive to develop relationships with patients that are intersubjective/connected. [source] Dementia and Driving: Autonomy Versus SafetyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2005Article first published online: 23 SEP 200, Charlene Hoffman Snyder MSN, NP-BC Purpose This article reviews the effects of various types of dementia on driving skills, the available assessment measures, legal considerations, and the important role played by the nurse practitioner (NP) in the process of recommending driving cessation. It provides strategies and resources that may offer guidance to NPs who are attempting to balance the continued independence of patients with dementia, as represented by driving, with the safety not only of such patients but also of the public at large. Data sources A review of the biomedical literature, resources available on the World Wide Web, and illustrative case studies were used. Conclusions The diagnosis of dementia alone is often insufficient to determine driver competence because the topographic losses of dementia are complex. Recognizing when cessation should occur is made more difficult because objective assessment tools do not exist to predict impaired driving skills. Recommending driving cessation at the appropriate time can be a challenge for NPs, who must balance such a significant impact on the driver's autonomy with concerns about public safety if the patient continues to drive despite progressive impairment. Implications for practice The progressive loss of cognitive abilities in dementia presents a series of ongoing challenges for the patient throughout the disease continuum. Unfortunately, the recommendation to stop driving can present one of the more immediate issues confronting the patient, the family, and the healthcare provider. Failure to assess diminished driving skill can lead either to premature or to delayed driving cessation. Either outcome can have adverse effects on the patient, the patient's family, and public safety. [source] Nonadherence Consensus Conference Summary ReportAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009R. N. Fine This report is a summary of a ,Consensus Conference' on nonadherence (NA) to immunosuppressants. Its aims were: (1) to discuss the state-of-the-art on the definition, prevalence and measurement of NA, its risk factors and impact on clinical and economical outcomes and interventions and (2) to provide recommendations for future studies. A two-day meeting was held in Florida in January 2008, inviting 66 medical and allied health adherence transplant and nontransplant experts. A scientific committee prepared the meeting. Consensus was reached using plenary and interactive presentations and discussions in small break-out groups. Plenary presenters prepared a summary beforehand. Break-out group leaders initiated discussion between the group members prior to the meeting using conference calls and e-mail and provided a summary afterward. Conclusions were that NA: (a) is more prevalent than we assume; (b) is hard to measure accurately; (c) tends to confer worse outcomes; (d) happens for a number of reasons, and system-related factors including the patient's culture, the healthcare provider and the setting and (e) it is not currently known how to improve adherence. This consensus report provided some roadmaps for future studies on this complicated, multifaceted problem. [source] Chlamydia trachomatis in Tasmania 2001,2007: rising notification trendsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Nicola Stephens Abstract Objectives: To investigate trends in notification rates of Chlamydia trachomatis in Tasmania, Australia, by population sub-groups, from 1 January 2001 to 31 December 2007. Methods: An enhanced surveillance dataset was used to supplement case notifications. Rates based on age group were analysed by sex, geographic region, indigenous status, sexual exposure, reason for testing and healthcare provider. Results: In all age groups, the notification rate increased steeply. The highest rates were seen in the ages 15,24 years; this age group represented 15% of the population but accounted for 74% of the chlamydial notifications. The increased rates in females aged 15,24 years and males 15,19 years in Tasmania were larger than the increases observed nationally. Rates were consistently higher in urban areas. Females were more likely to have been tested as a result of screening, and males were more likely to have been tested when presenting with symptoms or as a result of contact tracing. The majority of cases reported sexual exposure with opposite sex partners only. Conclusions: This study highlights the increasing significance of chlamydial infection as a public health issue, the gender differences in health-seeking behaviour, and the discrepancies in testing patterns. These findings will assist with the design of health promotion programs. [source] Rural health care in MalaysiaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2002Kamil Mohamed Ariff ABSTRACT: Malaysia has a population of 21.2 million of which 44% resides in rural areas. A major priority of healthcare providers has been the enhancement of health of ,disadvantaged' rural communities particularly the rural poor, women, infants, children and the disabled. The Ministry of Health is the main healthcare provider for rural communities with general practitioners playing a complimentary role. With an extensive network of rural health clinics, rural residents today have access to modern healthcare with adequate referral facilities. Mobile teams, the flying doctor service and village health promoters provide healthcare to remote areas. The improvement in health status of the rural population using universal health status indicators has been remarkable. However, differentials in health status continue to exist between urban and rural populations. Malaysia's telemedicine project is seen as a means of achieving health for all rural people. [source] THE ETHICS OF INTERCOUNTRY ADOPTION: WHY IT MATTERS TO HEALTHCARE PROVIDERS AND BIOETHICISTSBIOETHICS, Issue 7 2010SARAH JONES ABSTRACT The goal of this paper is both modest and ambitious. The modest goal is to show that intercountry adoption should be considered by ethicists and healthcare providers. The more ambitious goal is to introduce the many ethical issues that intercountry adoption raises. Intercountry adoption is an alternative to medical, assisted reproduction option such as in vitro fertilization (IVF), intracytoplasmic sperm injection, third party egg and sperm donation and surrogacy. Health care providers working with assisted reproduction are in a unique position to introduce their clients to intercountry adoption; however, providers should only do so if intercountry adoption is ethically equal or superior to the alternatives. This paper first presents a brief history of intercountry adoption. The second section compares intercountry adoption with medical alternatives. The third section examines the unique ethical challenges that are not shared by other medical alternatives. The final section concludes that it is simplistic for a healthcare provider to promote intercountry adoption unconditionally; however, in situation where intercountry adoption is practiced conscientiously it poses no greater ethical concern than several medical alternatives. This conclusion is preliminary and is intended as a start for further discussion. [source] Colon cancer screening practices and disclosure after receipt of positive or inconclusive genetic test results for hereditary nonpolyposis colorectal cancer,,§CANCER, Issue 18 2009Anne L. Ersig PhD Abstract BACKGROUND: Patients who receive conclusive genetic test results for hereditary nonpolyposis colorectal cancer (HNPCC) tend to adopt appropriate colorectal cancer screening behaviors and disclose their test results. However, little is known about the disclosure processes or screening behaviors of individuals who receive inconclusive genetic test results. This study compared endoscopy use and disclosure between individuals with positive and inconclusive genetic test results, within a year after results were received. METHODS: Individuals with a personal history of cancer and suspected of having HNPCC participated in genetics education and counseling, underwent HNPCC testing, and received genetic test results (GCT) within a prospective cohort study. Demographic, psychosocial, and behavioral data were obtained from questionnaires and interviews completed before and after GCT. RESULTS: Index cases with inconclusive genetic test results were less likely to screen within 12 months. Index cases who disclosed test results to children within 6 months were more likely to screen within 12 months, controlling for mutation status. Index cases with inconclusive genetic test results were less likely to share results with a healthcare provider within 6 months. Index cases who disclosed genetic test results to healthcare providers within 6 months were more likely to have endoscopy within 12 months. CONCLUSIONS: Genetic test results and disclosure significantly affected colon cancer screening at 12-month follow-up. Interventions to improve adherence to colorectal cancer screening should consider increased education of those receiving inconclusive results and encourage disclosure to healthcare providers and family members. Cancer 2009. Published 2009 by the American Cancer Society. [source] Influence of family history and preventive health behaviors on colorectal cancer screening in African AmericansCANCER, Issue 2 2008CRNP, Kathleen A. Griffith PhD Abstract BACKGROUND. African Americans (AAs) have low rates of colorectal cancer (CRC) screening. To the authors' knowledge, factors that influence their participation, especially individuals with a family history of CRC ("family history"), are not well understood. METHODS. A secondary analysis of the 2002 Maryland Cancer Survey data examined predictors of risk-appropriate, timely CRC screening ("screening") in AAs with a family history and in individuals without a family history. Predictors that were evaluated included age, sex, family history, mammogram or prostate-specific antigen (PSA) screening, body mass index, activity, fruit/vegetable consumption, alcohol, smoking, perceived risk of cancer, education, employment, insurance, access to a healthcare provider, and healthcare provider recommendation of fecal occult blood test (FOBT) and/or sigmoidoscopy/colonoscopy. RESULTS. In individuals without a family history of CRC (N = 492), recommendation for FOBT (odds ratio [OR] of 11.90; 95% confidence interval [95% CI], 6.84,20.71) and sigmoidoscopy/colonscopy (OR of 7.06; 95% CI, 4.11,12.14), moderate/vigorous activity (OR of 1.74; 95% CI, 1.06,2.28), and PSA screening history (OR of 2.68; 95% CI, 1.01,7.81) were found to be predictive of screening. In individuals with a family history (N = 88), recommendation for sigmoidoscopy/colonscopy (OR of 24.3; 95%, CI 5.30,111.34) and vigorous activity (OR of 5.21; 95% CI, 1.09,24.88) were found to be predictive of screening. However, family history did not predict screening when the analysis was controlled for age, education, and insurance. AAs who had a family history were less likely to screen compared with their white counterparts (N = 293) and compared with AAs who were at average risk for CRC (P < .05). CONCLUSIONS. Regardless of family history, healthcare provider recommendation and activity level were important predictors of screening. Lower screening rates were observed in AAs who had a family history compared with individuals who did not. The authors believe that, for AAs who have a family history, further examination of barriers and facilitators to CRC screening within the cultural context is warranted. Cancer 2008. © 2008 American Cancer Society. [source] Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010L. Baandrup Baandrup L, Allerup P, Lublin H, Nordentoft M, Peacock L, Glenthoj B. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients. Objective:, To evaluate the effect of a multifaceted educational intervention on the frequency of antipsychotic co-prescribing in adult schizophrenia out-patients. Method:, Controlled quasi-experimental study performed in two Danish municipalities matched for baseline prevalence of antipsychotic polypharmacy, socioeconomic status and functional level of patients. The intervention was aimed at psychiatric healthcare providers and consisted of 1 day of didactic lectures, six 3-h educational outreach visits and an electronic reminder during drug prescribing. Results:, Between-group use of antipsychotic polypharmacy was compared at baseline (intervention group, N = 232/control group, N = 351) and after 1 year of intervention (intervention group, N = 216/control group, N = 386). The prevalence of antipsychotic polypharmacy at follow-up was not significantly different between treatment settings when adjusting for differences in case-mix (P = 0.07). Conclusion:, This multifaceted educational intervention failed to reduce the frequency of antipsychotic co-prescribing, but it suggested that future efforts to improve prescribing practice should address organizational barriers to implementation. [source] A qualitative investigation of the views and health beliefs of patients with Type 2 diabetes following the introduction of a diabetes shared care serviceDIABETIC MEDICINE, Issue 10 2003S. M. Smith Abstract Aims A qualitative research approach was adopted in order to explore the views and health beliefs of patients with Type 2 diabetes who had experienced a new structured diabetes shared care service. Methods Patients from 15 general practices were randomly selected and invited to attend three focus groups. Two independent researchers adopted the ,Framework' technique to analyse the transcribed data and identify key themes expressed by patients. Results Themes relating to diabetes included frustration, victimization and powerlessness in relation to living with diabetes, controlling blood sugar, medication and economic barriers to care. Differences in emphases between patients and healthcare providers emerged. Patients were generally positive about shared care and largely identified it with the nurses involved. Conclusion This research highlights the importance of an in-depth exploration of patients' views during changes in diabetes care delivery to identify service delivery failures and gaps in patient knowledge such as lack of awareness of the extent of macrovascular risk. [source] | |||||||||||||||||||||||||||||||||||||