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Selected AbstractsBRITISH SOCIAL HOUSING AND THE VOLUNTARY SECTORECONOMIC AFFAIRS, Issue 2 2008Robert Whelan Housing for the poor was a thriving part of the voluntary sector in the nineteenth century, providing thousands of homes through hundreds of societies without subsidy. It was undermined by state action which has effectively driven other providers from the field. [source] Comparison of costs and utilization among buprenorphine and methadone patientsADDICTION, Issue 6 2009Paul G. Barnett ABSTRACT Aims Buprenorphine is an effective alternative to methadone for treatment of opioid dependence, but economic concerns represent a barrier to implementation. The economic impacts of buprenorphine adoption by the US Veterans Health Administration (VHA) were examined. Design Prescriptions of buprenorphine, methadone treatment visits, health-care utilization and cost, and diagnostic data were obtained for 2005. Findings VHA dispensed buprenorphine to 606 patients and methadone to 8191 other patients during the study year. An analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11 597 for buprenorphine and $14 921 for methadone (P < 0.001). Cost was not significantly different in subsequent months. The first 6 months of buprenorphine treatment included an average of 66 ambulatory care visits, significantly fewer than the 137 visits in methadone treatment (P < 0.001). In subsequent months, buprenorphine patients had 8.4 visits, significantly fewer than the 21.0 visits of methadone patients (P < 0.001). Compared to new methadone episodes, new buprenorphine episodes had 0.634 times the risk of ending [95% confidence interval 0.547,0.736]. Implementation of buprenorphine treatment was not associated with an influx of new opioid-dependent patients. Conclusion Despite the higher cost of medication, buprenorphine treatment was no more expensive than methadone treatment. VHA methadone treatment costs were higher than reported by other providers. Although new buprenorphine treatment episodes lasted longer than new methadone episodes, buprenorphine is recommended for more adherent patients. [source] The dynamics of the health labour marketINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2006Marko Vujicic Abstract One of the most important components of health care systems is human resources for health (HRH),the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour,doctors, nurses and other providers,those who demand labour, and how these actors respond to incentives when formulating health workforce policy. Copyright © 2006 John Wiley & Sons, Ltd. [source] Kenosha County Falls Prevention Study: A Randomized, Controlled Trial of an Intermediate-Intensity, Community-Based Multifactorial Falls InterventionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007Jane E. Mahoney MD OBJECTIVES: To decrease the rate of falls in high-risk community-dwelling older adults. DESIGN: Randomized, controlled trial. SETTING: Community-based. PARTICIPANTS: Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems. INTERVENTION: Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment. MEASUREMENTS: The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year. RESULTS: There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008). CONCLUSION: This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required. [source] Electronic health records: Use, barriers and satisfaction among physicians who care for black and Hispanic patientsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2009Ashish K. Jha MD MPH Abstract Objectives, Electronic health records (EHRs) are a promising tool to improve the quality of health care, although it remains unclear who will benefit from this new technology. Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers. Methods, We used survey data from stratified random sample of all medical practices in Massachusetts in 2005. We determined rates of EHR adoption, perceived barriers to adoption, and satisfaction with EHR systems. Results, Physicians who reported patient panels of more than 40% black or Hispanic had comparable levels of EHR adoption than other physicians (27.9% and 21.8%, respectively, P = 0.46). Physicians from minority-serving practices identified financial and other barriers to implementing EHR systems at similar rates, although these physicians were less likely to be concerned with privacy and security concerns of EHRs (47.1% vs. 64.4%, P = 0.01). Finally, physicians from high-minority practices had similar perceptions about the positive impact of EHRs on quality (73.7% vs. 76.6%, P = 0.43) and costs (46.9% vs. 51.5%, P = 0.17) of care. Conclusions, In a state with a diverse minority population, we found no evidence that minority-serving providers had lower EHR adoption rates, faced different barriers to adoption or were less satisfied with EHRs. Given the importance of ensuring that minority-serving providers have equal access to EHR systems, we failed to find evidence of a new digital divide. [source] Problems and Risks of Unsolicited E-mails in Patient-Physician Encounters in Travel Medicine SettingsJOURNAL OF TRAVEL MEDICINE, Issue 3 2001Andreas Sing Background: International travel and use of modern information technology are expressions of modern life style. Seeking on-line travel health advice via E-mail for preventive (teleprevention) or diagnostic reasons may become increasingly popular among patients with financial resources and Internet access. This study was undertaken to compare the behavior of travel clinic or tropical medicine physicians and other providers of travel-related medical information services toward unsolicited E-mails from fictitious patients in pretravel and post-travel scenarios. We also wanted to test the potential of E-mail advice for preventive medicine (teleprevention), and to find out how the "Good Samaritan Law" is observed. Methods: Two different E-mails were posted to E-mail addresses of 171 physicians (members of travel health and/or tropical medicine societies) and services offering advice on travel health issues identified by an AltaVista search. These E-mails, from two different fictitious travelers, were asking for advice regarding malaria prophylaxis in a pretravel scenario and describing symptoms suggesting acute malaria. Results: Of the contacted addresses 43.3% and 49.7% respectively, replied to the pre- and post-travel E-mail. Of those suggesting antimalarial chemoprophylaxis in the pretravel scenario, 13.2% proposed inadequate regimens, and at least 3.5% of the post-travel replies were inappropriate. The "Good Samaritan Law" was observed by a significant number of physicians. Conclusions: Both patients and physicians have to be aware of the limitations of E-mail communication. Guidelines protecting physicians against legal and ethical consequences of this new communication technology are urgently needed. [source] Pediatric Travel Consultation in an Integrated ClinicJOURNAL OF TRAVEL MEDICINE, Issue 1 2001John C. Christenson Background: In May 1997, a pediatric travel service was created within a larger integrated University-County Health Department international travel clinic. The purpose of the service was to further enhance the travel advice and care provided to children and their parents or guardians. The current study was designed to describe the care of children in this setting and to compare the care of children seen in the Pediatric Travel Service with that of children seen by other providers. Methods: All pediatric patients (defined as individuals , 18 years of age) receiving care in the travel clinic were considered candidates for inclusion in the analysis. Patients seen by the Pediatric Travel Service were compared to those seen by other staff members in the travel clinic (referred to as Regular Clinic). The following information was noted: basic demographic data, medical history including allergies, prior immunization records, intended place and duration of travel, and immunizations and medications prescribed at the time of visit. Travel advice covering water and food precautions, preventive measures against insect bites, injury prevention, malaria prevention, prevention of parasitic infections, and environmental-related problems was provided to all patients in both groups when necessary. Results: Between May 1997 and December 1999, 287 pediatric age individuals were given pretravel care by the Pediatric Travel Service (median age, 6 years; range, 1 month-18 years). During the same time period, 722 pediatric age travelers (median age, 14 years; range, 8 months-18 years) were evaluated in the Regular Clinic by other staff members. Travel destinations most commonly traveled by both groups in descending order were: Africa, Central America and Mexico, South America, and Southeast Asia. When compared to travelers seen in the Regular Clinic, individuals in the Pediatric Travel Service group were more likely to travel for humanitarian work, and for parental work relocation. Persons in the Regular Clinic were more likely to travel to Mexico and Central America. They were also more likely to travel on vacation and for missionary work or study. Hepatitis B and tetanus-diphtheria booster vaccinations were given more frequently to travelers seen in the Regular Clinic. Also, ciprofloxacin and antimotility agents were more commonly prescribed in this group. No differences were noted in the duration of travel or in the time interval between clinic visit and departure. Conclusions: While general travel advice was considered to be similar in both clinic groups, some differences were observed in the frequency of administration of certain vaccines and prescriptions of medications. These differences were likely due to a difference in age in the two study groups. The high volume and success of the clinic suggest that integrated pediatric and adult travel services in a coordinated setting can be effective. [source] A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing roleOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2008Justin J. Needle Abstract Purpose:, Recent changes in medicines legislation in the UK have broadened the opportunities for optometrists to use and supply therapeutic drugs. We set out to investigate the current therapeutic practice of UK optometrists and to elicit their views on an extended prescribing role. Methods:, Members of the College of Optometrists were invited via email to take part in an online survey. The survey questions covered four areas: mode of practice, proximity and relationship to other providers of eye care, scope of current therapeutic practice and future plans regarding prescriber training. Results:, Of the 1288 responses received (response rate 24%), over 90% were from optometrists working in community practice. Common, non-sight-threatening conditions were managed frequently or occasionally by between 69 and 96% of respondents. Blepharitis and dry eye were the most common (managed routinely by >70%). In terms of therapeutic agents used, large numbers of optometrists reported that they commonly supplied or recommended over-the-counter (non-prescription) drugs, particularly lubricants and anti-allergic agents. However, fewer respondents supplied antibiotics (only 14% supplying chloramphenicol or fusidic acid frequently). Overall, relatively few respondents (14%) expressed no interest in undertaking further training for extended prescribing, although several barriers were identified, including cost and time taken for training, lack of remuneration and fear of litigation. Conclusion:, Significant numbers of community optometrists are currently managing a range of common ocular conditions using a limited formulary. Enabling optometrists to train as independent prescribers will further develop this role, allowing greater use of their skills and providing patients with quicker access to medicines. [source] Abraham Flexner and the roots of interprofessional educationTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue S1 2008FCAHSArticle first published online: 4 DEC 200, John H. V. Gilbert PhD Abstract This paper explores the culture underlying the practices of physicians and other health care providers in the 20th century and implications for interprofessional education for collaborative practice in the 21st century. Today's practice of medicine flows from the 1920s work of Dr. Abraham Flexner recommending that North American medical schools introduce rigor and consistency in teaching, moving them from private, for-profit, somewhat ad hoc institutions to university affiliation employing physicians dedicated to teaching and research. The education of physicians and other providers was transformed by Flexner's work. However, a sequela has been the "stovepiping" of professions, in both their education and their practices, with minimal interaction among professions, and provider- or system-centric care rather than patient-centric care. The result has been learning environments that lack sympathy for interprofessional education and its concomitant of learning and working together. [source] Do rural hospitals lag behind urban hospitals in addressing community health needs?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009An analysis of recent trends in US community hospitals Abstract Objective:,This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs. Design:,This study used a multivariate, longitudinal research design. Research setting:,A cross-sectional survey was the setting for this study. Participants:,The participants were rural or urban hospitals in the United States. Main outcome measures:,The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location. Results:,Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information. Conclusions:,This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations. [source] Information Technology Projects by International Logistics Services Providers: The Case of Canada's Small Customs BrokersCANADIAN JOURNAL OF ADMINISTRATIVE SCIENCES, Issue 1 2006Michael A. Haughton Abstract This study explores the motives and effects of information and communication technology (ICT) investments made by some of Canada's small customs brokers. Like other providers of support services for global supply chain operations, customs brokers have been implored to recognize the significant rewards of effectively deployed ICT. Using qualitative data on eight small Canadian customs brokers, this study determines the extent to which expectation of those rewards motivated the workers' ICT investments. Drawing on institutional theory to complement the analysis, the study finds that the motives transcend belief in ICT projects' inherent utility. This and related findings on the impact of ICT projects on the brokers, extend knowledge concerning the study of important ICT investment decisions in the context of trans-border goods movement. Résumé Cette étude examine les motifs et les effets des investissements rélisés dans la technologie de l'information et de la communication (ICT) par de petits agents en douane canadiens. Comme d'autres fournisseurs d'abonnement de maintenance des opárations de chaîne d'approvision-nements, ces agents étaient invités à identifier les récompenses considérables liées au déploiement efficace de l'ICT. À partir de données qualitatives portant sur huit agents, l'étude s'attelle à déterminer dans quelle mesure l'espérance des récompenses motive les investissements. S'inspirant de la théorie institutionnelle pour compléter l'analyse, l'étude constate que les motifs dépassent la croyance en l'utilité intrinsèque des projets ICT. Cette conclusion et l'impact des projets sur les agents, s'inscrit dans le prolongement des études sur les décisions d'investissement en ICT dans le contexte du commerce transfrontalier. [source] | |||||||||||||