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Preventive Services (preventive + services)
Selected AbstractsSTUDY GUIDES DOCTORS ON PREVENTIVE SERVICES FOR IMPROVING HEALTHCA: A CANCER JOURNAL FOR CLINICIANS, Issue 5 2001Article first published online: 31 DEC 200 No abstract is available for this article. [source] A trial of 3 interventions to promote colorectal cancer screening in African AmericansCANCER, Issue 4 2010Daniel S. Blumenthal MD Abstract BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC incidence and mortality rates are higher among blacks than among whites, and screening rates are lower in blacks than in whites. For the current study, the authors tested 3 interventions that were intended to increase the rate of CRC screening among African Americans. METHODS: The following interventions were chosen to address evidence gaps in the Centers for Disease Control and Prevention's Guide to Community Preventive Services: one-on-one education, group education, and reducing out-of-pocket costs. Three hundred sixty-nine African-American men and women aged ,50 years were enrolled in this randomized, controlled community intervention trial. The main outcome measures were postintervention increase in CRC knowledge and obtaining a screening test within 6 months. RESULTS: There was substantial attrition: Two hundred fifty-seven participants completed the intervention and were available for follow-up 3 months to 6 months later. Among completers, there were significant increases in knowledge in both educational cohorts but in neither of the other 2 cohorts. By the 6-month follow-up, 17.7% (11 of 62 participants) of the Control cohort reported having undergone screening compared with 33.9% (22 of 65 participants) of the Group Education cohort (P = .039). Screening rate increases in the other 2 cohorts were not statistically significant. CONCLUSIONS: The current results indicated that group education could increase CRC cancer screening rates among African Americans. The screening rate of <35% in a group of individuals who participated in an educational program through multiple sessions over a period of several weeks indicated that there still are barriers to overcome. Cancer 2010. © 2010 American Cancer Society. [source] European comparison of costs and quality in the prevention of secondary complications in Type 2 diabetes mellitus (2000,2001)DIABETIC MEDICINE, Issue 7 2002A. Gandjour Abstract Aims To compare the out-patient costs and process quality of preventing secondary complications in patients with Type 2 diabetes mellitus in France, Germany, Italy, The Netherlands, Sweden, Switzerland, and the UK. Methods A total of 188 European physician practices assessed annual services for one hypothetical average patient (cost evaluation) and 178 practices reported retrospective data on one or two real patients (quality evaluation) in 2000/2001. In countries with a detailed fee-for-service schedule (Germany, Italy, and Switzerland) reimbursement fees were used to approximate costs. These fee-for-service schedules were also used to develop index (average) fees for all countries, in order to measure resource utilization. The following process quality indicators were evaluated: control of HbA1c; control of lipids; urine test for (micro)albuminuria; control of blood pressure; foot examination; neurological examination; eye examination; and patient education. For each country an average quality rating was calculated by weighting the response to each quality indicator with the level of scientific evidence. Results Average quality ratings ranged from 0.40 in The Netherlands to 0.62 in the UK (0 = lowest rating; 1 = highest rating). Total annual costs for secondary prevention were higher in Switzerland than in Germany and Italy (EUR475, EUR381, and EUR283, respectively). Resource utilization was highest in Germany and lowest in the UK. Conclusions The overall quality of preventive services documented was found to be poor in the seven European countries studied. The UK rated as both the most effective and the most efficient country in providing secondary prevention in Type 2 diabetes. [source] Alcohol screening and brief intervention: dissemination strategies for medical practice and public healthADDICTION, Issue 5 2000Thomas F. Babor This paper introduces the concept of risky drinking and considers the potential of alcohol screening and brief intervention (SBI) to reduce alcohol-related problems in medical practice and in organized systems of health care. The research evidence behind this approach is reviewed. Potential strategies for the dissemination of SBI to systems of health care are then discussed within the context of a public health model of clinical preventive services. There is an emerging consensus that SBI should be promoted in general healthcare settings, but further research is needed to determine the best ways to achieve widespread dissemination. In an attempt to provide an integrative model that is relevant to SBI, dissemination strategies are discussed for three target groups: (1) individual patients and practitioners; (2) health care settings and health systems; and (3) the communities and the general population. Dissemination strategies are considered from the fields of social change, social science, commercial marketing and education in terms of their potential for translating SBI innovations into routine clinical practice. One overarching strategy implicit in the approaches reviewed in this article is to embed alcohol SBI in the more general context of preventive health services, the utility of which is becoming increasingly recognized as a critical supplement to more traditional clinical medicine. [source] Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiryHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2006Thilo Kroll PhD Abstract Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural,environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants. [source] Suboptimal provision of preventive healthcare due to expected enrollee turnover among private insurersHEALTH ECONOMICS, Issue 4 2010Bradley Herring Abstract Many preventive healthcare procedures are widely recognized as cost-effective but have relatively low utilization rates in the US. Because preventive care is a present-period investment with a future-period expected financial return, enrollee turnover among private insurers lowers the expected return of this investment. In this paper, I present a simple theoretical model to illustrate the suboptimal provision of preventive healthcare that results from insurers ,free riding' off of the provision from others. I also provide an empirical test of this hypothesis using data from the Community Tracking Study's Household Survey. I use lagged market-level measures of employment-induced insurer turnover to identify variation in insurers' expectations and test for the effect of turnover on several different measures of medical utilization. As expected, I find that turnover has a significantly negative effect on the utilization of preventive services and has no effect on the utilization of acute services used as a control. Copyright © 2009 John Wiley & Sons, Ltd. [source] Can paying for results help to achieve the Millennium Development Goals?JOURNAL OF EVIDENCE BASED MEDICINE, Issue 2 2009Overview of the effectiveness of results-based financing Abstract Objective Results-based financing and pay-for-performance refer to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. Results-based financing is widely advocated for achieving health goals, including the Millennium Development Goals. Methods We undertook an overview of systematic reviews of the effectiveness of RBF. We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007). We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants. We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format. Results We found 12 systematic reviews that met our inclusion criteria. Based on the findings of these reviews, financial incentives targeting recipients of health care and individual healthcare professionals are effective in the short run for simple and distinct, well-defined behavioral goals. There is less evidence that financial incentives can sustain long-term changes. Conditional cash transfers to poor and disadvantaged groups in Latin America are effective at increasing the uptake of some preventive services. There is otherwise very limited evidence of the effects of results-based financing in low- or middle-income countries. Results-based financing can have undesirable effects, including motivating unintended behaviors, distortions (ignoring important tasks that are not rewarded with incentives), gaming (improving or cheating on reporting rather than improving performance), widening the resource gap between rich and poor, and dependency on financial incentives. Conclusion There is limited evidence of the effectiveness of results-based financing and almost no evidence of the cost-effectiveness of results-based financing. Based on the available evidence and likely mechanisms through which financial incentives work, they are more likely to influence discrete individual behaviors in the short run and less likely to create sustained changes. [source] Health Screening and Developmental DisabilitiesJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3 2006Teresa Iacono Abstract, Adults with developmental disabilities often experience health disparities when compared with the general population. Early detection of risk of disease may help to reduce such disparities, but many adults often do not participate in preventive health care at recommended levels. The aim of the present study was to describe health screening activities involving a large group of adults and explore how factors, such as living arrangement, type and severity of disability, and age, influence reported rates of participation. The study involved administering surveys to adults with disabilities and their immediate support persons (parents, carers, and professional support workers) and asking whether adults had visited a general practitioner (GP) and what was their participation in preventive services during the previous 12-month period. Participation in preventive screening services ranged between 3% (screening for sexually transmitted infection) and 58% (screening for elevated blood pressure), and rates for certain services appeared low, particularly in comparison with equivalent screenings in the general population. Results showed a relationship between participation rates and living situation, type of disability, and age, but not severity of disability. The results suggest that higher rates of participation in preventative health activities among those enrolled in formal services may reflect a greater obligation or concern among paid workers and possibly a lack of awareness of health issues by families, and also that screening disparities may be attributed to GPs who may be applying guidelines from the general population but who are not aware of disability-specific issues when examining adults with disabilities. [source] Dental Services for Migrant and Seasonal Farmworkers in US Community/Migrant Health CentersTHE JOURNAL OF RURAL HEALTH, Issue 3 2006Sherri M. Lukes RDH ABSTRACT:,Context: Migrant and seasonal farmworkers are recognized as a medically underserved population, yet little information on need, access, and services is available,particularly with regard to oral health care. Purpose: This study describes the facilities, services, staffing, and patient characteristics of US dental clinics serving migrant and seasonal farmworkers, and identifies trends and issues that may impede or improve dental care access and service. Methods: National databases were used to identify community and migrant health centers providing oral health care to migrant and seasonal farmworkers. Mailed surveys collected information on clinic history, operational details, services provided, patient demographics, employment and resource needs, and perceived barriers to care. Findings: Among the 81 respondents (response rate 41%), hours of operation varied from 1 evening a week to more than 40 hours a week; 52% had no evening hours. Almost all the clinics offered preventive, diagnostic, and basic restorative dental services, and roughly two thirds also offered complex restorative services. Patients most frequently sought emergency dental care (44%) followed by basic restorative services (32%) and preventive services (26%). The dentist position was the most difficult to fill, and new funding sources were cited as the most important resource need. Respondents perceived cost of services, lack of transportation, and limited clinic hours as primary barriers to care. Conclusions: While some barriers to care have been almost universally addressed (eg, language), there is evidence that some impediments remain and may present significant obstacles to a broad improvement in oral health care for migrant and seasonal farmworkers. [source] Health Differences Among Lumbee Indians Using Public and Private Sources of CareTHE JOURNAL OF RURAL HEALTH, Issue 3 2004Alfred Bryant Jr. PhD ABSTRACT: Context: Of 2.4 million American Indians, approximately 60% are eligible to receive Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. It is unknown if their quality of care, health behaviors, and health status vary by source of care, as demonstrated for other populations. Purpose: The purpose of this study was to determine whether preventive services, health behaviors, and number of health conditions vary as a function of having non-IHS public versus private physicians as sources of usual care. Methods: 1,177 Lumbee Indians, who are ineligible to receive IHS services, completed a telephone interview that included information on receipt of preventive measures, tobacco use, physical activity, breast self-examination, and medical conditions. Frequencies, chi-squares, t tests, odds ratios, and confidence intervals were used to compare variables by source of care. Findings: 939 respondents (80%) had a private and 210 (18%) a public health clinic physician as their usual source of care; 28 (2%) reported having neither. Logistic regression analyses, restricted to the 1,149 participants who reported either a private or public source of care, revealed no differences in receipt of preventive services or health status by usual source of care. Smokeless tobacco use was less common among persons using private than public providers. Conclusions: Lumbees whose usual source of care was a public clinic physician did not differ in receipt of preventive services or in health status compared to their counterparts who received care from a private physician. More targeted research into health similarities and differences arising from access to public and private sources of care is warranted. [source] Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Rebecca M. Cunningham MD Abstract This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening,develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention,conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups,conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies,a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation,conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice. [source] Apgar score and dental caries risk in the primary dentition of five year oldsAUSTRALIAN DENTAL JOURNAL, Issue 3 2010AE Sanders Abstract Background:, Conditions in utero and early life underlie risk for several childhood disorders. This study tested the hypothesis that the Apgar score predicted dental caries in the primary dentition. Methods:, A retrospective cohort study conducted in 2003 examined associations between conditions at birth and early life with dental caries experience at five years. Dental examination data for a random sample of five-year-old South Australian children were obtained from School Dental Service electronic records. A questionnaire mailed to the parents obtained information about neonatal status at delivery (five-minute Apgar score, birthweight, plurality, gestational age) and details about birth order, weaning, and behavioural, familial and sociodemographic characteristics. Results:, Of the 1398 sampled children with a completed questionnaire (response rate = 64.6%), 1058 were singleton term deliveries among whom prevalence of dental caries was 40.1%. In weighted log-binomial regression analysis, children with an Apgar score of <=8 relative to a score of 9,10 had greater probability of dental caries in the primary dentition after adjusting for sociodemographic and behavioural covariates and water fluoridation concentration (adjusted PR = 1.47, 95% CI = 1.11, 1.95). Conclusions:, Readily accessible markers of early life, such as the Apgar score, may guide clinicians in identifying children at potentially heightened risk for dental caries and aid decision-making in allocating preventive services. [source] Public dental service utilization among adults in South AustraliaAUSTRALIAN DENTAL JOURNAL, Issue 2 2009L Luzzi Abstract Background:, Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3½-year period were examined. Methods:, Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3½ years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits. Results:, Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline. Conclusions:, Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care. [source] | ||||||||||||||||||||||