Health trends最新文献

This paper describes the responses of senior psychiatrists in Wales to a questionnaire exploring their knowledge and beliefs about patient advocacy. The results suggest mainly pro-advocacy attitudes; respondents who had not met advocacy groups involving their own patients holding attitudes almost as positive as those who had. However, despite these findings, further research is required to define the specific benefits of advocacy before further resources are diverted to the development of such services.

An evaluation of the quarterly Infectious Disease Report for Northumberland was undertaken by postal questionnaire. The response to the survey was encouraging, suggesting that this method of communicating local information is not only acceptable, but also effective and perceived as having a positive impact on practice.

In 1991, home carers in Derbyshire were asked to participate in a questionnaire survey in order to estimate the demand for home carers to assist elderly clients with specific medication tasks. The results indicate that 17% of regular clients require assistance with medication, and that 86% of home carers are expected to assist with at least one medication task. Home care aides received considerably more requests than home helps to assist with such tasks. The findings are discussed in relation to the way home carers perceive 'personal care'. The type of personal care tasks that home carers are expected to perform should be more clearly defined, and the findings highlight the importance of providing pharmaceutical advice and training to home carers.

Case-mix measurement is a basic requirement of clinical and resource management systems within health care organisations, and offers a potentially useful tool for the setting and monitoring of contracts. Ambulatory care has particular problems in the construction of appropriate case-mix measures, and day-case surgery provides an opportunity to test two existing measures, one inpatient (Diagnosis Related Groups) and one ambulatory (Ambulatory Visit Groups). These grouping systems were applied to the same data to compare the case-mix patterns that they produce. The findings show that Ambulatory Visit Groups appear to have advantages over the Diagnosis Related Groups with respect to their underlying assumptions and labelling of the groups; in particular, they assign greater weight to procedures. However, Diagnosis Related Groups are more developed, easier to use, more familiar and allow direct comparisons with inpatient care. Nevertheless, a proper evaluation of these issues requires further data collection and analysis, together with a fundamental examination of the uses of ambulatory case-mix.

This longitudinal survey of elderly people examines morbidity and service usage. 705 elderly people who lived in their own homes were interviewed as part of the Gospel Oak project in 1987/88, and in 1990, 524 (74.3%) were re-interviewed--90 (12.8%) had died, 51 (7.2%) had moved and 40 (5.7%) refused a follow-up interview. The results indicate that 60% of residents (1987/88 and 1990) had been in contact with community services within the month before the survey. Respondents with depression were mostly in contact with the health service, those with dementia were in contact with social services. Long-term activity-limited people had high contact with both services, although this finding was less likely among newly activity-limited people. Multiple service-users from the first survey were likely to be either dead, or high service-users in 1990. Low service-users tended to continue to be low service-users. New users were generally living alone, aged around 70 years and had been relatively healthy previously. Respondents who stopped using services were generally younger, mostly women, and possibly depressed. People who had never been service-users, were generally younger and healthier. Information on community services performance is inadequate to ensure targeted, efficient services, and this survey gives detailed information to help planning and resource allocation.

Baseline data on screening and health education were collected in 1984 from a national survey of general practitioners (GPs), and two groups of GPs who responded to this first survey were followed-up by a second postal questionnaire sent out in July 1990. One group comprised doctors who previously had a low involvement with screening and health education in 1984 (low-involvement group [LIG]), and the other doctors with high involvement (high-involvement group [HIG]). The results from the 1990 survey indicated that the HIG were still more committed to screening and health education than the LIG, but the differences between the two groups had greatly diminished. In 1990 similar proportions of both groups were expecting to receive payments for screening, child health surveillance and health promotion clinics under the new GP contract.

This paper reports the findings from a programme, which provided support to families with a subsequent baby following a cot death. One hundred families participated in the study. Fifty families were randomly allocated apnoea monitors, and the remainder provided with scales and weight charts for daily weighing. The results show that the parents in both groups expressed equal satisfaction with their designated method. However, compared with families allocated scales, those using apnoea monitors attended the child health clinics more often, and the number of contacts with the paediatrician was increased. They also had slightly more home and general practitioner contacts and hospital admissions. The capital and running costs of providing monitors was also greater for this group.

This paper reports the results of a case-note audit undertaken to detect the antenatal risk factors found at the initial booking visit, including the subsequent clinical action taken. From a total of 2,139 case-notes of women booked via an obstetric computer system, and delivered between March 1990 and March 1991, 136 (6.4%) were missing. The results showed that these 136 mothers experienced significantly worse delivery outcomes, ie higher incidence of perinatal death; preterm labour; a baby with a low Apgar score and low birth weight. There was also a higher incidence of perinatal death and babies with a low Apgar score for women booked manually compared with those booked via the computer system. These results show that many audit procedures may be the subject of substantial bias due to the problem of missing information. The extended use of a computer-based medical record system should help to resolve this problem, although hybrid information systems can themselves be biased.

A prospective study of the outpatient department was undertaken as part of a quality assurance initiative to improve patient care. Senior managers and clinicians set realistic performance targets for attendances, availability of records, waiting times and delay in correspondence to general practitioners. From February 1989 to January 1990, performance was analysed each month, and data and subsequent management changes publicised. The results show improvements in all areas studied, which supports the generally held belief that clinicians wish to improve the care offered to patients.

This paper describes a retrospective audit of a domiciliary visiting service in adult psychiatry in one district over a six-month period. General practitioners requested urgent assessment visits for three-quarters of the sample population, but were not present when the consultant attended. When the referrals were compared to the official definition of a domiciliary visit, less than a third were considered to fit the criteria. The implications of these findings are discussed.