Comparing user acceptance of a computer system in two pediatric offices: a qualitative study.
(41/1505)
The purpose of this qualitative study was to examine user acceptance of a clinical computer system in two pediatric practices in the southeast. Data were gathered through interviews with practice and IS staff, observations in the clinical area, and review of system implementation records. Five months after implementation, Practice A continued to use the system but Practice B had quit using it because it was unacceptable to the users. The results are presented here, in relation to a conceptual framework, which was originally developed to describe the process of successful implementation of research findings into practice. Five main themes were identified relative to the differences in user acceptance at the two practices: 1) Benefits versus expense of system use varied, 2) Organizational cultures differed, 3) IS staff's relationship with practices differed, 4) Post-implementation experiences differed, and 5) Transfer of technology from the academic center to private practice proved challenging in Practice B. The findings indicate a need for the development and validation of tools to measure healthcare organizational climate and readiness for change. (+info)
The primary care clinic as a setting for continuing medical education: program description.
(42/1505)
The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study. (+info)
Comparing the services and quality of private and public clinics in rural China.
(43/1505)
After 15 years eradication of the private health sector in Socialist China, private practice was restored in 1980 along with the market oriented economic reform. In recent years, however, debates on its pros and cons are increasing. Arguments against private practice have led to a ban on private practice in some rural counties. The arguments against private practice state that the service quality of private clinics tends to be lower than that of public ones; private clinics are less likely to provide preventive care; and private clinics are more likely to provide over-treatment. This paper presents the major findings from a study conducted in China, aiming at comparing private and public village health clinics in terms of quality of services, willingness to provide preventive care and over-prescription of drugs. While it was found that the quality of services was poor and a large proportion of patient expenditure was due to over-treatment for all village clinics, there was no difference between public and private clinics. Both private and public clinics were willing to provide preventive services if they were subsidized for the provision. This study finds no evidence that care provided by private clinics is inferior to that of public clinics. (+info)
Low infectious morbidity after intensive chemotherapy and autologous peripheral blood progenitor cell transplantation in the outpatient setting for women with breast cancer.
(44/1505)
Autologous peripheral blood progenitor cell (PBPC) transplantation is increasingly employed in the outpatient setting, yet data on early complications following PBPC transplantation are scant. We evaluated 105 women with high-risk primary or metastatic breast cancer who were treated at a single institution during 1996--1997. The mean duration of neutropenia (absolute neutrophil count, <500 cells/mm(3)) was 7.5 days. Twenty-nine percent of women remained afebrile throughout the neutropenic period. Of the remaining 71%, most (64 of 75) had fever of unknown origin. Infections, mostly of mild severity, occurred in 34% of women; these infections included bacteremia due to gram-positive organisms, catheter site infection, cellulitis, pneumonia, oral candidiasis, herpes simplex virus infection, and vaginitis. Fifty percent of PBPC transplant recipients required hospital admission, usually because of persistent fever; the mean duration of hospitalization was 3 days. No deaths or serious adverse events occurred. Such reduced infectious morbidity may be a consequence of minimal oral and/or gastrointestinal mucositis associated with the conditioning regimen and broad-spectrum antimicrobial prophylaxis used for this patient population. (+info)
Accrediting organizations and quality improvement.
(45/1505)
This paper reviews the various organizations in the United States that perform accreditation and establish standards for healthcare delivery. These agencies include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), the American Medical Accreditation Program (AMAP), the American Accreditation HealthCare Commission/Utilization Review Accreditation Commission (AAHC/URAC), and the Accreditation Association for Ambulatory HealthCare (AAAHC). In addition, the Foundation for Accountability (FACCT) and the Agency for Healthcare Research and Quality (AHRQ) play important roles in ensuring the quality of healthcare. Each of the accrediting bodies is unique in terms of their mission, activities, compositions of their boards, and organizational histories, and each develops their own accreditation process and programs and sets their own accreditation standards. For this reason, certain accrediting organizations are better suited than others to perform accreditation for a specific area in the healthcare delivery system. The trend toward outcomes research is noted as a clear shift from the structural and process measures historically used by accrediting agencies. Accreditation has been generally viewed as a desirable process to establish standards and work toward achieving higher quality care, but it is not without limitations. Whether accrediting organizations are truly ensuring high quality healthcare across the United States is a question that remains to be answered. (+info)
Comparison of anticoagulation clinic patient outcomes with outcomes from traditional care in a family medicine clinic.
(46/1505)
BACKGROUND: Giving patients oral anticoagulation therapy in an ambulatory clinic setting is associated with substantial risk of adverse outcomes leading to emergency department visits and unplanned inpatient admissions. This article describes an effectiveness study conducted in a well-characterized family practice setting that compares anticoagulation outcomes in patients managed by a traditional care model with outcomes obtained with an anticoagulation clinic model. METHODS: All study patients received continuous anticoagulation care at the Family Medicine of Southwest Washington (FMSW) clinic during the 1-year study period. The method was retrospective and used linked record review, including outpatient, inpatient, and emergency department records. Patients were divided into two groups as naturally observed: those treated in the clinic by traditional care compared with those treated in an anticoagulation clinic model. Data analyses compared the two groups in terms of patient demographics, anticoagulation control, and inpatient admissions and emergency department visits that were related to clotting or bleeding events. RESULTS: There were no differences in demographic variables between the anticoagulation clinic and traditional care groups. There was a statistically significant difference in anticoagulation control as measured by international normalized ratio (INR) values. The anticoagulation clinic group had fewer INR values outside the target range, +/- 0.1, than the traditional care group (40.4% vs 47.3% P = .022). The anticoagulation clinic group also had significantly fewer INR tests drawn more than 6 weeks apart than the traditional care group (3.7% vs 8.1% P = .01). There was no statistically significant difference in emergency department visit rates caused by adverse events. Inpatient admission rates for the anticoagulation clinic and traditional care groups were not statistically different; however, they were clinically different (4.7 vs 19.7 admissions per 100 patient years of therapy P = .15). CONCLUSIONS: More anticoagulation patients treated by the anticoagulation clinic model at FMSW received an INR test at least every 6 weeks than those treated by the traditional care model, and more of their INR results were within target range +/- 0.1 when compared with the traditional care model. (+info)
Primary care in Bosnia and Herzegovina. Health care and health status in general practice ambulatory care centres.
(47/1505)
OBJECTIVE: To assess the health care and health status of patients attending primary care clinics in Bosnia and Herzegovina. DESIGN: Assisted administration patient survey. SETTING: Two ambulatory care clinics (ambulantas) in each of three cities in Bosnia and Herzegovina: Tuzla, Mostar, and Banja Luka. PARTICIPANTS: Patients attending the ambulantas during a 1-week period in March 1999; 885 answered questionnaires. MAIN OUTCOME MEASURES: Each patient listed demographic characteristics and answered questions on satisfaction with health care and with the physical and financial accessibility of health care services and medications. A validated health status questionnaire (EuroQoL), previously used in parts of the former Yugoslavia, was administered. RESULTS: Only 22% of patients were employed; 57% could not pay the nominal fee to see a physician; 71% walked to the clinic; mean distance from patients' homes to the clinics was 2.3 km; 63% could not get the medications prescribed (in 85% of cases because of cost, not availability); 80% to 90% of answers to satisfaction questions suggested high satisfaction with the care patients received from their doctors; 67% of the time patients were referred to a specialist by general practitioners; 33% had problems walking; 17% had problems with self-care; 36% had problems with usual daily activities; 72% had at least some pain or discomfort; and 62% described at least some anxiety or depression. The three cities showed significant differences; patients in Tuzla generally had lower health status and more problems with health care. CONCLUSION: Unemployment and financial considerations reduced health care access in Bosnia and Herzegovina. While only one third of patients had physical difficulties, two thirds had emotional problems or pain. Satisfaction with physicians' care was high. (+info)
Consequences of over-prescribing on the dispensing process in rural Nepal.
(48/1505)
OBJECTIVE: To investigate the effect of increasing numbers of drugs prescribed on the dispensing process in rural Nepal. DESIGN: Cross-sectional survey, on average 25 exiting patients per facility in 33 government health facilities. OUTCOME MEASURES: Percentage of cases where there was a dispensing error, and where the patient knew the dosing schedules of the dispensed drugs. RESULTS: A greater number of drug items prescribed and dispensed per patient was significantly associated with a greater percentage of cases where there was a dispensing error (P=0.00000), and where the patient did not know the dosing schedules of the dispensed drugs (P=0.00000). CONCLUSION: The prescribing (and dispensing) of more drugs per patient, an indication of over-prescription, is associated with significantly poorer dispensing. (+info)