Observing the process of care: a stroke unit, elderly care unit and general medical ward compared.
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BACKGROUND AND PURPOSE: Patients on stroke units have better outcomes but it is not known why. We investigated the process of care on a stroke unit, an elderly care unit and a general medical ward. METHODS: Comparison of the three settings was by non-participant observation of 12 patients in each. Data were analysed using multi-level modelling methods. RESULTS: Stroke unit patients spent more time out of bed and out of their bay or room, and had more opportunities for independence than patients on the medical ward. There were more observed attempts on the stroke unit than on the general medical ward to interact with drowsy, cognitively- or speech-impaired patients. Stroke unit patients spent more time with visitors. Most of these aspects of care were also found on the elderly care unit, where patients also spent less time asleep or 'disengaged', more time interacting with nurses, and were given appropriate help more often than those elsewhere. Stroke unit patients received less eye contact, were ignored and treated in a dehumanizing way more frequently and had more negative interactions or activities than those elsewhere. CONCLUSIONS: We have identified some aspects of the process of care which may help explain the improved outcomes on stroke units. These aspects were also observed in the elderly care unit. (+info)
New contracts for specialist orthodontic practitioners?
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This paper discusses the possibility of new forms of contacting or commissioning emerging between UK Health Authorities (or other parties such as Primary Care Groups and Primary Care Trusts) and established providers of specialist orthodontic services. (+info)
The role of ethical principles in health care and the implications for ethical codes.
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A common ethical code for everybody involved in health care is desirable, but there are important limitations to the role such a code could play. In order to understand these limitations the approach to ethics using principles and their application to medicine is discussed, and in particular the implications of their being prima facie. The expectation of what an ethical code can do changes depending on how ethical properties in general are understood. The difficulties encountered when ethical values are applied reactively to an objective world can be avoided by seeing them as a more integral part of our understanding of the world. It is concluded that an ethical code can establish important values and describe a common ethical context for health care but is of limited use in solving new and complex ethical problems. (+info)
The Spanish health care system: lessons for newly industrialized countries.
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This article summarizes the organization, financing, and delivery of health care services in Spain, and discusses the elements that made it possible to maintain high levels of health among the population, while spending comparatively fewer resources on the health care system than most industrialized countries. The case of Spain is of particular interest for newly industrialized countries, because of the fast evolution that it has undergone in recent years. Considered, by United Nations' economic standards, a developing country until 1964, Spain became in a few years the fastest growing economy in the world after Japan. By the early 1970s the infant mortality rate was already lower than in Britain or the United States. (+info)
Private health care in Nigeria: walking the tightrope.
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The persistently low quality and inadequacy of health services provided in public facilities has made the private sector an unavoidable choice for consumers of health care in Nigeria. Ineffective state regulation, however, has meant little control over the clinical activities of private sector providers while the price of medical services has, in recent years, grown faster than the average rate of inflation. Reforms that are targeted at reorganizing the private sector, with a view to enhancing efficiency in the supply of services, are urgently required if costs are to be contained and consumers assured of good value for money. (+info)
Making house calls: using telecommunications to bring health care into the home.
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According to the U.S. Federal Trade Commission, an estimated 22 million Americans used their computers to seek medical information in 1995, making health concerns the sixth most common reason for using the Internet in the United States. Market research firms estimate that the number of people going online for this purpose is growing by 70% annually. Developments in computer technology, the Internet, and wireless and satellite telecommunications have led to major innovations in the nature and delivery of health care that have broad implications for the way people will receive health information and treatment in the future, even allowing health care providers to interact through cyberspace with their patients and other caregivers. (+info)
Survey of acupuncturists: practice characteristics and pediatric care.
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OBJECTIVE: To describe the practice characteristics and pediatric care provided by licensed acupuncturists. DESIGN: Cross-sectional survey. SETTING: Boston metropolitan area. SUBJECTS: 227 licensed acupuncturists were surveyed; 140 (62%) responded. MAIN OUTCOME MEASURES: (1) DEMOGRAPHICS, (2) practice characteristics, (3) pediatric care, (4) recommendations of peers recognized as experts in pediatric acupuncture. RESULTS: (1) DEMOGRAPHICS: 70% Caucasian, 61% female; (2) practice characteristics: average of 39 visits weekly with an average charge of $54 for a 57-minute visit; patients were typically scheduled for follow-up once or twice weekly; only 5% of fees were covered by insurance; 80% recommended herbal remedies and 66% dispensed herbs in the office; (3) few acupuncturists treated more than one child per week; most used non-needle techniques or Japanese-style acupuncture to stimulate points in children; 85% would refer a febrile two-week-old infant immediately to a physician; (4) only 17 acupuncturists were recommended by three or more peers and saw three or more patients weekly; their practices were all in wealthy suburban areas. CONCLUSIONS: Most acupuncturists in the Boston area are Caucasian and female. Compared with physicians, they schedule patients for more frequent follow-up, allocate more time, are less likely to be reimbursed by insurance, and treat fewer children. Additional studies are needed to assess effectiveness, quality, and access to acupuncture services for adults and children. (+info)
Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study.
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STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms. (+info)