Effects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression.
(41/2456)
STUDY QUESTION: Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia? DATA SOURCES: Baseline and periodic caregiver interviews with participants in the Medicare Alzheimer's Disease Demonstration. Client and caregiver attributes and caregiver outcomes such as depression and burden scores were among the measures. STUDY DESIGN: Applicants to the demonstration (all voluntary) were randomly assigned into treatment and control groups. Treatment group cases were eligible for case management and for up to $699 per month in community care benefits. (The actual monthly entitlement varied among the eight demonstration communities due to regional cost differences and inflation adjustments over the four-year demonstration period.) DATA COLLECTION: A total of 5,307 eligible individuals received a baseline assessment at the time of application to the demonstration and at least one semi-annual reassessment. Clients and their caregivers were periodically reassessed producing a total of 20,707 observations. PRINCIPAL FINDINGS: Persons in the treatment group had a high exposure to case management and a greater likelihood of community service use relative to those in the control group. Treatment group membership was associated with statistically significant, but very small reductions in caregiver burden (in four of eight sites) and depression (three of eight sites) over a 36-month tracking period. These findings are not sustained with all cases combined, or among a higher-resource demonstration model considered separately. CONCLUSIONS: Both the fact that these programmatic differences did not translate into substantial treatment group reductions in caregiver burden or depression, and the consistency of these findings with those of prior case management evaluations suggest the need to reformulate this programmatic intervention into areas not previously tested: 24-hour care, crisis intervention, coordination with primary care, or chronic disease management. (+info)
Effects of the Medicare Alzheimer's Disease Demonstration on nursing home entry.
(42/2456)
STUDY QUESTION: Did the Medicare Alzheimer's Disease Demonstration, with its goal of improving caregiver outcomes through case management and subsidized community services, affect the nursing home entry rate of treatments with dementia compared to controls? DATA SOURCES: Interviews conducted at baseline and six months thereafter. Measures include date of nursing home entry, client and caregiver health, and income. STUDY DESIGN: The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for an 80 percent discount on community care benefits, up to about $600 per month. DATA COLLECTION: All cases received baseline and semi-annual assessment interviews for up to three years after enrollment. Analyses are among cases that remained in the demonstration for more than 30 days after enrollment (n = 8,095). PRINCIPAL FINDINGS: The intervention of case management and subsidized community service had no effect on nursing home entry rates for treatments overall, compared to those of controls, and few effects on treatment subgroups, with the exception of one site where it may have increased nursing home entry rates. CONCLUSIONS: Providing case management and subsidized community services with the goal of improving caregiver outcomes may have little effect on nursing home entry rates for people with dementia. (+info)
A collaborative approach to management of chlamydial infection among teenagers seeking contraceptive care in a community setting.
(43/2456)
OBJECTIVES: To develop and assess a coordinated model of care for effective management of genital chlamydial infection in young women, identified through a selective screening programme in a community based teenage health clinic. METHODS: Selective screening for genital Chlamydia trachomatis was undertaken among young women aged 13-19 years who were having a routine cervical smear test, being referred for termination of pregnancy, or who reported behavioural risk factors, for, and/or symptoms of, genital infection. Collaboration among family planning, genitourinary medicine (GUM), and public health staff was used to enhance management of infected individuals, with particular focus on partner notification. RESULTS: 94 young women had confirmed genital chlamydial infection, representing 11% of those tested. All index patients received appropriate antibiotic therapy and follow up; 93 (99%) of these were counselled by a health adviser, of whom 62 (66%) were able to provide sufficient details for partner notification, resulting in treatment of male partners associated with 51 (82%) of these young women. Younger age (< or = 16 years) was significantly associated with delay in attending for treatment. CONCLUSIONS: Effective management of genital chlamydial infection is achievable in settings outside GUM clinics using a collaborative approach which incorporates cross referencing between community based services and GUM clinics. (+info)
Patterns of consultation and treatment for heartburn: findings from a Singaporean community survey.
(44/2456)
BACKGROUND: The prevalence of reflux-type symptoms among community individuals in Singapore is low. AIM: To describe the healthcare-seeking behaviour of those subjects with heartburn. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was carried out on a race-stratified random sample of residents, aged 21-95 years, in a Singaporean town; 93% responded (n = 696). RESULTS: The ethnic-adjusted prevalence of heartburn for the past 1-year was 4.6%. Sixteen (30%) of the 53 heartburn sufferers had sought consultation for their symptoms. They were more likely to have severe heartburn (P<0.001), and to have complained of nocturnal awakening due to heartburn (P<0.05) than those who did not present to medical attention. Ethnic origin did not influence the consultation pattern. Only 18 (34%) of the 53 heartburn sufferers received pharmacological therapy for their symptoms. The most commonly used medication was antacid. Medication use was associated with symptom severity (P<0.05), but not ethnicity. CONCLUSIONS: Heartburn is uncommon in the general population of Singapore. Few heartburn sufferers seek medical attention, and most do not receive medications for symptomatic control. The decision to seek medical advice and/or to medicate was generally linked to symptom severity, but not to ethnicity. (+info)
Rapid appraisal of needs in reproductive health care in southern Sudan: qualitative study.
(45/2456)
OBJECTIVES: To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. DESIGN: Rapid appraisal. This comprised interviews with key informants, in-depth interviews, and group discussions. Secondary data were collated. Freelisting, ranking, and scenarios were used to obtain information. SETTING: Communities affected by conflict in southern Sudan. PARTICIPANTS: Interviews and group discussions were chosen purposively. Twenty interviews with key informants were undertaken, in-depth interviews were held with 14 women, and 23 group discussions were held. MAIN OUTCOME MEASURES: Need for reproductive health care. Perceived priority afforded to reproductive health issues in comparison with other health problems. RESULTS: Reproductive health in general and sexually transmitted diseases in particular were important issues for these communities. Problems in reproductive health were ranked differently depending on the age and sex of the respondents. Perceptions about reproductive health issues in communities varied between service providers, and community leaders. Settled and displaced communities had different priorities and differing experiences of reproductive health problems and their treatment. CONCLUSION: Rapid appraisal could be used as the first step to involving communities in assessing needs and planning service provision. (+info)
Detection and control of high blood pressure in the community : Do we need a wake-up call?
(46/2456)
At the community level, the effect of national programs in increasing hypertension awareness, prevention, treatment, and control is unclear. This study evaluated the degree of detection and control of high blood pressure in a random population-based sample of Olmsted County, Minnesota, residents >/=45 years old, of whom 636 subjects among 1245 eligible residents agreed to participate. Home interview and home and office measurements of blood pressure were used to estimate awareness, treatment, and control rates for hypertension in the community. Mean blood pressures (+/-SD) were 138/80+/-20/12 mm Hg for men and 137/76+/-23/11 mm Hg for women. The overall prevalence of hypertension was 53%. The percentage of subjects with treated and controlled hypertension was 16.6%. Thirty-nine percent of subjects were unaware of their hypertension. Despite clinical trial evidence of reduced morbidity and mortality with antihypertensive therapy, recently reported national data suggest a leveling-off trend for treatment and control of hypertension. This population-based study supports these observations and suggests that at a community level, hypertension awareness and blood pressure control rates are suboptimal, presumably because of decreased attention to the detection and control of hypertension. (+info)
Home prophylactic warfarin anticoagulation program after hip and knee arthroplasty.
(47/2456)
OBJECTIVE: To determine the efficiency of a program designed to maintain prophylactic oral anticoagulation within a target range for 6 weeks after hip and knee arthroplasty. DESIGN: A prospective continuous quality improvement indicator. SETTING: A tertiary care university hospital. PATIENTS: Patients who underwent hip and knee arthroplasty and had no indications for routine anticoagulation other than postoperative thromboembolism prophylaxis. INTERVENTION: An outpatient warfarin prophylaxis program, which included an information letter given to the patient. Home Care coordinated community laboratory services, communication with and anticoagulant dosage adjustment by the patient's personal family physician. OUTCOME MEASURES: The proportion of international normalized ratio (INR) values within, below and above the target range of 2.0 to 3.0. RESULTS: Sixty-two patients were enrolled over a 3-month period. On the day of hospital discharge, 64% of patients had INR values that were within the target range, 31% were below and 5% were above. After hospital discharge, 42% of the INR values were within the target range, 48% were below and 10% were above. CONCLUSION: Despite a program designed to address patient information, physician communication and laboratory testing, tight control of home INR values could not be achieved with the existing resources of Home Care and family physicians. (+info)
Community care for people with chronic conditions: an analysis of nine studies of health and social service utilization in Ontario.
(48/2456)
A series of studies conducted in the same region found that programmatic, community-based health and social service interventions have a positive impact on client well-being. These proactive interventions, designed to address the full range of health and social needs, were usually provided at the same--or even lower--costs as uncoordinated, illness-focused care. The results of this series suggest that across-the-board health care reduction, at least in a system of national health insurance, will produce poorer results, at higher cost, for people with chronic conditions living in the community. Policy planners need more research that concentrates on comparisons of outcomes between and within different models of health and social service delivery. The studies should be designed to help them determine who benefits from different service configurations carried out within a range of policy environments at various costs. (+info)