Health Advisory Services Research Articles

Partnerships to promote mental health of NSW farmers: The New South Wales Farmers Blueprint for Mental Health

To describe the process and outcome of development of a framework for planning and implementation of a range of interventions aimed at improving the mental health and wellbeing of farmers and farm families in New South Wales (NSW). In response to a major drought in New South Wales (NSW), key agencies were invited to participate in a longer-term collaborative program aimed at improving the mental health and well-being of the people on NSW farms. These agencies became the NSW Farmers Mental Health Network. The Australian National Action Plan for Promotion, Prevention & Early Intervention for Mental Health 2000 proposed a population health approach base encompassing the range of risk and protective factors that determine mental health at the individual, family and community and society levels. It incorporated three traditional areas of health activity into programs aimed at achieving improved mental health for the Australian population - mental health promotion, prevention activities and early intervention. Although the farming population was not identified as a priority population, research has identified this population to be at high risk of suicide, and of having difficulty in coping with the range of pressures associated with life and work in this industry. Participants were agencies providing services across rural NSW in the fields of farmer and country women's organisations, financial counselling services, government departments of primary industries and health, mental health advisory and support services, charitable organisations and others. The NSW Farmers Blueprint for Mental Health (http://www.aghealth.org.au/blueprint) was developed to be 'a simplified summary of key issues that need to be addressed, and the major actions that we can be confident will be effective in achieving our purpose'. It has identified 'steps' along 'pathways to breakdown' from the range of known mental health and suicide risk factors that are relevant to the NSW farming population, and 23 areas of current and potential action that would contribute to improving mental health, as key steps along 'pathways to health'. For each of the areas of action there is described the rationale and basis for action, and the lead agency or individual who has accepted responsibility for coordinating and reporting further activity to the Network. It is suggested that the NSW Farm Blueprint and the activities being implemented by the NSW Farmers Mental Health Network partners represent a model for implementation of a mental health promotion in identified at-risk Australian populations.

Integrated system for e-health advisory web services provision using broadband networks

In this work an integrated system of electronic reports of laboratorial examinations results from electronic ultrasonograph and cardiotokograph, documents exchange and health advisory services provision is presented. The integrated system was developed for the private maternity hospital of Patras under the action Medical Enterprises Financing for Specialized Informatics Applications Provision and Installation of 'Information Society'. Its aim is to supply enhanced health services and information exchange services among health services provision organisations. Benefits from its usage are the direct exploitation of the enhanced Health Services and the cooperation and interaction between health organisations.

Patient Satisfaction With Care for Urgent Health Problems: A Survey of Family Practice Patients

Patient satisfaction is an important health care outcome. This study compared patients' satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services. We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied). The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8-6.4) compared with all other services (all P <.004, adjusted for multiple comparisons), with the exception of patients who used the after-hours clinic affiliated with their physician, whose satisfaction was not significantly different (mean 5.6; 95% CI, 5.2-6.0). Satisfaction was highest for patients receiving care from their own family physician or their physician's after-hours clinic. These results are important for new primary care models that emphasize continuity and after-hours availability of family physicians.

Pay for Performance—Neither Necessary nor Sufficient for Quality Improvement Yet Vital for Success

1Andrea B. Silvey, PhD MSN, is chief quality improvement officer at Health Services Advisory Group, Arizona's Medicare-contracted quality improvement organization, Phoenix, AZ. She is also an adjunct professor at Arizona State University W. P. Carey School of Business and Health Policy, Tempe, AZ, and a member of JHQ's review panel.

Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees: aims, experiences and descriptive results

Due to increased occupational dermatoses in certain professions such as health care workers (HCW), cleaning and kitchen employees (CKE), measures of prevention and skin protection are of high significance. Skin protection courses focus on educational aims (e.g. improving skin care habits, influencing the participants' attitudes towards health) and medical aims (e.g. optimising diagnostic procedures, complementing individual therapy). Participants are patients who have been suspected to suffer from an occupational skin disease and are insured with the German Accident Prevention & Insurance Association (BGW). Teaching units of the skin protection courses focus on basics of skin functioning and important aspects of occupational skin diseases. Practical parts include information and instructions about the correct implementation of skin protection, skin care and skin cleansing. Every participant is seen by a dermatologist obtaining a precise patient's history and performing a skin examination. All this results in working out individually adapted and professional skin protection strategies. In total, 791 participants (93 men and 698 women) completed the skin protections courses. Six hundred and sixty-seven patients (mean age: 36.9 years, SD = 11.6) were HCW and 124 patients (mean age: 40.4 years, SD = 10.8) were CKE. In HCW 82.5% (n = 550) and in CKE 86.3% (n = 107) suffered from hand eczema of the atopic, irritant or allergic type. Irritant contact dermatitis as a single diagnosis was the most frequent one in both groups (HCW: 34.5.%, n = 230; CKE: 49.2% n = 61). According to regularly performed evaluations, the participants rated the course as good to excellent. Nearly 80% of the participants had skin lesions while attending the course, in 27% the dermatosis was severe. There is a high need for health education, advisory services, diagnostics and additional therapy in occupational dermatology. Prevention of occupational skin diseases and maintenance of health through educational programmes are important complementary measures for dermatological care but still missing in endangered professions.

Educational and dermatological aspects of secondary individual prevention in healthcare workers

Healthcare workers (HCW) have an increased risk of suffering from occupational skin diseases (OSDs). Therefore, we established special prevention and skin protection courses for HCW. Medical aims are to optimize diagnostic procedures and individual therapy, educational aims are to improve individual skin protection/skin care habits of the patient and also to influence the participants' attitudes towards health. Participants are patients that have been suspected to suffer from an OSD and are insured with the German Accident Prevention Insurance Association for Health Care Workers (BGW). Teaching units mainly focus on the texture and functioning of the skin, general aspects of OSDs, general information concerning skin protection, instructions about the correct use of skin cleansing and skin protection products. Besides, every participant is clinically examined by a dermatologist and a precise patient's history is obtained. Individually adapted skin protection strategies are developed. Patients can ask the dermatologist questions in confidence. 504 patients (mean age: 36.9 years, SD = 11.7) participated in the skin protection courses. 94.6% (n = 477) suffered from hand eczema frequently caused by a mixture of atopic, irritant and allergic contact dermatitis, but irritant contact dermatitis was the most frequent diagnosis (55.4%, n = 279). The participants rated the course as good to excellent. Health education and advisory services in occupational dermatology are still fragmentary. Prevention of OSD and maintenance of health through education are important complementary measures for dermatological care. In the future, similar educational programmes should be offered for employees of other professions with an increased risk for OSD.

Australasian Association of Doctors’ Health Advisory Services

Medical Journal of AustraliaVolume 182, Issue 5 p. 255-255 Letter Australasian Association of Doctors’ Health Advisory Services Donald B Reid, Corresponding Author Donald B Reid Co-convenor dbreid@hotlinks.net.au Colleague of First ContactCorrespondence: dbreid@hotlinks.net.auSearch for more papers by this author Donald B Reid, Corresponding Author Donald B Reid Co-convenor dbreid@hotlinks.net.au Colleague of First ContactCorrespondence: dbreid@hotlinks.net.auSearch for more papers by this author First published: 07 March 2005 https://doi.org/10.5694/j.1326-5377.2005.tb06687.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume182, Issue5March 2005Pages 255-255 RelatedInformation

The general public's use of (and attitudes towards) interactive, personal digital health information and advisory services

Examines statistically the public's use and attitudes towards interactive and personal health services via an online questionnaire survey and enhances these data with an expert assessment of a number of consumer health sites and their services. Over a period of three weeks more than 1,300 people responded to an online questionnaire produced by The British Life and Internet Project. Of the respondents, 81 per cent were British. The likely potential uptake figure for support group participation among Internet health users is about 20 per cent while around 11 to 13 per cent will go online to describe a medical condition. Those in poor heath were approximately ten to 13 times more likely to have participated in an online support group. Those aged over 65 were four times as likely to e‐mail their doctor. More positive health outcomes were associated with those respondents that participated in online support groups and the least number of health outcomes were associated with those people that maintained e‐mail contact with a doctor or surgery.

M.D.s May Soon Be Free of Current E&amp;M Guidelines

Back to table of contents Previous article Next article Government NewsFull AccessM.D.s May Soon Be Free of Current E&M GuidelinesMark MoranMark MoranSearch for more papers by this authorPublished Online:2 Aug 2002https://doi.org/10.1176/pn.37.15.0002Ten years of making—and remaking—the federal government’s guidelines for how physicians must document “evaluation and management” of patients for Medicare payment could be unmade entirely.That’s if the government heeds its own broad-based advisory committee on regulatory reform urging that the “E&M” documentation guidelines be scrapped.The Department of Health and Human Services (HHS) Advisory Committee on Regulatory Reform recommended dumping the guidelines at a recent meeting in Denver. The 21-member committee has five physicians, including Nancy Nielsen, M.D., vice speaker of the AMA’s House of Delegates, as well as administrators of the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration).The recommendation awaits action by HHS Secretary Tommy G. Thompson.The guidelines for evaluation and management of patients are part of the government’s resource-based relative value scale for determining physician payment under the Medicare program and have been the object of heated controversy. Physician groups hailed the recommendation as long overdue.“The AMA has repeatedly informed HHS and the Regulatory Relief Advisory Committee that physicians identify E&M documentation guidelines as the single, largest paperwork burden imposed by the Medicare program,” the AMA said following the committee’s recommendation.Chester Schmidt, M.D., chair of APA’s Committee on RBRVS, Codes, and Reimbursement, echoed that view.“This is a very positive development,” he said. “The reason this panel is backing off is the very intense pressure that has been brought to bear to change the documentation requirements. Physicians believe that the guidelines are not clinically relevant and that they are merely a means for the government to do audits and to find fault, resulting either in civil or criminal actions [against doctors] because of documentation deficiencies.”Schmidt added, “The outcry from all specialties has consistently been that the E&M coding guidelines are not clinically relevant, are onerous, and impose on physicians extra paperwork for which there is no reimbursement.”Psychiatrists use the E&M codes for inpatient and partial hospitalization, consultation, nursing home visits, and some office visits. Especially controversial are the guidelines for determining the level of “medical decision making,” which is one of the three E&M components, along with history taking and examination. The guidelines for that component use a four-by-four grid designed to produce a numerical approximation of medical decision making.Schmidt has called the system so complex “it bears no resemblance to the actual practice of medicine.”Douglas L. Wood, M.D., chair of the advisory committee and a physician at the Mayo Clinic, summed up the view that the decade-long effort to revise or improve the guidelines has been exhausted.“The documentation guidelines that have been used are unworkable, and I think 10 years of effort to try to find one that works is a pretty strong statement that there is something fundamentally difficult or fundamentally impossible about trying to create documentation guidelines for evaluation and management services,” Wood said, according to transcripts of the advisory committee meeting in Denver.“The fact that no other commercial insurer uses them should be a pretty strong statement that they’re probably not applicable anyway,” Wood said. “And indeed, there is now and has been an adversarial environment that’s based on fraud and abuse actions and the actions of Medicare carrier medical directors.”The transcript of the Denver meeting is posted on the Web at www.regreform.hhs.gov/sacrr5_16.htm. ▪ ISSUES NewArchived

John E. Ware Jr. on health status and quality of life assessment and the next generation of outcomes measurement. Interview by Marcia Stevic and Katie Berry.

John E. Ware Jr. PhD, is a founder of QualityMetric. Inc., as well as its president and chief scientific officer. He also is executive director of the Health Assessment Lab at the Health Institute, New England Medical Center, and holds professorships at Harward University and at Tufts University School of Medicine. For 14 years, he was senior research psychologist at RAND, where he developed health status and patient satisfaction measures used in the Health Insurance Experiment. He also was principal investigator for the Medical Outcomes Study (MOS), which developed the SF-36 Health Survey and other tools widely used in monitoring patient outcomes. A coauthor of papers from the MOS that received the Association for Health Services Research (AHSR) Article of the Year Award in 1993, Dr. Ware has received numerous awards for work in the field of outcomes research. He now is principal investigator of the International Quality of Life Assessment Project, which is translating and validating the SF-36 Health Survey for use in 45 countries. Dr. Ware also is developing the next generation of patient-based assessments that use advances in computer technology to provide very brief measures, yet meet the standard of precision necessary for use on an individual patient basis.

Attitudes of health professionals towards cardiopulmonary resuscitation training for family members of cardiac patients

Summary Family members of cardiac patients are the most common witnesses of a cardiac arrest but are least likely to attempt cardiopulmonary resuscitation (CPR). Training within cardiac rehabilitation programmes for relatives has been recommended by the Scottish Health Service Advisory Council (1993) but little information exists on the attitudes of the health professionals who coordinate such programmes. Their attitudes would be a source of influence on training provision. Hence a postal questionnaire survey was carried out on all of the 45 Scottish cardiac rehabilitation programmes on the register of the British Heart Foundation. The response rate was 93%. All respondents agreed that the public should be trained in CPR. The majority though that relatives of cardiac patients should be trained (93%), within rehabilitation programmes (81%), and were happy to recommend such training to families (86%). However, only 48% felt that families should be informed of the training benefits by hospital staff before discharge and 53% disagreed or were undecided. The majority believed that CPR training decreases (63%) or does not increase patient and family anxiety (68–76%), but a sizeable minority (22–34%) were undecided on both directions. Issues and implications arising from consonance and dissonance between beliefs and behavioural intent are discussed.

Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland

Existing cardiopulmonary resuscitation (CPR) training programmes have failed to reach those most likely to witness a cardiac arrest, such as families of cardiac patients. In 1993, the Scottish Health Service Advisory Committee suggested that CPR training could be offered as part of cardiac rehabilitation programmes. A survey was carried out to identify the current extent and nature of such training and factors influencing its provision. Questionnaires were mailed to all the 45 Scottish cardiac rehabilitation programmes on the British Heart Foundation’s register. A 93% response rate was achieved. Only 37% of programmes provided information to families about attending a CPR course and 37% actually provided CPR training The numbers trained by these programmes were very small. Hospital programmes were significantly more likely than community programmes to provide CPR training (χ2=6.65, P<0.01) as were those which included an exercise component (χ2=7.63, P<0.01). Reasons for not providing training ranged from lack of resources and lack of staff training, to not having considered it. CPR training is provided as part of cardiac rehabilitation programmes to a limited extent. Ways of recruiting and increasing the number of family members of cardiac patients who are trained in CPR need to be found.

Violence and aggression in A&E: Recommendations for action

The problem of violence and aggression in health care settings has become a high-profile issue. Following the release of figures issued by the Health Services Advisory Committee (HSAC) which show nursing as the most dangerous profession in the UK, Frank Dobson, Health Secretary, urges health service managers to do everything they can to reduce violence. Violence is defined as any incident which puts a health care worker at risk and includes verbal abuse, threatening behaviour or assault by a patient or member of the public. It is suggested that most violent incidents within the hospital setting contain an intentional and, therefore, aggressive element. The theoretical background to the concept of aggression is explored to pinpoint its causes and identify the factors which originate its potential for harm. An analysis of the Accident and Emergency (A & E) environment with the conflicting demands of its workload highlights its potency for the creation of violent and aggressive behaviour towards its staff. In order to minimize its detrimental effects, this paper examines various approaches towards counteracting violence and aggression. It concludes that these methods fall into five major categories and details recommendations for action within these areas. The HSAC (1997) declares that it is possible to reduce the risk of violence by proactive management, underpinned by positive commitment from senior managers and staff at all levels.

Intravenous immune globulin shortage: experience at a large children's hospital.

The current shortage of immune globulin for intravenous use (IVIG) is being attributed to several events, including an increase in off-label use, and intense Food and Drug Administration (FDA) scrutiny of product lots and manufacturing facility upgrades that result in temporary production halts.1 Additionally, there has been an increase in product recall or failure to release product because donors at risk for Creutzfeldt-Jakob disease have been identified.2 Although transmission of Creutzfeldt-Jakob disease by blood products has not been established, the FDA has recalled IVIG lots with perceived risk of contamination. This shortage has caused sufficient concern among patients and their providers to capture congressional attention.2 During a recent meeting of the Health and Human Services Advisory Committee on Blood Safety and Availability, it was recommended that a systematic appraisal of off-label uses of IVIG be undertaken.3 This may assist in alleviating product shortages by discouraging use in inappropriate patient populations and by establishing priorities among approved indications. Another recommendation from that meeting was to sell product directly to hospitals and pharmacies, eliminating product handling and potential price gouging by third-party suppliers. Meanwhile, the shortage of IVIG nationwide continues and most tertiary care hospitals, especially those caring for seriously ill children, are affected. Texas Children's Hospital (TCH) is a 456-bed freestanding pediatric teaching institution affiliated with Baylor College of Medicine in Houston, Texas. Our medical staff provides primary care yearly for approximately 200 infants and children requiring administration of IVIG for serious or life-threatening medical conditions. These include primary immunodeficiency …

Reply

Letters to the EditorReply Muhammad Yousuf, MBBS, MRCS, MRCP Dib Abdulaziz Al-Saudi, MBBS, MSC Riaz Ahmad Sheikh, and MBBS, MD Mohammad Shafi LoneMBBS, MD Muhammad Yousuf Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author , Dib Abdulaziz Al-Saudi Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author , Riaz Ahmad Sheikh Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author , and Mohammad Shafi Lone Department of Medicine, King Abdul Aziz Hospital, Madinah Al-Munawarah, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1996https://doi.org/10.5144/0256-4947.1996.480bSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We thank Dr. F. Jamal for her interest in our paper. We were not able to carry out microbiological studies to determine the etiology of pneumonias among Haj pilgrims and in our paper have already suggested the need for further study to find out the factors and microorganisms responsible for pneumonias in both Makkah and Madinah. We foresee that pneumonias may become an interesting problem in the coming Haj seasons, which will fall in the relatively cooler months of the year, and such a study would help improve the management of pilgrims with this infection.Study based on sputum culture will, however, be technically quite difficult among pilgrims because of the problems of obtaining a good sample due to the language barrier, particularly in Turkish, Nigerian and Indonesian pilgrims who cannot speak English or Arabic. Evaluation of these cases by transtracheal aspiration (TTA), blood culture and serology may yield better information.1We agree with her that the availability and success of 23-polyvalent pneumococcal vaccine makes it particularly worthwhile to determine the proportion of cases caused by Streptococcus pneumoniae and characterize the strains implicated by serotyping and antibiotic sensitivity testing. We concur with her observations that Streptococcus pneumoniae can be the major cause of community-acquired pneumonias in old patients and an important cause of death,2–4 and the recommendations to vaccinate this high-risk group with polyvalent pneumococcal vaccine are worth consideration. However, Haj pilgrims constitute a special group of patients. Most of them are from Asia or Africa. They usually develop pneumonia after their stay in Haj camps of Mina and Arafat and not while living in the community. They have diabetes mellitus as the third common co-morbid illness. For these reasons, causative microorganisms responsible for their pneumonias may well be different from European or American studies of community-acquired pneumonias. Pneumococcal vaccine is not yet recommended for the general public by the Public Health Service Advisory Committee on Immunization Practice of the Centers for Disease Control.5 Furthermore, the efficacy of the vaccine is more in females as compared to males,6 whereas males constitute most of the pilgrims. Also, efficacy of the vaccine depends on the serotype, which varies with the age of the patient, hospital type and source of isolate7 and this information may be vital in pilgrims who may benefit from such vaccination.Keeping the above factors in mind, we recommend that pending the results of microbiological study in pilgrims with pneumonia, polyvalent pneumococcal vaccination can be recommended in high-risk cases, i.e., those with COPD, bronchial asthma and age above 60 years. Those who cannot afford the vaccine may take prophylactic antibiotics before they move to Mina or Arafat, as has been recommended earlier.8ARTICLE REFERENCES:1. Ostergaard L, Andersen PL. "Etiology of community-acquired pneumonia. Evaluation by transtracheal aspiration, blood culture or serology" . Chest. 1993; 104: 1400–7. Google Scholar2. Ortqvist A, Hedlund J, Grillner L, et al. "Etiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization" . Eur Respir J. 1990; 3: 1105–13. Google Scholar3. Pachon J, Prados MD, Capote F, et al. "Severe community-acquired pneumonia. Etiology, prognosis and treatment" . Am Rev Respir Dis. 1990; 142: 369–73. Google Scholar4. Moine P, Vercken JB, Chevret S, Chastang C, Gajdos P. "Severe community-acquired pneumonia. Etiology, epidemiology and prognostic factors. French study group for community-acquired pneumonia in the intensive care unit" . Chest. 1994; 105: 1487–95. Google Scholar5. Requejo HI. "Polyvalent pneumococcal polysaccharide vaccine: a review of the literature" . Rev Hosp Clin Fac Med. 1993; 48: 130–8. Google Scholar6. Gable CB, Holzer SS, Englehart L, et al. "Pneumococcal vaccine. Efficacy and associated cost savings" . JAMA. 1990; 264: 2910–5. Google Scholar7. Hager HL, Wooley W, Berk SL. "Review of recent pneumococcal infections with attention to vaccine and nonvaccine serotypes" . Rev-Infect Dis. 1990; 12: 267–72. Google Scholar8. Yousuf M, Zafar M, Maqbool M. "Medical problems of Pakistani pilgrims in Saudi Arabia" . Pak J Med Res. 1993; 32: 172–5. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 16, Issue 4July 1996 Metrics History Published online1 July 1996 InformationCopyright © 1996, Annals of Saudi MedicinePDF download

Outpatient management of diabetes mellitus in five Arizona Medicare managed care plans.

We report findings on the outpatient management of diabetes mellitus in Medicare beneficiaries enrolled in five Arizona Medicare-managed care plans. These findings are the baseline of an ongoing collaboration between the Health Services Advisory Group, Inc., Arizona's Peer Review Organization (PRO), and the five plans whose object is improved care of diabetes patients. The purpose of the study was to determine congruity between quality indicators identified by the five plans and the care actually received by diabetes patients enrolled in the five plans. The five plans agreed on a common set of quality indicators, including 10 services and 10 measures of patient status. Each plan has identified its diabetic population, 75 of whom are randomly selected each quarter by the PRO for chart review and inclusion in the study. The findings in this report cover two quarters of data. Data from chart review were examined to determine the extent to which actual practice reflected the indicators. The mean patient age was 71.8, and for most patients onset occurred between 55 and 69 years of age. About 25% had a positive family history, and we estimate the annual incidence of diabetes in this population to be about 1.1%. Mean hemoglobin A1c (HbA1c) was 8.9 +/- 2.1%; 46% were hypertensive; 42% continued to smoke cigarettes; 36% had retinopathy; 20% had proteinuria; and only 22% were on some kind of exercise program. Thirty-two percent were hospitalized during the 1-year baseline period, and the average number of outpatient visits per patient was 11.1 +/- 7.4. When care provided to diabetes patients enrolled in the plans was compared with the 10 quality standards identified by the plans themselves, only two of these standards was attained in more than 60% of patients: blood pressure, 98.7%; and foot examination, 62.7%. Two standards were achieved less than one-third of the time: urine dipstick, 10.4%, and appropriate use of angiotensin-converting enzyme (ACE) inhibitors, 31.25%. The others were all between 40 and 55%. Of the 10 service standards, about one-third received 1-4, one-third received 5-6, and one-third received 7-10. Only 5% of patients received 9 or 10 services. Outpatient management of diabetes patients in managed-care plans is similar to that in fee-for-service. When compared with fee-for-service or another HMO, a higher proportion of Arizona-managed care patients had HbA1c, and a much lower proportion had a dipstick test for urine protein. Values for other variables were usually within 10 percentage points of each other. Regardless of payment scheme, diabetes care is characterized by inconsistencies, omissions, and a lower than desirable level of services. Although few patients received most of the indicator services, diabetes patients are nevertheless high utilizers of medical care, both in and out of the hospital. The hospitalization rate is twice that of Arizona Medicare beneficiaries as a whole, and the number of office visits is three or four times that reported in other studies. Further, it seems that many visits are required to achieve even these modest service levels. Had the average number of visits been six or less, HbA1c rates, for example, would have fallen to less than one-third in three of the five plans. We believe that these data are conservative because it is likely that some and perhaps most of these indicators are underreported. It should be emphasized that these are baseline data whose purpose is to provide a basis against which subsequent improvements many be measured.

Management of health and safety in the health services: information for directors and managers30 pp Management of health and safety in the health services: information for directors and managers £7.50 . 0 7176 0844 1 0717608441 Health Services Advisory Committee

Management of health and safety in the health services: information for directors and managers30 pp Management of health and safety in the health services: information for directors and managers £7.50 . 0 7176 0844 1 0717608441 Health Services Advisory Committee

Antibody responses of healthy infants to a recombinant hepatitis B vaccine administered at two, four, and twelve or fifteen months of age

Hepatitis B vaccine was administered to healthy infants on two investigational schedules that fall within ranges recommended by the U.S. Public Health Service Advisory Committee on Immunization Practices and by the American Academy of Pediatrics Committee on Infectious Diseases. A month after receiving vaccine at 2, 4, and 12 or 15 months of age, 98% and 100% of the children had >10 mIU antibodies to hepatitis B surface antigen per milliliter, with geometric mean titers of 1358 mIU/ml and 3424 mIU/mL, respectively. (J P EDIATR 1994;125:67-9)

Medical concerns in people with severe learning difficulties: report on a vision week and symposium at the Royal College of Physicians and Surgeons of Glasgow, Scotland, 8-12 March 1993.

Over the course of a week, vision clinics were conducted in the wards of Lennox Castle, one of the largest remaining mental handicap institutions in Scotland. Receptions and a seminar encouraged participation by staff and local services. A day Symposium at the Royal College of Physicians and Surgeons in Glasgow presented recent developments in medical care and facilitated discussion on methods of ensuring effective health surveillance, assessment and advisory services.

Manual handling: proposed regulations

Injuries associated with manual handling operations account for most workplace injuries reported to the Health and Safety Executive and local authorities. In the health care services, they account for almost 50 per cent of all injuries reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RlDDOR) of 1985 (1). This article examines how proposed legislation may be applied to make the industry safer, drawing on work being carried out by some health authorities and organisations such as the Back Pain Association and WING (The Work-Injured Nurses Group of the Royal College of Nursing). The author draws on EC directives, and on consultative documents on the proposed regulations issued by the Health and Safety Executive (2), as well as draft guidance issued by the Working Party of the Health and Safety Commission's Health Services Advisory Committee (1).