Utilization Of Health Care System Research Articles

Internet et santé : les enseignements de l’enquête permanente sur les conditions de vie des ménages, France, 2005

Background The Internet is a major source of information for the general public in the field of health. However despite ever-increasing connection rates, a digital divide persists in the industrialised countries. The objective of this study was to assess the determinants involved in Internet access and then in Internet use for health information seeking. Methods This study is based on a cross-sectional survey of a representative random sample of French inhabitants: the Enquête permanente sur les conditions de vie des ménages conducted by Insee in 2005, which included a specific investigation on information and communication technology. Results Fifty-two percent of the French adult population had Internet access, and 28.5% of the Internet users had previously searched for medical information during the month before the survey. A first level of socioeconomic divide has been shown in Internet access: poor socioeconomic status, health problems. In terms of health information seeking among Internet users, the divide was not socioeconomic but more related to gender, the health care system utilization, and the diversified use of the Internet. Conclusion In a public health perspective, this study suggests that promoting Internet access and utilization is still necessary in order to make it a widely used tool for prevention and health promotion.

Complaints and health care system utilisation of ethnic German migrants from the former Soviet Union to Germany and their families

The aim of the study is the description of subjective morbidity, health care system utilisation and complaints of ethnic German migrants from the former Soviet Union at the beginning of migration. At present no data are available concerning aspects of health behaviour among this largest immigrant population in Germany. 300 ethnic German migrants and their families (mean age 37.2 and 51% female) were interrogated shortly after migration to Germany. They answered questions about prevalence of diseases, health care system utilization, actual health status and completed the Giessen Subjective Complaints List (GSCL-24). German standards exist for all questionnaires. 237 ethnic German migrants report to have suffered from at least one disease during the course of the last year. They see the gynaecologist and dentist as often as the German population, pay fewer visits to practitioners and specialists but seek more medical advice from the medical lay system. The majority of subjects are satisfied with their health. Migrants describe their health status as lower than the German population compared to which they also report more complaints (Overall distress in GSCL-24 : 17.2 for migrants and 14.0 for Germans) and different complaints (headaches, fatigue). The different medical care system and differences in the treatment of patients could account for the less frequent use of medical services by ethnic German migrants. Actual stressors like language differences and acculturation problems are discussed as possible reasons for the increased rate of complaints among ethnic German migrants. Although they suffer from more complaints the German migrants do not seem to modify their help-seeking behaviour.

Life and health concerns of Indonesian women in transnational marriages in Taiwan.

The number of transnational marriages between Taiwanese men and Southeast Asian women is increasing rapidly in Taiwan. Approximately one out of nine marriages in Taiwan is transnational. The rapid increase the number of foreign brides has greatly transformed Taiwan's social and demographic structures. This study focuses on Indonesian brides, the second largest immigrant group in Taiwan, to explore their life and health concerns. In-depth interview assisted by participant observation for a qualitative study was used in this study. Fifteen women participated in the study. Content analysis was used for data analysis. Findings revealed life and health concerns of immigrant Indonesian women in Taiwan could be categorized into four themes: immigrant adaptation, communication difficulty, family continuity, and barriers to healthcare system utilization. Based on the findings of this study, suggestions are made for healthcare and health policies. Moreover, healthcare professionals should understand that designing and providing culturally sensitive and appropriate healthcare to these women is very important for promoting their and their children's health.

Revealing moments: formulating understandings of adverse experiences in a health appraisal interview

Analysis of a health appraisal interview reveals how an interviewer employs formulations to organize talk about a patient’s medical history. When selected reportings by patient are paraphrased, a three-part formulations cycle is initiated: (1) interviewer’s formulated understandings, (2) patient’s confirmation, and (3) topic shift by interviewer. The reenactment of this interactional pattern promotes increasing attention to patient’s adverse experiences as “root problems” underlying adult health status (e.g. molestation, obesity, depression). Creating an environment for patient’s emergent disclosures is facilitated by displaying non-judgmental sensitivity to patient’s stated concerns, soliciting alignment to particular reconstructions and avoidance of moving the interview forward prematurely and to issues not grounded in patient’s illness circumstances. The identification and utilization of communication techniques for attending to patient’s bio-psycho-social history is critical for refining understandings of empathic interviewing, enhancing diagnosis and treatment (e.g. referrals), decreasing patients’ utilization of health care systems, and ultimately reducing costs for quality medical care.

Internet Use for Web-Education on the Overlooked Areas of Grief and Loss

Unrecognized and untreated acute depression or grief response following a significant loss can result in personal anguish, multiple somatic complaints, functional impairment, over utilization of health care systems, clinical depression, and a risk of suicide. Grief also impacts friends, family, co-workers, employers, and the community of those affected by the loss. Thus, the number of individuals impacted by loss, grief, and depression is significant. Journey of Hearts, http://www.journeyofhearts.org, a unique, integrative website, emerged after informal discussions with other primary care physicians. Collectively, we were seeing more people ultimately diagnosed with depression or grief. Changes in medicine are resulting in more depressed patients presenting to their primary care physicians. However, the pervasive social stigmatization of depression causes people to seek treatment for a “cold” or “flu” rather admitting the real reason—depression or grief. The focus of this website is a unique area, the co...

Utilization of health care system by chronic pain patients who applied for disability pensions: Højsted J, Alban A, Hagild K, Eriksen J. Pain 1999;82:275–82

Utilization of health care system by chronic pain patients who applied for disability pensions: Højsted J, Alban A, Hagild K, Eriksen J. Pain 1999;82:275–82

Utilisation of health care system by chronic pain patients who applied for disability pensions

The objective of this study was to investigate how economic compensation for disability (disability pensions) to chronic pain patients affected their utilisation of health care services. The study was carried out as a register investigation. Inclusion of 144 study patients was based on records from 1989 and 1990 of the Rehabilitation and Pension Board in the Municipality of Copenhagen. Only patients of Danish origin with chronic non-malignant pain were included. The study period was divided into three: Subperiod 1: The year preceding the submission of the application for a disability pension. Subperiod 2: The period from the submission of the application to the decision was made. Subperiod 3: The year following the final decision of the health authorities. The patients were divided into 4 Subgroups according to whether disability pensions was awarded or rejected, or whether the patients accepted or appealed the decision. Based on number and charges of visits to the GPs the total costs of care in the primary sector were calculated. By means of number of bed days, visits to outpatients clinics, operations, blood samples, and various investigations, the total costs of hospital care were calculated. We found that application for a disability pension in chronic pain patients significantly influenced the health care utilisation. Chronic pain patients had a significantly lower health care utilisation after receiving a disability pension than before the pension was awarded. Chronic pain patients who did not get a disability pension and those who were not satisfied with the level of the pension awarded, maintained their health care utilisation after the decision. The mean health care use by the patients who appealed the level of the pension was three times higher than the mean health care use by the patients who accepted the level of the pension awarded. The study may indicate that lack of or insufficient economic compensation from the social system in chronic pain patients contribute to an inexpedient pain behaviour resulting in increased expenses for the health care sector.

The Computer-based Patient Record

Coding systems in health care the CPR after the IOM report the structure of medical record data delivery of clinical information the future of the CPR in a restructured health care system utilization of medical record data medical data in diogene.

Long-Term Lifestyle Management

The Clinical Nurse Specialist impacts the client with chronicity by strategic management of cost and quality outcomes. Three enabling strategies: counseling, social support, and teaching-learning are the tools the nurse and client use to implement long-term lifestyle adjustment to chronicity. Reduced health care system utilization and increased self-esteem and self-care abilities are the result of the strategies. Lifestyle management warrants further nursing research.

Chronic TM Disorder and Non-TM Disorder Pain: A Comparison of Behavioral and Psychological Characteristics

The purpose of this paper is to determine whether patients with chronic temporomandibular disorder (TMD) pain manifest behavioral, experimental, and psychological characteristics similar to patients with other chronic pain illnesses. The Chronic Pain Battery (CPB), a multidimensional assessment tool for chronic pain patients, was used to compare several important variables between 78 TM disorder (TMD) patients and 98 non-TMD chronic pain patients. The study found that chronic TMD patients had lower "usual" pain intensity and suffering levels, fewer vegetative symptoms associated with depression, higher pain tolerance, less impairment of activity, more hope about treatment outcome, lower health care system utilization, but higher reported stress levels than non-TMD chronic pain patients. The two groups manifested no significant differences in use of narcotics, sedatives, and sleeping pills; levels of depression, anxiety, somatization, hostility, or psychoticism; illness behavior reinforcement in their social surroundings; or ratings of problems with work, family, self-esteem, or suicidal impulses. These findings suggest that chronic TMD pain patients (with a symptom duration of over six months) are behaviorally and psychologically similar to non-TMD chronic pain patients, but that they differ in their perceptions of their disorder, rendering them less handicapped by their problems. Psychological, social, and behavioral treatment methods useful for treating chronic pain syndrome may thus also be applied along with dental therapy for optimal treatment of TMD associated with chronic pain.

An analytic method for the evaluation of rural Emergency Medical Service development.

An analytic method is presented for assessing the marginal impact of incremental changes in rural Emergency Medical Services (EMS) on cardiac mortality, morbidity, EMS system process and performance, and health care system utilization. The method incorporates a model of the EMS system. This model specifies five sets of interactive variables characterizing EMS system development and effectiveness. The analytic method quantifies the contribution of each of these sets of interactive variables on the outcome variables (cardiac mortality, morbidity, EMS process/performance, and health care system utilization) for three target populations: those who utilize the EMS system, all hospitalized patients with acute ischemic heart disease independent of EMS system use, and the population of all patients dying from acute ischemic heart disease on a communitywide basis. By including in the model those factors unique to rural areas, such as scarcity of fiscal and health care system resources, geographical constraints, and the skewed severity of case mix due to the clinical and socioeconomic conditions found among rural patients, the analytic method is able to quantify and help explain the impact of these factors on the EMS system and the limitations which they impose. The analytic method affords planners and administrators and rational basis for decisions regarding future rural EMS system development through its identification of those system characteristics amenable to change and worth pursuing from a health policy perspective.

Preventive and episodic health care of inner-city children.

Children in low-income, inner-city households who used different sources of ambulatory care were analyzed with regard to their experiences in securing preventive and episodic illness care. This analysis is derived from a larger study that investigated the utilization of health care systems by groups within an inner-city community; it focused on the Outpatient Department of a large teaching hospital and on the impact of a new Health Maintenance Organization (HMO). Data were obtained through household interviews of three sample populations: enrollees in an HMO, residents of a public housing project, and persons from the general community. When preventive health care was examined, our findings showed that, while the majority of children of school age were immunized, only about half of the children under age 6 were. Among children aged 3 through 5, those attending day care centers were more likely to be immunized than those not in such programs. There were indications that children using the HMO were more frequently receiving preventive services, particularly general physical examinations. There was no relationship between the usual source of care, or day care participation, and whether a child received care for an episode of illness. There were differences by age and usual source of care in seeking care for earaches and in receiving regular care for asthma. The patterns of health care utilization found in this study promote interest in the influence of the source of ambulatory care for children in other socioeconomic groups.