Healthcare Service Delivery System Research Articles

Bedlam Community Health Clinic: A collaborative interdisciplinary health care service for the medically indigent

ObjectiveTo describe a collaborative interdisciplinary health care service delivery system for the medically indigent in the Tulsa and northeastern Oklahoma area independent of state or federal funding. SettingNortheastern Oklahoma and Tulsa. Practice descriptionCommunity and ambulatory care for indigent patients. Practice innovationBedlam Community Health Clinic (BCHC), which opened in August 2003, provides services to patients through partnerships among the health care disciplines of the University of Oklahoma College of Pharmacy, Nursing, and Medicine; is staffed by community physicians and pharmacists who volunteer their time and expertise; and is funded by the local community. Main outcome measuresExperiences and patients served. ResultsBCHC is a collaborative interdisciplinary clinic that addresses the needs of the medically indigent in Tulsa and northeastern Oklahoma. Conceived, developed, and funded by the local community, it does not depend on state or federal funding. A variety of services, both general medicine and specialty, are provided through BCHC. Since its opening in August 2003, the clinic has provided hands-on training for students from a variety of health care disciplines. The pharmacist–patient encounters provide helpful, meaningful drug information. The participation of volunteer pharmacists enables medically underserved or indigent patients to access pharmaceutical care and addresses the diverse health care needs of this often overlooked population. ConclusionHealth professionals and students in the Tulsa area have created an innovative mechanism for serving indigent patients who otherwise would lack adequate health care services.

Service learning: integrating student learning and community service.

Health professions education is directly effected by changes in health care service delivery and financing systems. In the United States, as the health care industry increasingly shifts to a market economy, service delivery venues are moving away from acute care facilities and into community-based settings. Additionally, there is increased emphasis on primary prevention programs, often provided in public health settings. For health professions programs that traditionally provide clinical training in hospitals and long-term care facilities, there are unique challenges associated with identifying new venues in order to insure that students are exposed to a wide variety of patients with a range of chronic to acute disease conditions. One set of tools that has demonstrated usefulness during these kinds of transitions is service learning. This teaching methodology emphasizes increased partnership with clinical training sites, extensive orientation to patient populations and community resources, structured reflection and instilling the ethic of service in future health care providers. Although this article describes utilization of service learning in the context of current conditions in the United States, we hope that the principles presented here can be readily adapted in any setting.

A Critical Inquiry of Enslaved African Females and the Antebellum Hospital Experience

There are a multitude of challenges within the academic study of the enslavement of African people, including the varying analyses regarding the extent and quality of medical care provided to these persons. Many of the New Orleans slave narratives detail how enslaved Africans received little in the way of formal medical care and treatment (Clayton, 1990). Other interpretations of antebellum history insist that slaves routinely received medical care from arrangements made or, in some cases administered, by the slave owner (Breeden, 1980). Furthermore, because enslaved Africans in Louisiana were subject to the laws governing consumer protection, and so on, slaveholders (owners, traders, or dealers) were required to guarantee them against disease and illness (Schafer, 1987a). However, there is evidence as well that enslaved Africans in the diaspora participated as skilled practitioners of medical care (Bankole, 1998b; Finch, 1990; Goodson, 1987; Harrison, 19751976). What is certain is that the field of medicine during the antebellum period was growing from rudimentary conceptions of the causes of illness (including the use of folk practices and a plethora of quack-physicians) to an organized health care service delivery system with trained and licensed physicians. Both Blacks and Whites during this period were at the same time victims of a burgeoning medical field and recipients of aggressive strategies to pro-

An Open System Approach to Process Reengineering in a Healthcare Operational Environment

The objective of this study is to examine the applicability of process reengineering in a healthcare operational environment. The intake process of a mental healthcare service delivery system is analyzed systematically to identify process-related problems. A methodology which utilizes an open system orientation coupled with process reengineering is utilized to overcome operational and patient related problems associated with the pre-reengineered intake process. The systematic redesign of the intake process resulted in performance improvements in terms of cost, quality, service and timing.

On psychological identity and training: A reply to Thomas and Chan (2000).

K. R. Thomas and F. Chan (2000) raised several concerns about the legitimacy and primacy of the Boulder model in the training of rehabilitatio n psychologists, particularly with regard to the unique needs and history of rehabilita- tion psychology. We address several of the issues they raise and maintain that the utility of the Boulder model, although in need of some revision to meet the evolving nature of health care service delivery systems, remains the most appropriate model for the training of professional psychologists.

On psychological identity and training: A reply to Thomas and Chan (2000).

K. R. Thomas and F. Chan (2000) raised several concerns about the legitimacy and primacy of the Boulder model in the training of rehabilitatio n psychologists, particularly with regard to the unique needs and history of rehabilita- tion psychology. We address several of the issues they raise and maintain that the utility of the Boulder model, although in need of some revision to meet the evolving nature of health care service delivery systems, remains the most appropriate model for the training of professional psychologists.

Oral mucosal transudate testing for HIV-1 antibodies: A clinical update

The HIV epidemic and the social and clinical responses to it have changed dramatically in recent years in ways that significantly affect the nursing profession. In scope, the HIV epidemic has broadened demographically and geographically, shifting the burden of the epidemic and continuing to place stress on our health care and social service delivery systems. During the past 2 years, there have been clinical advances in the ability to treat HIV disease as a more chronic, manageable condition, making it more important than ever for infected individuals to know their serostatus. A recently available HIV-1 antibody test that uses oral mucosal transudate (OMT) fluid that compares favorably to serum in reliability, because it is based on the same enzyme-linked immunosorbent assay Western blot algorithm, has become available. The OMT test for HIV involves simple, safe, and non-invasive specimen collection that offers clinical and outreach advantages to nurses in AIDS care who provide counseling and testing.

Recognizing the family caregiver: integral and formal members of the rehabilitation process

Radical and emerging changes in health care service delivery systems and steady increases in the number of chronic health conditions have shifted more responsibility to family caregivers of people with disabilities. These caregivers essentially operate as formal health care providers who receive little or no recognition, support, or preparation from health care systems. In this article, major societal and psychological issues in caregiving are discussed. We also explore interventions to prepare and assist caregivers that effectively integrate them into the rehabilitation process. © 1998 Elsevier Science Ltd.

Effects of the growth of managed care on academic medical centers and graduate medical education.

The author offers insights into how the proliferation of competitive health care financing and service delivery systems based on managed care affects the financial support available to academic medical centers (AMCs), especially to their programs in graduate medical education (GME). The paper is based largely on case studies of AMCs conducted by the author in the summer of 1994 in the health care markets of San Diego, California, Minneapolis-St. Paul, Minnesota, and Washington, D.C., complemented by a review of the literature. In sum, the investigator found consensus among all parties that in the current market, managed care plans neither are willing nor feel able to pay much, if any, premium for the services of AMCs, particularly when established, respected alternatives exist, as they typically do for most services in major urban markets. Relatively few short-term adverse effects on AMCs were found from the growth of competitive systems, but AMCs are nevertheless very concerned that managed care will put them at a disadvantage. They are thus seeking ways to position themselves for the future. The AMCs are concerned that at some point, the cost reductions they are making will hinder the fulfillment of their unique traditional mission, since they believe that the costs of their GME programs can be reduced only so far without harming residents' training. Many managed care plans, however, question the AMC mission, taking issue particularly with the training AMCs provide and its relevance to current needs for primary and ambulatory care. The investigators also found considerable support for pooled funding for GME among diverse parties, but no consensus on how this funding should be structured, who should receive it, or what it should support. Potential conflicts were also identified between national, state, and market objectives for provider supply and specialty distribution because these objectives can embody different criteria for assessing the handling and locations of specialists' training. In addition, the findings indicate that it could be unwise to consider AMC policy independent of workforce objectives; doing so could create conflicts about the kinds of physicians who should be trained. The author concludes with a list of approaches to future research that may be constructive.

Nursing Approaches to the Mental Health of the Elderly: A Position Paper

Although geropsychiatric nursing or mental health nursing with the elderly (MHNE) can be conceived of as a new subspecialty in psychiatric mental health nursing, in essence it is as old as nursing itself, for caring for people of all ages has always been within the purview of nursing. Today, however, in the more developed countries, older adults have increased both in numbers and in sophistication. These two changes have altered mental health care for the elderly. For example, mental health professionals now recognize that the elderly have an image problem which leads to underutilization of existing services. Psychiatric mental health nursing as a whole is questioning the nature of its practice and its place both within academic settings, and within the health care service delivery system. This paper explores the future possibilities and choices for the new subspecialty, mental health nursing with the elderly.