Reasons For Non-utilization Research Articles

Abstract P1-10-22: Evaluating the incidence of supportive care referrals generated using patient reported data from the Athena health questionnaire system

Abstract Background Patients at risk for or diagnosed with breast cancer have many symptoms and need for supportive care services. As part of the Athena Breast Health Network (a University of California-wide collaboration), the UCSF Breast Care Center (BCC) has incorporated an electronic health questionnaire system (HQS) prior to new patient and follow-up clinic visits, allowing patients to provide information on their personal health and family history, physical and psychological symptoms, and lifestyle. Based on these patient-reported outcomes (PRO), automated referrals for services including genetic counseling, psycho-oncology, social work, fertility preservation, and smoking cessation are generated. Algorithms defining thresholds to trigger these referrals were developed by clinicians and supportive care providers to proactively meet patients' needs. Objectives To evaluate the incidence and outcomes of supportive care referrals based on existing algorithms, and identify reasons for non-utilization of the services offered. The ultimate goal for this evaluation is to modify the existing algorithms to better meet patients' needs. Methods Patients initiating care at the UCSF BCC are invited by email to complete an HQS that provides information relevant to their clinical care. Patients sign an electronic consent, agreeing to have their PRO stored and accessed for research purposes. Family history, health behaviors, desired services, and responses to National Cancer Institute Patient Reported Outcomes Measurement Information System (PROMIS) items are processed through algorithms, generating referrals based on defined thresholds. A clinician summary report is generated and scanned into the electronic medical record (EMR), identifying services for which the patient has met thresholds. Referrals are sent to the clinician as pended orders through the EMR. Once signed by the care provider (physician or nurse practitioner), the order is routed through the EMR to the appropriate service and the patient is offered a visit or phone consultation when appropriate. Results Between 1/1/14 and 12/31/14, 1297 patients initiating care at the UCSF BCC completed an HQS prior to their clinic visit. 1108 patients (85.4%) agreed to have their data used for research. 623 patients (56.2%) were referred to at least one supportive care service. The table below summarizes the percentage of patients who met the defined referral thresholds: Referrals Made, 2014Referral TypeNumber of ReferralsPercent of Patients Referred (n=1108)Genetic Counseling Services44340.0%Psychological Services25723.2%Social Work13712.4%Smoking Cessation343.1%Fertility Preservation292.6% Ongoing analyses are underway to determine the percentage of patients who received services, explore barriers to accessing these services, and evaluate patients' preferences regarding provision of services in alternate formats, including webinars, online content, and group sessions. Conclusions Effective use of PRO identifies a high percentage of patients in need of supportive care services. Through analysis of utilization of services based on our existing thresholds, we hope to optimize our algorithms to better serve our patients' needs throughout the continuum of cancer care. Citation Format: Wong EC, Kaplan CP, Shumay DM, Leykin Y, Etzel KA, Stover Fiscalini A, van't Veer LJ, Esserman LJ, Melisko ME. Evaluating the incidence of supportive care referrals generated using patient reported data from the Athena health questionnaire system. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-22.

Patient utilization of supportive care services identified through the Athena Breast Health Questionnaire System.

226 Background: Psychological wellbeing and lifestyle changes are important factors in long-term health of cancer survivors. As part of the Athena Breast Health Network, the UCSF Breast Care Center (BCC) incorporated an electronic health questionnaire system (HQS) that collects patient-reported data on physical and psychological symptoms, medical conditions, family history, and lifestyle to identify patients’ supportive care needs. Methods: Through a semi-automated process, patients whose HQS responses meet pre-established thresholds are referred to Psycho-Oncology, social work, genetic counseling, and Onco-Fertility. Referrals generated within the HQS are signed and routed by clinicians at the time of a BCC visit. When patients decline appointments with these services, staff members document reasons within the electronic medical record (EMR). A retrospective chart review identified patients who did not receive supportive care services to which they were referred and a qualitative analysis was performed. Results: From 7/1/14-12/31/14, 525 patients completed an HQS and agreed to have their data used for research. The table summarizes referral information. 45 patients referred to Psycho-Oncology did not complete an appointment. Of these, ten did not respond to phone contact to schedule visits. 35 were reached, but declined an appointment. 25 (71.4%) were not ready to make an appointment; 5 (14.3%) cited distance as a primary barrier; 3 (8.6%) were satisfied with the psychological services they were receiving elsewhere; and 2 (5.7%) did not have insurance coverage. Reasons women disregarded referrals for genetic counseling and fertility are being evaluated. Conclusions: HQS can assist in identifying patient supportive care needs, but despite automation of referrals, many patients do not follow through to use supportive care and clinical resources. Timing and resource accessibility may be key. Through analysis of reasons for non-utilization, we hope to better tailor the delivery of supportive care services, when indicated, to better serve patient needs. [Table: see text]

Relevance of a laboratory physician's report to patient care in a tertiary health center.

Investigation results traditionally are given in two parts: Investigation results and report. When both are provided for a test done, reports offer in depth information, explanation and clarification of results. This trend has been lost over time as results are the only documentation routinely given currently in conventional hospital practice except reports are specially requested for although the service is obtainable at no extra cost to the patient or attending physician. To access the necessity of laboratory report as part of investigation results and reasons for non utilization of laboratory report services by physicians. A descriptive cross-sectional study was conducted amongst doctors of varying cadres in 3 specialties (Physician, Surgeon, Gender practitioners) at the University of Benin Teaching Hospital, Benin City, Nigeria. Data was collected from 121 participating doctors using a structured 19 item self administered questionnaire. The data was analyzed using IBM-SPSS Version 20.0. Most respondents agreed that the investigation results currently obtained from the laboratory were useful but would be better if laboratory reports accompanied them. Over 70% of the doctors noted that the above sometimes held true only sometimes and not always as stated by 28.1% of doctors. More than 90% of the doctors have knowledge of the difference between laboratory results and report; the necessity of a lab physician's report for every investigation requested for and its potential benefits such an investigation reporting system will have on patient management. Although most doctors (81.8%) discuss laboratory results with lab physicians, they do not routinely consult them to achieve the improved value of investigation results until a critical period of necessity arises. Laboratory investigations would offer doctors more information, which translates to enhanced patient care if investigation results are mandatorily accompanied by a laboratory report.

Utilization of maternal health services and determinants of skilled care during delivery in slums of Gujarat, India

Background: In India one in three women is delivering without skilled care. This is happening even after the Safe Motherhood Initiative began two decades ago. Aim & Objective: The aim of the present paper is to assess utilization of maternal health services and factors affecting skilled delivery care among urban slum women. Method: We selected 562 women delivered two year prior to survey using two stage clusters sampling for a community based cross sectional study. Using a pre-tested structured interview schedule, information was collected on demographics, socioeconomic status, use of maternal health services, and reasons for non-utilization of health services. Univariate and multivariate analysis were performed. Result: Majority (92%) of women received at least one antenatal care during pregnancy, while only 4 out of five women sought skilled care during the last delivery. Women of educationally and socially backward classes (OR=0.46, 95% CI 0.230.94), women live in a distance more than two kilometers from maternity health facility (OR=0.38, 95% CI 0.22-0.65), and women been on their second pregnancy (OR=0.44, 95% CI 0.21-0.94) utilized less of skilled care during delivery compared to their counterparts. Increase in education level of women and number of Antenatal care received were tending more utilization of skilled care during delivery. Minimal sense of need, cost, social barriers and perceptions about care were found to be the reasons for not seeking care. P oor attitude of providers, poor quality of services and long waiting time were found to be the reasons for non-utilization of public health facilities. Conclusion: The factors determine skilled delivery care were caste affiliation, education, service availability, parity, perceived utility of services and health seeking behaviors. Government institutions were lying underutilized as women do not prefer them for delivery.

Utilization of dental services among civil servants in Port Harcourt, Nigeria

Background: Civil servants are adults that cut across all ages, educational status, and social class. This study describes and compares dental service utilization among federal and state civil servants in Port Harcourt and identifies the determinants and barriers to the utilization of dental services among these groups. Materials and Methods: This study was a comparative cross-sectional study carried out among Federal and State civil servants in Port Harcourt, Rivers State, Nigeria. The study units were selected using multistage sampling technique. Data were collected using pretested self-administered questionnaires and analyzed using the Statistical Package for Social Sciences version 20.0. Results: A total of 638 participants comprising of 313 and 325 civil servants from the federal and state civil service respectively, completed and returned the questionnaires.Only 143 (22.4%) of the participants had visited the dentist in the past 1-year, this is made up of 80 (25.6%) federal and 63 (19.4%) state civil servants. Most of the federal workers 55 (68.8%) and state workers 45 (71.4%) had visited the dentist based on need. Participants with tertiary education were significantly more likely to utilize dental services (P = 0.009). The reasons for nonutilization of dental services reported among the respondents were no need for treatment 59%, cost of treatment 20%, being scared 13.5%, and fear of infection 10.3%. Conclusion: Dental visits were based on the need for treatment. Whereas education was a determinant of dental service utilization, perceived lack of treatment and cost of treatment constituted barriers to utilization of dental services.

Utilization of Insecticide Treated Nets among Pregnant Women Attending Antenatal Clinic in a Suburban Referral Hospital, North-East Nigeria

Aim: The aim of this study was to assess the knowledge and usage of ITNs among pregnant women attending antenatal clinic in a referral health facility in Nigeria. Materials and Methods: This was a cross-sectional study carried out at the antenatal clinic of the Federal Medical Centre Azare, North-East Nigeria between October and December 2012. A structured questionnaire was administered on consenting consecutive pregnant women until the sample size was reached. Data obtained were analysed and associations were compared using  and Fisher’s exact test where applicable, with Pvalue <0.05 considered significant. Results: A total of 197 pregnant women were recruited and interviewed. The maternal age ranged from 17-45 years with mean age of 24.2±5.5 years while the parity ranged from 0-11 with multipara constituting 95 (48.22%) and grand multipara, 29 (14.72%). Short Communication British Journal of Medicine & Medical Research, 4(12): 2343-2351, 2014 2344 While only 31 (15.74%) of the respondents had tertiary level of education, 64(32.49%) and 15(7.61%) of them had secondary and primary levels of education respectively. Twenty five (12.69%) had no formal education. Majority of the clients, 162 (82.23%) were unemployed, 14 (7.11%) were civil servants and 17 (8.63%) were petty traders. Although most of the women, 189 (95.94%), had knowledge of ITNs, only 132 (67.01%) owned them and much less, 97 (49.24%), used them. Para 5 and above were significantly more likely to use ITNs than para 1-4 and para 0 (=21.118; P=0.03). Age, educational status, occupation, ethnic groups and religion (=1.084; P=0.30) did not influence the use of ITNs. Thirty two (32.00%) and 23 (23.00%) of the ITN non-users gave heat and poverty respectively, as reasons for non utilization. Conclusion: Only few of the clients studied utilized ITNs mainly because of heat and poverty. Education of pregnant women to correct the myths associated with the use of ITNs will improve compliance rate.

Exploring Determinants of Health Seeking Behaviour and Perceptions of Need for Preventive Health Care among Rural and Urban Women of Shimla

This paper examines the factors that mostly affect the health seeking behaviour of rural and urban women of Shimla and their awareness, knowledge and opinion regarding the preventive health services. With the help of Chi square (2) tests the independent variables like age, marital status, education, income and occupation were analyzed for their independent predictive power on dependent variables comprising the perception of need for preventive health care and its utilization which included going/not going for voluntary health check up and reasons for non utilization of voluntary health care services in rural and urban areas. Education variable decided the perception of health needs as well as the capacity to acquire the health services (p < 0.01), thereby playing a vital role in determining the utilization pattern of health services.

English

BACKGROUND: India was the first country in the world to launch National Family Planning Programme in 1952. Ironically, even after 60 years of its initiation, the couple protection rate is far from what is desirable although it has quadrupled from 10.4 percent in 1971 to 44 percent in 1999. The present study was therefore taken up to evaluate the utilization of FW Services at grass root level and to identify the determinants of the same. OBJECTIVES: To assess the utilization and determinants of family welfare services in rural Jammu. SETTING: Rural. DESIGN: Crosssectional. METHODS: 10 sub-centres areas, out of the existing 25 in R S Pura Block of Jammu, were randomly selected. To assess the utilization of FW services, the house-hold survey registers maintained at the selected sub centres and updated during RCH survey 2007 were thoroughly scrutinized. This was followed by home-visits of 10% of the couples enlisted in those records for studying the determinants of utilization and reasons for non utilization of these services. STATISTICAL ANALYSIS: was done using proportions, percentages and Chi Square test. RESULTS: Utilization of FW services was observed among 61.91% of the eligible couples. On further statistical analysis, this utilization was found to be significantly associated with the age of the wife and husband and the number of living children. CONCLUSIONS: There is still scope for improving the utilization of Family Welfare Services and the predictors identified in the present study for utilization/ non-utilization of the same can be thoroughly scrutinized for planning targeted interventions.

Utilisation of multidisciplinary services for diabetes care in the rural setting

To quantify utilisation of allied health care services by diabetics in rural NSW and explore reasons for any underutilisation. Self-administered mail survey of 268 patients with diagnosed diabetes identified from practice registers. Two rural general practices. One hundred seventeen respondents with diabetes. Annual frequency of visits to allied health practitioners. In the last year, 40.2% of patients had seen a diabetes educator (DE), 21.4% a dietitian and 47% a podiatrist. However, 25-40% of patients had never used each of the services. Reasons for nonutilisation were non-referral (35.9-68.0%) and lack of perceived need (40.6-59.0%). One third of patients who had not seen a DE in the last year thought their 'general practitioner (GP) provides a similar service'. However, mean annual GP visits (5.6) were significantly lower than urban and rural comparisons. Patients with formal management plans were, in the last year, twice as likely to have seen a DE and podiatrist, and reported two extra visits to their GP compared to those without. Rates of allied health service utilisation were not significantly lower than urban rates; however, there is room for increased uptake of multidisciplinary services. Patients who do not access these services may expect their GP to fulfil multiple roles within a limited number of visits and may not understand the role of other practitioners. Where allied health services are available locally, utilisation may be improved by increasing use of management plans and fostering awareness of the role of allied health practitioners in diabetes management.

Utilization of screening services for cancer of the cervix in Makurdi, Nigeria

Background: Cancer of the cervix is a leading cause of death due to female genital malignancies in developing countries. Early detection through cervical screening is crucial for prevention and treatment. Objective: To determine the awareness and utilization of screening services for cancer of the cervix amongst women in Makurdi. Methods: A cross-sectional study using interviewer administered questionnaires to women attending the outpatient gynecological clinic at the Benue State University Teaching Hospital, Makurdi, North-Central, Nigeria between March and August 2012. Results: The average age and parity of respondents was 35±11.2 years and 2.4±2.3 respectively. Most 48.3% were civil servants, Married 89.0% and had post-secondary education (64.5%). About 65% were aware of cancer of the cervix. Fifty one percent were aware of cervical cancer screening. Main source of information was through the mass media (35.5%). Among the ‘aware’ group for screening services, only 13.6% had utilized the services (X 2 =12.2, p=0.0004, OR=3.7). Overall, only 7% of the study population have ever screened for the disease. Education significantly affected awareness for both cancer of the cervix (p=0.0001) and screening services (P=0.0002). Reasons for non utilization of services were; Ignorance, absence of screening centres, perceived non necessity, faith in God, prohibitive cost, physician’s non recommendation among others. Conclusion: Most women were aware of cancer of the cervix and screening for the disease but utilization of screening services was very poor. Services should be made available, accessible and affordable to the women while sustaining awareness campaigns.

Family biosocial variables influencing the use of insecticide treated nets for children in Eastern Nigeria

Background:Effective reduction of malaria morbidity and mortality in Nigerian children under the age of five depends to a large extent on family biosocial factors. Although, the awareness of insecticide treated bed nets (ITNs) is reportedly high and increasing in Nigeria there remain large gaps between awareness, possession and use by families with children under the age of five in Nigeria.Aim:To determine the family biosocial variables that influence the use of insecticide treated nets for children in Eastern Nigeria.Materials and Methods:A descriptive hospital-based study was carried out from June 2008-June 2011 on a cross-section of 415 mothers with children under the age of five, who were treated for confirmed malaria, and met the selection criteria were interviewed using a pretested, structured researcher-administered questionnaire. The questionnaire tool elicited information on family socio-demographic variables, inter-spousal discussion, communication, concurrence and participation in the use of insecticide treated bed nets; and reasons for non-utilization. The period of usage in the previous 6 months was assessed and graded using a scoring system of 0-4. Scores of 1-4 indicated usage while score of 0 meant non use.Results:The rate of ITNs use was 53.0%. The family variables that significantly influenced utilization were secondary education and above of parents (mother: P = 0.009; father: P = 0.001), monogamy (P value = 0.024), family size of 1-4 (P value = 0.016) and parents living together (P = 0.001); others included parents’ occupation (mother: P = 0.003; father: P = 0.04) and inter-spousal discussion (P value = 0.001), communication (P value = 0.001), concurrence (P = 0.000) and participation (P = 0.000). The commonest reason for non- use was inconvenience during sleep (P = 0.04).Conclusion:This study shows that the rate of ITN use was marginally good. Specifically, this rate was significantly influenced by some family variables. The families of children under the age of five should, therefore, be the focus of intensive health promotion campaign to influence the use of ITNs to produce ITN family friendly communities.

A study on awareness and utilization of \"Chiranjeevi Yojana&amp;#147; among members of BPL families in the field practice area of rural health training centre (RHTC), Sayla of Surendranagar district

Background: Government of Gujarat launched “Chiranjeevi Scheme” as a one-year pilot project in December 2005 in five backward districts (Banaskantha, Dahod, Kutch, Panchmahals, and Sabarkantha). The scheme has now been extended to the entire state. Aims & Objective: To assess (1) Awareness and utilization of ‘Chiranjeevi Yojana’; (2) Reasons for not utilizing the benefits of ‘Chiranjeevi Yojana’; (3) Problems faced in the utilization as perceived by the beneficiaries. Material and Methods: A total of 116 BPL families selected by Simple random sampling (SRS) method were included in the present study. All females of 15-49 years of age group and one male person who is the Head of Family were taken from each of the family. Results: Out of total 268 subjects, only 88 ( 32.84%) subjects were aware about ‘Chiranjeevi Yojana’. Out of them 56 were females and 32 were head of the family males. A total of 46 out of 152 (30.26%) females utilized the benefits of ‘Chiranjeevi Yojana’. There is a significant association between education and knowledge regarding ‘Yojana’. The reasons for non-utilization was unawareness about the procedural aspects of registration and availing the benefits, the types of services covered under the yojana and the misconception that they have to pay additional charges also. Conclusion: Most of the participants who were actually the beneficiaries of the scheme were unaware of ‘Chiranjeevi Scheme’. IEC activities with emphasis on Government programs focusing on maternal and child health should be strengthened. Key-Words: ‘Chiranjeevi Yojana’; Awareness; Utilization; BPL Families

Utilization of public health services in a rural area and an urban slum in Western Maharashtra, India

Background: An extensive primary health care system exists in India, yet it is inadequate in terms of coverage of the population, especially in rural areas, and gross underutilization. Assessment of the utilization of public health services is important for the health of a nation. Aims & Objective: To assess the utilization of public health services in a rural area and an urban slum in Maharashtra, India Material and Methods: A community based cross sectional study among 800 families, 400 each from a rural area and an urban slum in Karad, Maharashtra. Data was collected from the head of the families using a pretested questionnaire. Chi square test was applied to find any significant difference between the two areas in health seeking behaviour. Results: The utilization of public health services was very low in both the study areas and the main reason for non-utilization in rural area was because the centre took money for the services when it was supposed to be free and in the case of urban slum the centre was far away. Conclusion: The utilization of public health services is poor in both areas. It is important to revitalize the health system, encourage the utilization and provide better facilities for the health staff for effective delivery of service.

Determinants of Institutional Delivery in Rural Uttar Pradesh: Choice of Delivery Location

Access to quality care during pregnancy and especially at delivery seems to be the crucial factor in explaining the disparity in maternal health status. The choice of place of delivery has consistently been found to be associated with maternal and neonatal outcomes. The objective of the present paper is to understand the determinants of delivery location-institutional (public or private) and home; and reasons for non-utilization of facility for delivery care. The District Level Household Survey (2002-04) data for Rural Uttar Pradesh have been used, adopting the conceptual framework of Andersen Behavioural Model. A multinomial Logistic regression analysis was conducted to assess the determinants of home, public and private facilities for delivery. Most of the delivery had taken place at home, with public and private sector accounting for only seven percent and nine percent respectively. Women with higher birth order and those residing far from Primary health centres had greater odds of delivering at home than public facility, while maternal education, Antenatal care visits, regions and pregnancy complications are the significant predictor of institutional delivery. The results indicate that, after controlling for other variables access to health facilities do not have much effect on choice of public facility over home/private. Regional analysis showed significant differentials in reasons for not delivering at health facility. Given the predominance of home deliveries in the rural Uttar Pradesh, every attempt should be made to ensure that these are attended by trained birth attendants.

Impact of a decade-long anti-malaria crusade in a West African community

ObjectiveTo assess the rate of utilization of long lasting insecticide treated bed nets (LLINs) which is one of the cardinal components of the program, a decade-long antimalarial campaign under the roll back malaria (RBM) initiative. MethodsThe study was carried out between October and December 2009 and cross-sectional in nature involving adult women in Otukpo town and environs. Households were selected using systematic sampling methods where all the adult women in each household were interviewed. Relevant information such as age, marital status, occupation, utilization of LLINs and reasons for non-utilization were obtained. Data obtained were analysed using analysis of variance (ANOVA) and regression coefficient. ResultsAlmost 100% (3 154) of the respondents could associate malaria fever with mosquito bite although other causes were also mentioned. The overall any bed net utilization in Otukpo town was found to be 58.3% (1 849). LLINs utilization was found to be 23.3% (739). 35.0% (1 110) used untreated bed nets while 41.7% (1 322) had no bed net. Positive predictors for LLINs utilization were increasing educational levels, increasing wealth index and presence of an under five child, while lower wealth index and cultural beliefs negatively contributed to LLINs utilization. ConclusionsThe RBM program in the community has failed to yield the desired results. Efforts should be intensified towards addressing the socioeconomic, cultural, literary and logistic factors in order to reach this goal.

O96 Reasons for non utilization of orthodox health facilities by pregnant women; a pilot study in four Local Government Areas (LGAs) in Akwa Ibom State, Nigeria

O96 Reasons for non utilization of orthodox health facilities by pregnant women; a pilot study in four Local Government Areas (LGAs) in Akwa Ibom State, Nigeria

Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experience

To assess the indications, safety, utilization, and success of ovarian tissue freezing and transplantation. Prospective longitudinal analysis. Academic medical centers. Fifty-nine women who underwent ovarian tissue cryopreservation with a slow freezing technique between May 1997 and March 2008. A follow-up was conducted 36.8 +/- 3.6 months after the procedure. Ovarian tissue harvesting and cryopreservation. Indications, safety, and utilization rates. The mean age (+/- SE) was 26.7 +/-1.2 years (range 4-44 years). The majority of patients had either hematologic malignancies (45.7%) or breast cancer (22%). Of these, 57.6% underwent hematopoietic stem cell transplantation. No complications occurred and no histologic evidence of cancer was found in the harvested tissue. The median length of storage was 3.5 +/- 0.3 years (0.06-10.5 years). Fifty-six of 59 patients have not yet used their ovarian tissue. The reasons for nonutilization were social/personal, being still under treatment, and death in 54%, 38%, and 8%, respectively. Only three women (5.1%) underwent transplantation, two with the heterotopic (abdominal wall) and one with the orthotopic technique. One woman with a heterotopic transplant conceived spontaneously and delivered. Of the three transplants, one ceased function after 9 months and two are still functioning at up to 7 years follow-up. Ovarian tissue harvesting appears to be safe but the experience with ovarian transplantation is still limited due to low utilization. As a result, the true value of this procedure remains to be determined.

Utilization of oral health services by mothers of preschool children in Jos North Local Government Area, Plateau State, Nigeria

Objective: To determine oral health services utilization by mothers of pre school children in Jos North Local Government Area, Plateau State, Nigeria Design: Cross-sectional study Setting: Four Primary Health Care (PHC) Clinics in Jos North Local Government Area Participants: 200 mothers of pre school children Materials and Methods: Mothers of pre school children were. proportionately sampled in four randomly selected clinics. Structured questionnaires were administered to them in order to obtain information on the utilization of oral health services, their reasons for visitation and non visitation Results: Twelve and half percent (12.5 %) of the mothers reported to have visited the dentist before while only 4.5 % of the children of mother\'s surveyed had been taken to the dentist at least once. Literate mothers visited the dentist more compared to the illiterate mothers. All the illiterate mothers visited the dentist when there was a dental problem. All the mothers who were aged less than 20 years and their children had never visited a dentist. Cumulatively, 94 % of the mothers gave lack of perceived need as their reason for non utilization of dental services. Conclusion: The study showed that majority of mothers based their dental visits on presence of a dental problem and perceived need. Further studies are needed on oral health services utilization to better understand the role of socio-cultural barriers. Malawi Medical Journal Vol.16(2) 2005: 33-36

A Leisure-Time Frame of Reference Based on a Literature Analysis

This article describes a quality assurance study of patient utilization of adaptive equipment. A major component of occupational therapy practice has been the prescription of equipment to increase independent living. However, little information exists in the literature regarding patients use of equipment. The researchers found an unexpected high rate (85%) of utilization. Reasons for non-utilization are described. Caution is needed in interpreting the results as non-responders (22%) may have been primarily non-users. Based on the findings, the authors suggest establishing a system to retrieve items needed for a short time and individualizing the process of issuing equipment based on environmental and personal needs as opposed to the standard protocol based on a diagnosis.

Adaptive Equipment:

This article describes a quality assurance study of patient utilization of adaptive equipment. A major component of occupational therapy practice has been the prescription of equipment to increase independent living. However, little information exists in the literature regarding patients use of equipment. The researchers found an unexpected high rate (85%) of utilization. Reasons for non-utilization are described. Caution is needed in interpreting the results as non-responders (22%) may have been primarily non-users. Based on the findings, the authors suggest establishing a system to retrieve items needed for a short time and individualizing the process of issuing equipment based on environmental and personal needs as opposed to the standard protocol based on a diagnosis.