Care Related Services Research Articles

A Standalone RFID and NFC Based Healthcare

NFC is a standards-based, short-range wireless
 connectivity technology that enables simple and safe two-way
 interactions between electronic devices. The concept is based
 on combination of smartcard and contactless interconnection
 technologies; NFC is compatible with todays field proven RFIDtechnology.
 If this technology is used for identification of patient
 in hospital, it will be very useful. Patients have different illness.
 When doctors operate patients or exanimate patients, if the doctor
 confuses the disease of patient, a fatal medical circumstance
 may occur. If RFID and NFC technology is used for this case, we
 can easily protect patients from fatal medical mistakes. It has the
 potential to make almost all wireless technologies and also the
 applications on these technologies easy enough so that everyone,
 even the non-technical can use them.
 Technological development and modern medicine practices are
 amongst the outstanding factors triggering this shift. This trend is
 resulting in a greater demand for health care-related services and
 greater competition among health care providers. Achieving a
 high operational efficiency in the health care sector is an essential
 goal for organizational performance evaluation. Efficiency uses to
 be considered as the primary indicator of hospital performance.
 In order to bring down the cost and improve efficiency, intelligent
 systems can play a significant role in providing intelligently
 processed and personalized information about patients to doctors,
 their health care staff (i.e. nurses) and health care administrators

How fair is Medicare? The income‐related distribution of Medicare benefits with special focus on chronic care items

To use patient-level data, clinical information and linked Medicare records to assess the distribution of benefits (rebates) across income groups, including benefits relating to chronic conditions such as the Chronic Disease Dental Scheme (CDDS). Nationally representative, cluster-stratified survey (the Australian Hypertension and Absolute Risk Study) involving 322 general practitioners who each collected clinical data on 15-20 patients aged≥55,2012s who presented between 1 April 2008 and 30 June 2008 and who consented to have their information linked with Medicare administrative records over 12 months. Distribution of total out-of-hospital Medicare expenditure quantified using concentration indices and determinants of use calculated by odds ratios. There were 2862 patients in the study. After controlling for need, the concentration index for overall funding was slightly progressive (pro-poor) at -0.008 (95% CI, -0.009 to -0.008). Medicare expenditure on chronic care-related services consistently contributed to progressivity of the overall scheme, particularly services under the CDDS with a need-adjusted concentration index of -0.205 (95% CI, -0.208 to -0.201). Uptake of chronic care items varied by locality and comorbid conditions (there was greater uptake by patients with one or more comorbid conditions). Chronic care items, particularly dental items, have primarily been used by individuals from lower income households. Uptake of chronic care items contributes to the overall progressivity of Medicare.

Abstract 172: Stroke Clinical Champions and Quality Improvement

Objective: Clinical champions may serve as important facilitators of clinical quality improvement. We sought to understand how stroke clinical champions communicate within and between clinical services among providers of acute stroke care which spans clinical services. Methods: We conducted semi-structured, in-person baseline interviews with clinical providers of acute stroke care services and related administrators and service managers across 11 VA Medical Centers across the US. We consented the responders and audiotaped the interviews. Closed ended question responses were entered into a database and open ended question responses were transcribed and qualitatively coded. For qualitative data, we assigned at least two coders per transcript for analysis. A priori, we operationalized key constructs of stroke quality improvement and utilized these constructs as an initial coding scheme. Additionally, we coded emerging themes from the qualitative responses using Nvivo software. Coders met regularly to review and consolidate when possible the emergent themes. Results: We completed 104 interviews of which the respondents included the following service lines: neurology, emergency department, inpatient care, education, social work, quality improvement, rehabilitation. Qualitative analyses indicated that 5 of the 12 facilities had unanimously identified stroke clinical champions. These sites reported more frequent communications within neurology service and stronger communications across service lines. Respondents external to the neurology service line were more likely to identify the presence of a stroke clinical champion at VA facilities that had established acute stroke care processes across the medical center compared to facilities where no systematic acute stroke care processes currently existed. Conclusions: A stroke clinical champion may be associated with the establishment of systematic clinical processes that span interdisciplinary services within an organization. The coordination of such interdisciplinary care and the brokering of interdisciplinary relationships may need a clinical champion to foster. Impact: Understanding the development of a stroke clinical champion is crucial for organizations that seek to improve their clinical processes.

The Accelerated Benefits Demonstration and Evaluation Project: Impacts on Health and Employment at Twelve Months Volume 1

This demonstration tested the effects of earlier access to health care coverage and related services for new Social Security Disability Insurance (SSDI) beneficiaries. After one year, the program increased health care use, reduced reported unmet medical needs, and modestly improved health and functioning. It also increased job prep and search activities but did not raise employment levels.

A qualitative study exploring the experience of the partners of cancer survivors and their views on the role of primary care

The partners of cancer survivors may experience distress, anxiety, fear and uncertainty whilst also caring for and supporting a partner who is ill. As they concentrate on the cancer survivor's needs, their own needs may remain unaddressed. Primary care staff may be well placed to support partners as they are generally accessible and may have a better knowledge of the patient's background and family relationships. However, their current involvement in the cancer survivor's and partner's cancer-related care is unclear. This study aimed to describe the experience of the partners of cancer survivors in dealing with cancer-related issues in the first 3 years post-diagnosis, their use of primary care services in relation to these issues and the barriers in doing so and their views on the role that primary care could potentially play in supporting them as carers during this period. Semi-structured interviews with 22 partners of cancer survivors diagnosed within the last 3 years and recruited through six GP practices in the Thames Valley Region of the UK were analysed using the 'framework' approach to thematic analysis. Three issues were identified as of particular concern to partners: providing practical support, providing emotional support and managing their own health and well-being. Few partners had sought or received support from primary care specifically for cancer-related issues, indicating confidentiality, lack of knowledge of family relationships and the greater need of the cancer survivor as barriers. Most partners would welcome a proactive approach from primary care and felt that this would provide an opportunity to discuss issues they were concerned about. Needs and concerns of the partners of cancer survivors in caring for patients are often not addressed. There is a scope for primary care to elicit these needs and provide greater support. Changes to clinical practice in primary care could lead to greater involvement of and to better outcomes for cancer survivors and their partners. A proactive approach to patients and their partners or other close family members at the time of diagnosis through an offer of support and the inclusion in a designated review appointment at the end of initial treatment would be useful.

Ten steps or climbing a mountain: a study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding.

BackgroundThe Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia.MethodsThe study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis.ResultsThree main themes were identified: 'Belief and Commitment'; 'Interpreting BFHI' and 'Climbing a Mountain'. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings.ConclusionDespite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation.

Pharmacy Patrons 'Awareness of Pharmacists' Education and Routine Patient Care Responsibilities

To assess the similarities between pharmacists' and pharmacy patrons' views of pharmacists' roles and to explore the extent to which persons actually see pharmacists assuming certain roles. Cross-sectional survey was administered to pharmacists and patients who were filling prescriptions or seeking nonprescription medications in 9 community pharmacies in Morgantown, West Virginia. The survey assessed 11 routine patient care services. Main outcome measures include opinions of pharmacists and patients about responsibility for providing 11 routine care services and the extent to which these services are provided. Pharmacists and patients had similar opinions about services that pharmacists should provide for 7 of the 11 services evaluated. For the other 4 items for which opinions were divergent, the mean scores for the extent to which pharmacists provide these services indicated that pharmacists do not always provide these services. Pharmacy patrons might not attribute certain patient-related functions to pharmacists because pharmacists do not frequently perform these routine care-related services in actual practice. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Review of Management of ART Service Delivery for People Living with HIV/AIDS in Nepal

HIV/AIDS epidemic has been gradually spreading in Nepal. It is one of the major public health problems of the nation. Treatment, Care and Support are the critical and essential components of the response to HIV infection and AIDS related morbidity in Nepal. The cross sectional study was carried out at four public and three private Anti Retroviral Therapy (ART) sites during last 6 months of 2006 by selecting public ART sites based on the developmental regions of the country. From institutional set-up, human resources supply and availability of ART medicine's perspectives, the management practices of ART in Nepal is satisfactory. However, services need to be improved to make it more effective and efficient and client friendly, considering the standardization and sustainability of services. Government has targeted to increase the number of certified service delivery points for provision of comprehensive treatment and care services in relation to HIV/AIDS. Hence, in order to achieve the targets with increasing the coverage there is a need to review the management process in established ART service delivery sites. Key Words: HIV/AIDS; Nepal; ART DOI: 10.3126/saarctb.v5i1.3081 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(1)

Towards a Sociological Understanding of Irish Travellers: Introducing a People

Introducing a People Niall C. McElwee, PhD President, Irish Association for Social Care Educationl Head of Department, Athlone Institute of Technology, Athlone, Ireland N mcelwee@ait.ie & Ashling Jackson, M.A. Lecturer in Sociology, Department of Humanities, Athlone Institute of Technology, Athlone, Ireland Adugganjackson@ait.ie & Grant Charles, Ph.D., R.S.w. Assistant Professor, School of Social Work and Family Studies, University of British Columbia, Vancouver, BC, Canada. This paper is one in a series of three papers viewing aspects of native cultures and, in this instance, will primarily define the Traveller population in Ireland, give a brief history of this population whilst discussing racism and some of its implications. There will be a particular focus on current systems of health, education and child protection in order to determine Traveller experiences of these key child and youth care related service providers in Ireland. The second paper will focus upon an examination of the experiences of aboriginal people in Canada. It will have a particular emphasis upon the marginization of aboriginal children and youth within the dominant culture. The third paper will be a comparison of the issues experienced by Traveller and Canadian aboriginal populations in terms of the helping systems.

Developing models for pharmacy practice

All hospital and health-system pharmacists have a stake in The Pharmacy Practice Model Initiative (PPMI) sponsored by ASHP and the ASHP Research and Education Foundation, given that one of its major objectives is to “determine patient care-related services that should be consistently provided by

Oral Disease Burden and Utilization of Dental Care Patterns Among Pediatric Solid Organ Transplant Recipients

We conducted a study among pediatric renal (RTRs) and liver transplant recipients (LTRs) to determine: a) the overall burden of oral disease; and b) the frequency with which this population utilizes dental care services in relation to sociodemographic factors and oral disease burden. In this cross-sectional survey, study procedures included the completion of a standardized questionnaire (by parents/guardians), oral mucosal examination, assessment of caries, gingival enlargement, and plaque index. The 142 children (82 RTRs and 60 LTRs) enrolled from April 2002 to November 2005 were predominantly Latino (41 percent) and Caucasian (34 percent). Forty-three percent had at least one carious surface (in either a deciduous or permanent tooth), 19 percent had five or more carious surfaces, and 25 percent had gingival enlargement. We found only one case of oral candidiasis. Even though 72 percent of parents/guardians reported their child had a regular source of dental care, only 49 percent had a dental cleaning and 44 percent had dental radiographs in the past year, reflecting a low prevalence of preventive dental care. Among children with no regular source of dental care, there were statistically significantly higher proportions of Latinos, younger children, and families with an annual household income <$35,000. While the prevalence of oral mucosal disease and gingival enlargement was low, the prevalence of children with caries was high, and there was low use of preventive dental care. Strategies to improve this population's utilization of preventive dental care are needed.

Health Care Services for HIV-Positive Substance Abusers in a Rural Setting: An Innovative Program

ABSTRACT Agencies that deliver health care services to HIV-positive substance abusers living in rural areas of the United States face particular treatment challenges and barriers to care. Rural consumers of HIV/AIDS health care–related services identified long travel distances to medical facilities, lack of transportation, lack of availability of HIV-specific medical personnel, a shortage of mental health and substance abuse services, community stigma, and financial problems as leading barriers to access to care. This article discusses barriers to care for rural HIV-positive substance abusers, and challenges for rural health care providers. In addition, it presents a case study of Health Services Center, a model program that has devised innovative practices in the delivery of health care services to HIV-positive substance abusers in rural northeastern Alabama.

Quality improvement in Indigenous primary health care: History, current initiatives and future directors

This paper addresses the question: "What is the current situation for Aboriginal primary health care services in relation to continuous quality improvement (CQI) in clinical care and what is needed for sustainable practice to be achievable five years from now?" The paper describes a number of recent CQI initiatives that evolved within an accountability framework, the origins of which are based on a top-down government approach to performance measurement. Over the last decade there has been a shift to a more negotiated approach and most recently to an emerging agenda that focuses more on systems to support CQI at the primary care coalface. Further development should aim to capitalise on the synergies between different CQI-related initiatives and effectively align quality improvement with performance measurement. Principles of CQI and key challenges for the future are identified.

Young people’s experiences of negotiating health care services in relation to sexual and gender identities: A communitybased approach to service improvement

LGBTIQ young people experience intersecting forms of disadvantage concerning youth status and sexual and/or gender identity, contributing to poorer wellbeing. The paper presents a research project with a youth mental health service, youth reference group and researchers to improve services to this community in Australia. An online survey was designed to learn about their views on service access, experiences and improvements to inform the development of training programmes for health care professionals. Thematic analysis of surveys (N=101) highlights the salience of: services’ visible commitment to LGBTIQ communities; how the relevance of sexuality and/or gender to service interaction is negotiated; and the heteronormative and cisnormative shaping of health care interactions. Implications for health-enabling contexts are reflected upon from a community health psychology perspective.

Systemwechsel in der Pflegeversicherung?

Summary In October 2004, in Germany a pre-operating study was started in order to prove the feasibility and consequences of the use of personal budgets by persons who are in need of nursing care. About 1.000 care dependent persons living in seven regions are included in this triannual study. For three years they receive a budget amounting to 100 percent of their right of benefit in kind according to the German compulsory long term care insurance. This budget has to be used exclusively for care-related services and must not be spent for assistance deliv­ered by family members or neighbours. From socio-economic perspectives, the personal budget will result in a pro­motion of individuals instead of certain services or service institutions. An analysis shows, that the consequences might be an increased efficiency and effectiveness as well as structural changes within the supply of nursing care services. But to achieve these advantages, certain conditions must be provided. At first, the amount of the budget has to correspond to the individual need of care, which can change over time. Secondly, a misapplication of the personal fund has to be prevented without to exclude the potential of local or family dedication. And finally, new ways of quality assurance are requested due to the scope for development, which arises through deregulation.

Relational Contracting Between Local Authorities and Independent Fostering Providers: Lessons in Conducting Business for Child Welfare Managers

Policy developments since 1997 have changed the nature of foster care placements and related educational and therapeutic services. A succession of initiatives aimed at improving placement quality, choice and stability for children and their foster families has had two major impacts. The first is the significant expansion of independent fostering providers (IFPs) alongside local authority fostering agencies. The second has been the change in attitude and working arrangements between staff and managers in both these sectors as they adjust to the government's commissioning agenda for the mixed economy of foster care provision. Although the first area has received some research scrutiny, the second area has not. In the absence of a relevant social work literature base this article explores a series of legal and policy studies of ‘relational contracting’ alongside a recent study of working arrangements between local authority and IFP managers. It concludes that there are lessons to be learnt for fostering agencies from these studies of contracting and the practice of trust.

Theme Issue on Chronic Diseases in Infants, Children, and Young Adults: Call for Papers

PEDIATRICS HAS TRADITIONALLY BEEN DEFINED BY ACUTE illnesses, but with the aid of public health measures, modern medications, vaccines, and product safety advances, acute illnesses are more preventable and treatable than ever. The major challenge for health care professionals who care for infants, children, and young adults and for those who will treat them as they age into adulthood has become the management of chronic diseases. Chronic illnesses in children include a wide range of maladies. Some, such as obesity, malnutrition, and cardiovascular disease, begin in childhood and can continue into adulthood. Others, such as congenital heart disease, are very different from adult-onset disease and require different management. Illnesses such as sickle cell disease and certain cancers that manifest in childhood have had gradual advances in treatment, and these diseases and others, such as neonatal prematurity, present new challenges as children live longer. While all children require general pediatric care (attention to immunization, proper nutrition, development, etc), some problems, such as cancer, congenital heart disease, and autism, are treated primarily by subspecialists. Others, such as cerebral palsy, require the teamwork of multiple disciplines. The prevalence of chronic conditions in childhood varies depending on the condition and how it is defined in terms of severity and functional impact. The Maternal and Child Health Bureau proposed an encompassing view of chronic illness, defining children with special health care needs as “those children who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health care-related services of a type or amount beyond that required by children generally.” In 2001, an estimated 12.8% or 9.3 million US children younger than 18 years had special health care needs. Prevalence was higher in boys, older children, and those from low-income families. A national survey in 20022003 found similar results. The leading chronic health conditions causing activity limitation in children differed by age and sex, but included speech problems, asthma, mental retardation, learning disability, and attention-deficit/ hyperactivity disorder. The impact of chronic diseases in childhood is enormous, whether measured economically or in terms of mortality and morbidity. Children with special health care needs accounted for 42.1% of total medical care costs for US children in 2000. In 2003, 5 of the 10 leading causes of death in childhood were chronic diseases: malignant neoplasms; congenital malformations, deformations, and chromosomal abnormalities; diseases of the heart; chronic lower respiratory tract diseases; and cerebrovascular diseases. Chronic conditions resulted in 66 million restricted-activity days and 27 million days lost from school. The impact on families of having a child with a chronic illness should not be overlooked. Having a child with poor health has been associated with higher rates of marital stress, divorce, and paternal unemployment, and one fifth of families report financial problems caused by their child’s health care needs. Because the burden of chronic diseases on children, their families, and the health care systems throughout the world is sogreat, JAMAwilldevoteanissuetochronicdiseasesof infants, children, and young adults in June 2007. Research in the realm of chronic diseases of children has the potential to influence notonlyhealth inchildhoodbuthealthandwell-beingthroughout the child’s life and, as such, is of utmost importance. We wish to increase awareness of the variety of chronic diseases that can afflict children, encourage research on treatment and outcomes, and promote attention at the health policy level for patients who cannot advocate for themselves. Because the development and impact of chronic conditions are influenced by genetics, behavior, and environment, we encourage studies that consider the multidimensionality of these disorders and their management. Authors are invited to submit manuscripts on topics related to chronic diseases in infants, children, and young adults. High-quality original research, especially randomized clinical trials, systematic reviews, and commentaries, are welcome. Manuscripts received by January 8, 2007, will have the best chance of consideration for this theme issue. Please consult the JAMA Instructions for Authors for guidelines on manuscript preparation and submission.

Early Experiences with e-Health Services (1999–2002)

E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use. The objective of this study was to examine trends in e-health use and user characteristics. This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services. Approximately 3.3 million members of a large, prepaid IDS. Amount and frequency of e-health use over time and characteristics of users. The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types. Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.

Versorgungsforschung in der operativen Medizin am Beispiel der Mammakarzinomchirurgie

The epidemiological relevance of breast cancer in Germany has led to a number of initiatives actually changing the processes and structures of care. The ultimate aim of health services research in surgery is to evaluate the impact of these initiatives on the effectiveness and efficiency of the respective health care services. Results of international studies show for instance breast-conserving therapy to be related to the patients' socioeconomic status. In addition, breast specialists tend to operate more in adherence to practice guidelines and to implement new procedures like sentinel lymph node biopsies earlier. Preliminary results from Germany also demonstrate a considerable practice variation in breast cancer surgery. Causes and effects of such variation still have to be explored. For that purpose, newly available data sources on health care services in relation to breast cancer surgery in Germany could be used. The inherent challenge is to combine data from tumour registries, statutory comparative quality assurance activities and inpatient remuneration via DRGs for health services research in surgery.

Regional Policy and Long Term Care Program

The population's indicators predict a constant increase in the demand for health care and welfare related services, at least with reference to the most developed countries. In Italy the provision of the aforementioned services is devoluted to the local tier of government. This work focuses on the problem of financing the greater expenditure for elderly not self-sufficient people. The issues at stake concern on the one hand the analysis of the expenditure side and on the other hand the problem of a regional public sector financing. Two alternative policies are implemented in a general economic equilibrium framework. They regard two local taxes, respectively the regional additional taxation on income (IRPEF)and the regional taxation on production (IRAP). The study points out the efficiency and effectiveness effects of the manoeuvres, focusing both on the market distortions and on the regressive effects. Finally, by a welfare analysis, the net impact (i.e., levy compared with subsidies) on families, grouped according to their income class, is investigated.