Showing papers on "Health care published in 1970"

Medicine and the Computer. The Promise and Problems of Change

Abstract: Rapid advances in the information sciences, coupled with the political commitment to broad extensions of health care, promise to bring about basic changes in the structure of medical practice. Computing science will probably exert its major effects by augmenting and, in some cases, largely replacing the intellectual functions of the physician. As the “intellectual” use of the computer influences in a fundamental fashion the problems of both physician manpower and quality of medical care, it will also inevitably exact important social costs—psychologic, organizational, legal, economic and technical. Only through consideration of such potential costs will it be possible to introduce the new technology in an effective and acceptable manner. To accomplish this goal will require new interactions among medicine, the information sciences and the management sciences, and the development of new skills and attitudes on the part of policy-makers in the health-care system.

Introduction to public health

Abstract: Updated and thoroughly revised, this foundational resource surveys all major topics related to the U.S. public health system, including organization on local and national levels, financing, workforce, goals, initiatives, accountability, and metrics. The text is unique in combining the perspectives of both academicians and public health officials, and examines new job opportunities and the growing interest in the public health field.

Health care priority and sickle cell anemia.

Abstract: Health care priority for sickle cell anemia (SCA) should be based on its prevalence, severity, and on a standard of support set for similar conditions. Sickle cell anemia occurs in about one in 500 Negro births and median survival is still only 20 years of age. In 1967 there were an estimated 1,155 new cases of SCA, 1,206 of cystic fibrosis, 813 of muscular dystrophy, and 350 of phenylketonuria. Yet volunteer organizations raised $1.9 million for cystic fibrosis, $7.9 million for muscular dystrophy, but less than $100,000 for SCA. National Institutes of Health grants for many less common hereditary illnesses exceed those for SCA. Prevalence data in cities with sizeable black populations show that SCA is a major public health consideration. More appropriate priority for SCA depends on improved public and professional understanding of its importance.

Should Health Education Abandon Attitude Change Strategies? Perspectives from Recent Research

Abstract: Educational strategies which emphasize change in attitude and beliefs in a social perspective are reviewed in this article from a larger monograph which reviews studies on health care education from 1961-1966. This review of published material indicates the need for greater attention to methods for bringing health education to individuals through the lay referral system by using channels of social influence and support for attitude and behavior change. Such bringing together of isolated individuals should help achieve preventive health behavior. In addition to creating social networks to help in the education of a population in preventive health care and health care maintenance the need for early diagnosis through surveillance programs is emphasized in this review. In this section cancer studies were reviewed to determine changes in attitude toward various cancers and behavior when confronted with them. Personality aspects should be taken into account when designing preventive health care programs.

The health care system.

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Medical care use in Sweden and the United States : A comparative analysis of systems and behavior

Abstract: Medical care use in Sweden and the United States : A comparative analysis of systems and behavior

Factors Influencing Prescribing Decisions of Physicians: A Review

Abstract: Background The pharmaceutical bill is increasing at an alarming rate. The physician practice variation has a pronounced effect on healthcare spending. A number of factors can influence the prescribing behavior of physicians. The aim of this review was to identify the factors affecting the prescribing decision of physicians. Methods Electronic databases including Scopus, PubMed/MEDLINE CENTRAL, Cochrane Libraries and Google scholar were searched systematically for literatures on factors influencing prescribing decisions of physicians from 2000 to 2016. There was no restriction on the study designs. Results Thirty-three studies met the inclusion criteria from 1122 search results. A total of 33 factors were identified. The most frequent factors were patients' clinical condition, pharmaceutical industries, physician attributes, patient preference and cost of medicine. Conclusion Physicians' personal attributes, cost of the medicine and pharmaceutical industries' marketing and promotion strategies were mostly mentioned to influence prescribing decision. The identified factors showed that prescribing is not only geared for patient benefit, but also towards personal interest. The use of valid and reliable practice guidelines could reduce the negative impact of wide ranges of factors and promote the rational prescribing effectively.

The Management of Obesity: Patient Self-Help and Medical Treatment

Abstract: Health care needs of this country have increased so rapidly that they have already far outdistanced the supply of physicians and medical facilities. A major response to the current crisis in health care has been reorganization of traditional systems of delivery of medical care, together with a greatly increased use of paramedical personnel. In the face of our pressing health needs, one source of assistance has received curiously little attention, the self-help group. Perhaps the most widely known of these groups is Alcoholics Anonymous, but individuals have organized to help themselves with problems as varied as psychosis, ileostomy, and narcotics addiction. This report deals with Take Off Pounds Sensibly (TOPS), one of two large and rapidly growing national organizations for the control of obesity. The other such organization (Weight Watchers), although it is a commercial venture and thus not strictly a self-help group, is also worthy of careful study. The

The logic of health care facility planning

Abstract: This study presents a logical model for the planning of health care facilities. The objective is an optimal facility pattern, that is, one which maximizes net social benefit for the population of a metropolitan region. Several orders of services are denned and a successively inclusive facility hierarchy assumed for the provision of these services. A method is stated for determining the optimal scale and service area for each order. Net social benefit is computed from a set of basic functions which describe the demand for services, the unit cost of services, travel cost and benefits derived. The geometry of location and a region-wide view of the system are discussed.

Chronic Disease and Disability in the Community: A Prevalence Study

Abstract: A two-stage prevalence survey of disability (defined as the inability to perform unaided defined activities essential to daily life) used questionnaires on a random sample of the population living in north Lambeth. The central estimates of the prevalence of disability in those aged 35-74 are 7·2% for men and 9·7% for women. Among the disabled population locomotor impairments were more common in women; internal impairments were more common in men. For men and women together chronic respiratory disease, mainly bronchitis, was shown to be the single most common condition associated with disability. Though for women there may be an association between low social class and disability and between marital break-up and disability, these associations, though statistically significant, are weak. The data are therefore considered to be more widely relevant for the planning of health and welfare services.

Multiphasic health testing and medical care as a right.

Abstract: Although no long-term evidence exists that the course of disease is influenced by multiphasic health testing, this is largely irrelevant. Such programs are essential for other very important reasons. The existing and spreading concept of medical care as a right, with its elimination of personally paid fees, is creating a demand for periodic health checkups and health appraisals. This demand cannot be met by traditional methods totally involving the physician without great waste of doctor time. Multiphasic health testing can help separate the entry mix of patients into the well, the asymptomatic sick and the sick. This separation makes possible optimum use of physicians' services, which can be devoted to the area where they are most needed: the care of the sick.

Pediatric practice in the United States with special attention to utilization of allied health worker services.

Abstract: This is a report of a mail survey undertaken on behalf of the Subcommittee on Pediatric Manpower of the Council on Pediatric Practice of the American Academy of Pediatrics. Its purposes were: (1) to collect information about how practitioners of pediatrics utilize their own time and that of other health workers for the performance of specific tasks carried out in the course of ambulatory pediatric care; (2) to ascertain the degree to which practice characteristics, including task delegation, were related to characteristics of the physician, his practice arrangement and his practice load; and, (3) to sound out general pediatric opinion concerning task delegation in ambulatory pediatric care. The genesis of this survey and its relationship to current health manpower shortages have been discussed elsewhere.1 Prior to this survey no information on a national basis had been available concerning the extent and nature of task delegation in pediatric office practice or the opinions of pediatricians about this subject. Although most American children receive preventive and therapeutic health care from physicians in private office practice, extraordinarily little information about the characteristics of this system of care is available. A structured, precoded questionnaire was designed to collect the desired information. In the summer of 1967, the first version was pretested on 273 Regular Fellows of the Academy of Pediatrics residing in Massachusetts and a 2% random sample of Fellows residing in the other 49 states and the District of Columbia. The results of this major pretest have been described elsewhere. Slight modifications were made in the original version of the questionnaire and the revised version was mailed in the late fall of 1967 to 6,820 Regular Fellows of tile American Academy of Pediatrics residing in the United States.

Consumer participation in OEO-assisted neighborhood health centers.

Abstract: A the nation sought to address the problems of poverty in the midsixties the Office of Economic Opportunity (OEO) was established as an action agency to redress the imbalance in national priorities. The War on Poverty was to be fought under many service banners-jobs, education, legal assistance, and health. Each of these, however, was to be pursued under a more general operational flag-community organization. While in many areas community participation has become an organizational goal without service objectives, each service program-Head Start, Legal Services, Health-was to assure consumer participation. There has always been discussionin OEO and elsewhere-among those interested in community organization. One school of thought has attempted to gather community residents together over issues of conflict and confrontation. In such programs, the issues may be real or imagined, but in either case they are used to arouse community interest, if not indignation. The principal work of such organization is to confront the power structure external to the community and to protest inequities. The other school-call it the service orientation-tries to identify real needs in communities and, together with the community residents, organize into a meaningful structure which meets their basic needs. This may be seen most generally in the service-based community organization such as Head Start, Health, Legal Services. The difference in this theory of community organization is that, if successful, it will bring antipolitical groups together in a situation where compromise-political or otherwise-will help both parties (sides) to achieve what they want. The end effect of the first school of thought, where there is an attempt to gather the community together over issues of conflict, can be and frequently is the establishment of a group calling for control that has nothing to control. Whereas, when the effect of organization can be put into community avenues to direct and control some of the factors that affect people's lives-family, education, legal and personal rights, health care, and housing-consumer participa-

Evaluating quality of medical care in the neighborhood health center program of the Office of Economic Opportunity.

Abstract: Twenty-four OEO Neighborhood Health Centers have been audited to determine the extent to which selected criteria were met in the fields of adult medicine, infant care, and obstetrical care. Principles of group operation, sample selection, the scoring process and findings are presented. The centers were ranked by their scores and various characteristics were examined. Program design, patient volume, medical school affiliation and, most important, administrative "know-how" were concluded to be major factors associated with high performance ratings. Audits of the professional judgments used in clinical management in six major specialty fields and dental care audits underway at the present time are described. Although comparable data is presently unavailable from other settings, it is believed that the majority of the centers are performing at a satisfactory level.

Health Maintenance Organizations and the Market for Health Services

Abstract: In its health care proposals pending in the Ninety-second Congress, the Nixon administration has specified the so-called "health maintenance organization," or "HMO," as one cornerstone of its solution to the widely noted health care crisis in the United States. First, the pending Medicare amendments, which were included in H.R. I along with the President's "Family Assistance Plan" of welfare reform,l would incorporate HMOs into the Medicare program as potential providers of care for those program beneficiaries who elect to enroll in them at the federal government's expense. Second, the President's package of health care proposals that was originally announced on February i8, I97I,2 places heavy emphasis on the restructuring of the health care delivery system by stimulating the organization and growth of HMOs through a series of affirmative measures. The administration hopes that by I980 HMO enrollment will be available to ninety per cent of the population as an alternative means of procuring health care.3 In addition to the administration's proposals, a number of other proposals for meeting the health care crisis are also pending in Congress. Many of these plans incorporate models of health care delivery organizations that are at least subspecies of HMO, indicating the breadth of the consensus that has embraced this mode of rendering health services. Thus, the Kennedy-Griffiths proposal4 for "national health insurance," widely thought to be the leading contender against the administration's

Determining of factors influencing the success and failure of hospital information system and their evaluation methods: a systematic review.

Abstract: Background:: Nowadays, using new information technology (IT) has provided remarkable opportunities to decrease medical errors, support health care specialist, increase the efficiency and even the quality of patient’s care and safety Objectives:: The purpose of this study was the identification of Hospital Information System (HIS) success and failure factors and the evaluation methods of these factors This research emphasizes the need to a comprehensive evaluation of HISs which considers a wide range of success and failure factors in these systems Materials and Methods:: We searched for relevant English language studies based on keywords in title and abstract, using PubMed, Ovid Medline (by applying MeSH terms), Scopus, ScienceDirect and Embase (earliest entry to march 17, 2012) Studies which considered success models and success or failure factors, or studied the evaluation models of HISs and the related ones were chosen Since the studies used in this systematic review were heterogeneous, the combination of extracted data was carried out by using narrative synthesis method Results:: We found 16 articles which required detailed analysis Finally, the suggested framework includes 12 main factors (functional, organizational, behavioral, cultural, management, technical, strategy, economy, education, legal, ethical and political factors), 67 sub factors, and 33 suggested methods for the evaluation of these sub factors Conclusions:: The results of the present research indicates that the emphasis of the HIS evaluation moves from technical subjects to human and organizational subjects, and from objective to subjective issues Therefore, this issue entails more familiarity with more qualitative evaluation methods In most of the reviewed studies, the main focus has been laid on the necessity of using multi-method approaches and combining methods to obtain more comprehensive and useful results

Determinants of medical care utilization: the impact of ecological factors.

Abstract: The location of health care facilities is an increasingly complex problem not only for the person seeking care, but for the pro? vider of services as well. Such factors as the increasing urbanization of the popula? tion with the rapid expansion of metro? politan areas and the concomitant choked and congested traffic flows combine to in? crease the importance of the location of medical services. This study is concerned with the effect of distance between patient and provider on the utilization of physicians' services in a metropolitan area. The data pre? sented bear on the effect that decentrali? zation of a medical care system has on the utilization of the services it provides. Spatial variables as factors in the utili? zation of medical services have been studied for more than 40 years.1 During this period, various measures of distance have been used to examine how an increase in distance between the patient and the provider of medical care acts as a barrier to utilization. Despite the use of different measures of distance, most studies show that the use of physicians' services tends to decrease with a corresponding increase in distance between patient and provider. For example, Jehlik and McNammara,2 in a study of rural families, report that as distance to a physician increases, overall utilization decreases and curative services tend to be used relatively more frequently than preventive care. These investigators also pointed to other factors as having an important bearing on utilization. Among these the spatial distribution of services and patients was found to be important. Ciocco and Altaian3 investigated the effect of distance on the travel of persons from rural and smaller urban places to a large metropolitan area for physicians' care. They found that distances and directions traveled depended upon the kind of ser? vices sought. The longest distance trips were made for specialists' services and shorter trips were made for the services provided by general practitioners. This tendency, in general, reflects the spatial distribution of physicians in private prac? tice in the United States. Thus, travel patterns depend, in part, on the organiza? tion of the medical care system. These studies and others have dealt with the travel patterns of populations in rural and smaller cities. However, the effect of distance on utilization in metropolitan areas is even more difficult to study than the effect of distance between fairly widely separated places. As stated by Shannon, Bashshur and Metzner,4 ". . . involvement in terms of effort, the distribution of effort over multiple purposes, choice between al? ternatives and the ease of transportation" James E. Weiss, Ph.D. is Director, Center for Population Research and Census, Portland State University, Oregon. Merwyn R. Greenlick, Ph.D. is Director of Medi? cal Care Research, Health Services Research Center, Kaiser Foundation Hospitals, Portland. Joseph F. Jones, Ph.D. is Director, Center for Sociological Research, Portland State University. This paper was presented to the Medical Care Section of the American Public Health Associa? tion at the 98th annual meeting in Houston, Texas, October 26, 1970. This research was sup? ported in part by U. S. Public Health Service Grants #5 TOI HS 00023-02 and CH00235 from the National Center for Health Services Research and Development.

Assessing the health care needs of the aged.

Abstract: A sample survey of the health care needs of the aged population of Monroe County, New York (including the city of Rochester), living at home and in health care institutions, was carried out largely by nurses, since pretests of interview methods and questionnaires showed that the important criterion in such an assessment was the degree of care or supervision needed, rather than medical diagnosis or symptomatology. Sampling problems in a survey of the aged are discussed, as well as the correlation of physical and mental disability among the aged with demographic and socioeconomic factors. Conclusions point to the misplacement of many aged persons in facilities providing a higher and more costly level of care than required and to the need for more congregate living and home care facilities.

Health-Policy Directions for the 1970's

Abstract: The health endeavor in the United States, a $60,000,000,000 human-services enterprise, is in a state of crisis that challenges the continuation of its pluralistic, independent, voluntary nature. Health care, although still predominantly a private-sector activity, is no longer solely the private concern of the individual. The evolution of the role of the government has proceeded through four phases, beginning with categorical grants-in-aid (1935), investments in the development of health resources (1946), organization and delivery of health services (1963) and a transition to comprehensive health-care systems (1967). Health-policy deliberations during the 1970's, including the debates over National Health Insurance, must focus on the modification of financing mechanisms and patterns of organization if society is to realize the most effective utilization of its health resources to provide health care for a population projected to reach 250,000,000 by the end of the decade.

Evaluating changes in the health care delivery system: an application to intensive care monitoring

Abstract: : The paper proposes a tool for evaluation of potential changes in the system for the delivery of health care. Starting with a definition of a community health production function, the paper introduces the concept of 'nested production functions' in health care. The production function approach is seen as providing a mechanism for explicit consideration of the substitution and optimal input combination questions which are the basis of all evaluations of changes in the health care delivery system. The discussion of this technique is followed by an application to intensive care monitoring. While actual data has not been gathered, a model was formulated for evaluating the effect of computerization of certain intensive care monitoring procedures.

Maximizing HIV partner notification opportunities for index patients and their sexual partners in Malawi

Abstract: Introduction HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment, care, and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However, partner notification strategies must be feasible in the healthcare setting and acceptable to the population. Methods We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study, newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive, contract, and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners, after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group, a healthcare provider notified partners directly. Results Although most index participants and partners expressed a preference for passive notification, they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing, including the opportunity to change behaviour. Conclusions Provider-assisted partner notification is not preferred, but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged.

The Economics of Mental Health

Abstract: Certainly we believe that drugs are one important and cost-effective part of the comprehensive solutions necessary to address complex mental health issues. Over the past several years, innovations in pharmacological treatments for mental illnesses have coincided with the extraordinary productivity of scientific research on the brain and behavior ... a dramatic transformation of many of societies’ approaches to mental health care ... and the emergence of powerful consumer and family movements.

Evaluation of the routine physical examination of infants in the first year of life.

Abstract: Because of the critical shortage of professional manpower to deliver child health care in the United States, new programs are being developed involving paramedical personnel for the provision of much of the routine health appraisal services traditionally accomplished by the physician. It is difficult to anticipate the effect of such programs Upon the health care of children without knowing what contribution is presently made by the existing system. In an effort to assess the role of the routine physical examination in the health care of the infant under the age of 12 months, the results of 6,668 such examinations by 83 private pediatricians were evaluated in a prospective study. One hundred and thirty significant physical abnormalities (1.9%) were discovered, many of which probably could have been detected by a specially trained nurse or physician9s assistant because of their inherent visibility or susceptibility to identification by simple screening procedures. It is concluded that more effective use of the physician9s time could be accomplished by the relegation of a major portion of the routine infant physical examination to a paramedical person.

The Training of Physician Assistants: Status and Issues

Abstract: The idea of having assistants for the physician is not new. The concept of the division of responsibilities and the stratification of functions among the various types of health professionals has been endorsed for many decades— in some instances, for centuries. Today heightened interest and concern about health and medical care in the nation are forcing a reexamination of interpretations of this concept by the medical community and the public. It is too early to seek a consensus about the descriptions and roles of such personnel in the United States. However, there is an identifiable interest in both the medical and the nonmedical sectors of US society. The goal is to develop means to make adequate health care available to more people. One consideration is the rational delegation of the physician's traditional functions to nonphysicians in the delivery of health care. If some of the physician's responsibilities and duties are