Showing papers on "Health care published in 1983"

The well-being of chronic mental patients : Assessing their quality of life

Abstract: • The concept, "quality of life" (QOL), offers a broad perspective for assessing the needs and outcomes of chronic mental patients. In this survey of Los Angeles board-and-care homes, 278 randomly selected, mentally disabled residents evaluated their QOL in structured interviews based on a general QOL model. Life areas studied included living situation, family, social relations, leisure, work, safety, finances, and health. The model performed as well among these residents as among the general population, explaining 48% to 58% of the variance in global well-being. Adding patients' subjective QOL evaluations doubled the explanatory power of a model based only on personal characteristics and objective life conditions. Global well-being was most consistently associated with personal safety, social relations, finances, leisure, and health care variables. The study identifies methodological and service issues in need of further examination.

Social Psychology of Health and Illness

Abstract: Contents: Part I:Health-Related Personality Traits SC Kobasa, The Hardy Personality: Toward a Social Psychology of Stress and Health CS Carver, C Humphries, Social Psychology of the Type A Coronary-Prone Behavior Pattern KA Wallston, BS Wallston, Who is Responsible for Your Health? The Construct of Health Locus of Control Part II:Medical Information Processing JA Skelton, JW Pennebaker, The Psychology of Physical Symptoms and Sensations GS Sanders, Social Comparison and Perceptions of Health and Illness Part III:Professional/Client Interaction SJ Mentzer, ML Snyder, The Doctor and the Patient: A Psychological Perspective H Leventhal, RS Hirschman, Social Psychology and Prevention C Maslach, SE Jackson, Burnout in Health Professions: A Social Psychological Analysis Part IV:Environmental Influences J Suls, Social Support, Interpersonal Relations, and Health: Benefits and Liabilities A Baum, A Wallace Deckel, RJ Gatchel, Environmental Stress and Health: Is There a Relationship? R Kastenbaum, Healthy, Wealthy, and Wise? Health Care Provision for the Elderly from a Psychological Perspective

Exploring dimensions of access to medical care.

Abstract: This paper examines the dimensions of the access concept with particular attention to the extent to which more parsimonious indicators of access can be developed. This process is especially useful to health policy makers, planners and researchers in need of cost-effective social indicators of access to monitor the need for and impact of innovative health care programs. Three stages of data reduction are used in the analysis, resulting in a reduced set of key indicators of the concept. Implication for subsequent data collection and measurement of access are discussed.

A Teaching Framework for Cross-cultural Health Care—Application in Family Practice

Abstract: Significant demographic changes in patient populations have contributed to an increasing awareness of the impact of cultural diversity on the provision of health care. For this reason methods are being developed to improve the cultural sensitivity of persons responsible for giving health care to patients whose health beliefs may be at variance with biomedical models. Building on methods of elicitation suggested in the literature, we have developed a set of guidelines within a framework called the LEARN model. Health care providers who have been exposed to this educational framework and have incorporated this model into the normal structure of the therapeutic encounter have been able to improve communication, heighten awareness of cultural issues in medical care and obtain better patient acceptance of treatment plans. The emphasis of this teaching model is not on the dissemination of particular cultural information, though this too is helpful. The primary focus is rather on a suggested process for improved communication, which we see as the fundamental need in cross-cultural patient-physician interactions.

An Introduction to Health Psychology

Abstract: Preference overview of health psychology physiological bases of behaviour and health stress control and learned helplessness cardiovascular disorders and behaviour psycho-neuroimmunology, cancer and AIDS psychophysiological disorders - psychological factors affecting medical conditions health care and patient behaviour psycholigical assessment in medical settings cognitive-behavioural treatment techniques in medical settings pain and management appetitive and addictive behaviours - obesity, smoking and alcoholism prevention and health promotion.

Problems in the conceptual framework of patient satisfaction research: an empirical exploration.

Abstract: Survey research into patient satisfaction has been responsible for developing a number of related concepts concerning the ways in which patients evaluate the health care that they receive. Recently doubts have been expressed as to the adequacy of this approach for understanding how patients anticipate and respond to medical encounters. This paper reports a study of patients attending neurological outpatient clinics. The results suggest that the conceptual framework deriving from patient satisfaction research provides only partial and sometimes misleading insights into the perspectives of the patients studied. The paper concludes that patients' varying concerns with regard to their illness need to be more directly considered in explaining different responses to medical consultations. This approach enables a more sensitive evaluation of health care from the patient's point of view.

Women's health issues.

Abstract: Issues related to women's physical health and health care reflect the broader concerns of women who must function within systems that have been constructed by and for men. The health care system in this country is still very much a male-dominated institution in which the demands on women to fit a male model are especially cogent (Lee, 1975). Because women traditionally have had primary responsibility for the care of children and for the ill and aging in their families, they typically assume greater responsibility in health matters than do men. Yet there is evidence that women as a group, and particularly women of limited educational, social, and economic resources, encounter significant obstacles to obtaining adequate diagnosis and treatment of medical disorders. From a prevention perspective also, less attention has been paid to the health risks of women than to those of men.

Bicentric evaluation of a teaching and treatment programme for type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months.

Abstract: In two hospitals an identical diabetes teaching and treatment programme (in-patient, Monday to Friday, group teaching) was set up. Seventy-eight consecutive, conventionally treated Type 1 diabetic patients (duration of diabetes 10 +/- 6 years), referred during a certain period, were reinvestigated after 1 year, and again (for assessment of metabolic control only) 22 months after the teaching and treatment programme. Initially, mean glycosylated haemoglobin was 2.6%, after one year 1.0%, and after 22 months 1.5% above the upper limit of the normal range (p less than 0.001). Hospital admissions were reduced from a mean of 10 to a median of 1 day per patient per year (p less than 0.001). The long-term quality of diabetes care achieved by the diabetes teaching and treatment programme was unrelated to intelligence quotient, diabetes duration, or diabetes-related knowledge. Patients with normal levels of glycosylated haemoglobin on follow-up (33% of all patients) had particularly good compliance rates, and significantly lower initial values of glycosylated haemoglobin than patients with glycosylated haemoglobin levels greater than or equal to 10%. The data indicate that the diabetes teaching and treatment programme resulted in a substantial long-term improvement of metabolic control and a striking reduction of hospital admissions. The study substantiates the feasibility of applying this teaching and treatment programme on a large scale to other hospitals, so as to improve the quality of diabetes care and decrease health care costs.

Health Interview Surveys in Developing Countries: A Review of the Methods and Results

Abstract: Health interview surveys are carried out to gain knowledge of people's perceived morbidity, their use of different kinds of health services, and their perceived need for health care Many of such studies in less developed countries (LDCs) have failed to consider the methodological improvements which have been developed in health care research in recent years In the first part of this paper the research on methodological issues is summarized and the inherent problems in health interview surveys are stressed Some specific requirements for cross-cultural research are described The second part deals with health interview surveys carried out on a national, provincial and local level in LDCs Recommendations for a standardization of the methodology are given

Health Care Needs and Distributive Justice

Abstract: A theory of health care needs should serve two central purposes. First, it should illuminate the sense in which we—at least many of us—think health care is “special” and that it should be treated differently from other social goods. Specifically, even in societies in which poeple tolerate (and glorify) significant and pervasive inequalities in the distribution of most social goods, many feel there are special reasons of justice for distributing health care more equally. Some societies even have institutions for doing so. To be sure, others argue it is perverse to single out health care in this way, or that if we have reasons for doing so, they are rooted in charity, not justice. In any case, a theory of health care needs should show their connection to other central notions in an acceptable theory of justice. It should help us see what kind of social good health care is by properly relating it to social goods whose importance is similar and for which we may have a clearer grasp of appropriate distributive principles.

Equity in health care: confronting the confusion.

Abstract: Despite general agreement that equity is part of the objective of the UK National Health Service (as indeed it is in other health services), there is little consensus on what is meant by equity in health care. This paper suggests seven possible definitions of equity not with the intention of trying to decide which is in any sense best but rather simply to try to reduce some of the confusion surrounding the concept of equity. These definitions include equality of expenditure per capita; equality of inputs per capita; equality of input for equal need; equality of access for equal need; equality of utilisation for equal need; equality of marginal met need; and equality of health. The paper then takes a closer look at some of the issues surrounding these definitions. The difference between equity by access and by utilisation lies in separating supply and demand (or need) issues. Thus equality of access is about equal opportunity: the question of whether or not the opportunity is exercised is not relevant to equity defined in terms of access. Utilisation is a function of both supply and demand. If access, a supply side phenomenon, is equalised, unless demand is the same, utilisation will not be equalised.(ABSTRACT TRUNCATED AT 250 WORDS)

The Second Sickness: Contradictions of Capitalist Health Care

Abstract: Chapter 1 List of Figures and Tables Chapter 2 Preface to the Second Edition Chapter 3 Preface to the First Edition and Acknowledgments Part 4 I: Medicine, Social Structure, and Social Pathology Chapter 5 1. Health Care, Social Contradictions, and the Dilemmas of Reform Chapter 6 2. Social Structures of Medical Oppression Chapter 7 3. The Social Origins of Illness: A Neglected History Part 8 II: Problems in Contemporary Health Care Chapter 9 4. Technology, Health Costs, and the Structure of Private Profit Chapter 10 5. Social Medicine and the Community Chapter 11 6. The Micropolitics of the Doctor-Patient Relationship Part 12 III: Policy, Practice, and Social Change Chapter 13 7. Medicine and Social Change: Lessons from Chile and Cuba Chapter 14 8. Conclusion: Health Praxis, Reform, and Political Struggle Chapter 15 Notes Chapter 16 Selected Bibliography Chapter 17 Index Chapter 18 About the Author

Health services utilization among the noninstitutionalized elderly.

Abstract: Data from a two-stage random sample of401 noninstitutionalized elderly individuals residing in 18 census tracts in the south-central part of Metropolitan St. Louis are used to assess the effects of the predisposing, enabling, and need characteristics on ten measures of health services utilization. Hierarchical multiple regression analyses indicate that: (I) Most of the explained variance in health services utilization may be attributed to the need characteristics, suggesting an apparently equitable system; (2) When a comprehensive version of Andersen's behavioral model is fielded, from 12 to 35 percent of the variance in health services utilization can be explained; and (3) Nutritional risk is the most important predictor of the total number of physician visits, visits to physicians in the emergency room, and the occurrence of hospital episodes. The implications of these analyses for modeling the health services utilization of elderly as well as for public policy concerning their health care, are discussed.

Functional health status levels of primary care patients.

Abstract: A cross-sectional study was conducted on functional status of adults visiting primary care practices. Limitations in physical and mental function were assessed independently in 28 practices by patients (N = 1,227) and physicians (N = 47) using a simple global index of disability. Results indicated 12% of patients rated their physical limitations as major and 8% rated major emotional limitations during the past month. Comparable assessments by physicians were 5% and 4%, respectively. Differences between patients and physicians were statistically significant and are demonstrated to be clinically relevant. Patients' functional limitations were associated with increased utilization of ambulatory care, older age, lower level of education, unemployment, and a primary diagnosis of a chronic condition. We conclude that functional status can be routinely recorded in medical practice to help describe severity, predict utilization, and improve the physician-patient relationship.

Health Care Technology and the Inevitability of Resource Allocation and Rationing Decisions: Part I

Abstract: Increasingly, it is recognized that resources available to meet health care needs are limited. Recently, this has been evidenced by reductions in federally funded health care programs and the leveling off of research funds made available to the National Institutes of Health. The problem of severely constrained resources is likely to become more acute, given new medical technology and the high cost of medical care. It is now apparent that both resource allocation and resource-rationing decisions will become inevitable, since not all persons with catastrophic or complicated medical conditions will be able to benefit from medical technology. While the careful assessment of health care technology can conceivably increase the efficiency of the health care delivery system, the methods by which allocation and rationing decisions are made must be improved. In doing so, it will ultimately be essential for this society to come to grips with life and death issues in a manner to which it is not accustomed. ( JAMA 1983;249:2047-2053)

Nursing staff turnover, stress and satisfaction: models, measures, and management

Abstract: Staff turnover, stress, and satisfaction are continual problems plaguing the delivery of health care and, specifically, nursing care Numerous investigations have been conducted to identify the major phenomena pertaining to these concerns Models have been constructed and tested specifying the relationships among staff stress, satisfaction, other predictive factors, and voluntary/involuntary turnover Traditionally, turnover has been the focus of research endeavors, while the other factors have been investigated in terms of their impact on it (Mobley, Griffeth, Hand, & Meglino, 1979)

The politics of menopause: the "discovery" of a deficiency disease*

Abstract: Menopause, once regarded as a sign of sin, and later neurosis, was redefined as a deficiency disease by physicians in the 1960s, when synthetic estrogen became widely available. Estrogen therapy, promoted by physicians and the pharmaceutical industry as a way of avoiding menopause and preserving youth and beauty, was linked to cancer and other health problems in the mid-1970s. Feminists argued that menopause was a normal aging process and that women's health care was a social problem. This paper looks at how these opposing definitions of menopause evolved and examines the efforts of women to fight off the stigma of the disease label. In the 1960s the medical profession in the United States hailed the contraceptive pill as the "great liberator" of women, and estrogens in general as the fountain of youth and beauty. Prominent gynecologists "discovered" that menopause was a "deficiency disease," but promised women that estrogen replacement therapy would let them avoid menopause completely and keep them "feminine forever." Yet within a few years, U.S. feminists in the vanguard of an organized women's health movement defined the health care system, including estrogen treatment, as a serious social problem. The male-dominated medical profession was accused of reflecting and perpetuating the social ideology of women as sex objects and reproductive organs. Treating women with dangerous drugs was defined as exploitation and an insidious form of social control. These issues raised several questions: How did such diametrically opposed definitions evolve? How, under what conditions, and by whom does a certain behavior become defined as deviant or sick? In what context does a putative condition become defined as a social problem? I believe that definitions of health and illness are socially constructed and that these definitions are inherently political. "Deviant behaviors that were once defined as immoral, sinful or criminal," according to Conrad and Schneider (1980:1), "have now been given new medical meanings" which are "profoundly political in nature" and have "real political consequences." Indeed "in many cases these medical treatments have become a new form of social control." I interpret the definition of menopause from this framework. During the 19th century, Victorian physicians viewed menopause as a sign of sin and decay; with the advent of Freudian psychology in the early 20th century, it was viewed as a neurosis; and as synthetic estrogens became readily available in the 1960s, physicians treated menopause as a deficiency disease (McCrea, 1981). Perhaps more important than these differences, however, are four themes which pervade the medical definitions of menopause. These are: (1) women's potential and function are biologically destined; (2) women's worth is determined by fecundity and attractiveness; (3) rejection of the feminine role will bring physical and emotional havoc; (4) aging women are useless and repulsive. In this paper I first analyze the rise of the disease definition of menopause and show that this definition reflects and helps create the prevailing ageism and sexism of our times. Then I show how the disease definition has been challenged from inside the medical community. Finally I examine how feminists outside the medical community have also challenged the disease model, claiming that menopause is normal and relatively unproblematic.

Living longer in the United States: demographic changes and health needs of the elderly.

Abstract: An examination of the demographic consequences of assumptions of declining mortality and slightly increasing fertility in the United States over the next 60 years is presented. The focus is on the implications of these changes with regard to health status use of health services and expenditures for health care. The authors suggest that recent trends in mortality fertility and immigration imply that by 2040 over 20 percent of the population will be over age 65. The inadequacy of current public programs to serve the aged is stressed. (ANNOTATION)

Uninsured and Underserved: Inequities in Health Care in the United States

Abstract: quality and most sophisticated systems of medical care in the world. Most Americans take for granted their access to this system of care. In times of emergency or illness, they can call upon a vast array of health resources-from a family physician to a complex teaching hospital-assured that they will receive needed care and that their health insurance coverage will pick up the tab for the majority of bills incurred.

The Royal College of General Practitioners

Abstract: The College was founded in 1952 as an act of faith and confidence in the aftermath of the Second World War by general practitioners who believed that they worked in a special branch of health care with its own skills, expertise, methods and tools. They believed that for general practice to flourish, improve and prosper demanded special education, training and research.

The Outcome of Hospitalization for Acute Illness in the Elderly

Abstract: The use of acute-care hospitals by the elderly is rising rapidly, particularly in the age group 75 and older. Any changes that will reduce the length of stay could result in considerable savings in health care costs. It is imperative to look at present policies and explore possible changes that could reduce costs by reducing the total hospital days. A study was conducted in a 290-bed county-founded community hospital in California that serves the majority of disadvantaged and poor elderly residing in an area with a population of approximately 300,000 persons. The objective was to determine what demographic, medical, and sociologic characteristics of elderly patients recorded at admission would be of value in predicting those most likely to change their functional status. It was found that the most important predictors of deterioration of function are (1) older age, especially 85+, and (2) abnormal mental status. Patients admitted from nursing homes had a longer than average length of stay, and those who survived (80 per cent) returned to a nursing home. It was concluded that routine assessment of elderly patients admitted for acute illness or injury could facilitate discharge planning by an early prediction of the level of care that will be required after discharge. This assessment should include preadmission mental and functional status; identification of causes for, and correction of, acute confusional states; and an assessment of the impact of the present illness or injury on future level of function following rehabilitation. This could result in a reduced length of average hospital stay.