School Health Services for Children with Special Health Care Needs in California

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Baker, Dian L.; Hebbeler, Kathleen; Davis-Alldritt, Linda; Anderson, Lori S.; Knauer, Heather

2015-01-01

Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study…

Mental health care services for children with special health care needs and their family members: prevalence and correlates of unmet needs.

Science.gov (United States)

Ganz, Michael L; Tendulkar, Shalini A

2006-06-01

To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.

Nurses graduating in Fiji between 2001 and 2010: sufficient supply for Fiji's health service demands?

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Aiyub, S; Linh, N N; Tayler-Smith, K; Khogali, M; Bissell, K

2013-03-21

Fiji's schools of nursing and government health services, 2001-2010. To report on 1) the number and characteristics of nurses who graduated in Fiji, 2) the proportion of vacant nursing positions in the government health services and 3) attrition among nurses. Descriptive study involving a retrospective record review of Ministry of Health annual reports and nursing registers. Over the period 2001-2010, a total of 1500 nurses graduated, with the overall trend being a gradual increase in newly qualified nurses year on year. Available data from 2007 onwards showed relatively low vacancy rates (range 0.4-2%), with a sharp rise to 15% in 2009. Complete data on nurse attrition were available only from 2007 onwards, with rates of attrition ranging from 4% to 10%; the most common reason for attrition was resignation. While it was unable to directly assess whether Fiji's supply of nursing graduates has been meeting the country's health service demands, this study provides a series of baseline data on Fiji's nurse graduate and nursing workforce. In addition, it identifies some of the challenges and gaps that need to be considered to better assess and address nursing staff shortages.

Veterans' Mental Health in Higher Education Settings: Services and Clinician Education Needs.

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Niv, Noosha; Bennett, Lauren

2017-06-01

Utilization of the GI Bill and attendance at higher education institutions among student veterans have significantly increased since passage of the Post-9/11 GI Bill. Campus counseling centers should be prepared to meet the mental health needs of student veterans. This study identified the mental health resources and services that colleges provide student veterans and the education needs of clinical staff on how to serve student veterans. Directors of mental health services from 80 California colleges completed a semistructured phone interview. Few schools track the number, demographic characteristics, or presenting needs of student veterans who utilize campus mental health services or offer priority access or special mental health services for veterans. Directors wanted centers to receive education for an average of 5.8 veteran-related mental health topics and preferred workshops and lectures to handouts and online training. Significant training needs exist among clinical staff of campus mental health services to meet the needs of student veterans.

Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries.

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Murray, Susan F; Hunter, Benjamin M; Bisht, Ramila; Ensor, Tim; Bick, Debra

2012-01-01

relevant to review questions on the utilisation of maternal health services, barriers to the provision of demand-side financing and supply-side preconditions to implementing demand-side financing schemes. There was insufficient evidence to provide comprehensive answers for review questions on the effect of demand-side financing interventions on maternal, perinatal and infant health outcomes and on the social and financial situation of underprivileged women. There was also insufficient evidence on the cost-effectiveness of demand-side financing interventions and preconditions for sustainability and scale-up of demand-side financing schemes.Salient recommendations for policymakers regarding demand-side financing for maternal health derived from the current evidence are:There is a pressing need for large, robust studies on the short- and longer-term impact of demand-side financing on maternal and infant mortality and morbidity, which should also reflect 'good practice' indicators such as the uptake and duration of exclusive breastfeeding and compliance with infant immunisation programmes. It is also important that the impact on outcomes of subsequent pregnancies is evaluated. Moderate and large-sized demand-side financing programmes that have recently or will soon be scaled up, such as those in Kenya, Uganda and Bangladesh, represent the most obvious sites for such evaluations, and lessons may be learnt from Mexico's PROGRESA/ Oportunidades about how to establish a well-embedded monitoring and rigorous evaluation structure.Other important areas that require further study include.

Applying WHO's 'workforce indicators of staffing need' (WISN) method to calculate the health worker requirements for India's maternal and child health service guarantees in Orissa State.

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Hagopian, Amy; Mohanty, Manmath K; Das, Abhijit; House, Peter J

2012-01-01

In one district of Orissa state, we used the World Health Organization's Workforce Indicators of Staffing Need (WISN) method to calculate the number of health workers required to achieve the maternal and child health 'service guarantees' of India's National Rural Health Mission (NRHM). We measured the difference between this ideal number and current staffing levels. We collected census data, routine health information data and government reports to calculate demand for maternal and child health services. By conducting 54 interviews with physicians and midwives, and six focus groups, we were able to calculate the time required to perform necessary health care tasks. We also interviewed 10 new mothers to cross-check these estimates at a global level and get assessments of quality of care. For 18 service centres of Ganjam District, we found 357 health workers in our six cadre categories, to serve a population of 1.02 million. Total demand for the MCH services guaranteed under India's NRHM outpaced supply for every category of health worker but one. To properly serve the study population, the health workforce supply should be enhanced by 43 additional physicians, 15 nurses and 80 nurse midwives. Those numbers probably under-estimate the need, as they assume away geographic barriers. Our study established time standards in minutes for each MCH activity promised by the NRHM, which could be applied elsewhere in India by government planners and civil society advocates. Our calculations indicate significant numbers of new health workers are required to deliver the services promised by the NRHM.

Factors influencing the demand of the service of community based animal health care in Zimbabwe.

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Mutambara, J; Dube, I; Matangi, E; Majeke, F

2013-11-01

This study was done to find out about animal health service providers and factors that determined demand for community based veterinary service delivery in smallholder sector of Zimbabwe. Focus group discussions and a questionnaire was used to collect data on veterinary services providers and socio-economic factors related to animal health from a sample (N=333) smallholder livestock farmers from Gutu district of Masvingo province in Zimbabwe. Analytical techniques used were descriptive statistics, K-mean cluster analysis and Tobit regression model. Results showed that the majority of farmers (45%) obtained services from both Community Based Animal Health Workers (CBAHWs) and Department of Veterinary Service (DVS), 25% DVS only, 20% used CBAHWs while 10% did not seek any services. Further analysis showed that distance to CBAHW, distance to AHMC and employment status were significantly related to demand for CBAHWs with coefficients of -1.5, 0.7 and -10.3, respectively. The study thus concluded that CBAHW is an alternative animal health service delivery approach already practiced in smallholder farming sectors of Zimbabwe. Socio-economic factors significantly influenced the demand for CBAHW services. Given limited resources by state sponsored veterinary services, it is recommended that the CBAHWs approach should be encouraged as supplementary service provider especially in areas further DVS. These community organizations can be empowered by the state to deliver more improved services based on hygiene and modern science at a relatively low cost to farmers. Copyright © 2013 Elsevier B.V. All rights reserved.

Examining the Supply of and Demand for Physiotherapy in Saskatchewan: The Relationship between Where Physiotherapists Work and Population Health Need.

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McFadden, Brighid; Jones McGrath, Kendra; Lowe, Teghan; Thiessen, Carla; Irinici, Steven; Shah, Tayyab; Milosavljevic, Stephan; Bath, Brenna

Purpose: This research examined the association between the distribution of physiotherapists in Saskatchewan relative to population health characteristics and self-reported physiotherapy use. Methods: Using a cross-sectional design, de-identified data were collected from the 2013 Saskatchewan College of Physical Therapy membership renewals ( n =643), and Saskatchewan population health characteristics data were obtained from the 2009-2012 Canadian Community Health Surveys (CCHSs). Age- and sex-adjusted proportions of selected population health characteristics were calculated and stratified by health region and rural-urban location; both were determined, for physiotherapists and CCHS participants, using postal codes. The association between physiotherapy distribution and physiotherapy use was calculated, and geospatial mapping techniques were used to display physiotherapist distribution across the province relative to population health characteristics. Results: Across health regions, a positive correlation ( r =0.655, p supply and distribution of physiotherapists and population health needs and demands. Conclusion: There is a discrepancy in Saskatchewan among the distribution of physiotherapists, self-reported physiotherapy use, and population health characteristics, especially in rural settings. These findings provide insight into which areas are in need of increased physiotherapy services.

Demand for Dental Services in Shiraz, Iran, 2013.

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Jahromi, Negin Nassaji; Jafari, Abdosaleh; Kavosi, Zahra; Shokrpour, Nasrin; Sajjadnia, Zahra; Ravangard, Ramin

This cross-sectional and descriptive-analytic study aimed to estimate the demands for the use of dental services by Shirazi inhabitants in Iran from June 2013 to October 2013. Six hundred eighty subjects older than 18 years were selected from among the people living in Shiraz, using a multistage sampling method. The collected data were analyzed using SPSS 16.0 and Stata 11.0. The results showed that the factors affecting the number of referrals to the dental services centers and the use of these services included the age groups of 28 to 37 and 38 to 47 years, household expenses per month, and having supplementary health insurance coverage (P dental services and increase the probability of utilizing such services by people in need, the researchers recommend that the authorities should design and develop basic and supplementary health insurance plans to cover different types of dental services, allocate subsidies to dental health services, and increase the knowledge of all the people in different age groups about adherence to dental health principles and prevention of oral and dental diseases.

Increased demand for E-mail health consultation service: analysis of a Web survey.

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Klinar, Ivana; Balazin, Ana; Basić, Martina; Plantas, Igor; Biskupić, Kresimir

2010-06-01

The aim of the study was to explore characteristics of the users of the Interactive Service "Your Questions" that is based on E-mail health consultations. We wanted to find out what motivated users to use it, were they satisfied with it and what were its impacts on their health behavior. Therefore, we developed a Web survey and invited 2,747 users to take part in it. 919 (33.5%) of users responded. Results showed that the majority of respondents were women (79.1%) and that most hold at least a college degree (52.4%). The Service was mostly used for obtaining information about certain medical symptoms or medical conditions (50.1%), for a second opinion on a diagnosis (18.6%) and for more information about medical treatment (14.4%). In terms of Service features, it was used because of its convenience with regard to time (38.7%) and a sense of privacy (25.7%). Before posting a question to the Service, 93.2% of the respondents searched for health articles on the PLIVAzdravlje portal while 90% of them read the Questions and Answers database. Over half of them (61.8%) posted their question after they already visited their physicians on that particular issue. Nevertheless, 48% of them were encouraged to visit their physicians after they received the answer. The results show an important trend of increased demand for e-mail health consultation and the need for reliable medical information, with one thousand questions submitted to the Service in the observed period of 40 days. If the source of medical information is reliable, as in case of our Service as well as other forms of e-mail health consultations, it can have positive impact on valuable physician-patient communication based on knowledge and mutual understanding.

Estimating demand pressures arising from need for social services for older people

OpenAIRE

Roy Carr-Hill; Gillian Dalley

1999-01-01

The twelve years preceding the introduction of the community care reforms in 1993/4 saw an increased demand for health and social services generated by the increase in numbers of older people (particularly the over 85s) and reflected in the rapid growth of residential and nursing home places over a twelve year period (from 224,000 in 1983 to 427,000 in 1994). While the move into the residential and nursing home sector was partly driven by the perverse incentives offered by social security in ...

Comparing Health and Mental Health Needs, Service Use, and Barriers to Services among Sexual Minority Youths and Their Peers

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Williams, Kelly A.; Chapman, Mimi V.

2011-01-01

Using a representative national sample (N = 20,745), this article explores health and mental health needs, service use, and barriers to services among sexual minority youths (SMYs) and heterosexual peers. SMYs were defined by ever having a same-sex romantic attraction or having a recent same-sex romantic relationship or sexual partner. SMYs…

Assessing Needs and Demand for Radiotherapy. Chapter 3

International Nuclear Information System (INIS)

Barton, M.; Williams, M.

2017-01-01

Cancer services, such as screening, surgery, chemotherapy or radiotherapy, should be delivered in the type and amount that meet local demand. Estimating demand requires knowledge of the types and numbers of cancers and the indications for services. For example, the demand for breast screening can be calculated by determining the number of women aged 50 to 70 years old. It is more complicated to determine the demand for services, such as radiotherapy or chemotherapy, that have a large number of indications relevant to small proportions of the cancer population. Different populations will have different incidence rates of cancer, and the proportions of the common types of cancer may vary. Cancer registries provide information on the types and frequency of cancer in a population. They may also record data about stage at presentation, which has a critical influence on the outcomes. In addition, factors relating to specific groups of patients, such as performance status and co-morbidities, may alter treatment recommendations. Unfortunately all these details are often poorly recorded by cancer registries. Nevertheless, planning of sufficient services to meet the needs of the treatment population is vital in providing optimal care. This chapter describes an evidence based approach to estimating the demand for radiotherapy, and its application to different treatment modalities and different populations. The work was done mainly for Australia, but has been used in Europe and North America. Cancer services include all cancer control interventions, such as screening, early detection, diagnosis, treatment, palliation and rehabilitation. The estimation of the demand for radiotherapy will be described in detail, and examples given of how this approach has been adapted to other modalities and other populations.

Estimating future dental services' demand and supply: a model for Northern Germany.

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Jäger, Ralf; van den Berg, Neeltje; Hoffmann, Wolfgang; Jordan, Rainer A; Schwendicke, Falk

2016-04-01

To plan dental services, a spatial estimation of future demands and supply is required. We aimed at estimating demand and supply in 2030 in Northern Germany based on the expected local socio-demography and oral-health-related morbidity, and the predicted number of dentists and their working time. All analyses were performed on zip-code level. Register data were used to determine the number of retiring dentists and to construct regression models for estimating the number of dentists moving into each zip-code area until 2030. Demand was modelled using projected demography and morbidities. Demand-supply ratios were evaluated and spatial analyses applied. Sensitivity analyses were employed to assess robustness of our findings. Compared with 2011, the population decreased (-7% to -11%) and aged (from mean 46 to 51 years) until 2030. Oral-health-related morbidity changed, leading to more periodontal and fewer prosthetic treatments needs, with the overall demand decreasing in all scenarios (-25% to -33%). In contrast, the overall number of dentists did only limitedly change, resulting in moderate decrease in the supplied service quantities (max. -22%). Thus, the demand-supply ratio increased in all but the worst case scenario, but was unequally distributed between spatial units, with several areas being over- and some being under- or none-serviced in 2030. Within the limitations of the underlying data and the required assumptions, this study expects an increasingly polarized ratio of dental services demand and supply in Northern Germany. Our estimation allows to assess the impact of different influence factors on demand or supply and to specifically identify potential challenges for workforce planning and regulation in different spatial units. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Vertical equity of healthcare in Taiwan: health services were distributed according to need

Directory of Open Access Journals (Sweden)

Wang Shiow-Ing

2013-01-01

Full Text Available Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.

Employee Health Service for Teaching and Nonteaching Staff: A Needs Assessment.

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Long, Bonita C.; And Others

1986-01-01

A needs assessment was conducted to identify the health needs of school district employees in planning a comprehensive employee health service. Survey questionnaires were analyzed to determine characteristics of those individuals who may be at greatest health risk. Results indicate that degree of stress can differentiate health risk predictors.…

Primary health care service use among women who have recently left an abusive partner: income and racialization, unmet need, fits of services, and health.

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Stam, Marieka T; Ford-Gilboe, Marilyn; Regan, Sandra

2015-01-01

Primary health care (PHC) can improve the health of women who have experienced intimate partner violence; yet, access to and fit of PHC services may be shaped by income and racialization. We examined whether income and racialization were associated with differences in PHC service use, unmet needs, fit with needs, and mental and physical health in a sample of 286 women who had separated from an abusive partner. Mothers, unemployed women, and those with lower incomes used more PHC services and reported a poorer fit of services. Poorer fit of services was related to poorer mental and physical health.

Perceived need for care and mental health service utilization among college students with suicidal ideation.

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Nam, Boyoung; Wilcox, Holly C; Hilimire, Matthew; DeVylder, Jordan E

2018-01-31

This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

Are more resources always the answer? A supply and demand analysis for public health services in Brazilian municipalities

Directory of Open Access Journals (Sweden)

Fabiana Rocha

2017-01-01

Full Text Available The aim of this paper is to determine whether it is necessary to increase available resources to local governments or if better use of these funds is sufficient. The paper contributes to the literature by looking both at the supply and demand for public health services. If the demand is estimated correctly, one can compare its expected value to actual health expenditures. Even if actual expenditures are lower than the estimated demand, it is not certain that additional spending is necessary. If the efficiency scores (supply side indicate that local governments can simply “save” resources to make up for the difference, then it is possible to reduce (or bring to zero new resources only by requiring local governments to efficiently manage their expenditures. Since municipalities in Brazil are very heterogeneous, we estimate their efficiency using the metafrontier approach (O’Donnell et al., 2008, while we estimate the demand through an equation derived from the median voter theorem model. Using 2010 data, we find evidence that efficient management of spending is sufficient to meet excess demand for goods and services in the health sector.

A new framework for assessing river ecosystem health with consideration of human service demand.

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Luo, Zengliang; Zuo, Qiting; Shao, Quanxi

2018-06-01

In order to study river health status from harmonic relationship between human and natural environment, a river health evaluation method was proposed from the aspects of ecosystem integrity and human service demand, and the understanding of river health connotation. The proposed method is based on the harmony theory and two types of river health assessment methods (the forecasting model and index evaluation). A new framework for assessing river water health was then formed from the perspective of harmony and dynamic evolution between human service demand and river ecosystem integrity. As a case study, the method and framework were applied to the Shaying River Basin, a tributary of the most polluted Huaihe River Basin in China. The health status of the river's ecosystem and its effect on the mainstream of Huaihe River were evaluated based on water ecological experiment. The results indicated that: (1) the water ecological environment in Shaying River was generally poor and showed a gradual changing pattern along the river. The river health levels were generally "medium" in the upstream but mostly "sub-disease" in the midstream and downstream, indicating that the water pollution in Shaying River were mainly concentrated in the midstream and downstream; (2) the water pollution of Shaying River had great influence on the ecosystem of Huaihe River, and the main influencing factors were TN, followed by TP and COD Mn ; (3) the natural attribute of river was transferring toward to the direction of socialization due to the increasing human activities. The stronger the human activity intervention is, the faster the transfer will be and the more river's attributes will match with human service demand. The proposed framework contributes to the research in water ecology and environment management, and the research results can serve as an important reference for basin management in Shaying River and Huaihe River. Copyright © 2018. Published by Elsevier B.V.

Demand for Health Care Services and Child Health Status in Nigeria ...

African Journals Online (AJOL)

Nigeria has experienced significant increase in economic growth in the last decade yet the health indicators are very poor particularly in the rural sector where ... In addition, improving education among women will enhance the demand for health inputs and improve the health of their children particularly for the poor and ...

Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities.

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Ekberg, Joakim; Timpka, Toomas; Angbratt, Marianne; Frank, Linda; Norén, Anna-Maria; Hedin, Lena; Andersen, Emelie; Gursky, Elin A; Gäre, Boel Andersson

2013-07-04

An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users' needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

[Effect of air pollution on health service demand of the elderly and middle-age patients with hypertension, cardiovascular and cerebrovascular diseases: based on analysis of data from CHARLS].

Science.gov (United States)

Shan, J; Li, H Y; Liu, G F; Yang, X; Dong, W; Jian, W Y; Deng, F R; Guo, X B

2016-06-18

To study the association of air pollution with health service demand of the elderly and middle-age patients with cardiovascular and cerebrovascular diseases, and to provide a scientific basis for development of environmental protection policy and health service policy of the Chinese government. This study included survey data on self-evaluated health, outpatient service demand and inpatient service demand of the patients with hypertension, heart disease and stroke in 62 cities of 17 provinces from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2013, and combined it with the data on the annual concentrations of inhalable particulate matter (PM(10)), sulfur dioxide(SO(2)) and nitrogen dioxide (NO(2)) of those provinces and cities. Conditional Logistic regression was carried out to assess the possible effects of air pollutants on self-evaluated health and health service utilization. The results showed that turning points existed in the effects of concentrations of NO(2) and SO(2) on the health service demand of the patients with hypertension, heart disease and stroke. The inpatient service demand of the hypertension patients increased with NO(2) concentration when it was lower than 35.1 μg/m(3) and decreased with NO(2) concentration for higher value. Self-evaluated health of the patients with heart disease and stroke decreased with SO(2) concentration when it was lower than 63.8 μg/m(3) and increased with SO(2) concentration for higher value. In addition, no evidence was found for the association between PM(10) and health service demand. Air pollution may have effects on health service demand of the patients with hypertension,cardiovascular and cerebrovascular diseases, and different air pollutants at high or low concentration may have different health effects.

Needs assessment under the Maternal and Child Health Services Block Grant: Massachusetts.

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Guyer, B; Schor, L; Messenger, K P; Prenney, B; Evans, F

1984-09-01

The Massachusetts maternal and child health (MCH) agency has developed a needs assessment process which includes four components: a statistical measure of need based on indirect, proxy health and social indicators; clinical standards for services to be provided; an advisory process which guides decision making and involves constituency groups; and a management system for implementing funds distribution, namely open competitive bidding in response to a Request for Proposals. In Fiscal Years 1982 and 1983, the process was applied statewide in the distribution of primary prenatal (MIC) and pediatric (C&Y) care services and lead poisoning prevention projects. Both processes resulted in clearer definitions of services to be provided under contract to the state as well as redistribution of funds to serve localities that had previously received no resources. Although the needs assessment process does not provide a direct measure of unmet need in a complex system of private and public services, it can be used to advocate for increased MCH funding and guide the distribution of new MCH service dollars.

[Characteristics of the emergency health service demand in Southern Brazil].

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Carret, Maria Laura Vidal; Fassa, Anaclaudia Gastal; Paniz, Vera Maria Vieira; Soares, Patrícia Carret

2011-01-01

This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.

[Economic evaluation of the demand of medical care for mental health in Mexico: schizophrenia and depression, 1996-2000].

Science.gov (United States)

Arredondo, Armando; Ramos, René; Zúñiga, Alexis

2003-01-01

Financing protection for both, users and providers of health care services is one of the main objectives of National Program of Health in Mexico, 2001-2006. In fact one of the elements of the present health care reform initiatives is need for the efficient allocation of financial resources, using resource allocation schemes by specific health care demands that combine both the economic, clinical and the epidemiological perspectives. The evaluation of such schemes has been approached in several ways; however, in the case of mental health services, there is dearth of studies that use economic assessment methods. Moreover, such studies are of limited scope, often a response to unmated health needs, disregarding the economic implication for health services production and financing and ensuing medical care market imbalances. This paper presents the results of an evaluative research work aimed to assess the average cost of depression and schizophrenia case management, the financial resources required to meet the health care demands by type of institution, period 1996-2000, in Mexico by type of health care provider. The case management average cost for schizophrenia was $211.00 US, and that for depression was $221.00 US. The demand of services for both conditions in each type of institution showed that the greatest relative demands (96% of the national total for depression and 94% of the national total for schizophrenia) occur in three institutions: IMSS, SSA and ISSSTE. The greatest demand of the health services for the two study condition corresponded to those insured by the IMSS, followed by those uninsured who use the SSA services, and those insured by the ISSSTE. The case management costs for mental conditions are in the middle range between hypertension and diabetes in the upper end, pneumonia and diarrhea in the lower end. The case managment costs of health care demands for the selected tracer conditions differ considerably among institutions for insure populations

Demand for long acting contraceptive methods and associated factors among family planning service users, Northwest Ethiopia: a health facility based cross sectional study.

Science.gov (United States)

Yalew, Saleamlak Adbaru; Zeleke, Berihun Megabiaw; Teferra, Alemayehu Shimeka

2015-02-04

Demand for long acting contraceptive methods is one of the key factors for total fertility rate and reproductive health issues. Increased demand for these methods can decline fertility rate through spacing and limiting family size in turn improving maternal and family health and socioeconomic development of a country. The aim of this study was to assess demand for long acting contraceptives and associated factors among family planning users in Debre-Tabor Town, Northwest Ethiopia. Facility based cross-sectional study was conducted from July to August 2013. Data was collected on 487 current family planning users through face to face interview using structured questionnaire. Study participants were selected by systematic sampling method. Data were entered in to Epi Info and analyzed by using SPSS version 20. Bi-variable and multi-variable regression analyses were done to identify factors associated with demand for long acting contraceptive methods. Odds ratio with 95% CI was used to assess the association between the independent variables and demand for long acting family planning methods. The study showed that, demand for long acting contraceptives was 17%. Only 9.2% of the women were using long acting contraceptive methods (met need). About 7.8% of women were using short acting methods while they actually want to use long acting methods (unmet need). Demand for LACMs was positively associated 3 with being a daily labour (AOR = 3.87, 95% CI = [1.06, 14.20]), being a student (AOR = 2.64, 95% CI = [1.27, 5.47]), no future birth intensions (AOR = 2.17, 95% CI = [1.12, 4.23]), having five or more children (AOR = 1.67, 95% CI = [1.58, 4.83]), deciding together with husbands for using the methods (AOR = 2.73, 95% CI = [1.40, 5.32]) and often having discussion with husband (AOR = 3.89, 95% CI = [1.98, 7.65]). Clients treated poorly by the health care providers during taking the services was negatively associated with demand for LACMs (AOR = 0.42, 95% CI = [0.24, 0

ANALISIS PERMINTAAN (DEMAND ANALYSIS PELAYANAN KESEHATAN PUSKESMAS DI KABUPATEN MOJOKERTO

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Wasis Budiarto

2012-09-01

Full Text Available A study on demand for health centre was carried out at Mojokerto Regency, East Java. The study convered 300 respondents (15 years old and over which were collected from two areas, urban (Kecamatan Bangsal and rural (Kecamatan Puri. The objectives of this study were to measure the demand for health centre services and to determine the influencing factors. A household survey was conducted in this study, using household and individual as unit of analysis and a multiple linier regression technique was used as analysis. In general, the result showed that needs were the most important factor affecting demand. In the urban health centres positive factor affecting individual demand were distance, family size and need, however in the rural health centre were cost, time and need were factors affecting demand. Factors affecting family demand for health services is different from individual demand. In urban and rural areas, family demand for health center was substitute alternative of the demand for the phycisian services.

Current Practice in Meeting Child Health Needs in Family Support Services: Variation by Service Type and Perspectives on Future Developments

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Gabhainn, Saoirse Nic; Dolan, Pat; Canavan, John; O'Higgins, Siobhan

2009-01-01

The needs of all service users include those related to physical, emotional, sexual and mental health. This article documents where child health needs are recognised and being met within family support services in the west of Ireland, investigates whether there is variation across different types of family support services and presents the views…

Generating demand and community support for sexual and reproductive health services for young people: A review of the Literature and Programs.

Science.gov (United States)

Kesterton, Amy J; Cabral de Mello, Meena

2010-09-24

This review investigates the effectiveness of interventions aimed at generating demand for and use of sexual and reproductive health (SRH) services by young people; and interventions aimed at generating wider community support for their use. Reports and publications were found in the peer-reviewed and grey literature through academic search engines; web searches; the bibliographies of known conference proceedings and papers; and consultation with experts. The studies were reviewed against a set of inclusion criteria and those that met these were explored in more depth. The evidence-base for interventions aimed at both generating demand and community support for SRH services for young people was found under-developed and many available studies do not provide strong evidence. However, the potential of several methods to increase youth uptake has been demonstrated, this includes the linking of school education programs with youth friendly services, life skills approaches and social marketing and franchising. There is also evidence that the involvement of key community gatekeepers such as parents and religious leaders is vital to generating wider community support. In general a combined multi-component approach seems most promising with several success stories to build on. Many areas for further research have been highlighted and there is a great need for more rigorous evaluation of programmes in this area. In particular, further evaluation of individual components within a multi-component approach is needed to elucidate the most effective interventions.

Generating demand and community support for sexual and reproductive health services for young people: A review of the Literature and Programs

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Cabral de Mello Meena

2010-09-01

Full Text Available Abstract Background This review investigates the effectiveness of interventions aimed at generating demand for and use of sexual and reproductive health (SRH services by young people; and interventions aimed at generating wider community support for their use. Methods Reports and publications were found in the peer-reviewed and grey literature through academic search engines; web searches; the bibliographies of known conference proceedings and papers; and consultation with experts. The studies were reviewed against a set of inclusion criteria and those that met these were explored in more depth. Results The evidence-base for interventions aimed at both generating demand and community support for SRH services for young people was found under-developed and many available studies do not provide strong evidence. However, the potential of several methods to increase youth uptake has been demonstrated, this includes the linking of school education programs with youth friendly services, life skills approaches and social marketing and franchising. There is also evidence that the involvement of key community gatekeepers such as parents and religious leaders is vital to generating wider community support. In general a combined multi-component approach seems most promising with several success stories to build on. Conclusions Many areas for further research have been highlighted and there is a great need for more rigorous evaluation of programmes in this area. In particular, further evaluation of individual components within a multi-component approach is needed to elucidate the most effective interventions.

Generating demand and community support for sexual and reproductive health services for young people: A review of the Literature and Programs

Science.gov (United States)

2010-01-01

Background This review investigates the effectiveness of interventions aimed at generating demand for and use of sexual and reproductive health (SRH) services by young people; and interventions aimed at generating wider community support for their use. Methods Reports and publications were found in the peer-reviewed and grey literature through academic search engines; web searches; the bibliographies of known conference proceedings and papers; and consultation with experts. The studies were reviewed against a set of inclusion criteria and those that met these were explored in more depth. Results The evidence-base for interventions aimed at both generating demand and community support for SRH services for young people was found under-developed and many available studies do not provide strong evidence. However, the potential of several methods to increase youth uptake has been demonstrated, this includes the linking of school education programs with youth friendly services, life skills approaches and social marketing and franchising. There is also evidence that the involvement of key community gatekeepers such as parents and religious leaders is vital to generating wider community support. In general a combined multi-component approach seems most promising with several success stories to build on. Conclusions Many areas for further research have been highlighted and there is a great need for more rigorous evaluation of programmes in this area. In particular, further evaluation of individual components within a multi-component approach is needed to elucidate the most effective interventions. PMID:20863411

[Study on elasticity of medical service demand at the township level in China].

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Shi, Hong-xing; Lv, Jun; Xie, Yi-ping; Wang, Ying; Jia, Jin-zhong; Chang, Feng-shui; Duan, Lin; Sun, Mei; Wang, Zhi-feng; Hao, Mo

2010-06-18

To find out the economic laws regulating medical service demand in accordance with influencing factors at the township level, thus to provide references for further adjusting the medical service demand reasonably in the future. The model of medical service demand was established to measure the elasticity of demand in 49 township health clinics in 1995, 1999, 2003 and 2007. The price elasticity of outpatient and inpatient demand was stable during the four periods, and the average value was -0.029 and -0.132 respectively; the average value of income elasticity was 0.973 and 0.977, registering a downward trend in general. The medical service demand at the township level is price inelastic, indicating that it is a necessity for rural residents. The downward trend of income elasticity under the influence of some health policies illustrates a lightening in economic burden for medical service demand among rural residents in township health clinics.

Mental health need and access to mental health services by youths involved with child welfare: a national survey.

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Burns, Barbara J; Phillips, Susan D; Wagner, H Ryan; Barth, Richard P; Kolko, David J; Campbell, Yvonne; Landsverk, John

2004-08-01

This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment. Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates. Nearly half (47.9%) of the youths aged 2 to 14 years (N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio = 2.7-3.5). In addition, for young children (2-5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio = 2.4) the likelihood of service use. Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.

HEALTH NEEDS

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Olivera Radulovic

2007-01-01

Full Text Available Human needs are of great interest to different scientific fields: sociology, anthropology, psychology, medicine, economy… Malinowski, Maslow, Adler and From have largely contributed to studying the needs. While trying to define the need concept, not only one definition is acceptable. In psychology, need is defined as a lack or disorder, i.e. the necessity to dislodge this lack. It was Maslow who gave the fullest classification and explanation of human needs. If we start from the fact that need represents the lack or deficit of something, in this context health needs would indicate the lack of health, and the measurement of health needs would be the same as the measurement of health. Therefore, almost all human needs can be enumerated as health needs, i.e. those which, after being satisfied, can lead to physical, psychical and social welfare. According to WHO, health needs can be defined as scientifically settled evasions from health which require preventive, curative and probably regulative and eradicative measurements. According to the medical method used by the health service while regarding the needs, the emphasis is on morbidity, mortality, incidence, prevalence, inability, etc. Usually, when we have very low level of health culture, and the responsibility for personal health is in most of the cases unacceptable, for the health service user the curative services will have priority over preventive ones. The measurement of health needs is a complex task. The needs can be regarded through medical documentation and by perception of the needs by people in the community.

MARKETING RESEARCHES OF THE POPULATIONS HEALTH STATE AS A FACTOR OF DEMAND FORMATION IN THE MARKET OF PAID MEDICAL SERVICES

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Nataliia Hrechanyk

2017-08-01

Full Text Available The state of health of the population is one of the most important indicators of the well-being of the nation. Important directions of health care reform are optimization of management, rational distribution of limited financial resources, efficient use of material resources, introduction of health insurance, restructuring of treatment and preventive care to the people. Marketing of medical services market is one of the most complex types of marketing. Because it is medical services that are connected with the protection and maintenance of the most important values ​​of a person - life and health. The market for medical services is a combination of socio-economic relations in the healthcare sector. The most important components of the analysis of any market, including the market of medical services, are marketing research, which is a systematic collection, processing, analysis of data and information in order to formulate proposals for effective activities on it. In the field of public health, marketing can be defined as a complex process of planning, economic substantiation and management of the process of provision of medical services, the formation of a pricing policy of the medical-preventive process, ensuring effective communication with patients. The purpose of the study is to identify the health of the population and determine the demand factors for paid health services and their demand. The main task set before market research on the health of the population is the formation and provision of benefits to consumers that meet their needs for qualified medical care and quality of life. The research methods used in the work are based on probabilistic, stratified, quota, representative samples for the entire population of Ivano-Frankivsk and Ivano-Frankivsk region. The obtained results allow us to give a realistic assessment of the main trends and allow us to assess the potential of socio-economic adaptation of the population in the

Using small-area variations to inform health care service planning: what do we 'need' to know?

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Mercuri, Mathew; Birch, Stephen; Gafni, Amiram

2013-12-01

Allocating resources on the basis of population need is a health care policy goal in many countries. Thus, resources must be allocated in accordance with need if stakeholders are to achieve policy goals. Small area methods have been presented as a means for revealing important information that can assist stakeholders in meeting policy goals. The purpose of this review is to examine the extent to which small area methods provide information relevant to meeting the goals of a needs-based health care policy. We present a conceptual framework explaining the terms 'demand', 'need', 'use' and 'supply', as commonly used in the literature. We critically review the literature on small area methods through the lens of this framework. 'Use' cannot be used as a proxy or surrogate of 'need'. Thus, if the goal of health care policy is to provide equal access for equal need, then traditional small area methods are inadequate because they measure small area variations in use of services in different populations, independent of the levels of need in those populations. Small area methods can be modified by incorporating direct measures of relative population need from population health surveys or by adjusting population size for levels of health risks in populations such as the prevalence of smoking and low birth weight. This might improve what can be learned from studies employing small area methods if they are to inform needs-based health care policies. © 2013 John Wiley & Sons Ltd.

Utilisation of oral health services, oral health needs and oral health status in a peri-urban informal settlement.

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Westaway, M S; Viljoen, E; Rudolph, M J

1999-04-01

Interviews were conducted with 294 black residents (155 females and 138 males) of a peri-urban informal settlement in Gauteng to ascertain utilisation of oral health services, oral health needs and oral health status. Only 37 per cent of the sample had consulted a dentist or medical practitioner, usually for extractions. Teenagers and employed persons were significantly less likely to utilise dentists than the older age groups and unemployed persons. Forty per cent were currently experiencing oral health problems such as a sore mouth, tooth decay and bleeding/painful gums. Two hundred and twelve (73 per cent) interviewees wanted dental treatment or advice. Residents who rated their oral health status as fair or poor appeared to have the greatest need for oral health services. The use of interviews appears to be a cost-effective method of determining oral morbidity.

Linking demand and supply factors in identifying cultural ecosystem services of urban green infrastructures

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Hegetschweiler, K. Tessa; de Vries, Sjerp; Arnberger, Arne

2017-01-01

and supply factors together. The aim was to provide an overview of this highly interdisciplinary research, to describe how these linkages are being made and to identify which factors significantly influence dependent variables such as levels of use, activities or health and well-being benefits. Commonly used......Urban green infrastructure provides a number of cultural ecosystem services that are greatly appreciated by the public. In order to benefit from these services, actual contact with the respective ecosystem is often required. Furthermore, the type of services offered depend on the physical...... characteristics of the ecosystem. We conducted a review of publications dealing with demand or social factors such as user needs, preferences and values as well as spatially explicit supply or physical factors such as amount of green space, (bio)diversity, recreational infrastructure, etc. and linking demand...

Demand and Signing of General Practitioner Contract Service among the Urban Elderly: A Population-Based Analysis in Zhejiang Province, China

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Yanrong Zhao

2017-03-01

Full Text Available This study aims to examine whether the urban elderly in the Zhejiang Province of China signed contracts with their general practitioner (GP based on their health service needs, and to further identify the determinants of their demand and signing decisions. A community-based cross-sectional study was conducted in 16 community health service (CHS institutions in Zhejiang Province, China. The urban elderly over 60 years of age were enrolled when visiting the sampled CHS. Baseline characteristics were compared between participants using Chi-Square tests for categorical variables. Univariate and multivariable logistic regression analyses were used to identify determinants of the GP contract service demand and signing decisions, respectively. Among the 1440 urban elderly, 56.67% had signed contracts with their GP, and 55.35% had a demand of the GP contract service. The influencing factors of demand were a history of diabetes or cardiovascular disease (OR = 1.33, 95% CI, 1.05–1.68; urban resident basic medical insurance (URBMI vs. urban employee basic medical insurance (UEBMI (OR = 1.96, 95% CI, 1.46–2.61; and middle-income vs. low-income (OR = 0.67, 95% CI, 0.50–0.90 for RMB 1001–3000; OR = 0.59, 95% CI, 0.39–0.90 for RMB 3001–5000. Having a demand for the GP contract service was the strongest determinant of signing decisions (OR = 13.20, 95% CI, 10.09–17.27. Other factors also contributed to these decisions, including gender, caregiver, and income. The urban elderly who had signed contracts with GPs were mainly based on their health care needs. Elderly people with a history of diabetes or cardiovascular disease, as well as those with URBMI, were found to have stronger needs of a GP contract service. It is believed that the high-income elderly should be given equal priority to those of low-income.

Mental Health Need, Awareness, and Use of Counseling Services among International Graduate Students

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Hyun, Jenny; Quinn, Brian; Madon, Temina; Lustig, Steve

2007-01-01

Objective and Participants: The authors examined the prevalence of mental health needs in international graduate students, their knowledge of mental health services, and their use of on-campus and off-campus counseling services. Methods: All registered graduate students in the Spring 2004 semester received an e-mail invitation to participate in a…

Consumer choice of on-demand mHealth app services: Context and contents values using structural equation modeling.

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Lee, Euehun; Han, Semi; Jo, Sang Hyun

2017-01-01

As smartphone penetration increases and the technology advances, various mobile services have reached the market. mHealth Applications are specifically highlighted for phenomena such as global aging & well-being, but the technology-driven mHealth services have not been successful in the market because consumer needs have not been reflected in the services properly. This study developed a research model consisting of context/contents values to explain the intention of consumers over the age of 40 in using mHealth Applications. To carry out this research, an online survey was conducted of mHealth Application users and recognizers in South Korea who are over 40 years old. 313 respondents gave usable data; those data were analyzed via a structural equation model. Context values (health stress, epistemic) produce an effect on contents values and contents values (convenience, usefulness), excepting reassurance and enjoyment, positively affect the intention to use mHealth Applications. The findings indicate that people who are stressed out about their health and are interested in new ways to control their health think that mHealth Applications are very convenient and useful because people can manage their health at home or at the office, even when they cannot go to a hospital. However, they feel that the current level of service does not provide reassurance. The level of service is behind people's expectations. Hence, a market-oriented approach that can determine user needs, specifically in terms of the reassurance value in the mHealth service field, is needed to develop mHealth Applications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Identifying Challenging Job and Environmental Demands of Older Nurses Within the National Health Service.

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Durosaiye, Isaiah Oluremi; Hadjri, Karim; Liyanage, Champika Lasanthi

2016-04-01

To explore the existing theoretical contexts of the job and environmental demands of the nursing profession in the National Health Service (NHS) and to investigate how these job and environmental demands impact on the personal constructs of older nurses within the NHS. Nursing is the single most widely practiced profession in the healthcare sector in the United Kingdom. However, nurses contend with challenging job and environmental demands on a daily basis, which deplete them of personal constructs (or resources) required to stay in the profession. A multilevel exploratory qualitative research design was employed. Ten managers were interviewed for the preliminary study, based on which the three characteristics of an age-friendly NHS workplace were established: health, retirement, and flexibility. Then an in-depth literature review revealed that the most adversely affected job within the NHS was the nursing profession. Finally, a focus group study was undertaken with six older nurses working in the NHS. The most compelling finding of this study is that older nurses would generally not want to stay on the job if they had to work in the ward area. The physical, cognitive, and sensory constructs of older nurses are negatively affected by the job and environmental demands of the ward areas. Understanding how these job and environmental demands of the workplace affect an older nurse's personal constructs may help support a better design of nurse work and the wards and help extend the working lives of older nurses in the NHS. © The Author(s) 2015.

Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury.

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Andelic, Nada; Soberg, Helene L; Berntsen, Svein; Sigurdardottir, Solrun; Roe, Cecilie

2014-11-01

To describe the self-perceived health care needs of patients with moderate-to-severe traumatic brain injury (TBI) and to assess the impact of the functional level at 1 year after injury on patients' unmet needs at the 5-year follow-up. A prospective follow-up study. Clinical research. A total of 93 patients participated in the 5-year follow-up. We registered demographic and injury-related data at the time of admission and the scores for the Disability Rating Scale, Glasgow Outcome Scale-Extended, and Short Form 36 subscales for physical functioning and mental health at 1 and 5 years. The patients' self-perceived health care needs and use of health care services at 5 years were the main outcome measurements. At the 5-year follow-up, 70% of patients reported at least 1 perceived need. The self-perceived health care needs were met for 39% of the patients. The patients with unmet needs (n = 29 [31%]) reported frequent needs in emotional (65%), vocational (62%), and cognitive (58%) domains. These patients were significantly more likely to present a less severe disability on the Disability Rating Scale at the 1-year follow-up (odds ratio [OR] 0.11 [95% confidence interval {CI}, 0.02-0.7]; P = .02). Worse mental health at the 1-year follow-up and a younger age (16-29 years) largely predicted unmet needs at the 5-year follow-up (OR 3.28 [95% CI, 1.1-10.04], P = .04; and OR 4.93 [95% CI, 0.16-15.2], P = .005, respectively). Gaps between self-perceived health care needs and health care services received at the 5-year follow-up were found. An important message to clinicians who provide health care services in the late TBI phase is that they should be aware of patients' long-term needs regarding cognitive and emotional difficulties. Of equal importance is an emphasis on long-term vocational rehabilitation services. To ensure the appropriateness of health care service delivery, health care services after TBI should be better targeted at less-severe TBI population as well

Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand.

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Ladabaum, Uri; Song, Kenneth

2005-10-01

Colorectal cancer (CRC) screening is effective and cost-effective, but the potential national impact of widespread screening is uncertain. It is controversial whether screening colonoscopy can be offered widely and how emerging tests may impact health services demand. Our aim was to produce integrated, comprehensive estimates of the impact of widespread screening on national clinical and economic outcomes and health services demand. We used a Markov model and census data to estimate the national consequences of screening 75% of the US population with conventional and emerging strategies. Screening decreased CRC incidence by 17%-54% to as few as 66,000 cases per year and CRC mortality by 28%-60% to as few as 23,000 deaths per year. With no screening, total annual national CRC-related expenditures were 8.4 US billion dollars. With screening, expenditures for CRC care decreased by 1.5-4.4 US billion dollars but total expenditures increased to 9.2-15.4 US billion dollars. Screening colonoscopy every 10 years required 8.1 million colonoscopies per year including surveillance, with other strategies requiring 17%-58% as many colonoscopies. With improved screening uptake, total colonoscopy demand increased in general, even assuming substantial use of virtual colonoscopy. Despite savings in CRC care, widespread screening is unlikely to be cost saving and may increase national expenditures by 0.8-2.8 US billion dollars per year with conventional tests. The current national endoscopic capacity, as recently estimated, may be adequate to support widespread use of screening colonoscopy in the steady state. The impact of emerging tests on colonoscopy demand will depend on the extent to which they replace screening colonoscopy or increase screening uptake in the population.

Identifying areas of need relative to liver disease: geographic clustering within a health service district.

Science.gov (United States)

El-Atem, Nathan; Irvine, Katharine M; Valery, Patricia C; Wojcik, Kyle; Horsfall, Leigh; Johnson, Tracey; Janda, Monika; McPhail, Steven M; Powell, Elizabeth E

2017-08-01

Background Many people with chronic liver disease (CLD) are not detected until they present to hospital with advanced disease, when opportunities for intervention are reduced and morbidity is high. In order to build capacity and liver expertise in the community, it is important to focus liver healthcare resources in high-prevalence disease areas and specific populations with an identified need. The aim of the present study was to examine the geographic location of people seen in a tertiary hospital hepatology clinic, as well as ethnic and sociodemographic characteristics of these geographic areas. Methods The geographic locations of hepatology out-patients were identified via the out-patient scheduling database and grouped into statistical area (SA) regions for demographic analysis using data compiled by the Australian Bureau of Statistics. Results During the 3-month study period, 943 individuals from 71 SA Level 3 regions attended clinic. Nine SA Level 3 regions accounted for 55% of the entire patient cohort. Geographic clustering was seen especially for people living with chronic hepatitis B virus. There was a wide spectrum of socioeconomic advantage and disadvantage in areas with high liver disease prevalence. Conclusions The geographic area from which people living with CLD travel to access liver health care is extensive. However, the greatest demand for tertiary liver disease speciality care is clustered within specific geographic areas. Outreach programs targeted to these areas may enhance liver disease-specific health service resourcing. What is known about the topic? The demand for tertiary hospital clinical services in CLD is rising. However, there is limited knowledge about the geographic areas from which people living with CLD travel to access liver services, or the ethnic, socioeconomic and education characteristics of these areas. What does this paper add? The present study demonstrates that a substantial proportion of people living with CLD and

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

LENUS (Irish Health Repository)

Elmusharaf, Khalifa

2015-09-01

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

Matching health needs of refugee children with services: how big is the gap?

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Raman, Shanti; Wood, Nicholas; Webber, Murray; Taylor, Kellie-Ann; Isaacs, David

2009-10-01

To document the health needs of refugee children accessing comprehensive refugee health services in New South Wales (NSW), to match needs with available services and establish gaps in services. We collated clinical data on all children aged under 14 years attending the three refugee specific clinics seeing children in NSW in 2005. We compared these data to the number of refugee children settling in NSW in 2005. NSW received 1,557 refugee children (vitamin D levels. Most children needed catch up immunisation. Other problems included chronic health, developmental and behavioural problems. Screening tests varied across sites. Follow up was problematic for most. A small proportion of refugee children arriving in NSW have access to comprehensive screening and assessment, in spite of significant health needs. There is variation in screening practices, and follow up is poor. There is a high pick up rate for diseases of personal and public health significance. There is a strong moral and public health imperative to provide appropriately resourced, culturally competent and comprehensive health care to optimise refugee children's wellbeing.

Predicting Urban Medical Services Demand in China: An Improved Grey Markov Chain Model by Taylor Approximation.

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Duan, Jinli; Jiao, Feng; Zhang, Qishan; Lin, Zhibin

2017-08-06

The sharp increase of the aging population has raised the pressure on the current limited medical resources in China. To better allocate resources, a more accurate prediction on medical service demand is very urgently needed. This study aims to improve the prediction on medical services demand in China. To achieve this aim, the study combines Taylor Approximation into the Grey Markov Chain model, and develops a new model named Taylor-Markov Chain GM (1,1) (T-MCGM (1,1)). The new model has been tested by adopting the historical data, which includes the medical service on treatment of diabetes, heart disease, and cerebrovascular disease from 1997 to 2015 in China. The model provides a predication on medical service demand of these three types of disease up to 2022. The results reveal an enormous growth of urban medical service demand in the future. The findings provide practical implications for the Health Administrative Department to allocate medical resources, and help hospitals to manage investments on medical facilities.

Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study.

Science.gov (United States)

Oda, Anna; Tuck, Andrew; Agic, Branka; Hynie, Michaela; Roche, Brenda; McKenzie, Kwame

2017-05-03

Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support. Copyright 2017, Joule Inc. or its licensors.

When Does an Immigrant with HIV Represent an Excessive Demand on Canadian Health or Social Services?

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KEDNAPA THAVORN

2010-01-01

Full Text Available The Canadian Immigration and Refugee Protection Act of 2001 outlines conditions under which individuals may be granted or denied admission to Canada. The Act stipulates that applications for residence will be rejected if their health is expected to generate excessive demand on Canadian health or social services. The purpose of this paper is to derive a statistical definition of excessive demand and to apply that threshold to persons with HIV who are seeking admission to Canada. The paper demonstrates that the current threshold used by Citizenship and Immigration Canada is much lower than the thresholds that may be derived statistically.

The Flexible Care Service: a third-sector service for older people with mental health needs.

Science.gov (United States)

Ryder, Elaine

2015-01-01

Demographic patterns indicate that by 2030, one in five people in England will be over 65. Together with the fact that as people age they are more likely to suffer from comorbidities, it is of paramount importance that local services are designed to meet the needs of individual older people. The Flexible Care Service is a resource for older people with mental health problems. Through the use of client case studies, the Department of Health's 'six Cs' (care, compassion, competence, communication, courage and commitment) are used as a framework to demonstrate how a third-sector service such as Flexible Care can offer a person-centred approach in order to meet the diverse needs of individual clients. The framework is also used to demonstrate the high level of skills needed by flexible carers in order to provide this support.

Health education needs of intimate partner violence survivors: Perspectives from female survivors and social service providers.

Science.gov (United States)

Ferranti, Dina; Lorenzo, Dalia; Munoz-Rojas, Derby; Gonzalez-Guarda, Rosa M

2018-03-01

To explore the health education needs and learning preferences of female intimate partner violence (IPV) survivors in a social service agency located in South Florida, United States. An exploratory two-phase sequential mixed-methods study was completed through semistructured interviews with social service providers (n = 10), followed by a survey with predominately female IPV survivors (n = 122, 98.4%). Data obtained from interviews with social service providers were analyzed through conventional thematic content analysis. Data from interviews were used in developing a health survey completed by IPV survivors and analyzed utilizing descriptive statistics, chi-square tests and t tests. Three themes emerged from interviews including multidimensional health needs, navigating barriers to health care, and self-improvement specific to survivors of intimate partner violence. Survey results indicated that depression and self-esteem were the health education needs of highest priority. Demographic characteristics, including age and language use, were significantly associated to preferred methods of learning, p education needs. Current study findings can inform public health nurses in developing interventions or health-based programs for female IPV survivors in social service agency settings. © 2017 Wiley Periodicals, Inc.

Global Health Education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 1 of 2: Mobility patterns & educational needs and demands).

Science.gov (United States)

Bozorgmehr, Kayvan; Schubert, Kirsten; Menzel-Severing, Johannes; Tinnemann, Peter

2010-10-08

In recent years, education and training in global health has been the subject of recurring debate in many countries. However, in Germany, there has been no analysis of the educational needs or demands of medical students, or the educational deficits or potential benefits involved in global health education. Our purpose is to analyse international health elective patterns of medical students enrolled at German universities and assess whether or how they prepare for their electives abroad. We examine the exposure of medical students enrolled at German universities to training courses in tropical medicine or global health and assess students' perceived needs and demands for education in global health. Cross-sectional study among medical students in Germany including all 36 medical schools during the second half of the year 2007. All registered medical students were eligible to participate in the study. Recruitment occurred via electronic mailing-lists of students' unions. We developed a web-based, semi-structured questionnaire to capture students' international mobility patterns, preparation before electives, destination countries, exposure to and demand for global health learning opportunities. 1126 online-replies were received and analysed from all registered medical students in Germany (N = 78.067). 33.0% of all respondents (370/1126) declared at least one international health elective and of these, 36.0% (133/370) completed their electives in developing countries. 36.0% (131/363) did not prepare specifically at all, 59.0% (214/363) prepared either by self-study or declared a participation in specific preparation programmes. 87.8% of 5th and 6th year students had never participated in a global health course and 72.6% (209/288) had not completed a course in tropical medicine. 94.0% (861/916) endorsed the idea of introducing global health into medical education. Students in our sample are highly mobile during their studies. International health electives are common

Socio-economic inequalities in health services utilization: a cross-sectional study.

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Ranjbar Ezzatabadi, Mohammad; Khosravi, Ameneh; Bahrami, Mohammad Amin; Rafiei, Sima

2018-02-12

Purpose Developing country workers mainly face important challenges when examining equality in health services utilization among the population and identifying influential factors. The purpose of this paper us to: understand health service use among households with different socio-economic status in Isfahan province; and to investigate probable inequality determinants in service utilization. Design/methodology/approach Almost 1,040 households living in Isfahan province participated in this cross-sectional study in 2013. Data were collected by a questionnaire with three sections: demographic characteristics; socio-economic status; and health services utilization. The concentration index was applied to measure inequality. Analysts used STATA 11. Findings Economic status, educational level, insurance coverage and household gender were the most influential factors on health services utilization. Those with a high socio-economic level were more likely to demand and use such services; although self-medication patterns showed an opposite trend. Practical implications Female-headed families face with more difficulties in access to basic human needs including health. Supportive policies are needed to meet their demands. Originality/value The authors used principle component analysis to assess households' economic situation, which reduced the variables into a single index.

Youth with special health care needs: transition to adult health care services.

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Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N

2013-12-01

Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

Unmet Health Care Service Needs of Children With Disabilities in Penang, Malaysia.

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Tan, Seok Hong

2015-11-01

Information on unmet health care needs reveal problems that are related to unavailability and inaccessibility of services. The study objectives were to determine the prevalence, and the reasons for unmet service needs among children with disabilities in the state of Penang, Malaysia. Caregivers of children with disabilities aged 0 to 12 years registered with the Penang Social Welfare Department in 2012 answered a self-administered mailed questionnaire. A total of 305 questionnaires were available for analysis (response rate 37.9%). Services that were very much needed and yet highly unmet were dental services (49.6% needed, 59.9% unmet), dietary advice (30.9% needed, 63.3% unmet), speech therapy (56.9% needed, 56.8% unmet), psychology services (25.5% needed, 63.3% unmet), and communication aids (33.0% needed, 79.2% unmet). Access problems were mainly due to logistic issues and caregivers not knowing where to obtain services. Findings from this study can be used to inform strategies for service delivery and advocacy for children with disabilities in Penang, Malaysia. © 2015 APJPH.

[Health care economics, uncertainty and physician-induced demand].

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Domenighetti, G; Casabianca, A

1995-10-21

The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

Exploring Demand and Provision in English Child Protection Services

OpenAIRE

Hood, Rick; Goldacre, Allie; Grant, Robert; Jones, Ray

2016-01-01

This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year per...

Vertical equity of healthcare in Taiwan: health services were distributed according to need

OpenAIRE

Wang, Shiow-Ing; Yaung, Chih-Liang

2013-01-01

Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health ne...

The impact of health information technology and e-health on the future demand for physician services.

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Weiner, Jonathan P; Yeh, Susan; Blumenthal, David

2013-11-01

Arguably, few factors will change the future face of the American health care workforce as widely and dramatically as health information technology (IT) and electronic health (e-health) applications. We explore how such applications designed for providers and patients will affect the future demand for physicians. We performed what we believe to be the most comprehensive review of the literature to date, including previously published systematic reviews and relevant individual studies. We estimate that if health IT were fully implemented in 30 percent of community-based physicians' offices, the demand for physicians would be reduced by about 4-9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4-7 percent. Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2-5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings. Future predictions of physician supply adequacy should take these likely changes into account.

Health Concerns and Health Service Utilization in a Population Cohort of Young Adults with Autism Spectrum Disorder

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Weiss, Jonathan A.; Isaacs, Barry; Diepstra, Heidi; Wilton, Andrew S.; Brown, Hilary K.; McGarry, Caitlin; Lunsky, Yona

2018-01-01

Individuals with autism spectrum disorder (ASD) have many health needs that place demands on the health service sector. This study used administrative data to compare health profiles in young adults 18-24 years of age with ASD to peers with and without other developmental disability. Young adults with ASD were more likely to have almost all the…

Children's behavioral health needs and satisfaction and commitment of foster and adoptive parents: Do trauma-informed services make a difference?

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Barnett, Erin R; Cleary, Sarah E; Butcher, Rebecca L; Jankowski, Mary K

2018-05-03

Caring for children in foster or adoptive care with behavioral health needs can severely stress parents, contributing to adverse outcomes for children and families. Trauma-informed services from the child welfare and mental health sectors may help prevent poor outcomes by helping children and parents identify and understand trauma and its impact on children's behavioral health and receive effective treatment. To help understand the role of trauma-informed services for the child welfare population, we examined whether trauma-informed child welfare and mental health services moderated the relationship between children's behavioral health needs and parent satisfaction and commitment. The researchers analyzed data from a cross-sectional statewide survey of foster and adoptive parents (n = 512 respondents, 42% of 1,206 contacted) from one state. Foster (but not adoptive) parent ratings of trauma-informed mental health services significantly moderated the relationship between children's behavioral health needs and foster and adoptive parent satisfaction and commitment. As ratings of trauma-informed mental health services increased, the association between child behavioral health needs and parent satisfaction and commitment became nonsignificant, suggesting a buffering effect. Trauma-informed child welfare services did not moderate the relationship for foster or adoptive parents. Leaders and policymakers are urged to promote trauma-informed mental health services for children involved with child welfare to potentially buffer foster parents against lower parenting satisfaction and commitment. More research is needed to replicate and expand on these findings and to examine the effectiveness of trauma-informed services on other relevant child and family outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Implementation of nurse demand managment in primary health care service providers in Catalonia].

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Brugués Brugués, Alba; Cubells Asensio, Irene; Flores Mateo, Gemma

2017-11-01

To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Unmet Support Service Needs and Health-Related Quality of Life among Adolescents and Young Adults with Cancer: The AYA HOPE Study

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Ashley Wilder Smith

2013-04-01

Full Text Available Introduction: Cancer for adolescents and young adults (AYA differs from younger and older patients; AYA face medical challenges while navigating social and developmental transitions. Research suggests that these patients are under- or inadequately served by current support services, which may affect health-related quality of life (HRQOL.Methods: We examined unmet service needs and HRQOL in the National Cancer Institute’s Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE study, a population-based cohort (n=484, age 15-39, diagnosed with cancer 6-14 months prior, in 2007-2009. Unmet service needs were psychosocial, physical, spiritual, and financial services where respondents endorsed that they needed, but did not receive, a listed service. Linear regression models tested associations between any or specific unmet service needs and HRQOL, adjusting for demographic, medical and health insurance variables.Results: Over one-third of respondents reported at least one unmet service need. The most common were financial (16%, mental health (15%, and support group (14% services. Adjusted models showed that having any unmet service need was associated with worse overall HRQOL, fatigue, physical, emotional, social, and school/work functioning, and mental health (p’s<0.0001. Specific unmet services were related to particular outcomes (e.g., needing pain management was associated with worse overall HRQOL, physical and social functioning (p’s<0.001. Needing mental health services had the strongest associations with worse HRQOL outcomes; needing physical/occupational therapy was most consistently associated with poorer functioning across domains.Discussion: Unmet service needs in AYAs recently diagnosed with cancer are associated with worse HRQOL. Research should examine developmentally appropriate, relevant practices to improve access to services demonstrated to adversely impact HRQOL, particularly physical therapy and mental

Evaluation of socio-economic factors affecting the demand for health

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Abdosaleh Jafari

2014-04-01

Full Text Available Introduction: Individual health has been proved to be under the influence of various factors such as the use of health care services, diet, smoking and alcohol, physical environment, and health-related behaviors. Therefore, the main determinants of health are factors such as income, education, and access to health services, and systematic changes in these factors lead to socio-economic injustice in health. The present study was carried out through library and internet search. Medline and Google Scholar databases were also utilized. Combining Contents and Results: According to the present study, an increase in health input expenses would inevitably lead to aggravation of the health situation and decrease in income would result in the worst health status of the poor. Moreover, people with higher education use less health inputs; however, they enjoy higher status than those with lower educational levels. Conclusion: Health demand approach provides only a part of the information needed for policy-makers and decision-makers in health system. Theoretical and empirical analyses of the health claim could indicate that policy actions are likely to be more effective in overcoming barriers to health but are not capable of determining which one is likely to be more cost-effective . The demand for information about the health only provides the necessary tools about the benefits of special policy making decisions. So the tool should be combined with other techniques including cost-effectiveness and cost-benefit analyses.

Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components.

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Mariko, Mamadou

2003-03-01

The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect

Geographic information systems (GIS): an emerging method to assess demand and provision for rehabilitation services.

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Passalent, Laura; Borsy, Emily; Landry, Michel D; Cott, Cheryl

2013-09-01

To illustrate the application of geographic information systems (GIS) as a tool to assess rehabilitation service delivery by presenting results from research recently conducted to assess demand and provision for community rehabilitation service delivery in Ontario, Canada. Secondary analysis of data obtained from existing sources was used to establish demand and provision profiles for community rehabilitation services. These data were integrated using GIS software. A number of descriptive maps were produced that show the geographical distribution of service provision variables (location of individual rehabilitation health care providers and location of private and publicly funded community rehabilitation clinics) in relation to the distribution of demand variables (location of the general population; location of specific populations (i.e., residents age 65 and older) and distribution of household income). GIS provides a set of tools for describing and understanding the spatial organization of the health of populations and the distribution of health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery. Implications for Rehabilitation It is important to seek out alternative and innovative methods to examine rehabilitation service delivery. GIS is a computer-based program that takes any data linked to a geographically referenced location and processes it through a software system that manages, analyses and displays the data in the form of a map, allowing for an alternative level of analysis. GIS provides a set of tools for describing and understanding the spatial organization of population health and health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery.

Quantifying the demand for hospital care services: a time and motion study

NARCIS (Netherlands)

van Oostveen, Catharina J.; Gouma, Dirk J.; Bakker, Piet J.; Ubbink, Dirk T.

2015-01-01

The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch

Special Health Care Needs Across the School and Family Contexts: Implications for Service Utilization.

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O'Connor, Meredith; Rosema, Stefanie; Quach, Jon; Kvalsvig, Amanda; Goldfeld, Sharon

2017-08-01

A fifth of children enter school with special health care needs (SHCN), many of whom have difficulties that are milder or not yet formally diagnosed (emerging SHCN). This study aimed to investigate how differing perceptions of children's emerging SHCN across the family and school contexts relates to service utilization. Sample: The nationally representative birth cohort of the Longitudinal Study of Australian Children, which includes parent reports on the abbreviated Children with Special Health Care Needs Screener. For a subsample of 2459 children teachers also completed the Australian Early Development Census, a measure of early childhood development at school entry that includes SHCN. Logistic regression analyses were conducted adjusting for severity of condition, gender, language background, and disadvantage. Overall 24.1% of children were identified by their parent and/or teacher as experiencing emerging SHCN. Compared with those with consistent reports, children with parent-only identified needs had lower odds of accessing school services (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.10-0.81). Similarly, children with parent-only (OR, 0.39; 95% CI, 0.20-0.75) and teacher-only (OR, 0.25; 95% CI, 0.14-0.46) identified needs had significantly lower odds of accessing services in the community. When parent and teacher perceptions of children's emerging SHCN were inconsistent, service use was lower at school and in the community. Further efforts are needed by health and education providers to ensure that common understandings about a child's needs at school are established early in children's educational careers. Copyright © 2017. Published by Elsevier Inc.

Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand.

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Pachanee, Cha-aim; Wibulpolprasert, Suwit

2006-07-01

The Thai government has implemented universal coverage of health insurance since October 2001. Universal access to antiretroviral (ARV) drugs has also been included since October 2003. These two policies have greatly increased the demand for health services and human resources for health, particularly among public health care providers. After the 1997 economic crisis, private health care providers, with the support of the government, embarked on new marketing strategies targeted at attracting foreign patients. Consequently, increasing numbers of foreign patients are visiting Thailand to seek medical care. In addition, the economic recovery since 2001 has greatly increased the demand for private health services among the Thai population. The increasing demand and much higher financial incentives from urban private providers have attracted health personnel, particularly medical doctors, from rural public health care facilities. Responding to this increasing demand and internal brain drain, in mid-2004 the Thai government approved the increased production of medical doctors by 10,678 in the following 15 years. Many additional financial incentives have also been applied. However, the immediate shortage of human resources needs to be addressed competently and urgently. Equity in health care access under this situation of competing demands from dual track policies is a challenge to policy makers and analysts. This paper summarizes the situation and trends as well as the responses by the Thai government. Both supply and demand side responses are described, and some solutions to restore equity in health care access are proposed.

Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey

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Souza-Júnior Paulo RB

2010-07-01

Full Text Available Abstract Background The Brazilian health system is founded on the principle of equity, meaning provision of equal care for equal needs. However, little is known about the impact of health policies in narrowing socioeconomic health inequalities. Using data from the Brazilian World Health Survey, this paper addresses socioeconomic inequalities in the use of outpatient services according to intensity of need. Methods A three-stage cluster sampling was used to select 5000 adults (18 years and over. The non-response rate was 24.7% and calibration of the natural expansion factors was necessary to obtain the demographic structure of the Brazilian population. Utilization was established by use of outpatient services in the 12 months prior to the interview. Socioeconomic inequalities were analyzed by logistic regression models using years of schooling and private health insurance as independent variables, and controlling by age and sex. Effects of the socioeconomic variables on health services utilization were further analyzed according to self-rated health (good, fair and poor, considered as an indicator of intensity of health care need. Results Among the 5000 respondents, 63.4% used an outpatient service in the year preceding the survey. The association of health services utilization and self-rated health was significant (p Conclusions The analysis showed that the social gradient in outpatient services utilization decreases as the need is more intense. Among individuals with good self-rated health, possible explanations for the inequality are the lower use of preventive services and unequal supply of health services among the socially disadvantaged groups, or excessive use of health services by the wealthy. On the other hand, our results indicate an adequate performance of the Brazilian health system in narrowing socioeconomic inequalities in health in the most serious situations of need.

Climate Services to Improve Public Health

Science.gov (United States)

Jancloes, Michel; Thomson, Madeleine; Costa, María Máñez; Hewitt, Chris; Corvalan, Carlos; Dinku, Tufa; Lowe, Rachel; Hayden, Mary

2014-01-01

A high level expert panel discussed how climate and health services could best collaborate to improve public health. This was on the agenda of the recent Third International Climate Services Conference, held in Montego Bay, Jamaica, 4–6 December 2013. Issues and challenges concerning a demand led approach to serve the health sector needs, were identified and analysed. Important recommendations emerged to ensure that innovative collaboration between climate and health services assist decision-making processes and the management of climate-sensitive health risk. Key recommendations included: a move from risk assessment towards risk management; the engagement of the public health community with both the climate sector and development sectors, whose decisions impact on health, particularly the most vulnerable; to increase operational research on the use of policy-relevant climate information to manage climate- sensitive health risks; and to develop in-country capacities to improve local knowledge (including collection of epidemiological, climate and socio-economic data), along with institutional interaction with policy makers. PMID:24776719

A review of systematic and quantifiable methods of estimating the needs of a community for alcohol treatment services.

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Crook, G M; Oei, T P

1998-01-01

The purpose of this paper was to review a variety of systematic and quantifiable methodologies for planning and evaluating the provision of alcohol treatment services for communities. These methods include: (a) developing and evaluating indicators of alcohol-related harm in and across defined geographic areas, to assess the relative need for services; (b) demand-oriented techniques that involve the prediction of future demand for services based on the previous utilisation of treatment facilities; (c) comprehensive systems approaches to planning services; and (d) the estimation of the prevalence of individuals who need or would benefit from an intervention for their alcohol problem. In practice, service planners may incorporate a combination of approaches that could be compared and contrasted to assess the convergent validity of results. These methodologies can also be used to provide information for planning and evaluating prevention/health promotion and early intervention initiatives.

Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data).

Science.gov (United States)

Weller, Wendy E; Minkovitz, Cynthia S; Anderson, Gerard F

2003-09-01

To determine how sociodemographic factors and type of insurance influence use of medical and health-related services by children with special health care needs (CSHCN), after controlling for need. A cross-sectional analysis of 1994 National Health Interview Disability Survey was conducted. Children between 5 and 17 years were identified as chronically ill according to the Questionnaire for Identifying Children with Chronic Conditions (n = 3061). Independent variables included child and family characteristics categorized as predisposing, enabling, and need. Dependent variables included use of 4 medical or 7 health-related services. Most children (88.7%) had seen a physician; 23.9% had an emergency department visit, 11.4% had a mental health outpatient visit, and 6.4% were hospitalized. Health-related service use ranged from <5.0% (transportation and social work) to 65.1% (medical care coordination); 20% to 30% of children used the remaining services (therapeutic, assistive devices, nonmedical care coordination, housing modifications). In fully adjusted logistic models, children with public insurance were significantly more likely than privately insured children to use 2 of the 4 medical services and 5 of the 7 health-related services. Non-Hispanic black children and children from less educated families were significantly less likely to use many of the services examined. In 1994, factors in addition to need influenced medical and health-related service use by CSHCN. Differences in the scope of benefits covered by public insurance compared with private insurance may influence utilization of medical and especially health-related services. Attention is needed to ensure that CSHCN who are racial/ethnic minorities or are from less educated families have access to needed services. Future studies should determine whether these patterns have changed over time.

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

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AlBuhairan FS

2014-09-01

Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

Tacit knowledge of public health nurses in identifying community health problems and need for new services: a case study.

Science.gov (United States)

Yoshioka-Maeda, Kyoko; Murashima, Sachiyo; Asahara, Kiyomi

2006-09-01

The purpose of this study was to explore the tacit knowledge of public health nurses in identifying community health problems and developing relevant new projects. Previous research only roughly showed those skills for creating new community health services, such as lobbying. Nine Japanese public health nurses who had created new projects in their municipalities were selected by theoretical sampling and interviewed in 2002-2003. Yin's Case Study Method, especially the multiple-case study design, was used. All 9 public health nurses used similar approaches in identifying community health problems and the need for creating new services, even though their experiences differed and the kinds of projects varied. They identified the difficulties of clients, recognized clients who had the same problems, elucidated the limitations of existing services, and forecasted outcomes from the neglect of the clients' problems. Then they succeeded in creating a new project by examining individual health problems in the context of their community's characteristics, societal factors, and using existing policies to support their clients. This is the first study to explore the skills of public health nurses and their intention to use such skills in creating new projects as well as the exact process. They could identify community health problems that will be the basis for developing new services to provide care for individual clients. This is different from the traditional community assessment approach that requires the collection of a huge amount of information to clarify community health problems. The tacit knowledge of public health nurses will help to create needs-oriented new services more smoothly.

Building a print on demand web service

Science.gov (United States)

Reddy, Prakash; Rozario, Benedict; Dudekula, Shariff; V, Anil Dev

2011-03-01

There is considerable effort underway to digitize all books that have ever been printed. There is need for a service that can take raw book scans and convert them into Print on Demand (POD) books. Such a service definitely augments the digitization effort and enables broader access to a wider audience. To make this service practical we have identified three key challenges that needed to be addressed. These are: a) produce high quality image images by eliminating artifacts that exist due to the age of the document or those that are introduced during the scanning process b) develop an efficient automated system to process book scans with minimum human intervention; and c) build an eco system which allows us the target audience to discover these books.

Reforms are needed to increase public funding and curb demand for private care in Israel's health system.

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Chernichovsky, Dov

2013-04-01

Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

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Kanchanachitra, Churnrurtai; Lindelow, Magnus; Johnston, Timothy; Hanvoravongchai, Piya; Lorenzo, Fely Marilyn; Huong, Nguyen Lan; Wilopo, Siswanto Agus; dela Rosa, Jennifer Frances

2011-02-26

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues. Copyright © 2011

How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011.

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Kiil, Astrid; Houlberg, Kurt

2014-11-01

This article reviews the quantitative evidence on the behavioural effects of copayment within the health area across a wide range of countries. The review distinguishes itself from previous similar reviews by having a high degree of transparency for the search strategy used to identify the studies included in the review as well as the criteria for inclusion and by including the most recent literature. Empirical studies were identified by performing searches in EconLit. The literature search identified a total of 47 studies of the behavioural effects of copayment. Considering the demand effects, the majority of the reviewed studies found that copayment reduces the use of prescription medicine, consultations with general practitioners and specialists, and ambulatory care, respectively. The literature found no significant effects of copayment on the prevalence of hospitalisations. The empirical evidence on whether copayment for some services, but not for others, causes substitution from the services that are subject to copayment to the 'free' services rather than lower total use is sparse and mixed. Likewise, the health effects of copayment have only been analysed empirically in a limited number of studies, of which half did not find any significant effects in the short term. Finally, the empirical evidence on the distributional consequences of copayment indicates that individuals with low income and in particular need of care generally reduce their use relatively more than the remaining population in consequence of copayment. Hence, it is clear that copayment involves some important economic and political trade-offs.

UNMET NEED IN TURKEY: HOME CARE SERVICE

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Nuket SUBASI

2006-02-01

Full Text Available Home care services can be provided as an alternative to institutional care to people, in case of their demand, who need care because of aging and chronic diseases. Structured home care service in health system does not exist in Turkey. Relatives try to provide care at home to those people. In this cross-sectional study, household was selected as a sampling unit, determining prevalence of home care at the households and gathering some information about home care in Cankaya district of Ankara was intended. It was found that in one-month period before this study was carried out, home care services were provided at 8.7% of the households in Cankaya district. 62.5% of people who received home care service were women, 15.3% of them were belonging to 65-74 age group; 31.7% of those were illiterate and 12.5% had no social and health insurance. Among people, 15.4% were receiving home care after surgical operation, 15.4% were receiving care because of stroke and cerebrovascular diseases and 9.6% were cancer patients. 81.7% of adults who were taken care at home were found to be dependent at different levels while performing daily living activities, the most common treatment method was detected as oral medication (81.4%. These people were in need of preventive, curative and rehabilitative and supportive services. A home care service model, which takes into consideration the social characteristics of the country, should be developed at this district where there is a large elderly population. [TAF Prev Med Bull 2006; 5(1.000: 19-31

Mental health service use types among Asian Americans with a psychiatric disorder: considerations of culture and need.

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Nguyen, Duy; Bornheimer, Lindsay A

2014-10-01

Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n = 230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.

The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans.

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Lee, Minsun; Takeuchi, David; Gellis, Zvi; Kendall, Philip; Zhu, Lin; Zhao, Shanyang; Ma, Grace X

2017-08-01

The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.

Determinants of Demand in the Public Dental Emergency Service.

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Matsumoto, Maria Sa; Gatti, Marcia An; de Conti, Marta Hs; de Ap Simeão, Sandra F; de Oliveira Braga Franzolin, Solange; Marta, Sara N

2017-02-01

Although dental emergencies are primarily aimed at pain relief, in practice, dental emergency services have been overwhelmed by the massive inflow of patients with less complex cases, which could be resolved at basic levels of health care. They frequently become the main gateway to the system. We investigated the determinant factors of demand at the Central Dental Emergency Unit in Bauru, São Paulo, Brazil. The questionnaire was applied to 521 users to evaluate sociodemographic profile; factors that led users to seek the service at the central dental emergency; perception of service offered. About 80.4% of users went directly to the central dental emergency, even before seeking basic health units. The reasons were difficulty to be attended (34.6%) and incompatible time (9.8%). To the perception of the necessity of the service, responses were problem as urgent (78.3%) and pain was the main complaint (69.1%). The profile we found was unmarried (41.5%), male (52.2%), white (62.8%), aged 30 to 59 (52.2%), incomplete basic education (41.6%), family income up to 2 minimum wages (47.4%), and no medical/dental plan (88.9%). It was concluded that the users of central dental emergency come from all sectors of the city, due to difficult access to basic health units; they consider their complaint urgent; and they are satisfied with the service offered. To meet the profile of the user urgency's service so that it is not overloaded with demand that can be fulfilled in basic health units.

Profile and Predictors of Service Needs for Families of Children with Autism Spectrum Disorders

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Hodgetts, Sandra; Zwaigenbaum, Lonnie; Nicholas, David

2015-01-01

Purpose: Increasing demand for autism services is straining service systems. Tailoring services to best meet families' needs could improve their quality of life and decrease burden on the system. We explored overall, best, and worst met service needs, and predictors of those needs, for families of children with autism spectrum disorders. Methods:…

Teachers' Perspectives of Children's Mental Health Service Needs in Urban Elementary Schools

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Williams, James Herbert; Horvath, Violet E.; Wei, Hsi-Sheng; Van Dorn, Richard A.; Jonson-Reid, Melissa

2007-01-01

This study uses a phenomenological approach to investigate elementary school teachers' perspectives on children's mental health service needs. Focus groups were conducted at two elementary schools with differing levels of available social services in a moderate-sized urban midwestern school district. Data collection centered on six prominent…

Impact assessment of a maternal health project in a megacity, Nigeria: toward a future with more demand for maternal health services.

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Matsuoka, Sadatoshi; Koga, Sumiko; Suzui, Emiko; Tsukada, Yoshiko; Ohashi, Kazutomo; Johnson, Taiwo

2017-10-01

To improve the quantity and quality of maternal health services in Lagos State, Nigeria having a maternal mortality ratio of 555 per 100 000 live births, a four-year project was implemented since February 2010. The major activity of the project was training for both the service supply and demand sides. This study aimed to examine the impact of the project on coverages and quality of the services in target areas, and guide statewide policies. The Cochran-Armitage test for trend was applied to understand trends in the service coverages during 2009-2013. The same test was performed to analyse trends in the proportions of perineal conditions (i.e. intact or tear) and to evaluate variations in midwives' snkill during 2011-2013. The paired t-test was used to analyse changes in midwives' knowledge. The project interventions contributed to a significant increase in the overall service coverages, including improvements in midwifery knowledge and possibly in their skills. However, the service coverage was still limited as of the termination of the project. To instal the interventions and maximise the effect of them state-wide, it is recommended to undertake five tasks: (i) establishment of public primary health centres offering 24-h maternal health services; (ii) redeployment and recruitment of public health personnel; (iii) expansion of midwifery trainings and continuous education by the local trainers; (iv) review of grass-roots level activities; and (v) scrutiny of barriers to maternal health services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Association of functional limitation with health care needs and experiences of children with special health care needs.

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Nageswaran, Savithri; Silver, Ellen Johnson; Stein, Ruth E K

2008-05-01

The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs. We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences. Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation. Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.

The need for mental health services research focusing on poor young women.

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Miranda, Jeanne; Green, Bonnie L.

1999-06-01

Despite the fact that the relationship between poverty and increased risk for a broad spectrum of mental disorders has been documented for several decades, very little is known about providing mental health treatments to poor individuals. In this paper, we emphasize the importance of developing, and empirically evaluating, sensitive and appropriate interventions for poor young women who suffer from common mental disorders. WHO ARE THE US POOR?: In the US, nearly 14% of individuals live in poverty, and another 20% in near poverty. The poor are disproportionally women and children such that 63% of female-headed households are poor. Young women and ethnic minorities are over-represented among the poor also, with 55% of those living below the poverty level being minorities. NEEDS AND BARRIERS TO CARE AMONG POOR, YOUNG WOMEN: The poor have more mental disorders than those with more resources. Further, women are twice as likely as men to have a mood or anxiety disorder, including major depression and post-traumatic stress disorder (PTSD), with younger women at higher risk than older women. Research alos indicates that poor women have high exposure to traumatic events and cumulative adversity that is directly related to their mental health. This history may serve, in part, as a barrier to seeking mental health care. Other barriers in this population include lack of insurance, lack of access to primary care where mental disorders might be detected, practical problems like lack of childcare or transportation, and the inflexibility of low-income service jobs. Religious beliefs and attitudes about mental health treatment may play a role as well. Recent policy changes in the US have contributed to the vulnerability of this group as eligibility for welfare programs has reduced, and time limits have decreasd. Services for immigrants are also severely limited, and managed care strategies for those in the public sector may be confusing. IMPORTANT, UNANSWERED QUESTION: More needs

Pursuing cost-effectiveness in mental health service delivery for youth with complex needs.

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Grimes, Katherine E; Schulz, Margaret F; Cohen, Steven A; Mullin, Brian O; Lehar, Sophie E; Tien, Shelly

2011-06-01

Mental health advocates seek to expand children's services, noting widespread failure to meet the needs of public sector youth suffering from serious emotional disturbance (SED). However, state and national budgets face deepening cuts, with rising health care costs taking the blame. As the gap between needs and finances widens, identification of cost-effective treatments that will benefit children with SED and their families is of increasing importance. Community-based interventions for this population, such as the wraparound approach and systems-of-care, are being disseminated but literature is scant regarding effects on expense. The Mental Health Services Program for Youth (MHSPY) model is aligned philosophically with wraparound and systems-of-care but unique in blending public agency dollars to deliver integrated medical, mental health and social services. MHSPY's linked clinical and expense data is useful to study community-based treatment cost-effectiveness. To examine the cost-effectiveness of an intensively integrated, family and community-based clinical intervention for youth with mental health needs in comparison to "usual care.'' Study and reference populations were matched on age, gender, community, psychiatric diagnosis, morbidity and insurance type. Claims analyses included patterns of service utilization and medical expense for both groups. Using propensity score matching, results for study youth are compared with results for the population receiving "usual care.'' Clinical functioning was measured for the intervention group at baseline and 12 months. The intervention group used lower intensity services and had substantially lower claims expense (e.g. 32% lower for emergency room, 74% lower for inpatient psychiatry) than their matched counterparts in the "usual care'' group. Intervention youth were consistently maintained in least restrictive settings, with over 88% of days spent at home and showed improved clinical functioning on standard measures

Quantifying the demand for hospital care services: a time and motion study.

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van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T

2015-01-22

The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.

Impact of the London 2012 Olympic and Paralympic Games on demand for microbiology gastrointestinal diagnostic services at the Public Health Laboratory London.

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Williams, K; Sinclair, C; McEwan, R; Fleet, K; Balasegaram, S; Manuel, R

2014-07-01

Planning for the London 2012 Olympic and Paralympic Games at the Public Health Laboratory London was based on the requirement to meet potential increased demand with scalable capacity. The aim of this study was to determine the impact on demand for microbiology gastrointestinal diagnostic services during the Games period. Retrospective cross-sectional time-series data analysis was used to assess the number of gastrointestinal specimens received in the laboratory and the number of positive results. There was no increase in the number of gastrointestinal specimens received during the Games period, thus the Games had no impact on demand for microbiology gastrointestinal diagnostic services at the laboratory. There was a decrease in the number of public health specimens received for culture [incidence rate ratio = 0.34, 95% confidence interval (CI) = 0.13-0.86, P = 0.02] and a decrease in the number of culture positive community specimens (odds ratio = 0.59, 95 % CI = 0.40-0.85, P = 0.005), suggesting a decrease in gastrointestinal illness during the Games period. As previous planning assumptions were not based on actual specimen activity, the results of this study may modify the extent of additional planning for microbiological services required for mass gatherings. © 2014 The Authors.

New solutions for personalised health management: citizens' needs, healthcare changes, and market perspectives round table debate.

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Olsson, Silas; Hofmann, Isa; Brambilla, Piero Maria; Jacobsson, Ulf; Kennedy, Paul; Roca, Josep; Schmitt, Karl-Jürgen; Wyke, Alexandra

2004-01-01

The aim with the round table was to give additional inputs and views to the specific technology oriented presentations focusing on issues dealing with the need, patients' view, the use and the business opportunities relating to wearable eHealth systems for personalised health management. Wearable eHealth systems for personalised health management are targeting citizens, patients at health risks and patients enrolled in open care or home care for monitoring, treatment or follow up. The developments so far show promises for these group categories, and in addition, could support developments in health care organisations and systems. However, the ethical issues and data privacy nature have to be seriously taken into account. The market is not yet developed, and this is the situation both in Europe and in the US. To be able to give the customers solid product information a standardised test bed for new equipment and services might speed up the market development. In the round table discussion it was highlighted that one has to differ between needs and demands. Needs are related to the prevalence of the diseases, the health risks, etc. Demands are more related to market developments and customers' willingness to pay for the new products and services. Further, technical interoperability was seen as a fundamental prerequisite for market acceptance. As wearable eHealth systems for personalised health management differ completely from traditional way of deliver healthcare, new reimbursement systems have to be developed and implemented.

Differential Association of Stigma with Perceived Need and Mental Health Service Use.

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Wong, Eunice C; Collins, Rebecca L; Breslau, Joshua; Burnam, M Audrey; Cefalu, Matthew; Roth, Elizabeth A

2018-06-01

This study examined the role of stigma at two stages of the treatment-seeking process by assessing associations between various types of stigma and perceived need for mental health treatment as well as actual treatment use. We analyzed cross-sectional data from the 2014 and 2016 California Well-Being Survey, a telephone survey with a representative sample of 1954 California residents with probable mental illness. Multivariable logistic regression indicated that perceived need was associated with less negative beliefs about mental illness (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.95) and greater intentions to conceal a mental illness (OR = 1.47; 95% CI = 1.12-1.92). Among respondents with perceived need, treatment use was associated with greater mental health knowledge/advocacy (OR = 1.63; 95% CI = 1.03-2.56) and less negative treatment attitudes (OR = 0.66; 95% CI = 0.43-1.00). Understanding which aspects of stigma are related to different stages of the help-seeking process is essential to guiding policy and program initiatives aimed at ensuring individuals with mental illness obtain needed mental health services.

Interoperable computerized smart card based system for health insurance and health services applied in cardiology.

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Cocei, Horia-Delatebea; Stefan, Livia; Dobre, Ioana; Croitoriu, Mihai; Sinescu, Crina; Ovricenco, Eduard

2002-01-01

In 1999 Romania started its health care reform by promulgating the Health Insurance Law. A functional and efficient health care system needs procedures for monitoring and evaluation of the medical services, communication between different service providers and entities involved in the system, integration and availability of the information. The final goal is a good response to the needs and demands of the patients and of the real life. For this project we took into account, on one hand, the immediate need for computerized systems for the health care providers and, on the other hand, the large number of trials and experiments with health smart cards across Europe. Our project will implement a management system based on electronic patient records to be used in all cardiology clinics and will experiment the health smart cards, will promote and demonstrate the capabilities of the smart card technology. We focused our attention towards a specific and also critical category of patients, those with heart diseases, and also towards a critical sector of the health care system--the emergency care. The patient card was tested on a number of 150 patients at a cardiology clinic in Bucharest. This was the first trial of a health smart card in Romania.

Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada.

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Deslauriers, Simon; Raymond, Marie-Hélène; Laliberté, Maude; Lavoie, Amélie; Desmeules, François; Feldman, Debbie E; Perreault, Kadija

2017-12-01

The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services. © 2017 John Wiley & Sons, Ltd.

[Health services research for the public health service (PHS) and the public health system].

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Hollederer, A; Wildner, M

2015-03-01

There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia.

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Ensor, Tim; Firdaus, Hafidz; Dunlop, David; Manu, Alex; Mukti, Ali Ghufron; Ayu Puspandari, Diah; von Roenne, Franz; Indradjaya, Stephanus; Suseno, Untung; Vaughan, Patrick

2012-08-29

Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system. A standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country. Substantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia

Directory of Open Access Journals (Sweden)

Ensor Tim

2012-08-01

Full Text Available Abstract Background Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system. Methods A standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country. Findings Substantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population

Organizing integrated health-care services to meet older people's needs.

Science.gov (United States)

Araujo de Carvalho, Islene; Epping-Jordan, JoAnne; Pot, Anne Margriet; Kelley, Edward; Toro, Nuria; Thiyagarajan, Jotheeswaran A; Beard, John R

2017-11-01

In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders - everyone has a role to play.

Our Community, Our Schools: A Case Study of Program Design for School-Based Mental Health Services

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Capp, Gordon

2015-01-01

Schools face increasing demands to support the mental health needs of students and families; some estimate that 80 percent of students receive mental health services at school. Thus, schools face two daunting challenges: (1) to provide effective mental health support to students and (2) to address how mental health needs affect other students,…

Developing a service-learning module for oral health: A needs assessment

Directory of Open Access Journals (Sweden)

R Ebrahim

2017-03-01

Full Text Available Background. Service learning (SL as a pedagogy in higher education must be differentiated from other services with a primarily philanthropic intent. Dental therapy and oral hygiene students at Sefako Makgatho Health Sciences University, School of Oral Health Sciences, Pretoria, South Africa visit community sites during their 2nd year of study. However, the current curricula would need restructuring for alignment with the espoused pedagogy and standards of SL. Such an SL curriculum design would thus allow for the provision of meaningful services to communities as an integral component of these programmes. Objective. To explore (i perceptions of 2nd-year oral health students; and (ii opinions of academics with regard to the need for an SL module. Methods. Purposive sampling was used to conduct two focus group discussions with academics involved in curriculum development (n=11 and students who had previous exposure to communities (n=10. A survey containing open-ended questions was completed by 9 academics, who would implement the proposed SL module. Frequencies were calculated and data from the open questions were analysed for emergent themes. Results. Most academics (89%, n=8 indicated that working effectively with others as members of a team and developing cultural sensitivity were achievable from an SL module. Two themes emerged from the focus groups, i.e. (i enhanced teaching and learning – students could apply theoretical and clinical training in an authentic setting; and (ii standardisation of training – an SL module would ensure consistency when engaging with communities. Conclusion. The needs assessment was valuable to inform the development and implementation of the SL module.

Predisposing, enabling, and need factors associated with high service use in a public mental health system.

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Lindamer, Laurie A; Liu, Lin; Sommerfeld, David H; Folsom, David P; Hawthorne, William; Garcia, Piedad; Aarons, Gregory A; Jeste, Dilip V

2012-05-01

The purpose of this study was twofold: (1) To investigate the individual- and system-level characteristics associated with high utilization of acute mental health services according to a widely-used theory of service use-Andersen's Behavioral Model of Health Service Use -in individuals enrolled in a large, public-funded mental health system; and (2) To document service utilization by high use consumers prior to a transformation of the service delivery system. We analyzed data from 10,128 individuals receiving care in a large public mental health system from fiscal years 2000-2004. Subjects with information in the database for the index year (fiscal year 2000-2001) and all of the following 3 years were included in this study. Using logistic regression, we identified predisposing, enabling, and need characteristics associated with being categorized as a single-year high use consumer (HU: >3 acute care episodes in a single year) or multiple-year HU (>3 acute care episodes in more than 1 year). Thirteen percent of the sample met the criteria for being a single-year HU and an additional 8% met the definition for multiple-year HU. Although some predisposing factors were significantly associated with an increased likelihood of being classified as a HU (younger age and female gender) relative to non-HUs, the characteristics with the strongest associations with the HU definition, when controlling for all other factors, were enabling and need factors. Homelessness was associated with 115% increase in the odds of ever being classified as a HU compared to those living independently or with family and others. Having insurance was associated with increased odds of being classified as a HU by about 19% relative to non-HUs. Attending four or more outpatient visits was an enabling factor that decreased the chances of being defined as a HU. Need factors, such as having a diagnosis of schizophrenia, bipolar disorder or other psychotic disorder or having a substance use disorder

Adolescents perception of reproductive health care services in Sri Lanka

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Agampodi, Suneth B; Agampodi, Thilini C; UKD, Piyaseeli

2008-01-01

Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Conclusions and recommendations

Adolescents perception of reproductive health care services in Sri Lanka

Directory of Open Access Journals (Sweden)

Agampodi Thilini C

2008-05-01

Full Text Available Abstract Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners

The role of government policy in service development in a New Zealand statutory mental health service: implications for policy planning and development.

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Stanley-Clarke, Nicky; Sanders, Jackie; Munford, Robyn

2014-12-01

To explore the relationship between government policy and service development in a New Zealand statutory mental health provider, Living Well. An organisational case study utilising multiple research techniques including qualitative interviews, analysis of business and strategic documents and observation of meetings. Staff understood and acknowledged the importance of government policy, but there were challenges in its implementation. Within New Zealand's statutory mental health services staff struggled to know how to implement government policy as part of service development; rather, operational concerns, patient need, local context and service demands drove the service development process. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Adolescents perception of reproductive health care services in Sri Lanka.

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Agampodi, Suneth B; Agampodi, Thilini C; Ukd, Piyaseeli

2008-05-03

Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17-19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Adolescent health services are inadequate and available services

The consequences of health service privatisation for equality and equity in health care in South Africa.

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Price, M

1988-01-01

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.

Service on demand for ISS users

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Hüser, Detlev; Berg, Marco; Körtge, Nicole; Mildner, Wolfgang; Salmen, Frank; Strauch, Karsten

2002-07-01

Since the ISS started its operational phase, the need of logistics scenarios and solutions, supporting the utilisation of the station and its facilities, becomes increasingly important. Our contribution to this challenge is a SERVICE On DEMAND for ISS users, which offers a business friendly engineering and logistics support for the resupply of the station. Especially the utilisation by commercial and industrial users is supported and simplified by this service. Our industrial team, consisting of OHB-System and BEOS, provides experience and development support for space dedicated hard- and software elements, their transportation and operation. Furthermore, we operate as the interface between customer and the envisaged space authorities. Due to a variety of tailored service elements and the ongoing servicing, customers can concentrate on their payload content or mission objectives and don't have to deal with space-specific techniques and regulations. The SERVICE On DEMAND includes the following elements: ITR is our in-orbit platform service. ITR is a transport rack, used in the SPACEHAB logistics double module, for active and passive payloads on subrack- and drawer level of different standards. Due to its unique late access and early retrieval capability, ITR increases the flexibility concerning transport capabilities to and from the ISS. RIST is our multi-functional test facility for ISPR-based experiment drawer and locker payloads. The test program concentrates on physical and functional interface and performance testing at the payload developers site prior to the shipment to the integration and launch. The RIST service program comprises consulting, planning and engineering as well. The RIST test suitcase is planned to be available for lease or rent to users, too. AMTSS is an advanced multimedia terminal consulting service for communication with the space station scientific facilities, as part of the user home-base. This unique ISS multimedia kit combines

Service Demand Discovery Mechanism for Mobile Social Networks.

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Wu, Dapeng; Yan, Junjie; Wang, Honggang; Wang, Ruyan

2016-11-23

In the last few years, the service demand for wireless data over mobile networks has continually been soaring at a rapid pace. Thereinto, in Mobile Social Networks (MSNs), users can discover adjacent users for establishing temporary local connection and thus sharing already downloaded contents with each other to offload the service demand. Due to the partitioned topology, intermittent connection and social feature in such a network, the service demand discovery is challenging. In particular, the service demand discovery is exploited to identify the best relay user through the service registration, service selection and service activation. In order to maximize the utilization of limited network resources, a hybrid service demand discovery architecture, such as a Virtual Dictionary User (VDU) is proposed in this paper. Based on the historical data of movement, users can discover their relationships with others. Subsequently, according to the users activity, VDU is selected to facilitate the service registration procedure. Further, the service information outside of a home community can be obtained through the Global Active User (GAU) to support the service selection. To provide the Quality of Service (QoS), the Service Providing User (SPU) is chosen among multiple candidates. Numerical results show that, when compared with other classical service algorithms, the proposed scheme can improve the successful service demand discovery ratio by 25% under reduced overheads.

The relationship between demand and need for orthodontic treatment in high school students in Bangkok.

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Atisook, Pitraporn; Chuacharoen, Rattiya

2014-07-01

Orthodontic service is limited in Thailand and cannot meet the demand of the population. (1) To assess the need for orthodontic treatment (OT) using the Index of Orthodontic Treatment Need (IOTN) to analyze the relationship between demand and need for OT and (2) to compare the demand and need for OT between genders. A cross-sectional study was conducted on 450 students aged 12- to 14-years-old in three government high schools in Bangkok. A constructed questionnaire was used to assess demand for OT Clinical examination was done by two orthodontists to determine the needfor OT using the IOTN RESULTS: Most of the students (74.0%) wished to have OT while only one-third (37.5%) had severe need, and one-third (34.4%) had moderate need for OT as judge by the DHC of the IOTN. The AC of the IOTN indicated that most students (55.8%) had mild or no need for OT Females (79%) demanded OT more than males (66% p-value = 0.033) but the need was similar in both sexes. Most functional factors had strong relationships with the demand for OTexcept lower teeth bite on palate, but none was found to be associated with need for OT All of the aesthetic factors had strong relationships with demand for OT There were significant relationships with needs in five categories, 1) crooked, crowded, or spacing teeth, 2) worried when speaking or smiling, 3) had suggestedfor OT 4) breath smell and halitosis, and 5) wanted to put on braces to be like other people or for fashionable reasons. Most of the students requested OT but females had significantly higher demand for OT than males. Most of the samples needed to have OT The aesthetic factors that had strong relationships with the need for OT were 1) crooked, crowded, or spacing teeth, 2) worried when speaking or smiling, 3) had suggested for T07 4) breath smell and halitosis, and 5) wanted to put on braces to be like otherpeople orfor fashionable reasons.

Convergence of service, policy, and science toward consumer-driven mental health care.

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Carroll, Christopher D; Manderscheid, Ronald W; Daniels, Allen S; Compagni, Amelia

2006-12-01

A common theme is emerging in sentinel reports on the United States health care system. Consumer relevance and demands on service systems and practices are influencing how mental health care is delivered and how systems will be shaped in the future. The present report seeks to assemble a confluence of consumer-driven themes from noteworthy reports on the state of the mental health system in the U.S. It also explores innovative efforts, promising practices, collaborative efforts, as well as identification of barriers to consumer-directed care, with possible solutions. The report reviews the relevant public mental health policy and data used in published work. The findings indicate an increasing public and private interest in promoting consumer-driven care, even though historical systems of care predominate, and often create, barriers to wide-spread redesign of a consumer-centered mental health care system. Innovative consumer-driven practices are increasing as quality, choice, and self-determination become integral parts of a redesigned U.S. mental health care system. The use of consumer-driven approaches in mental health is limited at best. These programs challenge industry norms and traditional practices. Limitations include the need for additional and thorough evaluations of effectiveness (cost and clinical) and replicability of consumer-directed programs. Consumer-driven services indicate that mental health consumers are expecting to be more participative in their mental health care. This expectation will influence how traditional mental health services and providers become more consumer-centric and meet the demand. Public and private interest in consumer-driven health care range from creating cost-conscious consumers to individualized control of recovery. The health care sector should seek to invest more resources in the provision of consumer-driven health care programs. The results of this study have implications and are informative for other countries where

Utilization of Dental Services in Public Health Center: Dental Attendance, Awareness and Felt Needs.

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Pewa, Preksha; Garla, Bharath K; Dagli, Rushabh; Bhateja, Geetika Arora; Solanki, Jitendra

2015-10-01

In rural India, dental diseases occur due to many factors, which includes inadequate or improper use of fluoride and a lack of knowledge regarding oral health and oral hygiene, which prevent proper screening and dental care of oral diseases. The objective of the study was to evaluate the dental attendance, awareness and utilization of dental services in public health center. A cross-sectional study was conducted among 251 study subjects who were visiting dental outpatient department (OPD) of public health centre (PHC), Guda Bishnoi, and Jodhpur using a pretested proforma from month of July 2014 to October 2014. A pretested questionnaire was used to collect the data regarding socioeconomic status and demographic factors affecting the utilization of dental services. Pearson's Chi-square test and step-wise logistic regression were applied for the analysis. Statistically significant results were found in relation to age, educational status, socioeconomic status and gender with dental attendance, dental awareness and felt needs. p-value dental services, thereby increasing the oral health status of the population.

Investigating the efficacy of a whole team, psychologically informed, acute mental health service approach.

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Araci, David; Clarke, Isabel

2017-08-01

Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches. (1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme. ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention. The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measure t-tests demonstrated significant decrease in distress (p mental health (p mental health service and results in improvement in self management skills and facilitation of recovery.

Public health capacity in the provision of health care services.

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Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick

2015-12-01

In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

User Requirements & Demand for Services and Applications in PNs

DEFF Research Database (Denmark)

Jiang, Bo

This paper focuses on the methodology for analyses of user requirements and demand for specific services and applications in relation to personal networks (PNs). The paper has a strong user-centric approach to service and application development based on the widely accepted fact that future servi...... demand for services and applications in a PN setting. This further includes discussion of service categorization, service description and human-value issues as personalization, security and privacy, billing and price and human-computer interaction paradigms....

Demands and Needs for Psycho-Oncological eHealth Interventions in Women With Cancer: Cross-Sectional Study.

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Ringwald, Johanna; Marwedel, Lennart; Junne, Florian; Ziser, Katrin; Schäffeler, Norbert; Gerstner, Lena; Wallwiener, Markus; Brucker, Sara Yvonne; Hautzinger, Martin; Zipfel, Stephan; Teufel, Martin

2017-11-24

Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients. This cross-sectional study aimed to explore the cancer-affected women's needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden. Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated. Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications. Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a

Survey on demand of the aged people for college volunteers in home nursing care service

Directory of Open Access Journals (Sweden)

Tian Meng

2017-01-01

Full Text Available Objects: To study the demand of the aged community residents for college volunteers in home nursing care service and its influence factors. Methods: Questionnaires on the aged residents’ expectation and requirements for college volunteers in home nursing care was prepared on basis of studies of reference books, study materials and pre-investigation, and then the questionnaires was completed by means of convenient sampling of 200 aged residents. Results The demand and expectation of the elderly for college volunteers in health care and spiritual comfort was strong. The old people who have more children, living alone and often feel lonely are more likely to need college volunteers. Conclusions: Volunteers should be arranged reasonably according to the needs of the aged people, and priority should be given to those who have more children, living alone and often feel lonely.

The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services.

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Moreau, Jessica L; Cordasco, Kristina M; Young, Alexander S; Oishi, Sabine M; Rose, Danielle E; Canelo, Ismelda; Yano, Elizabeth M; Haskell, Sally G; Hamilton, Alison B

Women veterans are a growing segment of Department of Veterans Affairs (VA) users with distinct mental health needs and well-documented barriers to care. Telemental health holds much promise for reducing barriers to mental health care. We assessed VA stakeholders' perceptions of telemental health's appropriateness and potential to address the mental health needs of women veteran VA users. We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics. Transcripts were summarized in a template of key domains developed based on the interview guide, and coded for topics relevant to women's mental health needs and telehealth services. Telemental health was perceived to increase access to mental health care, including same-gender care and access to providers with specialized training, especially for rural women and those with other limiting circumstances. Respondents saw women veterans as being particularly poised to benefit from telemental health, owing to responsibilities associated with childcare, spousal care, and elder caregiving. Interviewees expressed enthusiasm for telemental health's potential and were eager to expand services, including women-only mental health groups. Implementation challenges were also noted. Overall, our stakeholders saw telemental health as a good fit for helping to address the perceived needs of women veterans, especially in addressing the geographical barriers experienced by rural women and those with a limited ability to travel. These findings can help to inform gender-tailored expansion of telemental health within and outside of the VA. Published by Elsevier Inc.

Estimating spatially specific demand and supply of dental services: a longitudinal comparison in Northern Germany.

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Schwendicke, Falk; Jäger, Ralf; Hoffmann, Wolfgang; Jordan, Rainer A; van den Berg, Neeltje

2016-09-01

Assessing the spatial distribution of oral morbidity-related demand and the workforce-related supply is relevant for planning dental services. We aimed to establish and validate a model for estimating the spatially specific demand and supply. This model was then applied to compare demand-supply ratios in 2001 and 2011 in the federal state of Mecklenburg-Vorpommern (Northern Germany). The spatial units were zip code areas. Demand per area was estimated by linking population-specific oral morbidities to working times via insurance claim data. Estimated demand was validated against the provided demand in 2001 and 2011. Supply was calculated for both years using cohort data from the dentist register. The ratio of demand and supply was geographically mapped and its distribution between areas assessed using the Gini coefficient. Between 2001 and 2011, a significant decrease of the general population (-7.0 percent), the annual demand (-13.1 percent), and the annual supply (-12.9 percent) was recorded. The estimated demands were nearly (2001: -4 percent) and completely (2011: ±0 percent) congruent with provided demands. The average demand-supply-ratio did not change significantly between 2001 and 2011 (P > 0.05), but was increasingly unequally distributed. In both years, few areas were over-serviced, while many were under-serviced. The established model can be used to estimate spatially specific demand and supply. © 2016 American Association of Public Health Dentistry.

The impact of family planning programs on unmet need and demand for contraception.

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Bongaarts, John

2014-06-01

Much of the existing literature on the demographic impact of family planning programs focuses on their role in increasing contraceptive use, which, in turn, accelerates fertility decline. What is not clear, however, is whether this effect operates solely through a reduction in unmet need brought about by eliminating obstacles to use or whether and to what extent the programs also affect demand for contraception through messages concerning the benefits of family planning. This article aims to shed additional light on this issue by analyzing data drawn from recent Demographic and Health Surveys conducted in 63 developing countries. The first section reviews general levels and trends in unmet need, demand, and use over the course of the fertility transition. The second section presents different types of evidence of program effects, including results from a controlled experiment and from country case studies. The evidence indicates a program impact on both unmet need and demand. © 2013 The Population Council, Inc.

Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey.

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Bobevski, I; Rosen, A; Meadows, G

2017-12-01

While epidemiological surveys worldwide have found a considerable proportion of people using mental health services not to have a diagnosis of a mental disorder, with possible implications of service overuse, other work has suggested that most people without a current diagnosis who used services exhibited other indicators of need. The aims of the present study were, using somewhat different categorisations than previous work, to investigate whether: (1) Australians without a diagnosis of a mental disorder who used mental health services had other indicators of need; and (2) how rate and frequency of service use in Australia related to level of need, then to discuss the findings in light of recent developments in Australian Mental Health Policy and other epidemiological and services research findings. Data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB) 2007 was analysed. Most people using mental health services had evident indicators of need for mental health care (MHC), and most of those with lower evident levels of need did not make heavy use of services. Only a small proportion of individuals without any disorders or need indicators received MHC (4%). Although this latter group comprises a fair proportion of service users when extrapolating to the Australian population (16%), the vast majority of these individuals only sought brief primary-care or counselling treatment rather than consultations with psychiatrists. Access and frequency of MHC consultations were highest for people with diagnosed lifetime disorders, followed by people with no diagnosed disorders but other need indicators, and least for people with no identified need indicators. Limitations include some disorders not assessed in interview and constraints based on survey size to investigate subgroups defined, for instance, by socioeconomic advantage and disadvantage individually or by characteristics of area. MHC for individuals with no recognised disorders or other

A systemic approach to understanding mental health and services.

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Cohen, Mark

2017-10-01

In the UK mental health and associated NHS services face considerable challenges. This paper aims to form an understanding both of the complexity of context in which services operate and the means by which services have sought to meet these challenges. Systemic principles as have been applied to public service organisations with reference to interpersonal relations, the wider social culture and its manifestation in service provision. The analysis suggests that the wider culture has shaped service demand and the approaches adopted by services resulting in a number of unintended consequences, reinforcing loops, increased workload demands and the limited value of services. The systemic modelling of this situation provides a necessary overview prior to future policy development. The paper concludes that mental health and attendant services requires a systemic understanding and a whole system approach to reform. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Urban women's socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: findings of a Canadian cross-sectional survey.

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Kurtz Landy, Christine; Sword, Wendy; Ciliska, Donna

2008-10-03

Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED) postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA) postpartum women's health, health service needs and utilization patterns. Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000) who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use. When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01-2.18)], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35-0.67)], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64-4.4)]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47-3.40)]. Although SED women experienced poorer mental and overall health they reported similar health service needs and utilization patterns to more SEA women

Urban women's socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: findings of a Canadian cross-sectional survey

Directory of Open Access Journals (Sweden)

Ciliska Donna

2008-10-01

Full Text Available Abstract Background Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA postpartum women's health, health service needs and utilization patterns. Methods Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000 who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use. Results When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01–2.18], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35–0.67], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64–4.4]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47–3.40]. Conclusion Although SED women experienced poorer mental and overall health they reported similar

The education and training needs of health librarians - the generalist versus specialist dilemma.

Science.gov (United States)

Petrinic, Tatjana; Urquhart, Christine

2007-09-01

The aims of the study were to examine whether and how librarians with a generalist background can transfer to roles demanding more expert knowledge in the health sector. The objectives were (i) to compare the education and training needs of health librarians with science degrees with the education and training needs of health librarians with arts and humanities degrees; (ii) to compare the education and training needs of librarians working in the National Health Service (NHS) sector with the education and training needs of librarians working for the health sector but within higher education. Face-to-face interviews with 16 librarians, a convenience sample of librarians working in the Thames Valley NHS region. The main findings confirmed that structured continuing professional development (CPD) is required to meet the rapidly changing needs in the health sector. The emphasis ought to be on teaching skills, outreach work, marketing and promotion, research skills and methods, subject knowledge and terminology, and management skills. Library school curricula do not appear to meet the demands of medical library posts. A first degree in scientific subjects is advantageous in the early stages of a career but diminishes with continuing training and experience. There is no evidence of a significant difference in training needs and provision between the librarians in NHS posts as opposed to those in higher education (HE) posts. The conclusions suggest that library schools need to update their programmes to include teaching skills, advanced search skills, project management skills, research methods, with more practical exercises. Particular attention should be given to librarians with a first degree in non-scientific subjects in terms of time allocated for CPD, quality of training and access to reliable mentorship.

Assessing the health, functional characteristics, and health needs of youth attending a noncategorical transition support program.

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Woodward, Jason F; Swigonski, Nancy L; Ciccarelli, Mary R

2012-09-01

To assess the health, functional characteristics, and health care service needs of youth and young adults with special health care needs attending a comprehensive, noncategorical transition program. A self-administered survey was developed from national health surveys and clinical experience to assess concepts identified as important for successful transition to adulthood. Surveys were mailed to 198 parents of youth and young adults with special health care needs attending the transition clinic. Parents were asked about the youth's health, functional status, and health care services needed. The clinical database provided demographic and patient health characteristics. Results were compared against the 2005-2006 National Survey of Children with Special Health Care Needs. Forty-four percent of surveys were returned. Average age of youth was 17.5 (11-22) years old and diagnoses included cerebral palsy (36%), spina bifida (10%), developmental delay or Down syndrome (17%), and autism (6%). Most youth needed assistance with personal care (69%) and routine needs (91%) and used assistive devices (59%). Compared with the 2005-2006 National Survey of Children with Special Health Care Needs, parents reported higher needs for all services except mental health care and tobacco or substance use counseling. Forty three percent reported at least one unmet health need. Few parents reported the need for counseling on substance use (1%), sexual health screening (16%), nutrition (34%), and exercise (41%). Youth attending our transition program had more functional limitations, poorer reported health status, different diagnosis distribution, and higher levels of needed health services. Few parents identified needs for other recommended adolescent preventive services. Transition programs should assess patient health characteristics and service needs to design effective patient-centered services. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All

Unmet needs for comprehensive services in outpatient addiction treatment.

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Pringle, Janice L; Emptage, Nicholas P; Hubbard, Robert L

2006-04-01

Many addiction treatment patients suffer from health and psychosocial problems in addition to substance misuse at the time of their treatment entry. Outpatient treatment programs have attempted to address these problems by providing or facilitating access to comprehensive health and social services. Nevertheless, previous research have suggested high levels of unmet needs for these services in the addiction treatment population. Using data from a large study on community-based outpatient addiction treatment, this article provides additional information on levels of unmet service needs and the relationship between need and receipt of services during treatment. Our results suggest extremely high levels of unmet needs for a wide variety of health and psychosocial services. Specifically, the data suggest that unmet service needs may be far more prevalent than previous estimates and that addiction treatment populations in rural areas may be particularly disadvantaged.

Estimating oxygen needs for childhood pneumonia in developing country health systems: a new model for expecting the unexpected.

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Beverly D Bradley

Full Text Available Planning for the reliable and cost-effective supply of a health service commodity such as medical oxygen requires an understanding of the dynamic need or 'demand' for the commodity over time. In developing country health systems, however, collecting longitudinal clinical data for forecasting purposes is very difficult. Furthermore, approaches to estimating demand for supplies based on annual averages can underestimate demand some of the time by missing temporal variability.A discrete event simulation model was developed to estimate variable demand for a health service commodity using the important example of medical oxygen for childhood pneumonia. The model is based on five key factors affecting oxygen demand: annual pneumonia admission rate, hypoxaemia prevalence, degree of seasonality, treatment duration, and oxygen flow rate. These parameters were varied over a wide range of values to generate simulation results for different settings. Total oxygen volume, peak patient load, and hours spent above average-based demand estimates were computed for both low and high seasons.Oxygen demand estimates based on annual average values of demand factors can often severely underestimate actual demand. For scenarios with high hypoxaemia prevalence and degree of seasonality, demand can exceed average levels up to 68% of the time. Even for typical scenarios, demand may exceed three times the average level for several hours per day. Peak patient load is sensitive to hypoxaemia prevalence, whereas time spent at such peak loads is strongly influenced by degree of seasonality.A theoretical study is presented whereby a simulation approach to estimating oxygen demand is used to better capture temporal variability compared to standard average-based approaches. This approach provides better grounds for health service planning, including decision-making around technologies for oxygen delivery. Beyond oxygen, this approach is widely applicable to other areas of

'Demand pull' government policies to support Product-Service System activity: The case of Energy Service Companies in the UK

OpenAIRE

Hannon, MJ; Foxon, TJ; Gale, WF

2015-01-01

Product-Service Systems (PSSs) constitute a family of service-based business models designed to satisfy our societal needs in an economically and environmentally sustainable manner. To date however PSS application has remained niche due to a variety of critical barriers. This paper explores how ‘demand pull’ national government policies could support PSS activity by addressing these barriers and cultivating market demand. Lessons are drawn from a case study of how regulatory, economic incenti...

People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review

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Louisa Chou

2018-04-01

Full Text Available Question: What needs of non-biomedical services are perceived by people with low back pain? Design: Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016. Participants: Adults with low back pain of any duration. Data extraction and analysis: Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need. Results: Twenty studies (19 qualitative and one quantitative involving 522 unique participants (total pool of 590 were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help. Conclusion: People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini

Health resources in a 200,000 urban Indian population argues the need for a policy on private sector health services.

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Furtado, Kheya Melo; Kar, Anita

2014-04-01

There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals.

Supply and demand in physician markets: a panel data analysis of GP services in Australia.

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McRae, Ian; Butler, James R G

2014-09-01

To understand the trends in any physician services market it is necessary to understand the nature of both supply and demand, but few studies have jointly examined supply and demand in these markets. This study uses aggregate panel data on general practitioner (GP) services at the Statistical Local Area level in Australia spanning eight years to estimate supply and demand equations for GP services. The structural equations of the model are estimated separately using population-weighted fixed effects panel modelling with the two stage least squares formulation of the generalised method of moments approach (GMM (2SLS)). The estimated price elasticity of demand of [Formula: see text] is comparable with other studies. The direct impact of GP density on demand, while significant, proves almost immaterial in the context of near vertical supply curves. Supply changes are therefore due to shifts in the position of the curves, partly determined by a time trend. The model is validated by comparing post-panel model predictions with actual market outcomes over a period of three years and is found to provide surprisingly accurate projections over a period of significant policy change. The study confirms the need to jointly consider supply and demand in exploring the behaviour of physician services markets.

Position of the American Dietetic Association: Providing nutrition services for people with developmental disabilities and special health care needs.

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Van Riper, Cynthia L; Wallace, Lee Shelly

2010-02-01

It is the position of the American Dietetic Association that nutrition services provided by registered dietitians (RDs) and dietetic technicians, registered (DTRs), are essential components of comprehensive care for all people with developmental disabilities and special health care needs. Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community-based, and culturally competent. People with developmental disabilities and special health care needs frequently have nutrition concerns, including growth alterations (failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, medication-nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Individuals with special needs are also more likely to develop comorbid conditions such as obesity or endocrine disorders that require nutrition interventions. Poor health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Health maintenance and avoidance of complications can be promoted by timely and cost-effective nutrition interventions. Public policy for individuals with special needs has evolved over time, resulting in a transition from institutional facilities and programs to community living. The expansion of public access to technology and health information on the Internet challenges RDs and DTRs to provide accurate scientific information for those with developmental disabilities and special health care needs. Nationally credentialed RDs and DTRs are best prepared to provide appropriate nutrition information for wellness and quality of life.

Electronic Health Records Prospects in Egypt: A Demand-Side Perspective

OpenAIRE

Badran; Mona Farid

2017-01-01

The present study sheds light on the expected factors that would impact the Electronic Health Records (EHR) service in Egypt from the demand-side perspective, i.e. the health care consumer. This empirical study is motivated by the widespread use of EHR as a method of promoting health services globally, where it is considered as an efficiency enhancing, cost effective technology. Moreover, the healthcare sector in Egypt is gaining momentum, especially that the comprehensive healthcare and soci...

Meeting the Oral Health Needs of Immigrants: National Public Health Services Vs. Charitable Volunteer Services In Rome, Italy

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Denise Corridore

2012-03-01

Full Text Available

Abstract:
Background: oral health is an important aspect of well-being. In Italy immigrants can have different access to health care services, and can opt for the national Health Service (nHS and/ or private non- profit health care organizations. The purpose of this study was to develop an instrument to evaluate oral health in the immigrant population of rome and to investigate the differences between two different types of ser- vices: the First observation unit at the department of oral and Maxillo Facial Sciences, at the "Sapienza" university of rome (a nHS affiliate, and a charitable organization, the caritas dental center (cdc.
Methods: a multiple-choice questionnaire was administered between the last trimester of 2006 and the first trimester of 2007. a chi square analysis was performed and the level of significance was set at p<0.05. reSulTS: The sample was composed of 250 people, of which 100 were patients of the cdc and 150 were patients of the nHS. The percentage of non-Italians was 80% (n=80 in the cdc sample, and only 16% (n=25 in the nHS sample. In the cdc, definitive resolving therapies, such as tooth extractions, prevailed (60% v’s 47% nHS; p=0.033. In addition, the frequency of consumption of sugary foods and drinks was significantly higher among cdc patients (31% reported to consume these over 9 times a day compared to nHS patients (11% reporting this consumption.
Discussion: the study shows a substantial under using of the national Health Service for oral health care needs by the immigrant population. The particular composition of the sample, with a high prevalence being of romanian nationality, might reflect specific conditions of this nationality. The results showed that immigrants were satisfied with the health care even though they encountered difficulties in terms of level of communication.

Comparative Analysis of Health Care Needs among Children with Special Health Care Needs in Ohio's Metropolitan and Appalachian Counties.

Science.gov (United States)

Earley, Elizabeth; Asti, Lindsey; Chisolm, Deena

2015-08-01

The study assessed whether children with special health care needs (CSHCN) living in Appalachian Ohio have differential health care utilization, unmet needs, and health outcomes compared with CSHCN in Ohio's metropolitan counties using a statewide Ohio survey. Based on this survey, an estimated 28% of children in Appalachian Ohio counties have special health care needs compared with 25% of children in metropolitan counties. In Appalachia, CSHCN are poorer and more likely to have Medicaid than their metropolitan counterparts, but had no reported significant differences in health outcomes or unmet needs. Data suggested a trend toward higher use of emergency department care and inpatient services and lower use of well-child visits but these differences did not reach significance. We conclude that CSHCN in Appalachian and metropolitan areas face similar levels of health status and unmet needs but results suggest a need for additional research on access to primary care services.

The state of the psychology health service provider workforce.

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Michalski, Daniel S; Kohout, Jessica L

2011-12-01

Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of the PsyD degree and the formalization of the predoctoral internship placement system (the APPIC Match) have been well noted, but efforts to gain a complete understanding of professional practice are lacking. Specifically, piecemeal research on the provider workforce has led to the study of specific subpopulations using varying approaches and definitions of those providing direct clinical service. Consequently, estimates of the supply and need for health service providers are distinctly divergent and generate protracted debate in organized psychology. The APA membership directory and the APA Doctorate Employment Surveys have traditionally been relied on for workforce analyses. Yet, these data have become characterized by limited generalizability in recent years because of declining survey response rates and the fact that APA member data may not be as representative of the entire psychology health service provider population as they were previously. The 2008 APA Survey of Psychology Health Service Providers targeted these limitations by including nonmember psychologists in the sampling frame. Results revealed emerging themes in the demographics, work settings, and delivery of health services of the psychology health service provider workforce. Future areas of research for APA and organized psychology to undertake in addressing need and demand are suggested. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

[Actual conditions of occupational health activities in small-scale enterprises in Japan: system for occupational health, health management and demands by small-scale enterprises].

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Hirata, M; Kumagai, S; Tabuchi, T; Tainaka, H; Andoh, K; Oda, H

1999-11-01

In order to clarify the real conditions of occupational health services (OHS) in small-scale enterprises (SSEs) in Japan, we analyzed questionnaires recovered from 765 SSEs in the area of a city neighboring Osaka City (recovery rate, 69.3%). The SSEs included 358 SSEs with 1 to 4 workers (46.8% of total SSEs), 203 with 5 to 9 (26.5%), 163 with 10 to 29 (21.3%) and 41 with 30 to 49 (5.4%). The main types of businesses were manufacturing (374, 48.9% of total SSEs), wholesale/retail trade/restaurants (153, 20.0%), community, social and personal services (132, 17.3%) and construction (72, 9.4%). Health examinations were performed in 47.7% of SSEs. The reason for the lack of examinations were "shortage of time" (33.3% of SSEs lacking health examination) and "employees do not want to be examined" (28.1%). Some health promotion measures were conducted in 29.2% of SSEs. Health examination (59.0% of SSEs), health promotion (36.5%), measure of mental health (25.9%) and information service for employers and employees (25.5%) were demanded by SSEs as OHS. Financial subsidies and economical incentives were demanded by 46.4% and 28.8% of SSEs, respectively. Regional occupational health center in this area was poorly known among SSEs (8.2%), but health examination (48.4%), information service (37.5%), assessment of work method and advice to improve (19.8%) and environment measurement (12.4%) are demanded of the center by SSEs.

Adult mental health needs and expenditure in Australia.

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Burgess, Philip; Pirkis, Jane; Buckingham, Bill; Burns, Jane; Eagar, Kathy; Eckstein, Gary

2004-06-01

Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

42 CFR 84.163 - Man test for gases and vapors; Type C supplied-air respirators, demand and pressure-demand...

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Man test for gases and vapors; Type C supplied-air respirators, demand and pressure-demand classes; test requirements. 84.163 Section 84.163 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF...

The MacGyver effect: alive and well in health services research?

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Moriarty Helen J

2011-09-01

Full Text Available Abstract Background In a manner similar to the television action hero MacGyver, health services researchers need to respond to the pressure of unpredictable demands and constrained time frames. The results are often both innovative and functional, with the creation of outputs that could not have been anticipated in the initial planning and design of the research. Discussion In the conduct of health services research many challenges to robust research processes are generated as a result of the interface between academic research, health policy and implementation agendas. Within a complex and rapidly evolving environment the task of the health services researcher is, therefore, to juggle sometimes contradictory pressures to produce valid results. Summary This paper identifies the MacGyver-type dilemmas which arise in health services research, wherein innovation may be called for, to maintain the intended scientific method and rigour. These 'MacGyver drivers' are framed as opposing issues from the perspective of both academic and public policy communities. The ideas expressed in this paper are illustrated by four examples from research projects positioned at the interface between public policy strategy and academia.

A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.

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Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Mustafa, Ghulam; Abbas, Ghazanfer; Ishaque, Muhammad; Bilgrami, Mohsina; Temmerman, Marleen

2014-05-30

High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.

Driving demand for broadband networks and services

CERN Document Server

Katz, Raul L

2014-01-01

This book examines the reasons why various groups around the world choose not to adopt broadband services and evaluates strategies to stimulate the demand that will lead to increased broadband use. It introduces readers to the benefits of higher adoption rates while examining the progress that developed and emerging countries have made in stimulating broadband demand. By relying on concepts such as a supply and demand gap, broadband price elasticity, and demand promotion, this book explains differences between the fixed and mobile broadband demand gap, introducing the notions of substitution and complementarity between both platforms. Building on these concepts, ‘Driving Demand for Broadband Networks and Services’ offers a set of best practices and recommendations aimed at promoting broadband demand.  The broadband demand gap is defined as individuals and households that could buy a broadband subscription because they live in areas served by telecommunications carriers but do not do so because of either ...

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

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Meaney Christopher

2011-08-01

Full Text Available Abstract Background Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Methods Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS during our study interval (2003-2005 are obtained from the National Ambulatory Care Reporting System (NACRS. Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS which provides individual level medical, socio-demographic, psychological and behavioral information for

Modeling factors influencing the demand for emergency department services in Ontario: a comparison of methods.

Science.gov (United States)

Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry

2011-08-19

Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency

Measuring unmet obstetric need at district level: how an epidemiological tool can affect health service organization and delivery.

Science.gov (United States)

Guindo, Gabriel; Dubourg, Dominique; Marchal, Bruno; Blaise, Pierre; De Brouwere, Vincent

2004-10-01

A national retrospective survey on the unmet need for major obstetric surgery using the Unmet Obstetric Need Approach was carried out in Mali in 1999. In Koutiala, the district health team decided to carry on the monitoring of the met need for several years in order to assess their progress over time. The first prospective study, for 1999, estimated that more than 100 women in need of obstetric care never reached the hospital and probably died as a consequence. This surprising result shocked the district health team and the resulting increased awareness of service deficits triggered operational measures to tackle the problem. The Unmet Obstetric Need study in Koutiala district was implemented without financial support and only limited external technical back-up. The appropriation of the study by the district team for solving local problems of access to obstetric care may have contributed to the success of the experience. Used as a health service management tool, the study and its results started a dialogue between the hospital staff and both health centre staff and community representatives. This had not only the effect of triggering consideration of coverage, but also of quality of obstetric care. Copyright 2004 Oxford University Press

Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.

Science.gov (United States)

Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee

2006-01-01

The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

Level of health care and services in a tertiary health setting in Nigeria

African Journals Online (AJOL)

Level of health care and services in a tertiary health setting in Nigeria. ... Background: There is a growing awareness and demand for quality health care across the world; hence the ... Doctors and nurses formed 64.3% of the study population.

Work environment and health promotion needs among personnel in the faculty of medicine, Thammasat university.

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Buranatrevedh, Surasak

2013-04-01

Work environment and health promotion needs are important factors for quality of life of workers. Study occupational health and safety hazards and control measures as well as health status and health promotion needs among personnel in Faculty of Medicine, Thammasat University. This was a cross sectional study. Questionnaires were designed to collect demographic data, health status, health promotion needs, occupational health and safety hazards, and job demand/control data. Questionnaires were sent out to 181 personnel and 145 were returned filled-out (80.1%). Among them, 42.8% had physical illness or stress, 68.3% had debt problem, 20% had some problems with coworker or work environment, 65.5% had a high workload, and 64.1% felt they did not get enough work benefits. Job demand and control factors included attention from leaders, fast-pace work, relationship among coworkers, repetitive work, hard work, high stress work, and high workload The occupational safety and health system included training to use new equipment, supervisor training, work skill training, work in sitting position for long period of time, appropriate periodic health exam, appropriate medical service, proper canteen, proper salary raise, and facilities for health promotion. In the occupational health hazards, employees were working in low temperature, bright light, and had a lack of health promotion programs. Requested programs to improve quality of life were Thai traditional massage, workplace improvement, health promotion, one-day travel, and Friday's happy and healthy program. Results from the present study can be used to improve workplace environment and health of personnel in the Faculty of Medicine, Thammasat University.

Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

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Dunn, Abe

2016-07-01

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. Published by Elsevier B.V.

Health services needs of older persons: emerging findings from Tarakan City, East Kalimantan

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Rina K. Kusumaratna

2011-12-01

Full Text Available As older persons are steadily increasing in number and there are no specialized comprehensive healthcare services for older persons in Indonesia, including East Kalimantan, the aim of the present study was to determine the extent of the problems facing healthcare staff and officials in Tarakan City, East Kalimantan, in providing comprehensive healthcare services attuned to the needs of older persons.This study was a qualitative interview-based survey with focus group discussions, involving heads and healthcare officials of seven puskesmas in Tarakan City, East Kalimantan district, with the addition of a number of district health planning officials. The results revealed a difference between daily hospital referral rate of older persons by puskesmas staff and actual daily hospital admission rate for the referrals. None of the consulted healthcare staff had any speciality education in geriatrics or older persons health. The older persons most frequently presented to the hospital with hypertension, diabetes, and myocardial insufficiency. On the other hand, at the health centers the presenting conditions were hypertension, gastroenteritis, rheumatism, sleep disorders, and upper respiratory tract infections. Improved access to healthcare for older persons should be achieved by improving knowledge and skills of human resources, including communication skills, and of supporting healthcare service infrastructure at puskesmas, specifically oriented towards the needs of and designed for use by older persons, such as ramps for wheelchairs, and handrails in corridors. Local governments should strengthen the appropriate service delivery to older persons, and provide support for the maintenance, sustainability and strengthening of community-based care for older persons.

Health service needs of older persons: emerging findings from Tarakan City, East Kalimantan

Directory of Open Access Journals (Sweden)

Rina K. Kusumaratna

2016-02-01

Full Text Available As older persons are steadily increasing in number and there are no specialized comprehensive healthcare services for older persons in Indonesia, including East Kalimantan, the aim of the present study was to determine the extent of the problems facing healthcare staff and officials in Tarakan City, East Kalimantan, in providing comprehensive healthcare services attuned to the needs of older persons.This study was a qualitative interview-based survey with focus group discussions, involving heads and healthcare officials of seven puskesmas in Tarakan City, East Kalimantan district, with the addition of a number of district health planning officials. The results revealed a difference between daily hospital referral rate of older persons by puskesmas staff and actual daily hospital admission rate for the referrals. None of the consulted healthcare staff had any speciality education in geriatrics or older persons health. The older persons most frequently presented to the hospital with hypertension, diabetes, and myocardial insufficiency. On the other hand, at the health centers the presenting conditions were hypertension, gastroenteritis, rheumatism, sleep disorders, and upper respiratory tract infections. Improved access to healthcare for older persons should be achieved by improving knowledge and skills of human resources, including communication skills, and of supporting healthcare service infrastructure at puskesmas, specifically oriented towards the needs of and designed for use by older persons, such as ramps for wheelchairs, and handrails in corridors. Local governments should strengthen the appropriate service delivery to older persons, and provide support for the maintenance, sustainability and strengthening of community-based care for older persons.

Local health departments and specific maternal and child health expenditures: relationships between spending and need.

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Bekemeier, Betty; Dunbar, Matthew; Bryan, Matthew; Morris, Michael E

2012-11-01

As a part of the Public Health Activities and Service Tracking study and in collaboration with partners in 2 Public Health Practice-Based Research Network states, we examined relationships between local health department (LHD) maternal and child health (MCH) expenditures and local needs. We used a multivariate pooled time-series design to estimate ecologic associations between expenditures in 3 MCH-specific service areas and related measures of need from 2005 to 2010 while controlling for other factors. Retrospective expenditure data from LHDs and for 3 MCH services represented annual investments in (1) Special Supplemental Nutrition for Women, Infants, and Children (WIC), (2) family planning, and (3) a composite of Maternal, Infant, Child, and Adolescent (MICA) service. Expenditure data from all LHDs in Florida and Washington were then combined with "need" and control variables. Our sample consisted of the 102 LHDs in Florida and Washington and the county (or multicounty) jurisdictions they serve. Expenditures for WIC and for our composite of MICA services were strongly associated with need among LHDs in the sample states. For WIC, this association was positive, and for MICA services, this association was negative. Family planning expenditures were weakly associated, in a positive direction. Findings demonstrate wide variations across programs and LHDs in relation to need and may underscore differences in how programs are funded. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less needs-based funding allocations.

Real-time appraisal of the spatially distributed heat related health risk and energy demand of cities

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Keramitsoglou, Iphigenia; Kiranoudis, Chris T.; Sismanidis, Panagiotis

2016-08-01

The Urban Heat Island (UHI) is an adverse environmental effect of urbanization that increases the energy demand of cities, impacts the human health, and intensifies and prolongs heatwave events. To facilitate the study of UHIs the Institute for Astronomy, Astrophysics, Space Applications and Remote Sensing of the National Observatory of Athens (IAASARS/NOA) has developed an operational real-time system that exploits remote sensing image data from Meteosat Second Generation - Spinning Enhanced Visible and Infrared Imager (MSG-SEVIRI) and generates high spatiotemporal land surface temperature (LST) and 2 m air temperature (TA) time series. These datasets form the basis for the generation of higher value products and services related to energy demand and heat-related health issues. These products are the heatwave hazard (HZ); the HUMIDEX (i.e. an index that describes the temperature felt by an individual exposed to heat and humidity); and the cooling degrees (CD; i.e. a measure that reflects the energy needed to cool a building). The spatiotemporal characteristics of HZ, HUMIDEX and CD are unique (1 km/5 min) and enable the appraisal of the spatially distributed heat related health risk and energy demand of cities. In this paper, the real time generation of the high spatiotemporal HZ, HUMIDEX and CD products is discussed. In addition, a case study corresponding to Athens' September 2015 heatwave is presented so as to demonstrate their capabilities. The overall aim of the system is to provide high quality data to several different end users, such as health responders, and energy suppliers. The urban thermal monitoring web service is available at http://snf-652558.vm.okeanos.grnet.gr/treasure/portal/info.html.

Identifying the clinical needs and patterns of health service use of adolescent girls and women with autism spectrum disorder.

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Tint, Ami; Weiss, Jonathan A; Lunsky, Yona

2017-09-01

Girls and women in the general population present with a distinct profile of clinical needs and use more associated health services compared to boys and men; however, research focused on health service use patterns among girls and women with Autism Spectrum Disorder (ASD) is limited. In the current study, caregivers of 61 adolescent girls and women with ASD and 223 boys and men with ASD completed an online survey. Descriptive analyses were conducted to better understand the clinical needs and associated service use patterns of girls and women with ASD. Sex/gender comparisons were made of individuals' clinical needs and service use. Adolescent girls and women with ASD had prevalent co-occurring mental and physical conditions and parents reported elevated levels of caregiver strain. Multiple service use was common across age groups, particularly among adolescent girls and women with intellectual disability. Overall, few sex/gender differences emerged, although a significantly greater proportion of girls and women accessed psychiatry and emergency department services as compared to boys and men. Though the current study is limited by its use of parent report and small sample size, it suggests that girls and women with ASD may share many of the same high clinical needs and patterns of services use as boys and men with ASD. Areas for future research are discussed to help ensure appropriate support is provided to this understudied population. Autism Res 2017, 10: 1558-1566. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service Use.

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Caicedo, Carmen

This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

College Health: Health Services and Common Health Problems

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... Many colleges also have a counseling center which students should go to for mental health concerns. How can I get seen at the ... services that I need? The staff at your student health center will know ... gynecologists, and mental health clinicians in the community in case you ...

Levels and trends in contraceptive prevalence, unmet need, and demand for family planning for 29 states and union territories in India: a modelling study using the Family Planning Estimation Tool.

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New, Jin Rou; Cahill, Niamh; Stover, John; Gupta, Yogender Pal; Alkema, Leontine

2017-03-01

Improving access to reproductive health services and commodities is central to development. Efforts to assess progress on this front have been largely focused on national estimates, but such analyses can mask local disparities. We assessed progress in reproductive health services subnationally in India. We developed a statistical model to generate estimates and projections of levels and trends in family planning indicators for subpopulations. The model builds onto the UN Population Division's Family Planning Estimation Model and uses data from multiple rounds of the Demographic and Health Survey, the District Level Household & Facility Survey, and the Annual Health Survey. We present annual estimates and projections of levels and trends in the prevalence of modern contraceptive use, and unmet need and demand for family planning for 29 states and union territories in India from 1990 to 2030. We also compared projections of demand satisfied with modern methods with the proposed goal of 75%. There is a large amount of heterogeneity in India, with a difference of up to 55·1 percentage points (95% uncertainty interval 46·4-62·1) in modern contraceptive use in 2015 between subregions. States such as Andhra Pradesh, with 92·7% (90·9-94·2) demand satisfied with modern methods, are performing well above the national average (71·8%, 56·7-83·6), whereas Manipur, with 26·8% (16·7-38·5) of demand satisfied, and Meghalaya, with 45·0% (40·1-50·0), consistently lag behind the rest of the country. Manipur and Meghalaya require the highest percentage increase in modern contraceptive use to achieve 75% demand satisfied with modern methods by 2030. In terms of absolute numbers, Uttar Pradesh requires the greatest increase, needing 9·2 million (5·5-12·6 million) additional users of modern contraception by 2030 to meet the target of 75%. The demand for family planning among the states and union territories in India is highly diverse. Greatest attention is needed in

Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania

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Marion W. Jenkins

2015-02-01

Full Text Available Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, attitudes, behavior, trends and rates of safe/unsafe emptying, and measure demand for a new hygienic latrine emptying service in unplanned communities in Dar Es Salaam (Dar, Tanzania, using data from a cross-sectional survey at 662 residential properties in 35 unplanned sub-wards across Dar, where 97% had pit latrines. A picture emerges of expensive and poor FSM service options for latrine owners, resulting in widespread fecal sludge exposure that is likely to increase unless addressed. Households delay emptying as long as possible, use full pits beyond what is safe, face high costs even for unhygienic emptying, and resort to unsafe practices like ‘flooding out’. We measured strong interest in and willingness to pay (WTP for the new pit emptying service at 96% of residences; 57% were WTP ≥U.S. $17 to remove ≥200 L of sludge. Emerging policy recommendations for safe FSM in unplanned urban communities in Dar and elsewhere are discussed.

Meeting health and psychological needs of women in drug treatment court.

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Morse, Diane S; Cerulli, Catherine; Bedell, Precious; Wilson, John L; Thomas, Katherine; Mittal, Mona; Lamberti, J Steven; Williams, Geoffrey; Silverstein, Jennifer; Mukherjee, Aninda; Walck, Donna; Chin, Nancy

2014-02-01

We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: (1) intrapersonal challenges participants termed an "evil cycle" of relapse, recidivism, trauma, and life challenges; (2) interpersonal context of parenting and stigma involving features of this "evil cycle"; (3) institutions with logistical barriers to legal and medical assistance; (4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model. © 2013.

Quality and Health Literacy Demand of Online Heart Failure Information.

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Cajita, Maan Isabella; Rodney, Tamar; Xu, Jingzhi; Hladek, Melissa; Han, Hae-Ra

The ubiquity of the Internet is changing the way people obtain their health information. Although there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown. The purpose of this study is to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online. Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure Web sites. Two independent raters then assessed the quality and health literacy demand of the included Web sites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using 7 established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials. A total of 46 Web sites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2%. Finally, the overall mean actionability score was 34.7% ± 28.7%. The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality but also the health literacy demand of the information found in their Web sites. This is especially important considering that low health literacy is likely prevalent among the usual audience.

Future Supply and Demand for Oncologists : Challenges to Assuring Access to Oncology Services

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Erikson, Clese; Salsberg, Edward; Forte, Gaetano; Bruinooge, Suanna; Goldstein, Michael

2007-01-01

include any alterations based on changes in practice patterns, service use, or cancer treatments. Various alternate scenarios were also developed to show how supply and demand might change under different assumptions. Conclusions ASCO, policy makers, and the public have major challenges ahead of them to forestall likely shortages in the capacity to meet future demand for oncology services. A multifaceted strategy will be needed to ensure that Americans have access to oncology services in 2020, as no single action will fill the likely gap between supply and demand. Among the options to consider are increasing the number of oncology fellowship positions, increasing use of nonphysician clinicians, increasing the role of primary care physicians in the care of patients in remission, and redesigning service delivery. PMID:20859376

Mental Health Service Use in Schools and Non-School-Based Outpatient Settings: Comparing Predictors of Service Use.

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Langer, David A; Wood, Jeffrey J; Wood, Patricia A; Garland, Ann F; Landsverk, John; Hough, Richard L

2015-09-01

Researchers have consistently documented a gap between the large number of US youth meeting criteria for a mental health disorder with significant associated impairment, and the comparatively few youth receiving services. School-based mental health care may address the need-services gap by offering services more equitably to youth in need, irrespective of family economic resources, availability of transportation, and other factors that can impede access to community clinics. However, diagnoses alone do not fully capture the severity of an individual's mental health status and need for services. Studying service use only in relation to diagnoses may restrict our understanding of the degree to which service use is reflective of service need, and inhibit our ability to compare school and non-school-based outpatient settings on their responsiveness to service need. The present study evaluated predictors of mental health service use in school- and community-based settings for youth who had had an active case in one of two public sectors of care, comparing empirically-derived dimensional measurements of youth mental health service need and impairment ratings against non-need variables (e.g., ethnicity, income). Three dimensions of youth mental health service need were identified. Mental health service need and non-need variables each played a significant predictive role. Parent-rated impairment was the strongest need-based predictor of service use across settings. The impact of non-need variables varied by service setting, with parental income having a particularly noticeable effect on school-based services. Across time, preceding service use and impairment each significantly predicted future service use.

A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan

Science.gov (United States)

2014-01-01

Background High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. Methods/Design This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as ‘Suraj’ (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. Discussion The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group. PMID:24885657

Implementation and integration of regional health care data networks in the Hellenic National Health Service.

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Lampsas, Petros; Vidalis, Ioannis; Papanikolaou, Christos; Vagelatos, Aristides

2002-12-01

Modern health care is provided with close cooperation among many different institutions and professionals, using their specialized expertise in a common effort to deliver best-quality and, at the same time, cost-effective services. Within this context of the growing need for information exchange, the demand for realization of data networks interconnecting various health care institutions at a regional level, as well as a national level, has become a practical necessity. To present the technical solution that is under consideration for implementing and interconnecting regional health care data networks in the Hellenic National Health System. The most critical requirements for deploying such a regional health care data network were identified as: fast implementation, security, quality of service, availability, performance, and technical support. The solution proposed is the use of proper virtual private network technologies for implementing functionally-interconnected regional health care data networks. The regional health care data network is considered to be a critical infrastructure for further development and penetration of information and communication technologies in the Hellenic National Health System. Therefore, a technical approach was planned, in order to have a fast cost-effective implementation, conforming to certain specifications.

The Relationship between Patient, Parent and Orthodontic Treatment Need and Demand in 17-Year-Old Studentsresiding in Abade/Iran

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T. Hosseinzadeh Nik

2007-09-01

Full Text Available Objective: The planning of orthodontic treatment within a public health system requires information on the orthodontic treatment needs of the population. The aims of this study were to assess the student, parent and clinician normative need and demand for orthodon-tic treatment in a sample of Iranian students using the IOTN and to compare the treatment need levels according to sex and socio-economic status of the students and parents in ur-ban and rural areas.Material and Methods: A sample of 427, 17-year-old students was selected randomly from schools in Abade. A questionnaire of family socioeconomic status was proposed to the parents. All the students were examined according to the Aesthetic and Dental Health components (AC and DHC of Index of Orthodontic Treatment Need. Students' and par-ents' perceived need was also assessed using AC.Results: According to DHC classification, 18.7% of the students were in the "no need";35.6% in the "border line" and 45.7% in the "definite need" groups. The same categories for students assessed by the dentist were 66%, 30.2% and 3.7% respectively. AC assess-ment by students and parents entitled even more studentsin "no need" category. Sex and family income were the major factors in predicting orthodontic treatment demand (P<0.05.Conclusion: Orthodontic demand was highly related to the AC score and this component is of more value in predicting students demand instead of DHC.

Main Determinants of Supplementary Health Insurance Demand: (Case of Iran)

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Motlagh, Soraya Nouraei; Gorji, Hassan Abolghasem; Mahdavi, Ghadir; Ghaderi, Hossein

2015-01-01

Introduction: In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance. Method: In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran. Results: In 2012, an overall 8.04% of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance. Conclusion: Since demand for supplementary medical insurance is hugely influenced by households’ economic status, policy-makers in the health sector should devise measures to improve households’ economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their

The association between income source and met need among community mental health service users in Ontario, Canada.

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Durbin, Anna; Bondy, Susan J; Durbin, Janet

2012-10-01

We examined income source and match between recommended and received care among users of community mental health services. We conducted a secondary analysis of needs-based planning data on adults in Ontario community mental health programs from 2000 to 2002. The outcome was whether clients were severely underserved (yes/no) based on the match between level of care recommended and received. A logistic regression model investigated if income source predicted this outcome. 13% of clients were severely underserved. Over 40% were on public assistance and they had a higher risk of being severely undeserved than the others. Men were at greater risk. One aim of mental health reform is to increase access to care for vulnerable individuals. The finding that among users of community mental health services, individuals with public assistance income support are most vulnerable to being severely underserved should be considered by service planners and providers.

Comparing Trauma Exposure, Mental Health Needs, and Service Utilization Across Clinical Samples of Refugee, Immigrant, and U.S.-Origin Children.

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Betancourt, Theresa S; Newnham, Elizabeth A; Birman, Dina; Lee, Robert; Ellis, B Heidi; Layne, Christopher M

2017-06-01

Most mental health services for trauma-exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee-origin, immigrant-origin, and U.S.-origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee-origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity-matched samples of immigrant-origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.-origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.-origin youth (p refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.  In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (ps ranging from .030 to refugee-origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning. Copyright © 2017 International Society for Traumatic Stress Studies.

Meeting community health worker needs for maternal health care service delivery using appropriate mobile technologies in Ethiopia.

Directory of Open Access Journals (Sweden)

Alex Little

Full Text Available BACKGROUND: Mobile health applications are complex interventions that essentially require changes to the behavior of health care professionals who will use them and changes to systems or processes in delivery of care. Our aim has been to meet the technical needs of Health Extension Workers (HEWs and midwives for maternal health using appropriate mobile technologies tools. METHODS: We have developed and evaluated a set of appropriate smartphone health applications using open source components, including a local language adapted data collection tool, health worker and manager user-friendly dashboard analytics and maternal-newborn protocols. This is an eighteen month follow-up of an ongoing observational research study in the northern of Ethiopia involving two districts, twenty HEWs, and twelve midwives. RESULTS: Most health workers rapidly learned how to use and became comfortable with the touch screen devices so only limited technical support was needed. Unrestricted use of smartphones generated a strong sense of ownership and empowerment among the health workers. Ownership of the phones was a strong motivator for the health workers, who recognised the value and usefulness of the devices, so took care to look after them. A low level of smartphones breakage (8.3%,3 from 36 and loss (2.7% were reported. Each health worker made an average of 160 mins of voice calls and downloaded 27Mb of data per month, however, we found very low usage of short message service (less than 3 per month. CONCLUSIONS: Although it is too early to show a direct link between mobile technologies and health outcomes, mobile technologies allow health managers to more quickly and reliably have access to data which can help identify where there issues in the service delivery. Achieving a strong sense of ownership and empowerment among health workers is a prerequisite for a successful introduction of any mobile health program.

The need for a dedicated public service helicopter design

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Morrison, R.

1984-01-01

The need to provide the necessary funding to research, design and contract the building of an advanced technology rotorcraft that will meet the mission demands of public service (fire, police, paramedics and rescue) operators is discussed. Noise and cost factors, the greatest objections on the part of many police and public adminstrators are addressed. The growth of helicopter utilization in public service is documented.

Customer service: the key to remaining competitive in managed care.

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Howard, J E

2000-01-01

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.

The self-perceived health needs of the rural elderly who live alone.

LENUS (Irish Health Repository)

O'Connor, M

1992-04-01

A randomised cross-sectional survey of Public Health Nurses (PHN) registers was carried out in two rural counties, Westmeath and Longford, Ireland. 200 elderly people living alone, consisting of 50 aged 65-74 years in each of the two counties and 50 aged > or = 75 years expressed their health needs in terms of physical, mental and social well-being. 50% lived in accommodation with inadequate bathroom facilities and only 38.9% were content with their current accommodation. 37.9% felt their finances were inadequate while 15.7% were unsure of their eligibility for different entitlements. 17.6% had personal experience of crime. 39.4% lacked a means of obtaining emergency help. The majority (61.7%) perceived themselves as enjoying excellent\\/good health. The unmet demand for services, other than transport, varied from 11.6% for laundry services to 0% for PHN visits. Transport services were judged inadequate by 51.5% of the study group. It is concluded that by analysing and cross-analysing in terms of variables used in this study, aspects of health care needs could be targetted for different subgroups within the elderly alone group. While not complete in themselves they would help in the targetting of scarce resources.

An assessment of market and policy barriers for demand response providing ancillary services in U.S. electricity markets

International Nuclear Information System (INIS)

Cappers, Peter; MacDonald, Jason; Goldman, Charles; Ma, Ookie

2013-01-01

An impact of increased variable renewable generation is the need for balancing authorities to procure more ancillary services. While demand response resources are technically capable of providing these services, current experience across the U.S. illustrates they are relatively minor players in most regions. Accessing demand response resources for ancillary services may require a number of changes to policies and common practices at multiple levels. Regional reliability councils must first define ancillary services such that demand response resources may provide them. Once the opportunity exists, balancing authorities define and promulgate rules that set the infrastructure investments and performance attributes of a resource wishing to provide such services. These rules also dictate expected revenue streams which reveal the cost effectiveness of these resources. The regulatory compact between utility and state regulators, along with other statutes and decisions by state policymakers, may impact the interest of demand response program providers to pursue these resources as ancillary service providers. This paper identifies within these broad categories specific market and policy barriers to demand response providing ancillary services in different wholesale and retail environments, with emphasis on smaller customers who must be aggregated through a program provider to meet minimum size requirements for wholesale transactions. - Highlights: • We identify barriers keeping demand response from providing ancillary services. • Institutional, financial and program provider business model barriers exist. • Product definitions and rules do not always accommodate demand response well. • Expected revenues are uncertain and may not exceed required investments costs. • Regulatory compact and state statutes limit opportunities for program providers

Job demands and resources and their associations with early retirement intentions through recovery need and work enjoyment

Directory of Open Access Journals (Sweden)

Bert Schreurs

2011-05-01

Research purpose: The objective of this study was to examine the mechanisms through which job characteristics associate with early retirement intention, using the Job Demands-Resources (JD-R model as a theoretical framework. Motivation of the study: Early retirement presents a threat to existing health and pension systems, and to organisational functioning. Therefore, it is important to examine how workrelated factors contribute to early retirement decisions. Research design, approach and method: Two parallel processes were theorised to shape early retirement intention: a health impairment process (i.e. job demands → recovery need → early retirement intention and a motivational process (i.e. job resources → work enjoyment → early retirement intention. Survey data were collected from a heterogeneous sample of 1812 older workers (age > 45. Structural equation modeling was used to test the hypotheses. Main findings: Job demands and job resources were both associated with work enjoyment, which was associated with early retirement intention. Recovery need did not add to the prediction of early retirement intention. Practical/managerial implications: To retain older workers, companies should promote work conditions and practices that keep older workers motivated. Good health may be a necessary condition for retaining older workers, but it does not appear to be a sufficient one. Contribution/value-add: The results suggest that – for early retirement intention – the motivational process is more prominent than the health impairment process.

Four methodologies to improve healthcare demand forecasting.

Science.gov (United States)

Côté, M J; Tucker, S L

2001-05-01

Forecasting demand for health services is an important step in managerial decision making for all healthcare organizations. This task, which often is assumed by financial managers, first requires the compilation and examination of historical information. Although many quantitative forecasting methods exist, four common methods of forecasting are percent adjustment, 12-month moving average, trendline, and seasonalized forecast. These four methods are all based upon the organization's recent historical demand. Healthcare financial managers who want to project demand for healthcare services in their facility should understand the advantages and disadvantages of each method and then select the method that will best meet the organization's needs.

[Use of health services by a population of 60-year olds and older in Mexico].

Science.gov (United States)

Borges-Yáñez, S A; Gómez-Dantés, H

1998-01-01

To describe the sociodemographic characteristics and determinants of health services utilization by the Mexican population of 60 years of age or more. Information obtained from the National Health Survey II (ENSA-II) allowed analysis of 4,628 elderly people. Prevalence of chronic diseases was analyzed and the determinants of individuals who had used the health services in the two weeks prior to the interview. The chronic diseases most frequently reported were: hypertension, diabetes and heart disease. The utilization and hospitalization rates of that age group were 11.4 and 5.5%, respectively. The services most frequently used were: the private physician, social security (IMSS, ISSSTE) welfare services (Ministry of Health--SSA- and IMSS-Solidaridad). Interestingly, 25 to 45% of social security insurance holders did not use the services, instead they consulted a private physician. The most important explanatory variables for health services utilization were: the perceived illness, not having worked for the previous week and being a social security insurance holder. Gender, area of residence and level of education were not significant in the explanation of health services utilization. This study demonstrates the need to strengthen preventive and support programs for the elderly population, since they only demand health services when they feel sick.

University of Global Health Equity’s Contribution to the Reduction of Education and Health Services Rationing

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Agnes Binagwaho

2017-08-01

Full Text Available The inadequate supply of health workers and demand-side barriers due to clinical practice that heeds too little attention to cultural context are serious obstacles to achieving universal health coverage and the fulfillment of the human rights to health, especially for the poor and vulnerable living in remote rural areas. A number of strategies have been deployed to increase both the supply of healthcare workers and the demand for healthcare services. However, more can be done to improve service delivery as well as mitigate the geographic inequalities that exist in this field. To contribute to overcoming these barriers and increasing access to health services, especially for the most vulnerable, Partners In Health (PIH, a US non-governmental organization specializing in equitable health service delivery, has created the University of Global Health Equity (UGHE in a remote rural district of Rwanda. The act of building this university in such a rural setting signals a commitment to create opportunities where there have traditionally been few. Furthermore, through its state-of-the-art educational approach in a rural setting and its focus on cultural competency, UGHE is contributing to progress in the quest for equitable access to quality health services.

Managing the impact of growing low-acuity demand on ambulance services

OpenAIRE

KATHRYN JEAN EASTWOOD

2018-01-01

Increasing demand for emergency ambulances places a substantial burden on ambulance services. Many cases are low-acuity, having no urgent clinical need for paramedic treatment. Ambulance Victoria implemented a secondary telephone triage services to divert low-acuity cases away from emergency ambulances to more appropriate care. This research found this ‘Referral Service’ has had a substantial impact upon emergency operations, referring over 70% of the cases it managed away from emergency am...

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

Science.gov (United States)

Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

Survey of mental health needs of Hamedanian people

Directory of Open Access Journals (Sweden)

farshid Shamsaei

2010-02-01

Full Text Available For all individuals, mental, physical and social health is vital strands of life that are closely interwoven and deeply interdependent. And mental health is crucial to the overall well-being of individuals, societies and countries. Objectives: The aim of this study is to identify the mental health needs of Hamedanian people. Materials and Methods: This was a descriptive cross-sectional study. The participants consist of 1300 persons who were selected by stratified sampling. A 30- item questionnaire was used to gather data from the samples. It consisted of three parts: A-demographic factors, B-questions related to mental health service delivery and C- questions related to mental health needs. Results: Results showed that the Hamedan city people believed that mental health services are inadequate, they did not access services near their home (76% and mass media educational programs about services was poor(34%. The expressed needs of people were: mental health education (72%, established mental health centers in schools (52. 8% and factories (50. 7% and expanding the comprehensive mental health centers in the city(57. 8%. Expanding the assurance services (85. 6%, modifying wrong beliefs and ideas about mental illness (42. 6%, and improving the mental health in society. Conclusion: Community based mental health services should to provide comprehensive and local cares and treatments. Services should be comprehensive in that they provide a range of facilities to meet the mental health needs of the population at large as well as of special groups, such as children, adolescents, women and elderly people.

Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review

Science.gov (United States)

Peterson, Lauren A.; Hatt, Laurel E.

2013-01-01

Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and

Customer premises services market demand assessment 1980 - 2000. Volume 1: Executive summary

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Gamble, R. B.; Saporta, L.; Heidenrich, G. A.

1983-01-01

Estimates of market demand for domestic civilian telecommunications services for the years 1980 to 2000 are provided. Overall demand, demand or satellite services, demand for satellite delivered Customer Premises Service (CPS), and demand for 30/20 GHz Customer Premises Services are covered. Emphasis is placed on the CPS market and demand is segmented by market, by service, by user class and by geographic region. Prices for competing services are discussed and the distribution of traffic with respect to distance is estimated. A nationwide traffic distribution model for CPS in terms of demand for CPS traffic and earth stations for each of the major SMSAs in the United States are provided.

Sexual and reproductive health services for young people in Kenya and Zambia : Providers attitudes and young peoples needs and experiences

OpenAIRE

Warenius, Linnéa

2008-01-01

Background: Unintended pregnancy, abortion and STI, including HIV are common sexual and reproductive health problems among young people in Kenya and Zambia. Yet, the reproductive health services are underutilised. Nurses and midwives are key providers in the promotion young people s sexual and reproductive health in Kenya and Zambia. Aim: The overall aim was to describe and explore young people s sexual and reproductive health needs and experiences and to describe health ...

International trade of health services: global trends and local impact.

Science.gov (United States)

Lautier, Marc

2014-10-01

Globalization is a key challenge facing health policy-makers. A significant dimension of this is trade in health services. Traditionally, the flow of health services exports went from North to South, with patients travelling in the opposite direction. This situation is changing and a number of papers have discussed the growth of health services exports from Southern countries in its different dimensions. Less attention has been paid to assess the real scope of this trade at the global level and its potential impact at the local level. Given the rapid development of this area, there are little empirical data. This paper therefore first built an estimate of the global size and of the growth trend of international trade in health services since 1997, which is compared with several country-based studies. The second purpose of the paper is to demonstrate the significant economic impact of this trade at the local level for the exporting country. We consider the case of health providers in the South-Mediterranean region for which the demand potential, the economic effects and the consequence for the health system are presented. These issues lead to the overall conclusion that different policy options would be appropriate, in relation to the nature of the demand. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Development of the organisational health literacy responsiveness (Org-HLR) framework in collaboration with health and social services professionals.

Science.gov (United States)

Trezona, Anita; Dodson, Sarity; Osborne, Richard H

2017-08-01

The health literacy skills required by individuals to interact effectively with health services depends on the complexity of those services, and the demands they place on people. Public health and social service organisations have a responsibility to provide services and information in ways that promote equitable access and engagement, that are responsive to diverse needs and preferences, and support people to participate in decisions regarding their health and wellbeing. The aim of this study was to develop a conceptual framework describing the characteristics of health literacy responsive organisations. Concept mapping (CM) workshops with six groups of professionals (total N = 42) from across health and social services sectors were undertaken. An online concept mapping consultation with 153 professionals was also conducted. In these CM activities, participants responded to the seeding statement "Thinking broadly from your experiences of working in the health system, what does an organisation need to have or do in order to enable communities and community members to fully engage with information and services to promote and maintain health and wellbeing". The CM data were analysed using multidimensional scaling and hierarchical cluster analyses to derive concept maps and cluster tree diagrams. Clusters from the CM processes were then integrated by identifying themes and subthemes across tree diagrams. Across the workshops, 373 statements were generated in response to the seeding statement. An additional 1206 statements were generated in the online consultation. 84 clusters were derived within the workshops and 20 from the online consultation. Seven domains of health literacy responsiveness were identified; i) External policy and funding environment; ii) Leadership and culture; iii) Systems, processes and policies; iv) Access to services and programs; v) Community engagement and partnerships; vi) Communication practices and standards; and vii) Workforce. Each

Anticipating demand for emergency health services due to medication-related adverse events after rapid mass prophylaxis campaigns.

Science.gov (United States)

Hupert, Nathaniel; Wattson, Daniel; Cuomo, Jason; Benson, Samuel

2007-03-01

Mass prophylaxis against infectious disease outbreaks carries the risk of medication-related adverse events (MRAEs). The authors sought to define the relationship between the rapidity of mass prophylaxis dispensing and the subsequent demand for emergency health services due to predictable MRAEs. The authors created a spreadsheet-based computer model that calculates scenario-specific predicted daily MRAE rates from user inputs by applying a probability distribution to the reported timing of MRAEs. A hypothetical two- to ten-day prophylaxis campaign for one million people using recent data from both smallpox vaccination and anthrax chemoprophylaxis campaigns was modeled. The length of a mass prophylaxis campaign plays an important role in determining the subsequent intensity in emergency services utilization due to real or suspected adverse events. A two-day smallpox vaccination scenario would produce an estimated 32,000 medical encounters and 1,960 hospitalizations, peaking at 5,246 health care encounters six days after the start of the campaign; in contrast, a ten-day campaign would lead to 41% lower peak surge, with a maximum of 3,106 encounters on the busiest day, ten days after initiation of the campaign. MRAEs with longer lead times, such as those associated with anthrax chemoprophylaxis, exhibit less variability based on campaign length (e.g., 124 out of an estimated 1,400 hospitalizations on day 20 after a two-day campaign versus 103 on day 24 after a ten-day campaign). The duration of a mass prophylaxis campaign may have a substantial impact on the timing and peak number of clinically significant MRAEs, with very short campaigns overwhelming existing emergency department (ED) capacity to treat real or suspected medication-related injuries. While better reporting of both incidence and timing of MRAEs in future prophylaxis campaigns should improve the application of this model to community-based emergency preparedness planning, these results highlight the need

Service Use and Unmet Needs in Youth Suicide: A Study of Trajectories

Science.gov (United States)

Renaud, Johanne; Séguin, Monique; Lesage, Alain D; Marquette, Claude; Choo, Bettina; Turecki, Gustavo

2014-01-01

Objective: While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. Method: We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects’ psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. Results: Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. Conclusions: Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people. PMID:25565685

Service use and unmet needs in youth suicide: a study of trajectories.

Science.gov (United States)

Renaud, Johanne; Séguin, Monique; Lesage, Alain D; Marquette, Claude; Choo, Bettina; Turecki, Gustavo

2014-10-01

While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects' psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people.

Cost Effectiveness and Demand for Medical Services among Rural ...

African Journals Online (AJOL)

With daily improvement in science and technology, the demand for modern medical services is becoming increasing. This is because modern medical services provide answers to some medical problems which could not be handled by traditional or other forms of medicine. Regrettably, these medical services receive low ...

Identifying profiles of service users in housing services and exploring their quality of life and care needs.

Science.gov (United States)

Bitter, Neis A; Roeg, Diana P K; van Nieuwenhuizen, Chijs; van Weeghel, Jaap

2016-11-23

Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be

Nursing competence in adolescent health: anticipating the future needs of youth.

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Bearinger, L H; Wildey, L; Gephart, J; Blum, R W

1992-01-01

The health problems of youth have dramatically shifted in the last 30 years from biological to social causes of morbidity and mortality. To assess the adequacy of nurses' knowledge and skills in adolescent health, a national survey of 445 nurses, including members of the American Public Health Association, the American School Health Association, and the National Association of Pediatric Nurse Associates and Practitioners, was undertaken in 1985. Results indicated that even among nurses who work with young people the most, areas of greatest knowledge and skill deficiencies included common social morbidities of adolescents. In addition to self-assessed inadequacies in knowledge and skills, nurses identified excessive time demands as a primary obstacle to the provision of health services to adolescents. To assure adequate preparation of nurses, it is recommended that accreditation criteria for baccalaureate and graduate programs specify essential adolescent health content for curricula compared to current accreditation criteria that generalizes "across the life span." Focusing on the enhancement of educational opportunities in adolescent health, nurses identified strategies for further education that would bridge the gap between the health needs of youth and nurse's self-perceived competencies in providing these services.