摘要:

This paper examines the effects of inflation on the expenditures made by federal health programs, in total and by functional category. Over the period 1969-74, a total increase of more than 90 per cent in federal dollars was required to support real growth of 44 per cent. Federally financed service programs, like Medicare and Medicaid, and health manpower training programs made particularly large gains, while construction support for health care facilities lost substantially in real terms. Health research and prevention and control programs made more moderate real gains—25 and 29 per cent, respectively, over the period. Comparison of inflation rates in the health sector and in the economy generally suggest that there are important inflationary forces specific to that sector; policies to stem general inflation cannot be expected to solve the problem of health sector inflation.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

An analysis of the first year's operation of an ambulatory patient monitoring system is presented. The program was designed to accomplish the following objectives: 1) to demonstrate individual clinic effectiveness in giving each member of its service population a complete assessment of his health status, and 2) to implement patient surveillance for follow-up and periodic reevaluation. The system was adapted to the pre-existing computer-based ambulatory patient care reporting mechanism which is in use by Indian Health Service members and contracting facilities. It employs discrete health Status Categories whose definitions are based in specific clinical criteria.This approach permits the interpretation of categorical patient flow statistics as representative of identifiable clinic practices. Quarterly data printouts provide a basis for interpreting the degree of clinic progress toward initial health assessment of the total population served. Such data, when viewed against the backdrop of specific operational objectives allow for continuous program reassessment of community needs, and provide a technique for monitoring the effectiveness of the health care delivery system in meeting these needs.By controlling for individual variations in clinic objectives, comparisons can be made between separate facilities within the network. In addition, the technique provides a method for focusing on areas where objectives may not be realistic and provides a data base on which alternative program goals can be formulated.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The perception of Indian health care needs are shown to be related to particular positions within the Public Health Service (PHS) structure. This study is based on interview data gathered from three groups: Navajo consumers (N =271), Navajo PHS personnel (N = 80), and PHS non-Navajo professional staff (N = 31). The identification of health needs by the Navajo consumer is oriented toward unsolved problems in the immediate social and physical environment. Ninety-five per cent of the problems identified by the consumer centered around disease states, alcoholism, environmental problems, and transportation. Only 28 per cent of the Navajo personnel responses fell within these categories. The responses of the professional staff were systematically distributed among 14 identified health needs. Of major concern is the marginal position held by the Navajo PHS employee who seems to identify health problems which are similar to neither the Navajo consumer nor the PHS professional. While they are still tied to the Navajo culture per se, the Navajo personnel are economically dependent upon the PHS for a livelihood. This “man in the middle” position may require divided loyalties— to their community and to their employer. Such a schism can have serious consequences in their ability to function effectively as health workers.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Nineteen child health stations in New York City have added treatment services to their traditional role of well-child supervision with the objective of increasing the access of children living in underserved areas to integrated preventive and therapeutic care. The conversion process was studied at nine pediatric treatment centers (PTC) in upper Manhattan and the South Bronx. The Department of Health accomplished the conversion by adding full-time pediatricians, on-premises laboratory capability, prepackaged pharmacies, and informal arrangements with local hospitals. The proportion of patient visits at the PTCs for sick care ranged from 11 to 57 per cent and varied with the length of time the unit had been in operation. Personnel cost per visit was $16. Six child health stations were compared before and after conversion to PTCs. Registration increased 5 per cent, visits increased 50 per cent, and personnel cost increased 150 per cent. Review of 600 patient visits revealed that the majority of illness visits were for minor conditions, notably upper respirtory infections. Interviews of 600 parents at three PTCs revealed that approximately one-fourth regarded the PTC as a usual source of care. Increased access and continuity of child health services have been accomplished by these conversions. Adding treatment services to child health stations is a satisfactory alternative to the overcrowded hospital-based pediatric facility.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

This study of patient and bystander responses to medical emergencies revealed serious shortcomings in the public's ability to respond appropriately to such situations. Decision delays at least as long as ambulance response delays were found to be the result of confusion regarding the seriousness of the emergency, confusion regarding the appropriate reaction to the emergency, and a reluctance to burden the rescue service unnecessarily. A significant group of high-risk patients were identified who not only reacted slowly but who bypassed the emergency ambulance service entirely. A substantial fraction of these patients have had prior contact with the local medical care system for problems related or identical to the one causing the emergency.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The objective of this study was to test the feasibility of teaching secondary school students to perform cardiopulmonary resuscitation (CPR) according to National Research Council (NRC)—American Heart Association (AHA) standards. Criterion levels specified by AHA call for cardiac compression at a rate of 60 times a minute with two ventilations interposed after 15 cardiac compressions. Translated into numerical performance per minute, this standard equates to 36 compressions and six ventilations per minute.Students were instructed by their usual teachers who received a special educational program in preparation. Both immediate learning and retention of the students after three months were evaluated using a practical and a written test. Teacher performance was evaluated by means of a practical test and a behavior rating.CPR is a motor task involving both continuous and discrete processes. Results of the study corresponded to analogous studies in the psychomotor literature: practice group students' retention of continuous skills (breaths and compressions) was good (little loss of skill), while retention of discrete motor skills (open the airway, check vital signs) was poor.Fifty-five per cent of the practice group in the initial test and 31 per cent in the retention study were able to perform the skills. Retention figures compare favorably with studies in the area of psychomotor learning.The study suggests that it is possible to train secondary school students to perform the ABC's of CPR if they have an opportunity to practice these skills. The study also suggests that the teacher training is an important factor.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The kinds of health care problems ecountered in a 600-man panel institution were studied. Five hundred twenty-eight problems were identified in 333 inmates seen on sick call. The large number of psychosocial problems (194 out of 528) and the wide diversity of problems (125 in 333 inmates) were documented. The questionable suitability of the medical model for health care in this type of setting is discussed. The implications for primary health care delivery and education are considered.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Four hundred and nine female patients of both male and female physicians completed a self-administered questionnaire exploring their attitudes and practices regarding gynecologists and gynecological examinations. Responses to the question “Would you prefer a woman gynecologist?” divided the sample into three groups: those responding “yes” (33.9%); those responding “no” (19.3%); and those responding “no difference” (36.2%). Results revealed that patients who preferred female gynecologists were most likely to find gynecological examinations difficult and to be critical of gynecologists' understanding of women's psychological and sexual problems. A subsample of patients in psychotherapy was especially apt to prefer female gynecologists. The “no difference” group had the most positive attitudes towards gynecological examinations and gynecologists. Demographic differences were insignificant. The importance of judging a gynecologist's competence without sexual bias, of re-evaluating stereotypes of women physicians, and of increasing the proportion of women in gynecology is stressed.

ISSN:0025-7079    

出版商:OVID    

年代:1975

数据来源: OVID