ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

The Los Angeles County-University of Southern California Medical Center is one of the largest in the world. Over 600,000 outpatient prescriptions are processed yearly. These prescriptions are being processed, as a part of the drug dispensing system, by means of computer terminals. As a first step in controlling irrational prescribing, three types of undesirable or inappropriate prescriptions were defined and identified by physicians and pharmacists at the Medical Center. These are: 1. excessive drug quantities specified in individual prescriptions, 2. undesirably frequent prescriptions for the same drug, and 3. inappropriate concurrent prescriptions for different drugs. Of 52,733 consecutive prescriptions for the 78 drug products most frequently dispensed to outpatients, representing more than four fifths of all outpatient prescriptions, 13% represented excessive-quantity prescriptions. Most frequently involved were sedatives and tranquilizers. As many as 1,300 tablets of one such agent was dispensed on a single prescription. Only 1.7% of all prescriptions were judged to involve too frequent prescribing of a drug. However, analyses of patient drug records showed that some outpatients were receiving as many as 54 prescriptions over a 112-day period. Numerous examples were found of concurrent prescriptions of two different drug products which could result in serious drug interaction or potentiation.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

Examination of studies which attempt to evaluate the efficiency of psycho-active drugs administered to outpatients reveals an emphasis on easily quantified data, such as target symptoms, as well as a failure to distinguish clearly between independent and dependent variables in the research designs. A sociologic model of the patient undergoing the treatment experience is presented in order to direct attention to specific problems of data collection. A research paradigm is developed, utilizing the concept of multiple realities, which enables the researcher systematically to collect information from the patient and from significant others during the treatment process. The research paradigm has as its focus the patient's functioning within the treatment setting, as well as his functioning in the even-day world outside the treatment setting.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

A shortage of physicians and an increasing demand by the public for medical services after World War II has forced a reorganization of the health care system in Czechoslovakia. Private medical practice has been completely abolished and all health care institutions integrated into a comprehensive system utilizing a team approach among general practitioners and specialists working in state-supported hospitals and policlinics. In addition, factory physicians hold responsibility for industrial workers and employees. Coordination of health care services is managed by the Ministry of Health with the state divided into 11 regions, each region having about 10 districts. In the district, all preventive and curative services are integrated in the District Institute of National Health which supervises a main hospital and one or more secondary hospitals as well as polyclinics which, though joined to one of the hospitals in organization and function, may not be joined in location. Among the advantages of the system are the adequate distribution of personnel, financing according to need, and continuity in information concerning individual patients. On the other hand, the system does have a tendency to rigidity which restricts possibility of experimentation and an alienation of the physician-patient relationship.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

Analysis of Boston Police Department ambulance runs, emergency unit visits to three Boston hospitals located within a six-block radius of one another, and weather conditions during 1968 allows both a micro- and a macrovtew of the influence of ritualistic and meteorological factors on hospital emergency unit utilization. On a theoretical plane, differences in the temporal distribution of injuries vs. diseases and emergent vs. nonurgent conditions are reduced to variation in levels of risk attributable to meteorological influences and the pursuit by various segments of the population of activities prescribed by occupational and/or social ritual. Empirical findings and their implications have relevance for health care planners and administrators trying to reach decisions about appropriate staffing patterns in hospital emergency care facilities as presently utilized. Assessment of the relative inflexibility of expectations based upon occupational and/or social ritual as it effects supply suggests ways of reorganizing the system for treating the range of nonurgent to urgent conditions arising in the community in the course of the year.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

This study is a multivariate analysis of physicians' distribution in urban United States which examines the relationship between community characteristics in 299 Standard Metropolitan Statistical Areas and 27 physicians-population ratios listed by type of medical practice and specialty. The community characteristics arc: population size, population density, per capita buying power, per household buying power, the existence of a more populous metropolitan area within 75 miles, median years of education of the population, percentage of population aged 65 and over, percentage of population categorized as “white” and the number of non-Federal acute general hospital beds per 1,000 population. The physician-population ratios arc categorized as phvsicans in “patient care,” “private practice” (solo, partnership, group and other practice), and “hospital based practice,” with a total of 21 specialties. Using Morgan and Sonquist's Automatic Interaction Dectector Program (AID), it was determined which community characteristics most improved the ability to predict the distribution of the different types and specialties of physicians analyzed.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

Some of the limits of rationality in health planning are illustrated in contemporary England. The English penchant for “muddling through,” often considered to be the antithesis of rational planning, may in fact suggest that in certain stable political environments a model of comprehensive rationality in decision-making not only is not, but also cannot and should not, be followed. Development of policies in regard to physician manpower, hospital beds, and health centers reflects a complex mixture of advocacy and evidence in the decision process. Although the English style of health planning illustrates the limits of a rational model, the National Health Service appears to have provided extraordinary value for money over the post two decades.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID

摘要:

Chart review for quality of care and quality of record-keeping in an ambulatory setting has been generally unsatisfactory because of the episodic nature of ambulatory practice and the brevity of notes usually written. In the program described, the staff physicians choose a well-defined topic for review, establish standards, review the appropriate charts for a selected period of time and discuss the findings in regular staff meetings. The method of review is simple to perform and has been quite acceptable to the staff. The involvement of the staff at all stages appears to be contributing significantly to group cohesiveness and to the program of continuing education. Our follow-up study has demonstrated marked improvement both in practice and in charting.

ISSN:0025-7079    

出版商:OVID    

年代:1971

数据来源: OVID