Empowering patients to direct their health care

The American health care system has changed dramatically during the past 50 years. We no longer live in the days of cradle-to-grave care by a single family practice doctor who knew us and our medical history like the back of his hand. Health care is far more fluid and fast-paced; we often change insurance companies and primary care physicians. We are shuffled from one high-end specialist to another with great regularity, often with little or no communication between them. In addition, technologic advances in medicine have skyrocketed the science far beyond what the average person can comprehend. Despite these so-called advances, perhaps because of them, we have never been more vulnerable in the health care world.     

Barriers to accepting mental health care in cancer patients with depression

ABSTRACT

This study aimed to determine barriers to accepting mental health care among depressed cancer patients. Cancer patients who screened positive for depression were referred for mental health treatment and sent a validated questionnaire designed to assess barriers to receiving mental health care. Responses were compared between patients who accepted their referral and those who did not. Among 75 patients who agreed to participate, 51 (68%) completed the questionnaire. Reported barriers to accessing mental healthcare were not significantly different between the two groups but patients residing within 50 miles of the clinic had increased odds of attending their appointment.     

Perspectives of relatives and health care workers on care of terminally ill patients in the UK

Two parallel questionnaires were used to explore perceptions of healthcare workers (HCWs) and the relatives of terminally ill patients on the quality of care received by the patients. There was general agreement between the two groups of respondents in most of the assessed areas. The relatives, however were more satisfied with the control of pain and psychological symptoms than the HCWs, and the HCWs perceived the control of diarrhea, skin problems, and swallowing problems more positively than did the relatives. There also was some variation between the two groups in their perception of the care received by the relatives during visits at the hospital, with the relatives' group being more positive. Although HCWs reported that time to deal with patients and their families was inadequate, the relatives' group was generally satisfied with the standards in place.     

重症精神疾病患者家属健康教育效果评价

目的 对重症精神病患者家属开展健康教育,并评估健康教育取得的效果.方法 采用自行设计的问卷在健康教育开展前、后分别调查患者家属的知识、态度情况,并进行比较.结果 患者在接受健康教育后,各项重症精神疾病相关知识的知晓率均高于健康教育前(P＜0.01)；通过接受健康教育,患者对待重症精神病持正确态度的比例比健康教育前提高,差异具有统计学意义(P＜0.01).通过对各种健康教育形式的调查发现,家属接受经验座谈交流的比例最高,达到82.67％,其次为宣传手册和折页(78.00％)、讲座(67.33％)及宣传壁报和墙报(50.67％).结论 对重症精神病患者家属开展健康教育,能够提高患者家属对重症精神病相关知识的知晓,改变家属不正确的态度.在开展健康教育时,应当采用活泼生动、互动交流的形式来开展.     

Integrating mental health services through reimbursement reform and managed mental health care

People with serious and persistent mental illness require a range of community services typically provided by different specialized agencies. At the clinical level, assertive team case management is the strategy commonly used to achieve integration of services across specialized sectors. The USA also has used various financial and organizational approaches to reduce fragmentation and increase effectiveness, including development of stronger public mental health authorities, use of financial incentives to change professional and institutional behavior, requirements to allocate savings from hospital closures to community systems of care, and introduction of mental health managed care on a broad scale. These approaches have potential but also significant problems and there is often a large gap between theory and implementation. These US developments are discussed with attention to the implications for mental health services in the UK.     

The formal mental health care burden among recently deinstitutionalized patients

This article examines the extent to which the costs of formal health care are shifted from third-party payers to the patient and his or her family, especially during the transition to the community after discharge from a state hospital. Findings indicate that patients residing in the community are as likely to receive some care as their counterparts in institutions, but are at higher risk for uncovered care. Uncovered care is more likely to manifest as an unmet need for patients who have been recently discharged, especially for racial minorities, and as an out-of-pocket expense for patients who are established in the community.     

Care according to diabetes patients and their main caregivers

This case study aims to describe how diabetes patients and their main caregivers perceive the difficulties faced to control the disease. Data were collected through audio records made at the Nursing Education Center for Adults and Elderly in April 2003 and submitted to thematic content analysis. The following themes emerged from the analysis: dietary transgressions, medication-related problems and interpersonal influences. These themes are interconnected with interpersonal influence from family members and the peer group, which are based on a set of beliefs and values that interfere in the patients' motivation and capacity to face the decease. The results reveal the need to get to know the patients' and caregivers' pattern of answers related to feelings, conflicts and needs, so as to establish an effective link that offers conditions to develop collaborative strategies to achieve metabolic control.