Psychological services in hospices in the UK and Republic of Ireland

OBJECTIVE: To evaluate the level of psychological services available to patients and staff in hospices. DESIGN: Questionnaire analysis. SETTING: Hospices in the UK and Republic of Ireland. PARTICIPANTS: 224 hospices. MAIN OUTCOME MEASURES: The availability of professional psychological support for those with advanced disease. RESULTS: Responses were received from 166 hospices (74%). Only 50 hospices (30%) have access to a psychiatrist, whilst 68 (41%) have access to a clinical psychologist and 92 (45%) have neither. Only 21 hospices (12%) have service level agreements with local mental health trusts. Counsellors, complementary therapists and spiritual advisors such as chaplains were more plentiful. CONCLUSIONS: Delivery of the NICE guidelines, especially tier four, may be compromised by limited availability of specialist services. This has implications for the psychological assessment of applicants for voluntary euthanasia under an Assisted Dying Act.     

Assuring the quality of in-home supportive services: an evolving challenge

This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance services. Using four planning and service areas in the state of Ohio comprising over 40 countries, the project developed, implemented and evaluated quality assurance standards and monitoring activities for Older Americans Act services. In addition, a second part of the project included in-depth case studies with consumers receiving in-home care.     

AIDS and FDA drug-approval policy: an evolving controversy

AIDS treatment policy has become controversial in recent years as the Gay AIDS Movement has challenged FDA drug-testing and approval policies. Based on the Social Movements Model (Frierson, 1985) this movement has reached the stage of establishing a compelling trend of public pressure and is moving toward the stage of the enactment of policy change. Gays have demanded a number of changes in clinical trials and other FDA rules such as the creation of community-based trials, changes in the clinical protocols, and the increased availability of experimental drugs. The FDA has made a number of changes in response but many of the most controversial demands of the Gay community and their medical allies remain open to debate. The implications and conclusions for the possible outcomes of this controversy are considered.     

Survey of acute hospital infection control resources and services in the Republic of Ireland

Following the development of national guidelines on the control of antimicrobial resistance in 2001, a survey was carried out in 2003 of all 68 acute hospitals in the Republic of Ireland on resources available and current practice to control and prevent nosocomial infection. Completed questionnaires were received from 66 hospitals (97%). The median number of acute inpatient beds per hospital was 156; this was 522 in regional/tertiary referral centres. Only 31 (47%) hospitals had on-site consultant microbiologist sessions, and there was an infection control nurse in 56 (85%) hospitals. Eighteen (29%) hospitals had an occupational health physician, and 48 (73%) hospitals had an infection control committee. There was a median of one isolation room for every 16 acute beds, and a median of five rooms with en-suite bathroom facilities per hospital in those hospitals that provided data. All hospitals had documented infection control policies, and these were available in electronic format in 25 (38%) hospitals. Fifty-five (83%) hospitals undertook surveillance of nosocomial infection, and alcohol-based hand hygiene facilities were available, either at a handwashing sink or at the entrance to a ward, in 57 (86%) hospitals. In the Republic of Ireland, there remains a significant shortage of microbiologists/infection control doctors, occupational health physicians and infection control nurses. Isolation facilities are also inadequate. Although there is much agreement internationally on the importance of nosocomial infection and the priorities for surveillance, there are no agreed basic minimum standards for the resources and facilities necessary to control and prevent nosocomial infection.     

Child poverty as public policy: direct provision and asylum seeker children in the Republic of Ireland

This paper evaluates responses to asylum seeker children in Ireland from a child poverty perspective and from that of the United Nations Convention on the Rights of the Child. It draws upon research undertaken in early 2001 on behalf of the Irish Refugee Council among asylum seeker families with children in Cork, Limerick and Ennis on their experiences of poverty and social exclusion. The research was primarily qualitative. Interviews with adult members of households and some children were triangulated with data on benefit entitlements and take-up, household consumption, accommodation and amenities. The research sought to ascertain levels of income poverty and material deprivation. A range of indictors of child poverty and social exclusion were also employed. The research found that asylum seeker children experienced extreme income poverty, material deprivation, housing deprivation and social exclusion in considerable part due to the imposition of a system of lesser welfare entitlements, known as “direct provision”, introduced in April 2000. The paper argues that state-fostered social exclusion of asylum seeker children resulting from “direct provision” is contrary to Ireland's obligations under the United Nations Convention on the Rights of the Child, the goals of the National Children's Strategy and the goals of the National Anti-Poverty Strategy.     

Alcohol use and policy formation: an evolving social problem

This article explores the evolutionary course that the social problem of alcohol use has taken in the United States since the Colonial Era. This article utilizes a range of theoretical models to analyze the evolving nature of alcohol use from an unrecognized to a perceived social problem. The models used include critical constructionism ( Heiner, 2002 ), top-down policy model ( Dye, 2001 ) and Mauss' (1975) understanding of social problems and movements. These theoretical constructs exhibit the relative nature of alcohol use as a social problem in regards to a specific time, place, and social context as well as the powerful and influential 15 role that social elites have in defining alcohol as a social problem. Studies regarding the development of alcohol policy formation are discussed to illuminate the different powers, constituents, and factors that play a role in alcohol policy formation. Finally, implications for future study are discussed.     

Mentoring in health services management: reflections on an evolving training ground

Since the University of Chicago Health Management program was first initiated in 1932, programs and health delivery organizations have dealt with the issue of how to best provide a meaningful transition from academia to entry-level management. Today, new challenges face the same old questions: New federal legislation and increased demand for a finite supply of services cause increased revenue and expense pressures and result in the need for a higher performance level by a well-coordinated management team. In addressing these challenges, mentoring is an essential requirement for survival and success in health services. The long-term success of future practitioners will require both an understanding and incorporation of mentoring in their skill set. The University of Virginia Medical Center recently sponsored a health management education summit to examine the role of mentoring in health services administration education. Leading the program were John Westerman, former interim president of Association of University Programs in Healthcare Administration and chief executive officer emeritus of the University of Minnesota Health System, and R. Edward Howell, chief executive officer of the University of Virginia Medical Center. Summit participants included individuals who had completed administrative fellowship training programs. What follows is a review of the discussions during the summit, including a valuation of the health services fellowship as a learning experience as well as structure and essential elements of administrative mentoring programs.     

Acute gastroenteritis in northern Ireland and the Republic of Ireland: a telephone survey

Most people with acute gastroenteritis do not seek medical care and are therefore not captured by routine surveillance. For this reason, population-based studies are needed to measure the burden of illness. A study of acute gastroenteritis in Northern Ireland and the Republic of Ireland surveyed 9,903 people by telephone over the 12-month period from December 2000 to November 2001. The rate of acute gastroenteritis was 0.60 episodes per person per year. A general practitioner was consulted by 29.2% of those reporting illness, and 2.0% submitted a stool sample. The use of antibiotics was reported by 7.4% of ill respondents and 14.8% took anti-diarrhoeals. Taking days off work due to illness, was reported by 17.4% of respondents. Acute gastroenteritis causes a large amount of illness in the community. There are established and effective measures to prevent this condition and the challenge is to find new ways of promoting these precautions.     

The policy context of health services administration education through outcomes assessment

Effectively evaluating preparation programs for health services administrators is important for program providers, trainers, future employers, the health care system, and the American public. Because the methods employed for evaluation do not exist in a vacuum, policy formation with respect to learner outcomes assessment is a critical concern for all those interested in health care management issues. During the 1990s, the prevalent trend in evaluation is "assessment," which emphasizes performance-oriented outcomes rather than traditional testing approaches. This article examines the evolving role of assessment from a higher education policy perspective. Current trends and issues in general education, teacher testing, and nursing home administrator preparation are brought to bear on the problem of how to implement the goals of assessment. Realistic expectations of assessment are subsequently offered.     

Telemedicine and health policy: A systematic review

BackgroundTelemedicine diagnoses and treats patients remotely via telecommunications technology all over the world. Telemedicine becomes more prevalent as providers recognize the benefits, patients receive increased access and payers see the reduction in cost of care.ObjectiveTelemedicine studies have shown success in limiting geographical constraints, time spent, and costs incurred by patients with positive health outcomes across medical specialties. The aim of this review is to evaluate the implications of telemedicine and health policies.MethodsAn assessment of the literature in four databases was made on content germane to health policy implications of telemedicine. From the results of the search, 48 publications were kept for analysis.ResultsThe fifteen facilitators mentioned most often were increased access, increased convenience, improved population health, care enabled through mobile technology, self-efficacy, increased patient-to-provider communication, cost advantages, efficacy of modality, increased health outcomes, reaches developing countries, increased quality, a positive previous experience, and a secure means of care. The twelve barriers mentioned most often were the increased cost to providers, patient privacy, technical literacy, state licensing, data security, socioeconomics, limited reimbursements, issues of interoperability, patient safety, less personal means of care, misaligned incentives, and ethical concerns.ConclusionsTelemedicine has the potential for growth and adoption, however, there are several implications and barriers of health policy surrounding telemedicine that make it difficult to adopt. Policies will likely encourage and incentivize its spread and use. Future research should focus on standardization of telemedicine and new policies and incentives that encourage its use.     

Telemedicine: an overview

Telemedicine involves the transfer of medical data for use in diagnosis, treatment and education. The interaction may involve two-way live audio and video visits between patients and medical professionals, sending patient monitoring data from the home to a clinic or transmitting patient images and medical file from a primary care provider to a specialist. Telemedicine is already widely used in radiology, cardiac monitoring and other forms of remote patient monitoring and in targeted population groups such as correctional care populations, the military and veterans' health care.     

Telemedicine: an overview

Telemedicine--the use of telecommunications and computer technology to provide medical information and services at a distance--is growing in popularity. Because of the rapid advances being made in the technology, more and more clinical applications can now be performed via telemedicine. However, the decision to adopt telemedicine should be made only if a clinical need for this technology can be demonstrated. And successful implementation and operation depend on specifically designing the technical infrastructure--that is, the computer hardware and software and the telecommunications system--to meet this clinical need. But even more important is making sure that everyone involved in such a program, including clinicians, telecommunications suppliers, and patients, understands the objectives, benefits, and particular requirements of telemedicine. In this Guidance Article, we provide an overview of the issues surrounding telemedicine. We present examples of successful telemedicine programs, along with guidance for facilities considering programs of their own. We also outline the barriers to successful implementation. And we discuss how, once a telemedicine program is in place, facilities can evaluate the effect of the program on their delivery of healthcare. In supplementary articles, we discuss the technology used for telemedicine and provide a list of telemedicine resources for readers who wish to learn more about the subject.     

Telemedicine in managing demand for secondary-care services

The sustained growth in demand for hospital services has inspired new ways of managing the demands for secondary care. In Finland, teleconsultations have been used alongside an electronic referral system for hospital outpatient clinics for the management of primary-care patients by specialists. Direct outpatient costs of the internal medicine department of a district general hospital with an electronic referral system and using teleconsultations were compared with those of a similar department at another hospital using a paper referral system. The former were at least 20% lower. Almost every paper referral in the conventional system (over 95%) led to an outpatient visit, whereas only one-third of the teleconsultations resulted in actual outpatient visits. Thus virtual integration of secondary and primary care with an electronic referral system as part of an electronic medical record reduced both the costs of hospital outpatient care and the demand for it.     

Older people--recipients but also providers of informal care: an analysis among community samples in the Republic of Ireland and Northern Ireland

Data on both the provision and receipt of informal care among populations of older adults are limited. Patterns of both informal care provided and received by older adults in the Republic of Ireland (RoI) and Northern Ireland (NI) were evaluated. A cross-sectional community-based population survey was conducted. Randomly selected older people (aged 65+, n = 2033, mean age (standard deviation): 74.1 years (6.8), 43% men, 68% response rate) provided information on the provision and receipt of care, its location, and the person(s) who provided the care. Twelve per cent of the sample (251/2033) identified themselves as informal caregivers (8% RoI and 17% NI). Caregivers were more likely to be women, married, have less education and have less functional impairment. Forty-nine per cent (1033/2033, 49% RoI and 48% NI) reported receiving some form of care in the past year. Care recipients were more likely to be older, married, have more functional impairment, and poorer self-rated health. Receiving regular informal care (help at least once a week) from a non-resident relative was the most common form of help received [28% overall (578/2033); 27% RoI and 30% NI]. Five per cent (n = 102/2033) of the sample reported both providing and receiving informal care. Levels of informal care provided by community-dwelling older adults were notably higher than reported in single-item national census questions. The balance of formal and informal health and social care will become increasingly important as populations age. It is essential, therefore, to evaluate factors facilitating or impeding informal care delivery.     

Telemedicine applications for the regional paediatric cardiology service in Northern Ireland

The regional paediatric cardiology centre in Northern Ireland has a telemedicine network linking the neonatal units of three district general hospitals using ISDN and IP-compliant equipment. We have previously reported the use of ISDN transmission at 128 kbit/s for remote echocardiography. In a series of 61 patients, a total of 59 transmitted scans were of sufficient diagnostic quality to confirm or exclude the presence of major congenital heart disease (CHD). There were three diagnostic errors (7%). Subsequently, we have examined the use of ISDN transmission at 384 kbit/s. Echocardiographic studies were carried out on 21 patients and all were followed up. Fourteen patients (67%) had CHD confirmed. There were two diagnostic errors (10%). Our experience of transmitting live echocardiographic images suggests that ISDN at 384 kbit/s provides the optimum balance between the clarity of the transmitted images and costs. We expect that IP videoconferencing will offer similar quality but at a lower running cost, and are currently assessing it in a pilot study. All sites within our network will remain capable of ISDN transmission until the efficacy and reliability of IP transmission has been demonstrated in a controlled trial. The clinical telemedicine service has led to the earlier diagnosis of and instigation of appropriate treatment for CHD.     

新医改背景下社区卫生服务若干政策问题的探讨

在新医改政策精神的指导下,医药卫生体制改革进入新阶段,社区卫生服务也面临着新的机遇和挑战。本文从理论层面探讨了社区卫生服务中国家基本药物、信息化建设、绩效考核和人员编制、人才培养以及城乡医疗卫生服务均等化等几大核心问题,对其现有的政策逻辑、面临的问题挑战以及相应的对策建议进行了思考。     

Ill-health retirement of schoolteachers in the Republic of Ireland

BACKGROUND: To investigate the epidemiological profile and medical causes of ill-health retirement (IHR) of teachers in the Republic of Ireland. METHODS: Medical file review of teacher IHR in Irish primary and secondary schools, between 2002 and 2005 inclusive. RESULTS: In all, 466 employees were granted IHR between 2002 and 2005.The rate of IHR was 2.7/1000 teachers per annum, with an average age at IHR of 52 years. The most common reasons for IHR were mental disorders (46%), cancer (19%), circulatory (14%) and musculoskeletal disorders (10%). CONCLUSIONS: The rate of IHR among Irish teachers is similar to that of other occupational groups, with psychiatric conditions, cancer and circulatory diseases as the principal causes.