Judge rejects claim that prisons gave poor medical care

A Federal judge in New York rejected claims by six female inmates that prison health-care personnel did not address their medical complaints. The six inmates of the Bedford Hills, Albion and Taconic correctional facilities did not provide enough evidence to support their claims that prison officials were deliberately indifferent to their medical needs. The most serious allegation was that one prison was infested with insects and cats, putting HIV-positive inmates at increased risk of contracting diseases carried by the animals. Prison officials showed that they made an effort to control the infestation.     

Primary medical care in the United kingdom

Since 1948 health care in the United Kingdom (UK) has been centrally funded through the National Health Service (NHS). The NHS provides both primary and specialist health care which is largely free at the point of delivery. Family practitioners are responsible for registered populations of patients and typically work in groups of 4-6 self-employed physicians. They hire nurses and a range of other ancillary staff, and act as gatekeepers to specialist care. Recent reforms include a wide range of national quality improvement initiatives and a pay for performance scheme that accounts for around 25% of family practitioners' income. These reforms have been associated with some major improvements in quality, including improved chronic disease management and reduced waiting times for specialist care. The four countries of the UK differ in some important aspects of health care organization: proposed reforms in England would move towards a more market-driven system, with family practitioners acting as payers for specialist care and controlling 70% of the NHS budget. The other countries (Scotland, Wales and Northern Ireland) focus more on trying to create area-based integrated systems of care.     

Primary medical care in social health research

Primary health care as subject of recent and present research work carried out in the Institute of Social Hygiene is being described in the context of a historic review. The Institute's interest has been and is concentrated on morbidity and the state of health of rural populations as well as on health services provided for them. Emphasis is being layed on the growing independence of General Medicine as medical discipline because of it's key role in out-patient medical care. The Institute's contribution to one of the University's profile which is primary health care is being explained.     

Primary care physician incentives in medical group practices

CONTEXT: Although medical groups are adapting to changes in financing health care, little is known about individual physician incentives in this environment. OBJECTIVES: To describe methods group practices use to compensate primary care physicians in a managed care environment and to examine the association of revenue sources for the group practice from all patients and primary care physician incentives. DESIGN: We surveyed by mail group practice administrators for practices that had at least 200 members continuously enrolled in 1995. SETTING: Group practices that had contractual arrangements with Blue Cross/Blue Shield of Minnesota. PARTICIPANTS: One hundred of 129 group practices returned usable surveys. RESULTS: Most groups had some portion of primary care physicians' compensation at risk, although 17 groups compensated them through fully guaranteed annual salary. Seventy-one groups used productivity, 4 groups used quality of care, 1 group used utilization, and 30 used group financial performance. Factors reported to significantly influence primary care physician compensation included billings or charges, overall group practice performance, and net revenue or profit. Groups that had a higher proportion of income from various types of fee-for-service arrangements used lower proportions of base salary for primary care physician compensation and were more likely to relate physician income to measures of productivity. CONCLUSIONS: Substantial variation exists in the types of primary care physician incentives implemented by medical groups. Base salary, individual productivity, and group financial performance were most frequently used to determine compensation. Physician personal financial risk was higher overall in group practices that derived more revenue from fee-for-service contracts.     

Undergraduate teaching in palliative care in Irish medical schools: a questionnaire survey

INTRODUCTION: The Association for Palliative Medicine of Great Britain and Ireland published an official curriculum for undergraduate teaching in 1993. This study was conducted in order to establish the current status of undergraduate teaching in this important discipline in Irish medical schools. METHODS: A questionnaire survey was sent to 26 individuals identified as having responsibility for palliative care teaching in the five Irish medical schools. The questionnaire asked about aspects of the curriculum covered, the years and setting in which teaching occurs, and the teaching and assessment methods used. RESULTS: Identification of the relevant teachers proved to be difficult; most appeared to be unaware of what teaching other than their own was occurring within their medical schools in this discipline. In no school is the teaching centrally co-ordinated. All five medical schools have specific time dedicated to the teaching of palliative care; in two cases this is one day or less. All schools covered most of the topics outlined in the curriculum. The majority of the teaching is by didactic lecture; there is some use of group discussion and case studies. Other teaching methods are rarely used. All schools have some teaching in the hospice setting. Four medical schools offer elective clinical rotations in palliative care; uptake of these by students is very poor. Assessment is usually as part of a written paper in medicine. CONCLUSIONS: The teaching of palliative care in Irish medical schools appears to fulfil the suggested curriculum. Co-ordination of this teaching should be improved.     

Primary medical care and health outcome.

In order to examine the relationship between primary medical care and health outcome, a systemic sample of 485 persons in a typical metropolitan Midwest county was surveyed. Primary care was defined in functional terms including concepts of ready access, continuity over time, comprehensiveness, coordination, and personalized care. Health outcome encompassed self-reported health status, disability, patient satisfaction, and medical costs. Persons who had high levels of primary care tended to have more chronic medical problems and saw physicians more frequently, especially their own principal physician. They clearly were more satisfied with their medical care, but incurred higher medical costs. They did not differ from persons with a low level of primary care in current health status or disability. It was not possible to demonstrate that quality primary care led to better health outcome except on the parameter of patient satisfaction.     

Primary health care in an academic medical center.

In 1975-76 a one-year longitudinal study of the delivery of primary care services was carried out at all ambulatory institutional facilities in Durham County, North Carolina and in 47 of 50 community private practices covering the broad fields of surgery (including urology and orthopedics), medicine, pediatrics, and ob/gyn. The present paper focuses on the private and public clinics of Duke University Medical Center. Data were analyzed to document differentials in sociodemographic characteristics of patients attending these two systems of care. Results showed that patients attending the private clinics are predominantly white and covered by private insurance, while patients attending the public clinics are predominantly black and heavily dependent on Medicaid coverage. The potentially detrimental effects of a two-class system of care on the health of patients, as well as on the education of students, is discussed in the context of a scant medical literature on this subject.     

The need to improve health care in prisons

OBJECTIVE

To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons.

METHODS

We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups.

RESULTS

The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment.

CONCLUSIONS

This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.     

Health care needs assessment in prisons: a toolkit

BACKGROUND: Since 1999, prison health services and health authorities have been jointly responsible for assessing the health care needs of the prison population. To facilitate this process, the Department of Public Health and Epidemiology at the University of Birmingham developed a toolkit for carrying out a health care needs assessment of the prison population. METHODS: This paper describes the principles of the epidemiological approach to needs assessment and presents a stepped approach to carrying out a health care needs assessment in prisons. Some examples of the kind of health care needs to be found in prisons are presented. RESULTS: A systematic approach to the assessment of the health care needs of prisoners ensures that all the essential components of this important planning exercise are considered. The prison population is described, health problems are identified and quantified, and a review of current services is carried out. This allows the most effective solutions to addressing the health problems to be established. The process can be time consuming and is reliant on good data sources, but it does ensure that health problems and service elements are considered and addressed together rather than in a disjointed manner. CONCLUSION: The stepped approach to epidemiological needs assessment allows health problems and current services to be identified. It also allows these to be matched to appropriate service requirements.     

Speakers criticize quality of HIV health care in prisons

Speakers at the 9th National AIDS Update Conference were critical of the treatment that HIV-positive inmates were receiving in most Federal, State, and local correctional institutions. Specific complaints include: protease inhibitors are largely unavailable in correctional facilities; only three States allow prisons to consult with infectious disease specialists; there is a persistent mistrust of prison physicians; and secret blood testing is being conducted. The California Department of Corrections was noted for its adequate level of care. Medical services, psychosocial support, peer education, case management, and compassionate release programs are in effect in California. Efforts are underway to make protease inhibitors available in jails.     

Quality management in Irish health care

This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.