Reasons for poor understanding of when and how to access GP care for childhood asthma in Auckland,New Zealand

BACKGROUND: Attempts to explain why some patients lack the understanding needed to access GP care for childhood asthma are uncommon and have tended to be based on reported statistical associations. OBJECTIVES: The aims of this study were to describe and account for poor patient understanding of when and how to access GP care for childhood asthma in Auckland, New Zealand. METHODS: A general inductive approach was used to analyse 29 semi-structured, personal interviews, during March-May 2001, with Auckland key informants selected through maximum variation sampling. Informant checking and the literature supported the text analysis by two independent researchers. RESULTS: Key informants reported wide variations in the extent to which guardians and asthmatic children understand when and how to access GP services. Two sets of barriers to patient understanding were identified. The first limits the willingness of people to seek understanding and the second limits their ability to understand, even if they want to understand. CONCLUSIONS: Use of qualitative methodology was able to reveal barriers to patient understanding. Strategies operating at the GP and system levels were identified to help overcome these barriers.     

Effects of mobility and location on food access

Access to healthy food has become an important area of investigation for researchers interested in health disparities and inequalities. The debate about the existence and characteristics of 'food deserts' has increased the interest in food availability and equity in health research. This debate is crucial to an understanding of the factors leading to food security. Research reported here used in-depth interviews with respondents without private transport living within and outside food deserts in Adelaide, South Australia. The respondents came from a variety of households, including single and double parent families, and people living alone. The research found that living in a food desert did not, by itself, impose food access difficulties. Far more important was the access to independent transport to shops. A number of features were identified in this research including reliance on supermarkets, difficulties with public transport, and the provision of government schemes and systems that for some made food shopping much easier. The research suggests that food access problems in Adelaide are not so much the product of geographic distance between home and shop, as the social or welfare networks that allow people to access private transport.     

Legal review: AIDS patient records--legal issues of access and disclosure

All 50 states require AIDS cases to be reported to the department of health. Many jurisdictions require HIV and ARC reporting, as well. Many states have also enacted confidentiality provisions that prohibit health care providers from releasing HIV-related information without the patient's consent, although exceptions to the statutes authorize disclosure without consent to other health providers, spouses, and other persons under certain conditions set forth in the legislation. In addition, the patient may obtain access to his or her own records and may authorize release to third parties. Providers who violate the provisions are subject to liability. The patient usually has a private cause of action for damages and costs; in addition, the state may impose fines and jail terms for more egregious violations. Finally, courts may authorize disclosure of confidential HIV information in certain situations. In the absence of a statutory provision governing court-ordered disclosures, courts will balance the patient's privacy interest against the plaintiff's need to know and the public interest involved. Several states have enacted statutes that modify this traditional balancing approach, although it is unclear whether these statutes provide additional protection for health care providers and patients seeking to prevent disclosure of information. Health record practitioners should keep abreast of legislative and regulatory developments in their states that affect use and disclosure of AIDS patient records. Careful discussion with the health institutions' legal counsel of any situation not covered clearly by applicable statue or regulation is strongly recommended.     

Homeless and runaway youth mental health issues: No access to the system

Data from a center for homeless and runaway youth are presented in order to summarize the major mental health problems faced by these youth. This article also identifies indicators related to behavioral and environmental variables that may help in the development of intervention and prevention strategies for this population.     

The impact of standalone call centres and GP cooperatives on access to after hours GP care: a before and after study adjusted for secular trend

BACKGROUND: The After Hours Primary Medical Trials were initiated by the Australian government to redress difficulties in after hours (AH) GP care in areas of high need. The study's objective is to study the impact of two standalone call centres and one GP cooperative offering comprehensive services, in improving consumer access to services for residents of a defined geographic area. METHODS: A pre-post design was used to evaluate their impact after adjusting for secular trend at a national level. Access was considered in terms of availability, accessibility, affordability, acceptability and responsiveness of care. Unmet need and ease of obtaining AH telephone professional medical advice were also considered. Pre-trial and post-trial telephone surveys of two separate random samples of approximately 350 households using AH services in each trial area as well as in a national sample outside the trial areas. RESULTS: Consumer acceptability and affordability increased in residents in the area served by the GP cooperative. Access, however measured, did not improve in either of the standalone call centre areas. Reduction in unmet need approached but did not achieve statistical significance in most but not all trial areas. CONCLUSIONS: Improvements in access in the GP cooperative conformed to expectations based on current and pre-existing AH care arrangements put in place. Absence of improvements in access in the standalone call centres did not conform to expectations but may be partly explained by the reductions in consumer acceptability, following introduction of telephone triage systems reported elsewhere.     

Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States

PurposeHIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission. Finding a PrEP provider, however, can be a barrier to accessing care. This study explores the distribution of publicly listed PrEP-providing clinics in the United States.MethodsData regarding 2094 PrEP-providing clinics come from PrEP Locator, a national database of PrEP-providing clinics. We compared the distribution of these PrEP clinics to the distribution of new HIV diagnoses within various geographical areas and by key populations.ResultsMost (43/50) states had less than one PrEP-providing clinic per 100,000 population. Among states, the median was two clinics per 1000 PrEP-eligible men who have sex with men. Differences between disease burden and service provision were seen for counties with higher proportions of their residents living in poverty, lacking health insurance, identifying as African American, or identifying as Hispanic/Latino. The Southern region accounted for over half of all new HIV diagnoses but only one-quarter of PrEP-providing clinics.ConclusionsThe current number of PrEP-providing clinics is not sufficient to meet needs. In addition, PrEP-providing clinics are unevenly distributed compared to disease burden, with poor coverage in the Southern divisions and areas with higher poverty, uninsured, and larger minority populations. PrEP services should be expanded and targeted to address disparities.     

Same-day surgery: management issues and future growth.

Policy makers in all countries are searching for cost-effective, quality health care. In the realm of surgical care, one response to modern cost and quality pressures is same-day surgery. This article discusses three aspects of same-day surgery programs: key management issues; analysis of competitiveness; and, the growth potential of same-day surgery. Today's managers of same-day surgery programs are most concerned with issues related to their customers, be they physicians, insurers, or patients. Indeed, program managers identify market research, program development, and patient, physician, and facility management as areas critical to success. An exploratory survey carried out of ten same-day centers indicates that programs must excel in two areas to succeed. First, they must develop efficient and appropriate operations. Second, they must communicate aspects of these operations to different customers, realizing that each customer type is interested in different aspects of the program. This article provides a framework for the analysis of customer interests. It also suggests that surgery centers satisfy customer preferences rather better than do hospital outpatient programs. Same-day surgery will increase. Uncertainty lies in how quickly and in what form such activities in hospitals and centers will develop. Countries will likely experience different growth patterns, according to the relative power of factors affecting both the supply and demand of same-day surgery.     

Slippery when wet: the effects of local alcohol access laws on highway safety

Using detailed panel data on local alcohol policy changes in Texas, this paper tests whether the effect of these changes on alcohol-related accidents depends on whether the policy change involves where the alcohol is consumed and the type of alcohol consumed. After controlling for both county and year fixed effects, we find evidence that: (i) the sale of beer and wine may actually decrease expected accidents; and (ii) the sale of higher alcohol-content liquor may present greater risk to highway safety than the sale of just beer and wine.     

Better health reports when the grass is greener on your side of the fence? A cross-sectional study in older persons

Objective  

To study whether the luxury goods make older people feel in better health and whether this association is similar in higher and lower social classes.     

Neonatal circumcision: when is the decision made?

A self-administered questionnaire was completed by 277 new mothers to determine when the decision for neonatal circumcision is made. Seventy-eight percent of the women sampled were in favor of neonatal circumcision even before becoming pregnant. Over one half (56 percent) of the sample had decided before becoming pregnant that they would have their sons circumcised. Only 7 percent of the mothers made the decision after delivery. The circumcision status of the women's mates was a significant factor in making the decision for white women but not for black women. Sixty-one percent of all the women tried to learn more about circumcision before deciding. The most influential person in helping these women make the decision about circumcision was the husband.     

Energy conservation: when the bill is in millions

Current energy economy measures are estimated to be saving the NHS 30 m pounds a year. It is believed that at least another 30 m pounds at today's prices can be saved without affecting direct patient care or general comfort levels in hospitals. This article by V.E. Skegg, superintending engineer, DHSS, outlines the nature of the problem and the steps being taken. It also emphasises the need for the active co-operation of all staff, both administrative and other disciplines, particularly in the use of electricity, if the amount and cost of energy is to be contained.