A methodology for the analysis of rural primary health care delivery systems

A methodology for the analysis of rural primary health care delivery systems is presented. The basic approach is that the dynamics of rural primary health care delivery systems can be understood as an interaction between consumer and provider models. Computer modelling techniques can be used to analyze the efficiency of particular rural health care systems based on site-specific geographical data and economic data regarding the cost of gasoline and other costs to the consumer and provider. The methodology is relevant in developing countries as well as in the United States.     

Utilization of mental health care services among older adults with depression

Despite the availability of effective treatments for late life depression, data indicate that only a small minority of adults over the age of 65 years with depression access any kind of care for emotional or mental health problems. Using data from the Canadian Community Health Survey (Cycle 1.1), we compared patterns of mental health service utilization among middle-aged (45-64 years), younger old (65-74 years), and older old (75 years and older) adults with and without depression and identified predictors associated with accessing different services (n=59,302). Compared to middle-aged adults with depression, individuals aged 65 and older with depression were less likely to report any mental health consultation in the past year and especially unlikely to report consulting with professionals other than a family physician. Age remained a significant predictor of mental health service utilization even after accounting for other relevant variables such as gender, marital status, years of education, depression caseness, and number of chronic medical conditions. Although the prevalence of depression is lower in older age groups, the present study provides compelling evidence that mental health services are particularly underutilized by depressed older adults.     

Preparing psychologists to link systems of care in managing and preventing children's health problems

OBJECTIVE: To describe the need for innovations in training to link health, educational, and family systems and to illustrate how this can be accomplished through child-oriented psychology training programs. METHODS: We describe multiple pathways for the preparation of child-oriented psychologists to link health, educational, and family systems, in keeping with the National Institute of Mental Health guidelines for preparing professionals in child and adolescent psychology. These pathways include training embedded in graduate programs specializing in clinical child, pediatric, school, community, and family psychology. This article highlights a training initiative for preparing child-oriented psychologists based in a school psychology program. RESULTS: A partnership between Lehigh University and The Children's Hospital of Philadelphia has been developed to prepare school psychologists to coordinate community-based systems of care to promote positive educational and health outcomes for children. This program emphasizes both intervention and prevention and provides a set of integrated experiences in both health care and educational settings. CONCLUSIONS: We highlight components of this program relevant to the preparation of pediatric psychologists. We identify and discuss potential challenges in establishing training programs for the preparation of professionals to link health, school, and family systems.     

汶川地震受灾地区灾后社区、乡镇卫生院工作者精神卫生服务能力评估

目的:了解汶川受灾地区社区、乡镇卫生院工作者的精神卫生知识掌握情况及精神卫生服务能力,为精神卫生培训提供依据,为我国精神卫生服务体系建设提供科学参考。方法:选取灾后社区、乡镇卫生工作者心理卫生服务技能培训班学员353名为研究样本,回收有效问卷313份。使用自编精神卫生知识评估问卷和精神卫生服务调查表进行评估。自编精神卫生知识评估问卷包含抑郁症、酒精依赖、精神分裂症(阳性症状为主)、创伤后应激障碍和躯体形式障碍5种精神障碍。结果:受灾地区乡镇、社区卫生院工作者对于社区5种精神障碍准确诊断率最高的案例为抑郁症(77.0%),药物处理中位数得分最高的为酒依赖;非药物处理中位数得分最高的是酒依赖和创伤后应激障碍。培训前1月内报告未接诊过精神障碍患者的社区、乡镇卫生院工作者占53.4%。不知道任何1所精神卫生服务机构的卫生院工作者占35.1%;不知道精神科专科会诊的占37.7%;不能邀请精神科专科会诊的占39.6%。结论:汶川地震后,受灾地区的乡镇、社区卫生院工作者精神卫生知识和技能掌握较少,精神卫生服务能力相对弱。     

Women's attitudes towards receiving family planning services from community health workers in rural Western Kenya

BackgroundKenya ranks among the countries in Africa with high fertility rates. In order to reverse the trends in high fertility rates, there is need to increase uptake of family planning services particularly by use of community health workers (CHWs) in providing these services in rural areas.ObjectiveTo describe the perceptions of women towards family planning service provision by CHWs in four rural districts of Western Kenya. It is based on baseline survey data from a three-year, rural community-based family planning project funded by The David and Lucile Packard Foundation.MethodsA cross-sectional baseline survey was conducted in Western Kenya. The data presented is part of a broader the broader survey . A survey questionnaire was administered to 1,997 women (15–49 years) but only 963 cases were valid for our analyses.ResultsThe findings revealed that only a third of the respondents exhibited high approval for Family Planning services from CHWs. Only four out of the thirteen variables explored showed significance on attitudes towards family planning services from CHWs. These are age, level of education, knowledge about family planning benefits and districts.ConclusionWomen''s perception towards family planning services delivered by CHWs in Western region in Kenya is quite low. To improve the demand and supply for family planning services in this region, there is need to invest a substantial amount of effort into sensitization of women on the relevance of CHWs in providing family planning services.     

Connected care in a fragmented world: lessons from rural health care.

This paper uses the phenomenon of very high satisfaction with remote rural health services in Scotland as a trigger for exploring what consumers want and like in health service utilisation - and why. It draws on the business literature in customer services marketing and economic sociology to illuminate why long-term associations between consumers and providers in health care are important and beneficial. In doing so, it highlights wider lessons about the experience of good health care to be learned from the satisfaction expressed by rural residents and suggests, as health services become increasingly fragmented, the relevance of maintaining a connected experience for patients.     

The role of drug delivery systems in health care: the case of self- medication

Up to 80 % of illness episodes are first defined, diagnosed and treated at the household-level. In the developing world especially, approximately half the population has no access to public health services. It is obvious then that other sources of care will be used. We examined the availability of proprietary drugs in communities, and the extent and reasons for their use in the treatment of childhood malaria on the Kenyan Coast. Retail outlets are extensively used as the first tier of health care for illnesses considered to be mild or mundane. However, the wide range, types and formulations of over-the- counter (OTC) drugs including antimalarials available in these retail outlets constitute a major health hazard. Yet, both users and proprietors of retail outlets know little or nothing about the drugs and thus use or sell them inappropriately. Even, children are treated promptly by purchase of OTC drugs. The policy implications of these findings are discussed.     

Evaluation of TELEDERM for dermatological services in rural and remote areas

OBJECTIVE: This paper describes the Web-based decision support system (TELEDERM) that provides medical services to rural and remote general practitioners (GPs), and presents qualitative results on the usefulness and usability of the system obtained from trials in the GoldFields, Western Australia. METHODS: Diagnostic methods and other functions were developed to assist medical practitioners, who may not be familiar with aspects of decision support systems, to diagnose patients with dermatological problems. GPs in rural and remote areas took part in a trial to assess the usefulness of TELEDERM in clinical situations. In evaluating and assessing a number of the system's characteristics, questionnaires, seminars and interviews were used. RESULTS AND CONCLUSIONS: Feedback concerning the usefulness of TELEDERM shows that 67% of the GPs found the system useful or very useful, and 25% found the system somewhat useful. In terms of its usability, 83% found the system easy to use. The responses concerning the user interface and interactivity of TELEDERM are encouraging as 92% of the GPs found the text easy to read, 84% were happy with the appearance of the interface, and 84% found the system easy to navigate. 89% indicated that they are likely to use the system again. An issue with such systems is the reluctance of GPs to use them, even given that the development was quite sensitive to the needs of the GPs and the consultants, e.g. by streamlining the query process and emphasising that the system is a support tool and not a replacement.     

Unmet information needs about the delivery of rheumatology health care services: a survey among patients with rheumatoid arthritis

Objective

To measure patient-perceived knowledge and information need regarding regional health care services and their determinants among 400 patients with rheumatoid arthritis (RA) and to identify the preferred method of information provision.

Methods

Postal survey on knowledge and information need (content and accessibility) of 18 regional health care services and preferences for the mode of delivery of information. Logistic regression analyses determined which factors were associated with insufficient knowledge and information need.

Results

Two-hundred and thirty-seven (94%) patients reported insufficient knowledge about the contents and 235 (94%) about the accessibility of at least one health care services, whereas 172 patients (69%) reported an information need about the content and 154 (61%) on the accessibility. Age was significantly associated with knowledge whereas both age and physical functioning were significantly associated with information need. Seventy-nine percent of the patients mentioned written information, 21% the Internet and 12% personal contact with a professional as a preferred method of information delivery.

Conclusion

Many RA patients reported a lack of knowledge or information need concerning the contents and accessibility of regional health care services.

Practice implications

Active strategies to provide practical information about health care services are needed for RA patients.     

Health services and the adolescent health situation in a rural setting: the Kenyan experience

This study examined the adolescent health situation in Siaya District. The findings indicate that there are no particular health services specifically targeting the adolescent in the district. The adolescent health situation in the district is badly off and prevalence of diseases is high amongst them. They are faced with STDs/AIDS, pregnancies, drug abuse, abortion, alcoholism among others. The adolescent in the district are not aware of the existing health services that could be of help to them. They are not aware of their general and reproductive health as it were, but they are very much aware of contraceptives. The study revealed that their attitude towards the existing medical and nursing services including the medical staff is very negative. They do no have proper information system and the health facilities are inaccessible to them. Teachers and radio play a major part in disseminating information to them. The health staff are very much aware of the adolescent health needs. Most health staff have communication problems with the adolescents. Not so many schools offer heath services and for those which offer, it is only simple diagnosis and treatment. Students dropping out of schools are mostly victims of pregnancies and drug-abuse or alcoholism. This revealed that the adolescents in the district need immediate help as far as their health needs are concerned.     

A comparison of a cytokine status in pollenosis patients living in urban and rural areas

Sixty patients with pollenosis were examined: 36 city inhabitants and 24 villagers. The blood serum levels of IL-4, IFN-gamma and total IgE, production of IL-4, IFN-gamma by immunocompetent blood cells in vitro were determined. The correlation analysis detected more intensive involvement of IFN-gamma in allergic process in allergic patients living in the city. Estimation of spontaneous and induced cytokine production and their correlation (IS) showed that villagers had 2.5 times higher IS of IFN-gamma cytokine.     

Innovations in health care services: The CAALYX system

PurposeThis paper describes proposed health care services innovations, provided by a system called CAALYX (Complete Ambient Assisted Living eXperiment). CAALYX aimed to provide healthcare innovation by extending the state-of-the-art in tele-healthcare, by focusing on increasing the confidence of elderly people living autonomously, by building on the knowledge base of the most common disorders and respective characteristic vital sign changes for this age group.MethodsA review of the state-of-the-art on health care services was carried out. Then, extensive research was conducted on the particular needs of the elderly in relation to home health services that, if offered to them, could improve their day life by giving them greater confidence and autonomy. To achieve this, we addressed issues associated with the gathering of clinical data and interpretation of these data, as well as possibilities of automatically triggering appropriate clinical measures. Considering this initial work we started the identification of initiatives, ongoing works and technologies that could be used for the development of the system. After that, the implementation of CAALYX was done.FindingsThe innovation in CAALYX system considers three main areas of contribution: (i) The Roaming Monitoring System that is used to collect information on the well-being of the elderly users; (ii) The Home Monitoring System that is aimed at helping the elders independently living at home being implemented by a device (a personal computer or a set top box) that supports the connection of sensors and video cameras that may be used for monitoring and for interaction with the elder; (iii) The Central Care Service and Monitoring System that is implemented by a Caretaker System where attention and care services are provided to elders, where actors as Caretakers, Doctors and Relatives are logically linked to elders. Innovations in each of these areas are presented here.ConclusionsThe ageing European society is placing an added burden on future generations, as the ‘elderly-to-working-age-people’ ratio is set to steadily increase in the future. Nowadays, quality of life and fitness allows for most older persons to have an active life well into their eighties. Furthermore, many older persons prefer to live in their own house and choose their own lifestyle. The CAALYX system can have a clear impact in increasing older persons’ autonomy, by ensuring that they do not need to leave their preferred environment in order to be properly monitored and taken care of.