Knowledge and attitudes of AIDS health care providers before and after education programs

Analysis of the responses of 1,247 health care providers to questionnaires immediately before and after educational programs on acquired immunodeficiency syndrome (AIDS) revealed significant (P less than .05) improvements in accuracy of knowledge about 7 of 15 modes of transmission and 7 of 11 means of infection control. Sizeable percentages, however, continued to believe after the programs that AIDS could be transmitted by casual contact, such as sharing coffee cups. Provider attitudes about caring for persons with AIDS shifted in the direction desired (P less than .001) on six of nine questions. After programs, 92 percent believed that they had sufficient knowledge to protect themselves from getting AIDS, and 79 percent felt professionally competent to care for a person with AIDS. Both before and after programs, providers who established regulations for the care of persons with AIDS and outpatient care providers had the most accurate knowledge and felt most comfortable with persons with AIDS, while inpatient care providers had the least accurate knowledge and felt least comfortable. A 1-month followup of 159 providers revealed that postprogram changes in knowledge and attitudes were largely retained. Results point to the need for education at all levels of the health care system, to a persistent gap in knowledge and attitudes between those persons who establish regulations and those who carry them out, and to the possibility of creating significant changes through education.     

A study of attitudes toward medical care and health behaviors among older adults

In order to understand the attitudes of older adults toward medical care, we interviewed 480 persons living in Yokohama, and 180 persons living in Aikawa, Kanagawa, aged 45 to 84 years old. The following results were obtained; 1) Attitudes toward medical care can be classified into four types; self-determined medical care, self treatment attitudes, high dependence on the medical care system, and distrust of medical care. Those interviewees who had high self-determination in medical care and self treatment attitudes showed strong distrust of medical care. 2) There were two groups with trend toward low compliance to the advice of a physician for a physician diagnosed illness: the group that had strong self-determination in medical care, and the group that had high distrust of medical care. The interviewees who had a strong tendency to see a physician for potentially serious illness had high self treatment attitudes, but disease prevention behaviors was not associated with all of four types. 3) In both communities, those interviewees who were younger and with higher educational levels showed strong distrust of medical care and had more self-determination attitudes. Those interviewees who had actually experienced problems in medical treatment showed less dependence on medical care and more distrust of medical care compared to those who had not. In Yokohama, distrust of medical care appeared to be higher among those interviewees who did not have a family doctor than those who had. 4) Distrust of medical care and self-determination in medical care was significantly higher in Yokohama than in Aikawa. The differences in the distribution of educational level and family doctors were a part of the reason for area differences in attitudes of distrust of medical care.     

Knowledge and attitudes of health professionals toward adolescent health care

The rising concern over the competency of health care professionals in the United States to meet the health needs of adolescents was the impetus for a national survey of 3066 physicians, nurses, social workers, nutritionists, and psychologists. The survey explored perceptions of training and competency regarding 16 dimensions of adolescent health care. Major deficits were noted for each discipline. For physicians, self-perceived limitations were in the areas of eating disorders, learning disabilities, chronic illness, and delinquent behavior. The same limitations were also mentioned by nurses. Over half of the psychologists reported deficits related to the psychological sequelae of sexual concerns, sexual orientation conflict, eating disorders, and chronic illness. Many of the same concerns reflected the perceived competencies of social workers. Nearly half of all nutritionists surveyed acknowledged deficits in almost all adolescent food-related concerns. The impact of these low levels of perceived competency is discussed in terms of implications for clinical service.     

Physicians' attitudes toward health care rationing.

BACKGROUND: Optimal allocation of health care resources under a limited budget is controversial. Particularly important questions are whether rationing decisions should be based on efficiency considerations alone or in combination with equity considerations, and who should be in charge of such decisions. In this study, the authors sought to understand the position of Swiss physicians toward rationing using a previously developed rationing scenario. METHODS: The authors examined the acceptability of various scenarios implementing health care rationing in a mail survey of 1,184 physicians practicing in Geneva, Switzerland. Respondents were asked to choose between providing a suboptimal cancer screening test A to the whole population, which would save 1,000 lives, or selecting half of the population to receive a better but more expensive test B, which would save 1,100 lives. Physicians were randomly assigned to 3 versions of the scenario: Beneficiaries of test B could be chosen by lottery, on a first-come-first-served basis, or by medical associations. RESULTS: Only 26% of physicians chose the more effective selective rationing option; this proportion was lowest when test beneficiaries were selected by lottery (14%), intermediate for the first-come-first-served-scenario (26%), and highest when selection was left to medical associations (39%; P < 0.001). Hospital-based physicians and general practitioners were less likely to endorse selective rationing than community-based physicians and specialists. CONCLUSION: Swiss physicians appear to be more concerned about equal allocation of health services than about maximizing health in society, and they prefer physicians to be in charge of rationing decisions.     

AIDS education and training for health care providers

Many health care providers still harbor fears and misunderstandingsabout AIDS that negatively affect the delivery of patient care.In order to resolve these fears and misunderstandings, fiveregistered nurses representing the California Nurses Association,AIDS Project Los Angeles, the San Francisco AIDS Foundationand the California Statewide Nursing Program developed, implementedand evaluated an innovative AIDS ‘train the trainer’program. The program was designed to replace didactic lectureswith more effective methods to meet the needs of adult learners.Between November 1986 and April 1987, 27 two-day trainings wereconducted throughout California to train 759 key health careprofessionals in both adult learning principles and AIDS content.Creative teaching strategies such as guided fantasy, role playand case studies were utilized to encourage group interactionand the exploration of sensitive issues underlying the fearof AIDS. By June 1, 508 of the 759 Trainers had each conductedinstructional programs for groups of 25 or more health careproviders; a total of 18 879 people were educated in the secondarytrainings. Summative program evaluation showed that the trainingprogram gave participants the knowledge, skills and confidencenecessary to conduct AIDS education for health care providers.     

Strategies for improving corporate philanthropy toward health care providers

The authors report the results of a survey examining corporate donation behavior relative to the health care industry. The findings suggest that, despite the poor economic conditions of recent years, companies have continued to make substantial contributions--particularly to the health care industry--and that the single most identifiable factor influencing the availability of funds in any given year was the company's expected earnings in that year. Additionally, the authors suggest criteria that influence whether a company donates to a particular organization as well as the expected benefits and methods of recognizing donations. Finally, they discuss preferred solicitation methods along with marketing implications for the health care industry.     

Physicians' attitudes and behaviors toward home health care services

The authors investigate physicians' attitudes, information-seeking behaviors, and behavioral intentions toward home health care programs. Survey results show that physicians favor the concept, but knowledge and awareness levels about available programs vary with the physicians' specialties. Evidence also is reported on specific problems encountered, sources of information used to make home care referrals, and physicians' perceptions of the impact of home care programs on their practice. Finally, policy implications are drawn for marketers of home health care programs.     

Home health care workers' attitudes toward the elderly

This study examined home health care workers' attitudes toward the elderly and their elderly clients. Data were collected from a convenience sample of 106 home health care workers in South Central Florida in October 1994, using the Attitudes Toward the Elderly Questionnaire (ATE). Estimated internal consistency reliability of the scale was .60, using Cronbach's alpha. Findings suggest that home health care workers have positive attitudes toward the elderly, their elderly clients, and provide a reasonable level of service for them. Also, findings suggest that overall the attitudes and perceptions among urban and rural home health care workers are similar.     

Attitudes and intentions of future health care providers toward abortion provision

CONTEXT: Induced abortion is one of the most common procedures performed among women in the United States. However, 87% of all counties had no abortion provider in 2000, and little is known about the attitudes and intentions of future health care providers, including advanced clinical practitioners, regarding abortion provision. METHODS: During March 2002, first- and second-year students in health sciences programs (i.e., medicine, physician assistant and nursing) at the University of Washington were anonymously surveyed. Univariate, bivariate and multivariate analyses were used to determine students' attitudes and intentions regarding provision of abortion services. RESULTS: Of the 312 students who completed the survey, 70% supported the availability of legal abortion under any circumstances. Thirty-one percent intended to provide medical abortion in their practice, and 18% planned to offer surgical abortion. Fifty-two percent of all respondents agreed that advanced clinical practitioners should be able to provide medical abortion, and 37% agreed that they should be able to provide surgical abortion services; however, greater proportions of advanced clinical practitioners (45-83%) than of medical students (21-43%) expressed such support. Sixty-four percent of all respondents were willing to attend a program whose curriculum requires abortion training. CONCLUSIONS: Although it may not be possible to require abortion training for every future health care provider, making abortion a standard part of clinical training would provide opportunities for future physicians and advanced clinical practitioners, and would likely ameliorate the abortion provider shortage.     

Physicians' and consumers' conflicting attitudes toward health care advertising

The purpose of this paper is to explore the conflicting attitudes held by physicians and health care consumers toward health care advertising in an attempt to resolve the question. The paper introduces the differing positions held by the two groups. The rationale behind physicians' attitudes is then presented that advertising can be unethical, misleading, deceptive, and lead to unnecessary price increases. They believe that word-of-mouth does and should play the major role in attracting new patients. The opposite view of consumers is then presented which contends that health care advertising leads to higher consumer awareness of services, better services, promotes competitive pricing, and lowers rather than raises health care costs. The final section of the paper compares the arguments presented and concludes that health care advertising clearly has a place in the health care industry.     

Association of vaccine-related attitudes and beliefs between parents and health care providers

Objectives

Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child's health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child's primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.

Methods

We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.

Results

Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.

Conclusions

The beliefs of children's health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.     

Continuing medical education

Summary. The purpose of this paper is to report on the First International Conference on Continuing Medical Education. The article will first address the growing significance of continued medical education within the continuum of medical education. Secondly, it will address the justification and imperative for a global view of medical education and will then provide an overview of the events of the First International Conference. Finally, it will discuss plans for future collaborative efforts in support of global CME initiatives.     

Continuing medical education

While continuing medical education (CME) is receiving increasing attention from medical educators and health administrators worldwide, many efforts need to be made to improve its performance and overall effectiveness. Traditionally, CME has depended primarily on periodic courses and conferences. These remain of unproven cost-effectiveness and often the choice of their content is not tailored to meet best the needs of the learners. It is proposed that CME activities be reshaped to depend more on supervised small-group tutorials in which the learner is an active participant in preparation and presentation. Moreover, instead of having CME activities take place once or twice a year in a distant location, a more practical format would be to plan additional activities more frequently, but less condensed, on an ongoing basis and preferably at the place of work all year round. Factors that may increase learner motivation would be to depend not only on attendance at CME activities but also on the introduction of assessment mechanisms that will measure objectively the actual desired advancement of the learners. Incentives for good learners and teachers need to be introduced. The cost of CME is heavy and can be a burden on health authorities and medical institutions. Contributions from the medical/pharmaceutical industry are acceptable provided quality control is assured and conflict of interest is avoided. Increasing use of computer-assisted teaching and modern telecommunication should, in the near future, help to reduce costs and improve effectiveness of most CME programmes.