Chronic illness management and health literacy: an overview

Poor literacy skills can severely compromise effective chronic illness management by the patient. Practitioners' awareness of the prevalence of low health literacy, or the ability to understand and appropriately act on healthcare instructions, among their patients is a first step toward making changes in the practice to ensure patients understand how to manage their chronic illnesses. Researchers and clinicians in the health literacy field gathered recently at a national health literacy conference and shared techniques used and studied in their practices to aid in more effective provider-patient communications and to help improve outcomes and successful patient management of their chronic illnesses.     

Long-term care services in Spain: an overview

To date, both in Spain and virtually all the other European Union (EU) countries, dependency has been seen to be a fundamentally private problem to be dealt with by the family concerned. In this way, whether through informal carers or contracted professionals, in the domestic environment or in care homes, it is the dependent person themselves and their families who currently bear the majority of the costs. In light of this, current concern lies in the social change that is coming on, mainly the accelerated aging process and the increased participation of middle-aged women in the labour market, which heighten the need for collective organisation of that which until now has been resolved within family circles. In this context, at the same time that the Government announces to issue a by the end of 2005, our paper briefly analyzes what we consider the four crucial issues in this area: the current scope of dependency problems and its possible future evolution, the characteristics of the current spanish long-term care system and its main problems; the role that health services should have in the dependency issue; and finally, the benefits and drawbacks of the main alternatives that the Administration could manage in case it intends to increase its involvement in this field.     

Building the infrastructure for primary health care: an overview of vertical and integrated approaches

In the past four decades there has been a succession of different approaches to the development of infrastructure for the delivery of health services. There have been striking similarities among these approaches in both direction and timing in many different countries, particularly in the developing world. While the general trend has been strongly in the direction of a more comprehensive, integrated health infrastructure, there have been important regressions from this path. It is suggested that the recent attention given to the delivery of 'selective' packages of interventions has often diverted energy and resources from the essential task of developing comprehensive, efficient and effective health services. This paper begins with an historical review of trends in the development of health services infrastructure in recent decades. It proceeds to analyse the implications for the organization of health services and for resource allocation when the health services infrastructure is viewed as part of a health system based on primary health care. Finally, we maintain that district health systems based on primary health care provide an excellent practical model for health development, including an appropriate health system infrastructure. Within this model the concerns with accelerating the application of known and effective technologies and the concerns with strengthening of community involvement and intersectoral action for health are both accommodated. The district health system provides a realistic setting for dialogue and planning involving both professionals and non-professionals concerned with health and social development.     

Long-term care in the United States: an overview

Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection.     

Medical students' attitudes to psychiatric illness in primary care

Context Previous research has shown that general practitioners (GPs) hold negative attitudes towards patients with schizophrenia, which do not simply reflect the nature or chronic aspects of the illness. This study aimed to describe the attitudes and predicted behaviour of medical students towards patients with mental illness in a primary care setting and to investigate whether these were affected by the students’ level of training. Methods A sample of 1239 students from the University of Birmingham Medical School were each given one of four case vignettes, all of which were identical except that the patient involved was described as having a previous diagnosis of, respectively, schizophrenia, depression, diabetes or no illness. Students rated their level of agreement with 12 attitudinal statements relating to the vignette. Results A total of 1081 (88%) students responded to the questionnaire. Students were generally less favourable in their responses to patients with either schizophrenia or depression. They would not be as happy to have them on their list, believed they would consume more time and considered they would be less likely to comply with advice and treatment. They expressed more concern about the risk of violence, the potential welfare of children and the possibility of illegal drug and excessive alcohol use. General clinical and psychiatric training had little effect on these reactions. Conclusions Patients with mental illness provoke less favourable responses in medical students, which are not altered by furthering education. Undergraduate primary care‐based mental health education should be re‐evaluated to ensure that students develop an empathetic and positive approach to mental health patients and their treatment.     

The Canadian health care system: an overview

Although health care is a provincial responsibility in Canada, universal hospital insurance was fully adopted by 1961; universal medical insurance followed 10 years later. Each province enacted universal insurance after the federal government offered to pay 50% of provincial hospital and medical care costs. Hospital insurance had wide public and provider support but universal medical care insurance was opposed by organized medicine. The federal government soon realized that it had no control over total expenditures and no mechanisms for controlling costs. In 1977 it enacted Bill C-37 which limited total federal contributions and made those contributions independent of provincial health care expenditures so that increased costs had to be met by the provinces. Since private health care insurance for universal benefits is prohibited by the federal terms of reference for health insurance, the provinces must raise the money by taxes and (in some provinces) premiums. Although prohibited by the terms of reference of the universal program, some provinces have adopted hospital user fees and are allowing their physicians to bill patients in excess of provincial fee schedules. The 1980s have seen increased confrontations between the federal and provincial governments and between the provinces and their providers. The issues are cost containment and control of the system. The provinces have two broad options. The first is more private funding through private insurance and user fees. The proposed new Canada Health Act will probably prohibit such charges. A second option involves greater control and management of the system by the provinces; this has already occurred in Quebec. Greater control is vigorously opposed by physicians and hospitals. The Canadian solution to health insurance problems in the past has been moderation. Extreme moves in either direction would represent a break with tradition, but they may prove to be unavoidable.     

Barriers in addressing body image and eating issues in primary care: an overview of women’s narratives

ABSTRACT

Disordered eating and body image concerns continue to be rising problems for young women that come with significant mental and physical health risks. Primary care may be a potential avenue for early identification and intervention of eating and body image issues. However, few studies have explored this area in depth. Preliminary studies show that few women discuss these issues with their primary care providers (PCPs), and the barriers to these conversations remain unknown. This study used an open-ended survey to explore women’s narratives concerning their experiences and barriers to discussing eating and body image issues with their PCPs. A total sample of 102 female college students (aged 18–35 years) in the Boston area completed self-report questionnaires online (February 2015 through January 2016). Themes in both communication and relationship domain emerged. Communication themes for participants included: health information, prompting by the PCP, and other barriers. Relationship themes included: patient and provider characteristics, negative and positive emotions, and trust. According to these participants, many women experience negative interactions with their providers when discussing these sensitive topics. Strategies for improving these outcomes in primary care are discussed.     

Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population

OBJECTIVE: Our goal was to compare the prevalence of mental illness and its impact on functional status in an indigent uninsured primary care population with a general primary care sample. We also hoped to assess patient preferences about mental health and medical service integration. STUDY DESIGN: We compared a survey of consecutive primary care adults in April and May 1999 with a 1997-98 survey of 3000 general population primary care patients. Both studies used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and the 20-question Medical Outcomes Study Short Form. POPULATION: The patients were from a private nonprofit primary care clinic in Grand Junction, Colorado, that served only low-income uninsured people. We approached a total of 589 consecutive patients and enrolled 500 of them. MAIN OUTCOME MEASURE: The main outcomes were the prevalence of psychiatric illnesses and the relationship with functional impairment. We compared our findings with a more generalizable primary care population. RESULTS: This low-income uninsured population had a higher prevalence of 1 or more psychiatric disorders (51% vs 28%): mood disorders (33% vs 16%), anxiety disorders (36% vs 11%), probable alcohol abuse (17% vs 7%), and eating disorders (10% vs 7%). Having psychiatric disorders was associated with lower functional status and more disability days compared with not having mental illness. Patients indicated a preference for mental health providers and medical providers to communicate about their care. CONCLUSIONS: This low-income uninsured primary care population has an extremely high prevalence of mental disorders with impaired function. It may be important in low-income primary care settings to include collaborative care designs to effectively treat common mental disorders, improve functional status, and enhance patient self-care.     

Out of hours primary care: a critical overview of current knowledge

Out of hours care in the UK has undergone radical changes in the past five years, with a rapid increase in the number of general practitioner co-operatives operating from primary care centres. Patients wishing to see a general practitioner outwith normal surgery hours can now be asked to attend a centre, be given telephone advice or may still receive a home visit if required. This overview examines the current literature evaluating these changes. While there are now a number of studies examining general practitioner co-operatives and centres in both England and Scotland, there is little or no work on other forms of out of hours care. In particular, little is known about the continuing role of the single handed general practitioner or about out of hours care in small towns and in rural areas. The need for these issues to be addressed is discussed and the aims of the current Scottish study comparing different models of out of hours care outlined.