Role analysis of the position of the homemaker-home health aide

This research attempted to clarify the definition of the role of the homemaker-home health aide, the individual who provides directly the personal and homemaking services to enable persons who cannot perform these basic tasks for themselves to remain in their homes. The research focused on the definition of this role by analyzing it from the perspective of role theory and by describing the role activity among agencies that meet the National HomeCaring Council criteria for formal accreditation and/or approval. The findings revealed very little conflict in role definition between the providers and the consumers of homemaker-home health aide services.     

The unmet needs of the elderly with diabetes in home health care

The implementation of the Prospective Payment System (PPS) in Medicare home health care has raised concern about health outcomes of elderly patients since its intention is to curb spending. This study examines the unmet needs of older diabetic patients while receiving home health care and post-discharge from home health care (N = 129) in order to explore any effects of PPS on patients' need. The study found that a higher proportion of elders had unmet needs 30 days post-discharge compared with while receiving home health care. The specific unmet needs identified by the elderly diabetic patients included social work services, home health aide, homemaker services, and need for medical equipment. The study explores the role of social work to better manage the unmet needs of diabetic elders who live in the community.     

Redesigning a School Health Workforce for a New Health Care Environment: Training School Nurses as Nurse Practitioners

ABSTRACT: Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs     

Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations

This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.     

THE INFLUENCE OF INCOME ON THE EXPERIENCE OF INFORMAL CAREGIVING: POLICY IMPLICATIONS

Examining the need for an eldercare policy is relevant and timely because the population is aging, a focus of care has shifted from institutional to community based, and informal caregivers, primarily women, are increasingly pressured to be responsible for eldercare. The purpose of the study is to examine the differences in the experiences of low-income and those who are not low-income informal caregivers. Three hundred questionnaires were mailed to past and present home care clients and 58 questionnaires were returned (19% response rate). This research revealed that low-income caregivers have increased needs for support and education from those who can afford to pay for their support services. Low-income caregivers experience significantly greater caregiver distress than do caregivers who are not low income. The unique needs of low-income caregivers must be considered in the formation of Canadian eldercare policy as increased health care privatization promotes the growing inequality in health care provision.     

School Health Services

Data describing the utilization of school health services in a small rural elementary school were examined in terms of the costs of these services and the contributions of these to the school's educational mission. In the absence of health service personnel, teacher time needed to care for routine and emergency health services would equal almost one half of a teacher's time. When costs of health services wer compared to the value of the services provided by a health aide and part-time nurse, it was clear that health service costs were minimal compared to the contributions made to the school's educational mission.     

What do you do for a living? Toward a more succinct definition of health services research

This commentary discusses the need for, and the advantages of, a more concise, revised definition of the field of health services research. It argues for a definition that includes not only the topics on which health services research focuses but also the goals of health services research. A number of condensed definitions are provided for consideration.     

经济相对落后地区农村卫生服务现况分析

[目的]为评估经济相对落后地区农村卫生服务需求与卫生资源利用情况,进一步推动农村医疗卫生服务改革,对沾化县9个乡镇990户3418名居民进行了调查。[结果]调查人群两周患病率为20.22%,两周就诊率24.6%。两周患病率与乡镇居民经济收入无显著相关性;应就诊而未就诊的9.99%,基层医疗条件、居住偏僻、就诊意识差是主要原因;应住院而未住院的为8.54%,未住院率与乡镇经济条件显负相关;病人主要选择在村卫生室就诊,住院多选在县级医院,平均住院天数为12.2d,住院费用3808元;医疗消费占总消费的比例有显著性差异,越是贫困地区越是负担严重。[结论]在相对落后地区,乡镇卫生院处置疾病能力较差,农村居民两周患病率较高,未就诊比例较大,疾病防治工作和卫生政策亟待加强。     

The future of health economics

This paper discusses health economics as a behavioral science and as input into health policy and health services research. I illustrate the dual role with data on publications and citations of two leading health economics journals and three leading American health economists. Five important and relatively new topics in economics are commended to health economists who focus on economics as a behavioral science. This is followed by suggestions for health economists in their role of providing input to health policy and health services research. I discuss the strengths and weaknesses of economics, the role of values, and the potential for interdisciplinary and multidisciplinary research. The fourth section presents reasons why I believe the strong demand for health economics will continue, and the paper concludes with a sermon addressed primarily to recent entrants to the field.     

THE DETERMINANTS OF HEALTH CARE EXPENDITURE TOWARD THE END OF LIFE: EVIDENCE FROM TAIWAN

This paper empirically investigates the relationship between the health care expenditure of end‐of‐life patients and hospital characteristics in Taiwan where (i) hospitals of different ownership differ in their financial incentives; (ii) patients are free to choose their providers; and (iii) health care services are paid for by a single public payer on a fee‐for‐services basis with a global budget cap. Utilizing insurance claims for 11 863 individuals who died during 2005–2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end‐of‐life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public–private differences vary across accreditation levels. Copyright © 2013 John Wiley & Sons, Ltd.     

UNDERTAKING RESEARCH FOR THE BENEFIT OF THE RURAL COMMUNITY

ABSTRACT: This paper discusses the importance of disseminating clinical research findings to improve nursing practice and, ultimately, the health of rural Australia. It is argued that nursing in all settings must be practised within the context of changing healthcare trends. Currently, these changes include the restructuring of health services toward a greater emphasis on community-based services, a redirection of the focus of care toward population health rather than hospital-based service provision, multidisciplinary clinical decision-making with the community as partner, and the need for all health professionals to maintain fiscal and clinical accountability. To chart the process and outcomes of care in these changing circumstances requires ongoing, systematic research. The global movement toward evidence-based healthcare practice is thus timely and necessary. In order to provide a foundation for evidence-based practice that will demonstrate quality, efficiency, effectiveness and community acceptability, employers must address both infrastructure and educational needs. Educators must be responsive to changes in the organisation and funding of care. Also both groups must work collaboratively toward ensuring dissemination of research information that will make a difference to patient and community outcomes. The key to success is ongoing communication between employers, educators, practitioners in the field, community members and professional organisations so that research findings can be analysed in simple language that increases utility and that provides a forum for valuing information from all sources.     

THE STATUS OF RURAL NURSING IN AUSTRALIA: A REVIEW

ABSTRACT: While much has been written about the practice roles of remote area nurses in Australia, less is known about the role and function of the rural nurse. The majority of rural nurses practise in rural hospitals, community health settings and nursing homes. In contrast, the remote area nurses work setting is generally involved with Aboriginal and Torres Strait Islander primary health care services. Rural nurses' practice setting is usually located in a larger organisation than that of the remote area nurse. There is usually at least one medical practitioner in the town or on-call close by. Nurses who are employed in the smaller rural hospitals have what has been described as a 'specialist generalist' role. This means that they are required to be multi-skilled and competent in a wide range of nursing and non-nursing practice. In contrast, nurses who work in base/provincial hospitals, may have either a generalist or specialist role. This paper provides a summary of the literature on Australian rural nurses and develops some of the themes contained therein.     

THE HEALTH EFFECTS OF THE INTERNATIONAL TRANSFER OF MEDICAL TECHNOLOGY

The rapid international transfer of medical technologies to the developing countries is in progress, promoting a “high technology” model of medicine mat is reflected in the structure of hospitals and university faculties, and medical education and practice. The resulting growth of specialties and sub-specialties in hospitals may inhibit the development of appropriate, village-based primary care services. Postgraduate medical education programs donated by the United States, Australia or Europe may disregard the vital issues of provision of universal primary care and local control of health services, and train doctors to devote resources to high technology urban models of care. Medical graduates emigrate to industrial countries because they find no “market” for their services in villages, where needs are the greatest. Bilateral foreign aid programs, WHO sponsored projects, multinational corporate transactions and medical missions and education have been important sources of technology transfer. While a national pharmacopoeia requires only 200 drugs, with 17 basic drugs in village clinics, most patients are denied suitable drug therapy because of inadequate primary care and the inappropriate transfer and promotion of over 4000 drugs that are expensive, incompletely tested in local conditions, or toxic. The deficiency in basic health services means only about 4 million of the 80 million children born each year in Africa, most of Latin America and South East Asia are effectively immunised with available vaccines. There are some apparently successful examples of appropriate health systems, based on the principles of universal access to primary care by health workers, and a national referral system to secondary and tertiary care. Effective monitoring of technology transfer and the development of appropriate health services involves important roles for the WHO and greater international co-operation among community health workers.     

Home health care utilization: a review of the research for social work

The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aide, physical therapy, occupational therapy, or social work services. The review indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment of the care recipient is severe or caregiver burden is high. Implications for social work practice and research are discussed.     

An Assessment of the Use and Impact of Ancillary Prenatal Care Services to Medicaid Women in Managed Care

Objectives: Managed care plans under Medicaid are becoming a usual source of care for low-income pregnant women. This study describes an ancillary prenatal care service intervention developed by one managed care organization (MCO) for Medicaid-enrolled women, assesses the extent to which the intervention services were used, and appraises the influence of the intervention on prenatal care participation. Method: There were 226 intervention and 258 control women with a single live birth delivered between 28 and 44 weeks gestation who (1) were enrolled in the MCO's Medicaid program, (2) were high-risk based on a prenatal risk assessment, and (3) started prenatal care prior to 26 weeks gestation. Less than adequate and intensive prenatal care utilization were chosen as intervention outcomes measures. Results: Family planning, a 2-month postpartum baby visit, a maternal postpartum visit, and a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) referral were among the most self-selected intervention services for this population; home health aide and breast-feeding support were the least requested services. Over 90% of those needing family planning or breast-feeding services received the services, while over 20% of the intervention group refused child care, food assistance and family violence referrals, and home health aide and smoking cessation services. The intervention group had a significantly lower risk of less than adequate utilization of prenatal care (OR = .32; 95% CI: 0.17–0.60) and was more likely to have an intensive number of prenatal care visits (OR = 1.61; 95% CI: 1.05–2.48). Conclusions: The ability of managed care organizations to provide ongoing prenatal care to Medicaid populations in a cost-effective manner depends partly on their development of packages of prenatal services that foster positive preventive health care utilization behaviors and good pregnancy outcomes. The results of this project suggest that the intervention was beneficial in the area of improving utilization of prenatal care.     

武汉市居民卫生服务利用及影响因素调查研究

[目的]了解武汉市居民卫生服务需求及利用的现状,初步分析居民健康素养与卫生服务利用的关系以及影响卫生服务利用的因素。[方法]采用多阶段分层抽样方法,入户调查5600人。[结果]调查对象中两周患病673例(12.2%),两周就诊958人次(16.1%),年住院240例(4.4%),应住院未住院223人(48.2%)。随着健康素养得分的升高未住院率逐渐降低,同时公共卫生服务利用如孕产妇产前检查率、儿童计划免疫建卡率升高。住院服务用Logistic回归分析发现城乡分布、年龄、健康素养水平、两周患病情况是主要影响因素。[结论]武汉市居民的卫生服务利用不足,尤其是低健康素养人群。     

对HIV阳性患者提供医疗保健服务意愿调查

[目的]了解某艾滋病高流行地区从事临床工作的医护人员对HIV感染者/AIDS患者提供服务的意愿及影响因素。[方法]抽取该市2所市级综合性医院4所乡镇中心卫生院753名医护人员进行自填式问卷调查。[结果]大多数医务人员愿意为HIV阳性者提供卫生保健服务,每年接触HIV阳性患者超过10个的医务人员选择“不愿意”的比例最高,对患者健康权认知程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也较高。[结论]加强对医务人员的心理疏导和人权意识的培训。     

DELIMITING 'RURAL': IMPLICATIONS OF AN AGREED 'RURALITY' INDEX FOR HEALTHCARE PLANNING AND RESOURCE ALLOCATION

ABSTRACT: Rural and remote Australia is characterised by considerable geographical and social diversity. There is no 'natural' classification of what constitutes 'rural' or 'remote', and precise definition of what is meant by the term 'rural' has proved to be an elusive goal. Nonetheless, it is recognised that the differentiation of rural areas has important implications for healthcare planning and the research that underpins it. Whether it be the development of resource allocation formulae that determine the provision, location and type of rural health services, measuring service utilisation rates as an indicator of need for services or health outcome measures, the way in which populations and communities are delimited as urban, rural and remote will always influence and sometimes may even determine the assessment. The time is ripe for the development of an agreed classification for the investigation of rural health issues.     

Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale,supporting evidence and testing

Background

Among working age adults in the United States, there is a large, heterogeneous population that requires ongoing and elevated levels of healthcare and related services. At present, there are conflicting approaches to the definition and measurement of this population in health services research.

Aufgabenverständnis und Entwicklungsstand der Versorgungsforschung

Given the fact that health services research has become increasingly popular in Germany during the last 5 years this article focuses on the status quo of this research field in a multinational comparison. An overview of the health services research situation in the USA, UK, Australia and Germany is given by considering development status, definition and future challenges. This overview shows that health services research is by now regarded as an essential field in these countries. Despite clear distinctions in research tradition and research infrastructure there are cross-national themes and challenges regarding research questions and organisation of research. The common challenges of the future are probably the enhancement of research capacities, the further development of adequate research methods and the question of translating research results into practice. All countries concur that the cooperation between stakeholders of the health services research field needs to be strengthened.