Managed Care, School Health Programs, and Adolescent Health Services: Opportunities for Health Promotion

ABSTRACT: The rapid expansion of managed care creates opportunities and dilemmas for those involved in school health and adolescent health promotion. Managed care organizations (MCOs), public health agencies, and school and adolescent health providers share certain common goals and priorities including an emphasis on prevention, cost-effectiveness, and quality of care — and a willingness to explore innovative approaches to health promotion and disease prevention. However, MCOs often face conflicting challenges, balancing the goals of cost containment and investment in prevention. In considering support for school health programs, MCOs will be interested in evidence about the effectiveness of services in improving health and/or reducing medical expenditures. Mechanisms for improving prevention efforts within MCOs include quality assurance systems to monitor the performance of health plans, practice guidelines from professional organizations, and the contracting process between payers and health care providers. Development of partnerships between MCOs and schools will be a challenge given competing priorities, variation in managed care arrangements, structural differences between MCOs and schools, and variability in services provided by school health programs     

What Pregnant Women Want to Know: A Comparison of Client and Provider Perceptions

Objective: To compare client and health-care provider perceptions concerning health topics.
Design: A survey conducted at the first prenatal visit asked women to indicate levels of interest in 38 topics. Providers answered the same survey, indicating perceptions of clients' interests.
Setting: A prenatal clinic and a private office, both in an inner city area.
Participants: Two groups of prenatal clients (n = 135 private care and n = 250 public care) and their health-care providers (n = 32 nurses and physicians ).
Results: Significant differences were found (p < .01 for four topics , p < .05 for six topics) between the clients' interests and the providers' perceptions. Women in private and public care differed significantly (p < .01) in their levels of interest. Interest was significantly affected by parity, but not maternal education.
Conclusions: Nurses and other health professionals should be aware of the range of topics in which clients express interest. This study suggests that site of care and parity should be considered when developing prenatal health education.     

A mandatory smoking ban in restaurants: Concerns versus experiences

The purpose of this study was (a) to assess the concerns of restaurant representatives about a city ordinance that prohibited smoking in all restaurants prior to its enactment and (b) to determine if these concerns were realized 15 months after the ordinance had been in effect. Representatives from 34 randomly selected restaurants participated in both the pre- and post-interviews. Although 26.5 percent of the respondents were concerned that the ordinance would be difficult to enforce, 94 percent found the ordinance easy or very easy to enforce. While some customers appeared to have negative reactions to an ordinance that prohibited smoking, four times that many appeared to have positive reactions to the ordinance. Although approximately 12 percent of the respondents indicated that the ordinance had a slightly negative effect on employees, the majority (88.2%) felt that the ordinance had either no effect or a positive effect on employees. Most respondents believed that the ordinance would have no effect on their business and most reported that the ordinance had no or no known effect on business. Although many restaurant representatives had concerns about a non-smoking ordinance prior to its enactment, restaurant representatives' self-reported experience with the ordinance suggests that most of these concerns were not realized.This study was supported by the Center for Prevention and Health Promotion, Arizona Department of Health Services. The author acknowledges Lori Rawlins for her assistance in collecting and collating the data. David Dube, MPH and Marty Eckrem, MPH of the Coconino County Department of Public Health and John Meyers, PhD, Director of the School of Hotel and Restaurant Management at Northern Arizona University are thanked for their assistance in developing the questionnaires and designing the study.     

Implementing Patient Safety Initiatives in Rural Hospitals

ABSTRACT:  Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in 8 small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of 3 patient safety interventions: the Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey, use of personal digital assistants (PDAs), and sharing of emergency room protocols. The experience suggested that a collaborative model between rural hospitals, a payer, a hospital association, a quality improvement organization, and academic institutions can effectively support patient safety activities in rural hospitals. Successful implementation of the 3 patient safety interventions depended on leadership provided by nursing and patient safety/quality managers and open, trusting communications within the hospitals.     

Innovative clinical addiction research training track in preventive medicine

Medical education related to identification, diagnosis and management of alcohol and other drug problems receives inadequate attention in the undergraduate curriculum and during residency training. This article describes the design, implementation, and evaluation of a new track in Clinical Addiction Research Training (CART) in a General Preventive Medicine (GPM) residency program. CART is comprised of a new course in Addiction Medicine, new practicum sites in addiction medicine research and treatment, and a CART‐designated resident. An Advisory Group of educators, researchers, scholars, and administrators in addiction medicine, has provided guidance and support for this new track. Evaluation of the CART track suggested improvements in residents’ knowledge and attitudes. Residents engaged in high caliber clinical addiction research projects. The development of the CART track within the GPM residency is an approach that can be integrated into other specialties, such as internal medicine, family practice, and adolescent medicine, to develop residents’ interest and expertise in the addictive behaviors.