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Collaborative care in the United Kingdom

PRIMARY CARE 1999年第2期26卷 411-+页

作者： Jenkins, GC Counselling Primary Care Staines TW18 4DG England

It is estimated that in 1999, psychological counselors will work in over half of all general practices (primary care physician partnerships) in the United Kingdom. The history of the growth of counseling in general practice is, in many ways, typical of the British way of doing things. Ad hoc arrangements at a personal level, in which individual general practices let a counselor, of ten a social worker, colleague, or personal friend, see those patients who had a variety of problems the primary care physician felt unskilled to handle, characterized many of the early reports of General Practice Counseling.(2,3,26) From provisional data available from the first ever National Survey of general practice counselors,(29) it seems that most counselors are women (87%), with an average age of 48 years;all but a tiny handful have recognizable counselling or psychotherapy qualifications. Fifty percent usually possess a British Association for Counseling Recognized Certificate and Diploma, 25% possess additional counselling and psychotherapy qualifications, and 13% possess qualifications at a Masters level. The counselors surveyed come from many backgrounds, including social work, teaching, and nursing, and they work between 5 to 30 hours a week in general practice. As more research studies are published in the United Kingdom, their work, along with other members of the primary care teams (doctors, nurse practitioners, health visitors, psychotherapists, social workers, and others), is becoming increasingly valued by their fellow primary care team members, and by the patients they see who are referred to them by their primary care colleagues.(4,21,24)

关键词：合作行为咨询/组织和管理效率组织家庭医学/组织和管理大不列颠卫生保健费用/统计学和数值数据精神卫生服务/组织和管理初级卫生保健/组织和管理心理学临床/组织和管理人类

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Models of collaboration

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PRIMARY CARE 1999年第2期26卷 401-+页

作者： Lorenz, AD Mauksch, LB Gawinski, BA Univ Rochester Sch Nursing Dept Family Med Rochester NY USA

In order for primary care clinicians to address the complex needs of their patient population they must be able to collaborate with mental health professionals. The peculiar need for this collaboration arises from the mind-body split embedded in our cultural heritage and the resulting professional separatism. A brief review of that history is followed by sections on the spirit of collaboration, the spectrum of collaboration, key ingredients for effective collaboration, and some thoughts about the future of collaboration.

关键词：信息交流病人医护连续性合作行为家庭医学/组织和管理整体保健职业间关系精神卫生服务/组织和管理模型组织管理病人医疗小组初级卫生保健/组织和管理专业场所心理生理学人类

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Integration of mental health care into primary care - Demonstration cost-outcome study in India and Pakistan

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BRITISH JOURNAL OF PSYCHIATRY 2000年第6期176卷 581-588页

作者： Chisholm, D Sekar, K Kumar, KK Saeed, K James, S Mubbashar, M Murthy, RS Kings Coll London Ctr Econ Mental Hlth Inst Psychiat London SE5 8BB England Inst Hlth Sector Dev London England Natl Inst Mental Hlth & Neurosci Bangalore 560029 Karnataka India Inst Psychiat Rawalpindi Pakistan

Background Targeting resources on cost-effective care strategies is important For the global mental health burden. Aims To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries. Method Four rural populations were screened fbr psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use. Results Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms. disability and quality of life, while total economic costs were reduced. Conclusion Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services. Declaration of interest The study was funded by the Department for International Development, UK (HP-ACORD Small Project Grant RD 463).

关键词：印度精神障碍/经济学精神卫生服务/经济学精神卫生服务/组织和管理巴基斯坦初级卫生保健/经济学初级卫生保健/组织和管理前瞻性研究社会经济因素成年人女(雌)性人类男(雄)性

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Out-of-hours dental services: a survey of current provision in the United Kingdom

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BRITISH DENTAL JOURNAL 2000年第5期188卷 269-274页

作者： Anderson, R Thomas, DW Univ Wales Coll Cardiff Coll Med Dept Oral Surg Cardiff CF4 4XY S Glam Wales

Objective To describe the variety of arrangements for providing out-of-hours dental care in the UK. Design A telephone interview survey of health authorities and health boards. Setting United Kingdom. Subjects 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. Results At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements - for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. Conclusions There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.

关键词：卫生服务范围社区牙科学牙科保健服务/组织和管理急救医疗服务/组织和管理开业医生牙科/组织和管理健康计划卫生服务易得程度/组织和管理卫生服务需求采访(主题) 初级卫生保健/组织和管理转诊和会诊登记公费医疗/组织和管理电话伤病员分拣人类

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Occupational and environmental medicine and primary care

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PRIMARY CARE 2000年第4期27卷 813-+页

作者： Frumkin, H Emory Univ Rollins Sch Publ Hlth Dept Environm & Occupat Hlth Atlanta GA 30322 USA

This article introduces occupational and environmental medicine (OEM) to physicians in other specialties, and especially to primary care physicians, by highlighting the common foundations of OEM practice and primary care practice. These common foundations include careful diagnosis and treatment, appropriate use of consultants, collaboration with non-medical professionals, attention to psychosocial issues, care of the entire family, respect for confidentiality, patient education, preventing disability and maximizing function, diligent patient follow-up, epidemiological thinking, and continuing medical education.

关键词：出院后医疗机密合作行为环境卫生家庭/心理学家庭医学/组织和管理职业病/诊断职业病/病因学职业病/心理学职业病/治疗职业医学/教育职业医学/组织和管理病人医疗小组医师的作用初级卫生保健/组织和管理公共卫生工作转诊和会诊成年人女(雌)性人类男(雄)性中年人

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Workers' compensation in the United States and the role of the primary care physician

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PRIMARY CARE 2000年第4期27卷 831-+页

作者： Pye, H Orris, P Cook Cty Hosp Div Occupat Med Chicago IL 60612 USA Univ Illinois Sch Publ Hlth Great Lakes Ctr Occupat & Environm Safety & Hlth Chicago IL USA

The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking.

关键词：病例管理/组织和管理合格鉴定司法鉴定家庭医学/组织和管理筹资政府/组织和管理卫生服务使用研究密执安模型组织管理职业医学/组织和管理医师的作用政治初级卫生保健/组织和管理私营部门/组织和管理美国华盛顿工人补偿金/组织和管理人类

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Designing and implementing a primary care intervention trial to improve the quality and outcome of care for major depression

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GENERAL HOSPITAL PSYCHIATRY 2000年第2期22卷 66-77页

作者： Rost, K Nutting, PA Smith, J Werner, JJ Univ Arkansas Med Sci Dept Psychiat Ctr Mental Healthcare Res Little Rock AR 72204 USA Univ Colorado Hlth Sci Ctr Ctr Res Strategies Denver CO USA Univ Colorado Hlth Sci Ctr Dept Family Med Denver CO USA Ambulatory Sentinel Practice Network Denver CO USA

Complex interventions, which have been shown to improve primary care depression outcomes, are difficult to disseminate to routine practice settings. To address this problem, we developed a brief intervention to train primary care physicians and nurses employed by the practice to improve the detection and management of major depression. Before recruitment began, the research team conducted academic detailing conference calls with primary care physicians and nurses, and provided in-person training with nurses and administrative staff Administrative staff screened over 11,000 patients before their visits to identify those with probable major depression. Primary care physicians delegated increased responsibility to office nurses, who educated over 90% of patients about effective depression treatment and systematically monitored their progress over time. Early results demonstrate that community primary care practices can rebundle traditional team roles over the short-term to provide more systematic mental treatment without adding additional personnel. A rigorous evaluation of this effort will reduce time-consuming, expensive, and often unsuccessful efforts to "translate" research intervention findings into everyday practice. (C) 2000 Elsevier Science Inc.

关键词：抑郁症更年期/诊断抑郁症更年期/治疗疾病管理教育护士结果与过程评价(卫生保健) 病人遴选初级卫生保健/组织和管理精神病状态评定量表研究设计乡村卫生服务美国市区卫生服务女(雌)性人类男(雄)性

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Work interrupted: A comparison of workplace interruptions in emergency departments and primary care offices

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ANNALS OF EMERGENCY MEDICINE 2001年第2期38卷 146-151页

作者： Chisholm, CD Dornfeld, AM Nelson, DR Cordell, WH Methodist Hosp Indiana Emergency Med & Trauma Ctr Clarian Hlth Partners Indianapolis IN 46202 USA Indiana Univ Sch Med Dept Emergency Med Indianapolis IN USA Methodist Hosp Indiana Dept Med Res Clarian Hlth Partners Indianapolis IN 46202 USA

Study objective: We sought to determine the number of interruptions and to characterize tasks performed in emergency departments compared with those performed in primary care off ices. Methods: We conducted an observational time-motion, task-analysis study in 5 nonteaching community hospitals and 22 primary care offices in 5 central Indiana cities. Twenty-two emergency physicians and 22 office-based primary care physicians (PCPs) were observed at work. The number of interruptions, tasks, simultaneous tasks, and patients concurrently managed were recorded in 1-minute increments during 150- to 210-minute observation periods. Results: Emergency physicians were interrupted an average of 9.7 times per hour compared with 3.9 times per hour for PUS, for an average difference of 5.8 times per hour (95% confidence interval [Cl] 4.2 to 7.4). PCPs spent an average of 11.4 minutes per hour performing simultaneous tasks compared with 6.4 minutes per hour for emergency physicians (average difference, 5.0 minutes;95% Cl 12 to 8.8). Emergency physicians spent an average of 37.5 minutes per hour managing 3 or more patients concurrently compared with 0.9 minutes per hour for PCPs. PCPs spent significantly more time performing direct patient care, and emergency physicians spent significantly more time in analyzing data, charting, and taking reports on patients. Conclusion: Emergency physicians experienced more interruptions and managed more patients concurrently than PCPs. PCPs spent more time performing simultaneous tasks than emergency physicians. Our study suggests there are important ergonomic differences between emergency medicine and off ice-based primary care work environments that may require different training approaches, design considerations, and coping strategies.

关键词：卡方分布效率组织急救医学/组织和管理急诊室医院/组织和管理医师/统计学和数值数据初级卫生保健/组织和管理统计学非参数时间和运动研究工作负荷量工作场所/统计学和数值数据成年人女(雌)性人类男(雄)性

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The Spanish health care system:: lessons for newly industrialized countries

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HEALTH POLICY AND PLANNING 1999年第2期14卷 164-173页

作者： Rodríguez, E De Puelles, PG Jovell, AJ Cornell Univ Dept Policy Anal & Management Ithaca NY 14853 USA Catalan Hlth Serv Catalan Agcy Hlth Technol Assessment Dept Hlth & Social Secur Barcelona Spain

This article summarizes the organization, financing, and delivery of health care services in Spain, and discusses the elements that made it possible to maintain high levels of health among the population, while spending comparatively fewer resources on the health care system than most industrialized countries. The case of Spain is of particular interest for newly industrialized countries, because of the fast evolution that it has undergone in recent years. Considered, by United Nations' economic standards, a developing country until 1964, Spain became in a few years the fastest growing economy in the world after Japan. By the early 1970s the infant mortality rate was already lower than in Britain or the United States.

关键词：卫生保健提供/经济学卫生保健提供/组织和管理发达国家效率组织筹资政府卫生保健公平提供卫生经费支出卫生人力健康状况指标医院公立/组织和管理国家卫生规划/经济学国家卫生规划/组织和管理初级卫生保健/组织和管理公共卫生管理社会正义西班牙/流行病学世界卫生

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Integrating oral health into primary health care - experiences in Bangladesh, Indonesia, Nepal and Tanzania

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INTERNATIONAL DENTAL JOURNAL 1999年第4期49卷 240-248页

作者： Helderman, WV Mikx, F Begum, A Adyatmaka, A Bajracharya, M Kikwilu, E Rugarabamu, P Nijmegen The Netherlands Dhaka Bangladesh Jakarta Indonesia Kathmandu Nepal Dar es Salaam Tanzania [*]WHO Collaborating Centre Dentistry 117 Postbus 9101 6500 HB Nijmegen The Netherlands

When primary health care (PHC) was developed and implemented in developing countries, oral health was not included. The present consequences are marked disparities in the distribution of oral health care, since conventional dentistry can only serve relatively few people and at high costs. Oral health care is virtually non-existent in rural areas of most developing countries where more than 80 per cent of the population live. More recently, community based oral health programmes have been initiated in some countries to fill the gap. These programmes give more emphasis on oral health promotion and on the prevention of oral diseases than on treatment of its consequences, since history has shown that the latter is ineffective in preventing oral diseases. Unfortunately, most of these oral health programmes have been implemented next to the existing PHC system and hence they face enormous management, logistic and financial problems, which seriously threaten their sustainability. This paper presents a proposal to counteract the problems that many countries face in developing an adequate primary oral health care (POHC) service.

关键词：孟加拉国社区卫生服务/组织和管理卫生保健提供联合牙科医疗/分类牙科医疗/经济学牙科医疗/组织和管理牙科保健服务/组织和管理发展中国家/经济学财政支持健康教育牙科健康计划健康促进卫生资源/经济学卫生资源/组织和管理卫生服务易得程度/组织和管理印度尼西亚口腔疾病/预防和控制国家卫生规划/组织和管理尼泊尔口腔保健初级卫生保健/经济学初级卫生保健/组织和管理乡村卫生服务/组织和管理坦桑尼亚人类

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