Compliance aids--do they work?

The decision to use a compliance aid will depend on the motivation of the patient, their specific medication regimen, and their physical and cognitive ability. The administration of oral medicines may be facilitated through the appropriate use of 'organisers' which act as aides memoire. 'Medidos' and 'Dosett' are the most frequently studied compliance aids and both have been shown to be beneficial to the elderly and to community-based psychiatric patients. Adherence to a medication regimen may be improved without the use of proprietary compliance aids by ensuring that the most appropriate traditional container is used and by paying attention to the highest standard of labelling on the medicine container. Gadgets that are designed to improve physical dexterity can be useful when applying topical preparations, administering insulin injections, operating pressurised inhalers or administering eyedrops. The accurate administration of eyedrops is particularly important when treating glaucoma and may be facilitated by using devices that are designed to help with aiming of the eyedrops ('Easidrop', 'Mumford Auto-drop,' 'Opticare'). If squeezing the eyedrop container is a problem the 'Opticare' device may be particularly suitable. There may be value in the use of the compliance aids to provide assistance to carers who become involved with preparing medication for patients. Selection of an appropriate compliance aid is not likely to be the total solution to inadequate adherence and most patients will require a combination of strategies to facilitate adherence to treatment with medicines.

Resistance by college students to peer pressure to drink.

In two college samples, resistance to peer pressure to drink and desire to refrain from drinking correlated with variables in the college environment but not with personal background variables.

Nurses' uniform: an investigation of mobility.

An investigation of the mobility of nurses under three clothing conditions is reported. The need for such a study has arisen as a result of the concern over a possible mismatch between mobility and patient handling requirements. Thirty-seven nurses participated under two of the clothing conditions ('National' dress uniform, Trouser/tunic combination). In addition, ten of these nurses volunteered to provide control data by being measured in a leotard or a swimming costume. Eleven static and sixteen dynamic anthropometric measures were considered. Each nurse was asked to complete a short questionnaire, relating to her subjective attitudes to the uniform and to her own physical state at the time of measurement. Whilst both uniforms imposed restrictions on the shoulder girdle and trunk of up to 10%, the area of greatest concern was the mobility of the hip joint. Hip flexion was reduced by 26% in the dress uniform. The implications of these findings for patient handling procedures are discussed, as are those of the relationship between the environment and the material. Uniform and the nursing image is also considered.

Backing out: nurse wastage associated with back pain.

Results from a survey of 1008 National Health Service nurses and nursing auxiliaries leaving their current position are reported. These indicate that 1.3% of nurse leavers are leaving their positions for good solely because of back pain. Further, one nurse leaver in 29 is leaving their position with back pain as a main or contributory cause and 12% of all nurse leavers intending to leave for good cited back pain as either a main or contributory factor. The findings from this survey have implications for Health Authorities in relation to costs and manpower planning, and emphasize the need to provide further education and prompt referral and treatment to prevent long-term back morbidity and wastage, not only for registered nurses but also for nursing auxiliaries and aides.

Vertical banded gastroplasty: a treatment for morbid obesity.

Stomach stapling to aid the morbidly obese patient with weight loss has been available for years. Unfortunately, some methods of bariatric surgery (e.g., gastric bypass surgery) can lead to serious complications. This article discusses vertical banded gastroplasty (VBG) and presents on overview of morbid obesity and its inherent medical problems, the screening process and the physical and psychological needs of patients undergoing bariatric procedures, the anatomy and physiology of normal digestion, and the perioperative nursing considerations in caring for a patient undergoing VBG.

The relationship between hospital characteristics and the cost of hospital care.

This article examines the relationship between hospital characteristics and costs of hospital care, using the 1991 American Hospital Association Annual Survey of Hospitals. The results discussed herein have implications for hospital executives, researchers and policymakers.

Strategic choices for a primary care advantage: re-engineering osteopathic medicine for the 21st century.

The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called 'alternative', 'complementary' or 'holistic' medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?

Do HMO penetration and hospital competition impact quality of hospital care?

This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

The effects of organizational structure on hospital performance.

The relationship between organizational structure and organizational performance would seem at first to be straightforward and obvious. The more complex organizational structures will result in positive organizational performance (i.e. greater effectiveness or profitability). The premise is that the ability of an organization to achieve its mission successfully should be a result of the organizational structure. It is generally accepted that certain structural configurations are able to achieve certain goals better than others (i.e. a diversified structure as opposed to a simple structure). The research to date indicates that this is not necessarily true. The specific issue examined in this paper will be the effect of structural diversification on performance in industry and healthcare.

Organizational power and conflict regarding the hospital-physician relationship: symbolic or substantive?

The purpose of this paper is to provide a critical review of organizational power and conflict regarding the hospital-physician relationship. The issue of power being symbolic and/or substantive is discussed. The classification (Mintzberg Model) of organizations as simple structures, machine bureaucracies, professional bureaucracies, divisionalized forms and adhocracies are reviewed. Also, the issue of whether the perceived autonomy that professional employees enjoy increases the likelihood that an executive level manager in a professional bureaucracy (hospital entity) will devote substantial attention to influencing symbolic outcomes as opposed to substantive outcomes in a machine bureaucracy is discussed. In conclusion, conflicts between hospitals and physicians can be resolved in two ways: (1) by avoiding controversial decisions that might threaten the powers and prerogatives of professional groups; and (2) by agreeing to decisions that hold something for everyone involved in the hospital-physician power relationship.

Emerging factors shaping the future of the Veterans' Health Administration: a strategic analysis.

In response to societal and industry-wide forces, the Veterans' Health Administration (VHA) has undertaken a re-engineering process, changing the operational and management structure from individual, independent, and often competing large hospital centres into 22 integrated service networks or VISNs to provide structural incentives for efficiency, quality and improved access as well as transitioning the system to one that is grounded in ambulatory and primary care (Ashton et al., 1998). This paper presents a framework for evaluating the successes and/or failures of the recent re-organization efforts of the VHA in bringing together this multitude of medical care 'parts' or modules into an integrated, cost-effective healthcare delivery system. In total, this paper attempts to delineate an analytical framework by which the threats and opportunities as well as the strengths and weaknesses of the VHA are identified. More specifically, this paper addresses the external pressures driving reform in the VHA system and how the Veterans' Administration can respond to these pressures. Implications for the future of the VHA if its reform efforts are not successful are examined.

Hospital re-admissions: an empirical analysis of quality management in Taiwan.

This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.

Managing costs and managing care.

With a defined population served, contracted provider panels and the nature of care delivery integration, managed care has provided a solution, though not a panacea, to provide equitable services, standardized and prevention oriented cares to its enrolled members. Combined with the earmarked capitation reimbursement system and a series of cost containment and utilization review techniques, managed care has also demonstrated potently its capacity in cost-saving and quality promotion. Presents steps and measures related to managed care that federal government has taken to manage care and contain cost. It is crucial to identify and promulgate best practices continually, while managing utilization of resources for improving health care, containing cost, and equalizing medical care access to a greater proportion of the population. Concludes that it may take time for a universal adoption of managed care. However, Americans may actually benefit more from having a standard level of health care that managed care could achieve and provide.

Accountability and quality in managed care: implications for health care practitioners.

The development of managed care plans is the most dramatic change in the USA's health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations and examines what health care practitioners can do to minimize the impact of increased regulation. We look at the major factors that are likely to bring about changes in the health care sector, and predict how these changes will affect the quality of health care that is being delivered in the near future. Addresses how quality can become and remain the primary factor in the delivery of health care services. Finally, concludes that greater involvement by the federal government is necessary to protect consumers' rights, and ensure better quality health care from managed care programs.

Medicare risk contracting: analyzing managed care for the aging population in the USA.

This paper focuses on Medicare risk contracting in the USA. The issue of the current method of reimbursement versus Medicare risk contracting is explored. Risk sharing and payment mechanisms are described and analyzed. The strengths and weaknesses (score-card) of Medicare beneficiaries entering HMOs are reviewed. Finally, the issue of selection bias in Medicare HMOs is discussed regarding future implementation strategy.

Strategic decision-making processes in healthcare organizations.

Healthcare represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in strategic decision-making processes research, but not the study of healthcare-strategy research. This article reviews strategic decision-making in both context-free (generic) and context-specific (healthcare) domains.

The U.S. Medicaid reform: the current state and policy implications for low-income population.

Medicaid is the health care program that is financed jointly by the federal and state governments. Many states are seeking ways to contain the increased budgetary strain that has resulted from the increases in Medicaid spending. For many states, managed care has been viewed as the means to hold down costs for some of the population served by Medicaid. This article examines the origins and status of Medicaid and the options available to extend coverage to the low-income population.

Ensuring quality and accountability in managed care.

The rapid growth of new forms of managed care in the United States in recent decades has brought with it increasing concerns regarding the quality of care delivered by practitioners in these plans. This article examines the various regulatory demands that are being placed on Managed Care Organizations (MCOs). The authors look at the major determinants that are likely to bring about significant changes in the health care sector for both patients and providers and predict how these shifts will affect the quality of health care services in the near future. They discuss how the quality of health care, rather than the cost of those services, can become and remain the primary factor in the delivery of health care services. Ultimately, they conclude that increased participation by the federal government is required to protect the rights of patients and ensure better quality and accountability for health care services delivered by MCOs.

Strategic decision-making processes in health care organizations.

Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in strategic decision-making processes research but not the study of health care strategy research. This article reviews strategic decision-making in health care domains. Adopting Rajagopalan, Rusheed, and Datta's (1993) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

The ABCs for deciding on a decision support system in the health care industry.

As the information superhighway becomes clustered with various organizations sharing the hope of staying solvent with the aid of technology, managers in the health care industry are more and more looking to efficient Decision Support Systems (DSS). The focus of DSS selection has often been on evaluations that measure decision performance for determining the influence and efficacy of the tool. Such evaluations, in many instances, ignore pertinent measurements for a successful selection and implementation of a DSS. In this article, the authors present a simple but important set of evaluation factors that can "make or break" a DSS implementation in the health care industry.