RESUMEN
The central point in the U.S. Supreme Court upholding the Federal Trade Commission's action against the North Carolina State Board of Dental Examiners was that they acted without proper supervision from the State of North Carolina in curbing commercial activity: issuing cease and desist orders to teeth-whitening businesses, for example. It appears unlikely that the law of the land will allow professions to enforce and may substantially limit a profession's voice in defining nearby commercial activity. The line between professional services and commercial ones is not clear. Vending whitening agents, as drug stores do, is commercial but may not be professional. Providing such services in the dental office certainly should be professional, but is also certainly commercial. As dentistry becomes more overtly commercial in nature, it is likely that the profession will have less say over defining and enforcing oral healthcare practices.
Asunto(s)
Odontólogos/ética , Ética Odontológica , Licencia en Odontología/ética , Responsabilidad Social , Publicidad , Técnicos Medios en Salud/legislación & jurisprudencia , Odontólogos/legislación & jurisprudencia , Disentimientos y Disputas/legislación & jurisprudencia , Competencia Económica/legislación & jurisprudencia , Humanos , Licencia en Odontología/legislación & jurisprudencia , Comercialización de los Servicios de Salud , North Carolina , Autonomía Profesional , Autocuidado , Blanqueamiento de Dientes , Estados UnidosAsunto(s)
Protección a la Infancia , Investigación sobre Servicios de Salud/tendencias , Calidad de la Atención de Salud/normas , Niño , Femenino , Predicción , Investigación sobre Servicios de Salud/normas , Humanos , Masculino , Pediatría/normas , Pediatría/tendencias , Guías de Práctica Clínica como Asunto/normas , Calidad de la Atención de Salud/tendencias , Estados UnidosAsunto(s)
Continuidad de la Atención al Paciente/tendencias , Política de Salud , Cuidados a Largo Plazo/tendencias , Evaluación de Necesidades , Anciano , Anciano de 80 o más Años , Personas con Discapacidad , Predicción , Reforma de la Atención de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Cuidados a Largo Plazo/legislación & jurisprudencia , North Carolina , Recursos HumanosAsunto(s)
Reforma de la Atención de Salud/tendencias , Cobertura del Seguro/tendencias , Cuidados a Largo Plazo/tendencias , Atención a la Salud/organización & administración , Atención a la Salud/tendencias , Reforma de la Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/organización & administración , Medicaid , Medicare , North Carolina , Estados UnidosRESUMEN
PURPOSE: Doctors must understand patients' priorities to create an effective treatment partnership. Little is known about whether subspecialist pediatricians understand chronically ill adolescents' preferences. METHODS: A survey was conducted of 155 adolescents with chronic illnesses and 52 subspecialty physicians recruited from the same clinics of a children's hospital. Adolescents and physicians rated the importance that adolescents place on items relating to quality of care and physician-patient communication styles using a previously validated measure. RESULTS: For quality of care items, rank order correlation between physicians and patient responses was high (r = .63, p < .001) and both rated pain management items as most important. Physicians underestimated the importance adolescents placed on communicating with the physician as a friend and medical-technical aspects of care. For communication items, physicians' responses were significantly different than adolescents for 13 of 17 items. Except for three items pertaining to autonomy, physician and patient responses were in the same direction, but adolescent responses were less extreme. CONCLUSIONS: Physicians understood the importance of pain management to adolescents with chronic illnesses, but overestimated their desired level of autonomy. Asking adolescents for their preferences may be the first step in improving adolescents' experience of care.
Asunto(s)
Servicios de Salud del Adolescente/estadística & datos numéricos , Manejo del Dolor , Relaciones Médico-Paciente , Calidad de la Atención de Salud/estadística & datos numéricos , Adolescente , Conducta del Adolescente/psicología , Servicios de Salud del Adolescente/organización & administración , Adulto , Anemia de Células Falciformes/complicaciones , Artritis Juvenil/complicaciones , Niño , Enfermedad Crónica , Fibrosis Quística/complicaciones , Femenino , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Masculino , Dolor/etiología , Dolor/psicología , Satisfacción del Paciente , Vigilancia de la Población , Encuestas y CuestionariosAsunto(s)
Atención Odontológica/organización & administración , Servicios de Salud Dental/organización & administración , Odontólogos/provisión & distribución , Política de Salud , Accesibilidad a los Servicios de Salud , Atención Odontológica/estadística & datos numéricos , Servicios de Salud Dental/estadística & datos numéricos , Educación en Odontología , Humanos , North Carolina , Salud Bucal , Pobreza , Factores Socioeconómicos , Recursos HumanosRESUMEN
BACKGROUND: Efforts to make health care for adolescents with chronic illnesses more patient-centered must be grounded in an understanding and clear measures of adolescents' preferences and priorities. OBJECTIVE: To develop a measure of health care preferences of adolescents with chronic illnesses and to determine demographic, developmental, and health factors associated with adolescents' preferences. DESIGN: Mixed-method questionnaire development and survey. SETTING: Subspecialty clinics of a tertiary care children's hospital. PARTICIPANTS: All adolescents (age: 11-19 years) with juvenile rheumatoid arthritis, sickle cell disease, inflammatory bowel disease, or cystic fibrosis of at least 2-year duration who were being treated at the participating center were eligible to participate, and 155 of 251 did so (62%). The participants had a mean age of 15.5 +/- 2.4 years, 45% were male, and 75% were white. INTERVENTION: None. MAIN OUTCOME MEASURES: Ratings of 65 items related to quality of care and 17 items related to physician-patient communication styles. RESULTS: An 82-item questionnaire, devised from qualitative analysis of focus group results, contained 65 Likert scale items that adolescents considered important for health care quality and 17 forced-choice items related to adolescents' preferences for communication. Among the first 65 items, the group of questions related to physician trust and respect had the highest rating of 5.24 +/- 0.62 of 6, followed by patient power and control (mean rating: 4.72 +/- 0.77) and then caring and closeness in the patient-doctor relationship (mean rating: 4.19 +/- 0.91). For the communication items, the adolescents, on average, preferred communication directly to them rather than to their parents and were nearly neutral regarding physicians' inquiries about personal issues. CONCLUSIONS: Participants rated aspects of interpersonal care (especially honesty, attention to pain, and items related to respect) as most important in their judgments of quality. As in most previous studies of adults, technical aspects of care were also rated highly, suggesting that adolescents understand and value both scientific and interpersonal aspects of care.
Asunto(s)
Actitud Frente a la Salud , Enfermedad Crónica/terapia , Atención a la Salud , Adolescente , Servicios de Salud del Adolescente , Adulto , Anemia de Células Falciformes/terapia , Artritis Juvenil/terapia , Niño , Fibrosis Quística/terapia , Recolección de Datos , Femenino , Investigación sobre Servicios de Salud , Humanos , Enfermedades Inflamatorias del Intestino/terapia , Masculino , Análisis Multivariante , Relaciones Médico-Paciente , Calidad de la Atención de Salud , Asunción de Riesgos , Encuestas y CuestionariosRESUMEN
North Carolina is indeed fortunate to have avoided many of the extreme shortages of nurses reported in other states. Yet, there are important developments on the horizon that have the potential to cause such shortages. Taking action today to expand the production of new nurses, enhance their education, augment school-to-work transitions, and improve the nursing workplace environment can help reduce the likelihood of a future nursing workforce crisis. Some steps will require new financial commitments either from public or private sources. Others will require a renewed commitment on the part of employers, educators, regulators and the nursing community. However, these steps are necessary if we are to recruit and retain well-prepared and motivated nurses who are needed to meet our healthcare needs now and in the future. Nursing, especially nursing at the bedside in hospitals and in long-term care, requires increasingly sophisticated technical skills and continues to demand intellectual, physical and emotional energy beyond what would be required in many other professions and occupations. It is hoped that the recommendations offered here will help focus the efforts of legislators, educators, employers, the nursing community, trade associations, foundations and the public at large to ensure an adequate supply of well-trained nursing personnel for the future.
Asunto(s)
Comités Consultivos , Enfermeras y Enfermeros/provisión & distribución , Adulto , Educación de Postgrado en Enfermería/organización & administración , Humanos , Masculino , Persona de Mediana Edad , North Carolina , Selección de Personal , Formulación de Políticas , Lugar de TrabajoAsunto(s)
Estado de Salud , Hispánicos o Latinos/estadística & datos numéricos , Adulto , Niño , Barreras de Comunicación , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Lenguaje , Pacientes no Asegurados/etnología , North Carolina/epidemiología , Factores SocioeconómicosRESUMEN
Recent efforts to attain near-complete coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide or community-based childhood immunization registries. Plans for a single, national registry have been set aside in favor of a national network of local and state registries linked through the use of common definitions and unique child identifiers. However, both operational/technical and financing difficulties have slowed their development. The experience to date in selected areas has provided useful lessons for further development of a registry system and has underscored the potential of such systems to assure the success of childhood immunization initiatives.