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1.
Telemed J E Health ; 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38946672

RESUMEN

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

2.
Isr J Health Policy Res ; 9(1): 15, 2020 06 02.
Artículo en Inglés | MEDLINE | ID: mdl-32482166

RESUMEN

OBJECTIVES: Depressive symptoms are often undetected, particularly among older adults. The purpose of this study is to provide information on the prevalence, characteristics, and patterns of depressive symptoms among older adults residing in the community in Israel, and their health-care utilization. METHODS: A cross-sectional survey was conducted among a random sample of 2502 members of one HMO in Israel, aged 65+. They were interviewed by telephone with the GDS-15 scale, which serves as the gold standard for depressive symptoms. Data from the computerized medical records of the HMO were added to the interview file, including the diagnosis of depression, purchase of antidepressant medication and use of services. RESULTS: The average age of respondents was 73; 54% were women. They tended to be older, living alone, suffering from falls and from sleep disorders, and to have poor subjective health status. 24% scored 6+ on the GDS scale. A significant association was found between a GDS score of 6+ and increased hospitalizations, visits to the emergency room and/or to family physicians and specialists. CONCLUSION: We found a high prevalence of depression. Its negative effects on the individual and increased costs to the health system, supports the screening and treatment of the disease in the older population. This problem should be a national priority, with screening and treatment becoming part of the national quality of care indicators which would then be implemented by the HMOs as part of an integrated disease management program for the elderly.


Asunto(s)
Depresión/diagnóstico , Aceptación de la Atención de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Correlación de Datos , Estudios Transversales , Depresión/epidemiología , Femenino , Geriatría/métodos , Geriatría/estadística & datos numéricos , Sistemas Prepagos de Salud/organización & administración , Sistemas Prepagos de Salud/estadística & datos numéricos , Humanos , Israel/epidemiología , Masculino , Factores de Riesgo
3.
Occup Med (Lond) ; 68(3): 187-191, 2018 05 17.
Artículo en Inglés | MEDLINE | ID: mdl-29514323

RESUMEN

Background: Many physicians treat themselves despite established guidelines against such practice. Aims: To examine whether general practitioners (GPs) are satisfied with their personal primary care and how this could be improved. Methods: We sent a questionnaire to GPs in Israel. We examined the gap between preference to use formal medical care and use in practice, satisfaction with physicians' primary healthcare, self-prescribing and ways to improve physician access to care. Results: There were 203 respondents (response rate 203/985; 21%). Sixty-one per cent reported not having a GP. Older respondents were less likely to have their own GP. Thirty-seven per cent of physicians reported receiving less formal medical care than they desired. This gap was higher in those reporting self-prescription of benzodiazepines and anti-depressants (P < 0.05) and was significantly associated with dissatisfaction with primary healthcare. Odds for being satisfied with personal care was reduced by more than 85% in GPs who reported receiving less formal medical care than they desired (odds ratio 0.146; 95% confidence interval 0.064-0.333). Conclusions: Our findings inform the profile of physician self-treatment and the dissatisfaction associated with it. Dissatisfaction was associated with a gap between desired and actual care rather than with having or not having a personal GP. There was no consensus regarding what would assist physicians to access GPs.


Asunto(s)
Actitud del Personal de Salud , Médicos Generales/psicología , Satisfacción del Paciente , Atención Primaria de Salud/normas , Adulto , Anciano , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Autoinforme , Encuestas y Cuestionarios
4.
Patient Prefer Adherence ; 9: 1033-41, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26229450

RESUMEN

OBJECTIVES: The positive aspects of social support and its impact on health have been studied extensively. However, there may also be negative effects of social environments on the diabetic patient. This study developed and validated a new diabetic unsupportive social interaction scale (USIS), including two subscales: interference and insensitivity. METHODS: A list of 22 items depicting unsupportive interactions associated with management of diabetes was developed. A telephone survey was administered to 764 Israelis with diabetes. The questionnaire included the USIS and questions about social networks, social support, health behaviors, and health. The characteristics, validity, and reliability of the scale were tested. RESULTS: A principal component analysis was performed for extraction of two factors describing unsupportive social interaction concepts: interference and insensitivity. Cronbach's alpha for the full 15-item scale was 0.84, indicating internal consistency. The two subscales were calculated to have Cronbach's alphas of 0.85 and 0.73, respectively. The USIS showed construct validity as it was associated with social support, some measures of social networks, subjective measures of health, and health behaviors. Arabs, older respondents, those defining themselves as more religious, and the less educated reported higher rates of unsupportive interactions. CONCLUSION: This study suggests a new concept of unsupportive interactions including interference and insensitivity. These unsupportive interactions may adversely affect patients' ability to adhere to treatment and may undermine their health in various ways. Identifying these problems may enable clinicians to help patients cope with their unsupportive environments.

5.
J Am Board Fam Med ; 27(3): 321-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24808110

RESUMEN

BACKGROUND: Childhood and adolescent obesity constitute a significant public health concern. Family health care settings with multidisciplinary teams provide an opportunity for weight loss treatment. The objective of this study was to examine the effect of intensive treatment designed to reduce weight using a parent-child lifestyle modification intervention in a family health care clinic for obese and overweight children who had failed previous treatment attempts. METHODS: This was a practice-based 6-month intervention at Maccabi Health Care Services, an Israeli health maintenance organization, consisting of parental education, individual child consultation, and physical activity classes. We included in the intervention 100 obese or overweight children aged 5 to 14 years and their parents and 943 comparison children and their parents. Changes in body mass index z-scores, adjusted for socioeconomic status, were analyzed, with a follow-up at 14 months and a delayed follow-up at an average of 46.7 months. RESULTS: The mean z-score after the intervention was lower in the intervention group compared to the comparison group (1.74 and 1.95, respectively; P = .019). The intervention group sustained the reduction in z-score after an average of 46.7 months (P < .001). Of the overweight or obese children, 13% became normal weight after the intervention, compared with 4% of the comparison children. CONCLUSION: This multidisciplinary team treatment of children and their parents in family health care clinics positively affected measures of childhood obesity. Additional randomized trials are required to verify these findings.


Asunto(s)
Obesidad Infantil/terapia , Adolescente , Niño , Preescolar , Medicina Familiar y Comunitaria , Relaciones Familiares , Femenino , Humanos , Masculino
7.
Diabetes Res Clin Pract ; 101(1): 20-7, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23702029

RESUMEN

AIMS: To identify socioeconomic status and gender inequalities in long and short-term Medical Nutrition Therapy among Israeli adult patients with diabetes. METHODS: An analysis of data was performed on 90,900 patients over the age of 18 who were registered as patients with diabetes mellitus in Maccabi Healthcare Service Register which is the second largest health maintenance organization in Israel. Socioeconomic Rank for each patient was determined from the Israel Central Bureau of Statistics by geographical area of residence. Medical Nutrition Therapy was defined by the number of visits with registered dietitians. Short-term therapy was defined as one visit and long term therapy as two or more visits during the previous two years. Newly diagnosed patients were compared with veteran patients. RESULTS: Only 25.8% of the patients with diabetes received nutrition therapy during the previous two years. Newly diagnosed patients received therapy more frequently than veterans. We found that long term therapy was positively dependent on socioeconomic rank. Women under the age of seventy five had a higher chance of receiving therapy compared to men. CONCLUSIONS: A nationwide nutritional counseling service is available and accessible to all patients with diabetes. However, the patients with higher socioeconomic rank have a higher rate of persistence with long-term nutritional therapy.


Asunto(s)
Diabetes Mellitus/dietoterapia , Servicios de Salud/estadística & datos numéricos , Terapia Nutricional/estadística & datos numéricos , Clase Social , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Consejo , Femenino , Humanos , Lactante , Recién Nacido , Israel , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos , Veteranos , Adulto Joven
8.
Fam Pract ; 27(2): 192-7, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20032167

RESUMEN

OBJECTIVE: This article presents a narrative-based technique, which allows medical personnel to empower patients with diabetes and improve adherence. METHODS: The study was undertaken in Maccabi Healthcare Services, among 123 patients diagnosed with diabetes. Four empathic narratives were constructed, referring to different factors influencing resistance to treatment, as were identified by the Resistance to Treatment Questionnaire. Each narrative contains statements typical for patients whose resistance to treatment is influenced by a particular factor. An Empathic Narratives Evaluation Questionnaire was designed for this study. It contained three items, assessing the correlation of a specific empathic narrative with the patient's attitude and their reasons for resistance to treatment. The patients were asked to indicate whether they recognize these narratives as describing their reasons for resistance. Three empathic narratives were read to each patient: two narratives were matched for the two major categories of resistance for each patient and one narrative related to a category of resistance that received the lowest score. RESULTS: The narratives were found to correspond to the core reasons for resistance to diabetes treatment. Significant difference was found also between the scores of the empathic narrative related to the second strongest reason for resistance to treatment and the empathic narrative related to the weakest reason for resistance to treatment. This finding supports testimonial validity of the narratives. CONCLUSION: Short narrative interventions demonstrated in this study can be used by health care professionals as a working tool that provides the possibility reducing the patient's reasons for resistance to treatment.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/terapia , Narración , Aceptación de la Atención de Salud , Cooperación del Paciente , Anciano , Actitud Frente a la Salud , Empatía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Dirigida al Paciente , Encuestas y Cuestionarios
9.
Int J Health Care Qual Assur ; 22(2): 157-67, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19536966

RESUMEN

PURPOSE: This paper's aim is to identify whether community-level socioeconomic status (SES) predicts: screening test for pre-diabetes; actual diagnosis of pre-diabetes; or nutritional counseling. DESIGN/METHODOLOGY/APPROACH: This is an analysis of 1,348,124 insured adults receiving medical care from Maccabi Healthcare Services (MHS) in 107 MHS clinics throughout Israel. The research population comprised 79 percent of the MHS members over 18 years of age in 2004-2006. Area level socioeconomic data were drawn from the Israel Central Bureau of Statistics SES index for every geographical area and each MHS clinic in the study was coded from: - 1.03 to 2.73 (- 1.03 indicating low SES and 2.73 + high SES) according to the SES index for the location. The fasting glucose laboratory test was used for analysis. Pre-diabetes diagnosis was based on a fasting glucose above 100 mg/dl. Nutritional counseling was defined by dietitian visits in the claims database. FINDINGS: The percentage of insured individuals who underwent blood glucose testing during the study increased with age from 67 percent at ages 18-45 to92 percent for age 65 and over. The percentage of individuals diagnosed with pre-diabetes also increased with age, rising from 4 percent in the younger group to 14 percent in those aged 46-65 and to 14-16 percent of 65 and older. The percentage of individuals with pre-diabetes who visited a dietitian was 16-27 percent for those under 65 and 14-17 percent for those over 65 (males and females, respectively). Individuals living in lower socioeconomic areas were less likely to have blood tests. Among tested patients, the prevalence of pre-diabetes was higher in areas of lower SES and their dietitian visits were less frequent. PRACTICAL IMPLICATIONS: In lower SES index areas, there is a need for better identification and treatment of patients. ORIGINALITY/VALUE: The paper shows that a proactive approach is needed both to detect pre-diabetes and to encourage patients to receive nutritional treatment.


Asunto(s)
Estado Prediabético/dietoterapia , Estado Prediabético/epidemiología , Adolescente , Adulto , Anciano , Glucemia , Consejo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Adulto Joven
10.
J Ambul Care Manage ; 30(3): 231-40, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17581435

RESUMEN

Despite continuous efforts, healthcare organizations still find it difficult to influence physicians to follow clinical guidelines. Previous studies have not taken into account the organizational context of the physicians' practice. We conducted a survey of a representative sample of 743 primary care physicians employed in Israel's 2 largest managed care health plans. The findings indicated that "commitment to the health plan" and "perceived monitoring by the health plan" had an independent positive effect on familiarity with guidelines for treating diabetes. We propose that managers of healthcare organizations consider enhancing physicians' commitment to the organization as a means for increasing their adherence with clinical guidelines, thereby improving the quality of care provided to diabetic patients.


Asunto(s)
Diabetes Mellitus/terapia , Conocimientos, Actitudes y Práctica en Salud , Programas Controlados de Atención en Salud , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Femenino , Encuestas de Atención de la Salud , Humanos , Israel , Masculino , Persona de Mediana Edad
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