<p> Purpose: The purpose of this study is to explain the major barriers to medication access in rural seniors. How seniors access their prescription medications and make choices access helps to explain what seniors consider to be major barriers. This project has five goals: (1) describe what barriers rural seniors perceive that hinder access to their medicines and thus interfere with adherence to prescribed medication regimens; (2) understand what seniors perceive to be facilitators to accessing their prescriptions; (3) learn how or if social support networks play a role in helping rural seniors make decisions about how to use their resources to get their medications; (4) define the process that rural seniors use to move from potential access &mdash; the desire to get their medications, to revealed access &mdash; the actual ability to get their medications; and (5) describe what health care providers believe are the barriers that rural seniors face to getting their medicines. </p><p> Methods: I interviewed 19 low-income seniors in five towns in the San Luis Valley using semi-structured interviews, along with one pharmacist from each of seven pharmacies. A card study was conducted in nine clinics of the Valley Wide and Rio Grande systems. The interviews were coded using the grounded theory method. The card study survey was administered to primary care providers in eight clinics to gauge understanding of elderly patients' potential for barriers to access of medications. </p><p> Results: The primary finding is that poor structural health literacy (SHL) is the major barrier to access of medications, and to healthcare access generally. SHL is a factor in the more widely discussed barriers such as cost and transportation. </p><p> Discussion: SHL increases the chances that seniors will have access to healthcare by helping seniors learn how to take advantage of programs that enhance their ability to afford medications. Public Health agencies must work with community leaders to ensure that seniors are aware of their options for accessing medications, including financial and transportation options.</p>

An adequate measure of Control Over Nursing Practice (CONP) at the organizational level of the nurse's work unit was needed. The purpose of this study was to estimate the reliability and validity of a new unit-level version of an existing CONP scale using a descriptive survey design. A convenience sample of 91 staff Registered Nurses from two urban hospitals voluntarily completed two versions (individual-level and unit-level) of the CONP scale, and an index of work satisfaction.

<p> Bariatric surgery is not the panacea it was once thought to be for weight loss. Due to patient noncompliance issues, many weight loss surgery patients are relapsing and regaining the significant amounts of weight that bariatric surgery had initially helped them to lose. This failure is costly monetarily, psychologically, and medically to both the patient and to society. Using the narratives of 32 post-weight loss surgery patients, this narrative study explored: (a) whether Erikson's psychosocial stages of development occur after weight loss surgery, (b) whether successful patients (defined as those who are able to maintain their weight loss long term) have successfully navigated Erikson's stages, and (c) whether these patients formed new identities in the process. Recursive analysis and text analysis revealed noticeable trends toward developmental progress among participants after weight loss surgery, with regard to all stages in Erikson's psychosocial developmental theory. This trend suggests that participants are experiencing developmental changes after surgery and that participants who have successfully navigated psychosocial stages are at least beginning to build new identities. These findings may indicate the need for social changes in the way clinicians guide patients through the weight loss surgery process; these findings may also inspire the creation of programs that address developmental milestones, which may increase successes after weight loss surgery.</p>

Introduction : Les statines ont prouvé leur efficacité dans le traitement des dyslipidémies. Cependant, ces molécules sont associées à des effets secondaires d’ordre musculaire. Puisque ces effets peuvent avoir des conséquences graves sur la vie des patients en plus d’être possiblement à l’origine de la non-observance d’une proportion importante des patients recevant une statine, un outil pharmacogénomique qui permettrait d’identifier a priori les patients susceptibles de développer des effets secondaires musculaires induits par une statine (ESMIS) serait très utile. L’objectif de la présente étude était donc de déterminer la valeur monétaire d’un tel type d’outil étant donné que cet aspect représenterait une composante importante pour sa commercialisation et son implantation dans la pratique médicale courante. Méthode : Une première simulation fut effectuée à l’aide de la méthode de Markov, mais celle-ci ne permettait pas de tenir compte de tous les éléments désirés. C’est pourquoi la méthode de simulation d'évènements discrets fut utilisée pour étudier une population de 100 000 patients hypothétiques nouvellement initiés sur une statine. Cette population virtuelle a été dupliquée pour obtenir deux cohortes de patients identiques. Une cohorte recevait le test et un traitement approprié alors que l'autre cohorte recevait le traitement standard actuel—i.e., une statine. Le modèle de simulation a permis de faire évoluer les deux cohortes sur une période de 15 ans en tenant compte du risque de maladies cardio-vasculaires (MCV) fatal ou non-fatal, d'ESMIS et de mortalité provenant d’une autre cause que d’une MCV. Les conséquences encourues (MCV, ESMIS, mortalité) par ces deux populations et les coûts associés furent ensuite comparés. Finalement, l’expérience fut répétée à 25 reprises pour évaluer la stabilité des résultats et diverses analyses de sensibilité ont été effectuées. Résultats : La différence moyenne des coûts en traitement des MCV et des ESMIS, en perte de capital humain et en médicament était de 28,89 $ entre les deux cohortes pour la durée totale de l’expérimentation (15 ans). Les coûts étant plus élevés chez celle qui n’était pas soumise au test. Toutefois, l’écart-type à la moyenne était considérable (416,22 $) remettant en question la validité de l’estimation monétaire du test pharmacogénomique. De plus, cette valeur était fortement influencée par la proportion de patients prédisposés aux ESMIS, par l’efficacité et le coût des agents hypolipidémiants alternatifs ainsi que par les coûts des traitements des ESMIS et de la valeur attribuée à un mois de vie supplémentaire. Conclusion : Ces résultats suggèrent qu’un test de prédisposition génétique aux ESMIS aurait une valeur d’environ 30 $ chez des patients s’apprêtant à commencer un traitement à base de statine. Toutefois, l’incertitude entourant la valeur obtenue est très importante et plusieurs variables dont les données réelles ne sont pas disponibles dans la littérature ont une influence importante sur la valeur. La valeur réelle de cet outil génétique ne pourra donc être déterminée seulement lorsque le modèle sera mis à jour avec des données plus précises sur la prévalence des ESMIS et leur impact sur l’observance au traitement puis analysé avec un plus grand nombre de patients. / Introduction: Statins have proven their efficacy in the treatment of dyslipidemias. However, these molecules are associated with muscular side effects. Since these side effects may have adverse consequences on patients’ daily life and have an important role in the discontinuation of statin therapy in a large proportion of patients, it would be useful to develop a pharmacogenomic test that identifies a priori the individuals who are likely to develop statin-related muscular side effects (SRMSE). The objective of the present study was to determine of the monetary value of such a type of test considering that this aspect would represent an important component of its marketing and implementation into medical practice. Method: The first simulation was carried out using the method of Markov, but this one did not allow consider all the desired elements. This is why the discrete events simulation method have been used to study a population of 100 000 hypothetical patients newly initiated on a statin. This virtual population was duplicated to have two identical cohorts of patients. The first one was administered the test and a suitable treatment while the second received the current standard treatment—that is, a statin. The model allowed the two cohorts to evolve over a period of 15 years taking into account the risks of fatal and non fatal cardiovascular diseases (CVD), SRMSE and mortality from other causes than CVD. The consequences (CVD, SRMSE, death) incurred in these two populations and the associated costs were then compared. Finally, the process was repeated 25 times to assess the stability of the results and various sensitivity analyses were carried out. Results: The mean difference of CVD and SRMSE treatments, lost of human capital and drugs costs between the two cohorts was of 28.89 $, these costs being higher in the cohort who was not administered the test. However, the standard deviation with the average was considerable (416.22 $) calling in question the validity of the monetary estimate of the test pharmacogenomic.This difference varied a lot as a function of the proportion of patients being predisposed to SRMSE, the efficacy and the costs of the alternative treatments, the SRMSE cost, and the value assigned to one additional month of life. Conclusion: The results suggest that a test of genetic predisposition to SRMSE would have a value around 30 $ in patients who start a statin treatment. However, uncertainty surrounding the value obtained is very important and several variables for which the real data are not available in the literature have an important influence on the value. The real value of this genetic tool could thus be given only when the model is updated with more precise data on the prevalence of the ESMIS and their impact on the observance at the treatment and then analyzed with a higher number of patients.

The purpose of the proposed study is to explore the contribution of different types of continuing professional education (CPE) to the upward career mobility of current health services administrators working in a hospital setting. The objectives of the study were to determine the pattern of participation in CPE of a sample of hospital administrators, to ascertain the degree of upward career mobility over a 10-year period and to investigate the degree of association between these two factors as well as respondents' opinions concerning the impact of CPE on upward career mobility. / Data were collected by mailing a self-administered questionnaire to a national sample of senior-level health services administrators and to the chairpersons of the board from the same institutions. The sample of health services administrators was selected in such a manner as to eliminate confounding variables of education, length of professional experience and age. Respondents reported spending an average of 83 hours per year in formal varieties of CPE and over twenty times as much, or 1,673 hours per year, in informal varieties. In the informal domain, the greatest amount of time was spent in personal discussions, followed by personal reading. Most of the formal hours of CPE were spent in training provided during professional meetings. / The level of participation in CPE--both formal and informal--turned out to be significantly but weakly associated with indicators of the actual upward career mobility of these health services administrators. At the same time, both they and the board members responsible for hiring and firing them accorded CPE participation low causal weight in career success. Its principal effects seem due to the chance it offers to improve administrative competencies that contribute to professional development and to "network" with colleagues and influential parties who may support career advancement. / Source: Dissertation Abstracts International, Volume: 55-04, Section: A, page: 0831. / Director: Peter Easton. / Thesis (Ph.D.)--The Florida State University, 1994.

This study identified and assessed perceptions of eight (8) roles engaged in, and characteristic of, the competent allied health consultant. One hundred and thirty-eight respondents from across the nation completed a specially-designed questionnaire rating scale, and their responses were classified according to whether they were (1) consultants, (2) consultees, or (3) those who had served in both capacities. / The major thrust of this investigation was to determine how closely respondents approximated hypothesized role perceptions derived from a model by Lippitt and Lippitt (1986), to determine the degree to which three groups, identified above, converged on, or diverged from, one another (in the aggregate), and to determine if the rankings of the eight roles in terms of their importance were related to the groups' status, that is, whether consultant, consultee, or a combination of both. / A subsidiary consideration of this study, which proved late in the investigation to be salient, was whether respondents had some sense of the flow of the eight roles through the consultation process along a continuum from a nondirective to a directive conclusion. / Results indicated that no significant differences distinguished any one group from another and that respondents showed a midpoint approximation of the perceptions reflected in the model by Lippitt and Lippitt. Results also indicated that little, if any, sense of the temporal appearance of roles, as exhibited by the model, was evidenced. / Summaries revealed that traditional views of consultation as (1) fact finder, (2) problem solver, and (3) information specialist predominated in importance. A central conclusion was that, in spite of the general view that little, if any, consensus exists as to what constitutes a consultant, there was close agreement with the Lippitts' version of consultant roles. Thus, the model by Lippitt and Lippitt exhibits role perceptions around which allied health consultation can cohere. / Source: Dissertation Abstracts International, Volume: 51-06, Section: A, page: 1838. / Major Professor: Joseph Beckham. / Thesis (Ph.D.)--The Florida State University, 1990.

Purpose of study. This study is to determine whether DRG reimbursement has changed the structure of hospital costs. Due to incentives for greater output efficiency, inpatient per unit costs should fall, ceteris paribus. A countereffect for capital-intensive services is that hospitals may realize economies of scale to a lesser extent under DRGs due to inability to fully adjust in the short-run. Because outpatient services have remained under cost-reimbursement, per unit costs are not expected to decrease, ceteris paribus. However, more emphasis on outpatient services under DRGs could cause per unit costs to decrease due to greater realized economies of scale. / Procedure. A translog multiproduct cost function was used to estimate the structure of hospital costs in FY 1981-82 and 1985-86. The model included four outputs (medical-surgical discharges, outpatient visits, laboratory services, and ancillary procedures and treatments) and four annualized input prices. Other variables included fixed inputs (capital and physicians), casemix, payer mix, hospital ownership, and market structure. Product-specific economies of scale and average incremental costs were then calculated from estimation results. / Findings. Results of a joint likelihood ratio test showed that the cost structure was not significantly different in 1981-82 and 1985-86. However, t-tests regarding the difference in predicted costs evaluated at constant independent variable levels revealed that predicted costs are significantly higher in 1981-82 as anticipated. Comparative results of estimated parameters in the two years suggest hospitals are employing less capital under DRGS and physicians are inducing less demand. Further, average incremental costs for out-patient visits and laboratory services appear to be decreasing, while the average cost of discharges and ancillary procedures and treatments are increasing. Finally, unrealized economies of scale appear to be decreasing in 1985-86 for outpatient services and ancillary procedures and treatments. / Conclusion. The new DRG reimbursement system appears to have potential for reducing excess capacity, service intensity, and costs of services. / Source: Dissertation Abstracts International, Volume: 49-12, Section: B, page: 5213. / Major Professor: Gary Fournier. / Thesis (Ph.D.)--The Florida State University, 1988.

The purpose of this research study was to determine: (1) the selected job-required activities and (2) the duty performance effectiveness associated with those activities as perceived by Medical Service Corps officers in the United States Army Medical Department who had received a Master's deg / acase@tulane.edu

acase@tulane.edu

acase@tulane.edu