Please read the abstract in the section 00front of this document / Dissertation (MA (Publishing))--University of Pretoria, 2007. / Information Science / unrestricted

This study was an analysis of social work practice in a medical setting: analyzing the work of a medical social worker in an outpatient clinic located in a metropolitan area. The primary purpose of this descriptive study was to evaluate the performance of a medical social worker in a Kaiser-Permanente outpatient clinic and to determine if there were possible associations between social work intervention and patient utilization of existing services offered by the Kaiser Health Care system, also referred to herein as Kaiser. Specifically, the study attempted to determine if there were quantitative changes in patient contacts, and utilization of certain services such as clinic visits, telephone contacts, prescriptions, emergency room visits, hospitalizations, and physicians seen before and after social worker intervention. If there were changes, what were the direction and quantity? Did changes vary according to type of service? Did patient utilization of medical care vary according to the number of social work contacts?

This study evaluates the role of the Neighborhood Health Coordinators (NHC's) within Kaiser Foundation's Comprehensive Neighborhood Health Services (CNHS) Project. This project was established in September, 1967, under the provisions of the 1966 amendments to the Economic Opportunity Act, to provide and make readily available comprehensive medical care to 1ow-income persons. In compliance with the stipulations of this Act, persons who reside in target areas, designated as depressed neighborhoods, were hired to serve as NRC's. These indigenous non-professionals serve as links or "gatekeepers" between the low-income persons enrolled in this program, and the Kaiser medical care facilities which include the hospital-clinic and three neighborhood health clinics. The NRC's were to enroll these low-income families in the program, and assist them in obtaining appropriate health services. In addition to these primary responsibilities, the NHC’s were to refer their clients to community resources whenever necessary. The impact of the NHC's contact with families enrolled in the program was evaluated on the basis of two major indices: utilization of total medical care services and four specific areas of preventive health care. The findings of this study support the underlying assumption upon which the NRC's were hired and trained; that is, they are effective in increasing the total utilization of out-patient medical services and utilization of specific preventive health services by families with whom they have the most personal contact. In a secondary analysis, characteristics related to several CNRS Project objectives, attitudinal scales and socio-demographic characteristics are examined to determine their relationship to the staff's perception of an "ideal" NHC. This analysis shows that aptitude in interpersonal relationships and personal growth are two characteristics highly associated with rank. Several attitudinal scales, especially powerlessness and dogmatism, are positively associated with rank. Measures of knowledge in the areas of health and medical care programs have a low or negative association with rank. This study does not make an exhaustive investigation of characteristics which may be associated with rank; therefore, other variables considered by the administrative staff in their evaluation of an "ideal” NHC may not have been measured.

No description available.

No description available.

The primary focus of the current study was to identify health disparities between sexual minority subgroups by examining differences of health indicators in lesbians, gay men, and bisexual individuals, and compare these to their heterosexual counterparts. Data was drawn from the National Health and Nutrition Examination Survey (NHANES), and variables examined in sexual minorities were related to health care access and utilization, risky health behaviors, and overall disease prevalence and outcomes. Findings suggest there are still some current health disparities in terms of insurance coverage, access to medical care, substance use, and prevalence of certain health conditions. However, a trend analysis conducted to examine three NHANES panels, suggests a mild improvement in some of these areas. Further findings, discussion, limitations of the study, current implications, and future directions are addressed.

Using data from the Household Component of the 1996 Medical Expenditure Panel Survey, the study compares (1) the accessibility, and (2) the predictors of health care services utilization among African American and non-Hispanic White males, 18 to 65 years old in the United States. Using ANOVA procedure in comparing the means for use of physicians, hospitals, doctors, and difficulty obtaining care, seven hypotheses were tested in the study. First, it was hypothesized that African American men of working age will have less access to health care services (physicians, hospitals, and dentists), and be more likely to report having experienced delay or difficulty obtaining care, compared to non-Hispanic white males of working age. Second, it was hypothesized that, controlling for health status, African American men of working age will have less access to health care services (physicians, hospitals, and dentists), and will also be more likely to experience delay or difficulty obtaining care, than non-Hispanic white males. This was followed by the third hypothesis which compared utilization of physicians, hospitals, dentists, and difficulty obtaining care among African American and non-Hispanic white males, controlling for health status and insurance coverage (any insurance, private insurance, any public insurance, and Medicaid). Hypotheses four through six compared the utilization of physicians, hospitals, and dentists, as well as difficulty obtaining care among African American and non-Hispanic white males, controlling for the following variables sequentially: health status and poverty status; health status and having a usual source of care; and health status and employment status, in that order. Finally, it was hypothesized that, controlling for health status, any insurance, poverty status, and employment status, African American men of working age will have less access to physicians, hospitals, and dentists, and experience more difficulty and delay obtaining care, compared to non-Hispanic white males of working age. Results from the study indicated that Hypothesis 1 was supported for use of physicians and dentists. Hypotheses 2, 3a and 3c were supported for use of physicians, hospitals, and dentists. Hypotheses 3b, 3d, and 4 received support for use of physicians, hospitals, dentists, and difficulty obtaining care. Additionally, both Hypotheses 5 and 6 were supported for use of physicians, hospitals, and dentists, with the last hypothesis being confirmed for use of physicians, hospitals, dentists, and difficulty obtaining care. The study calls for a closure of the gap in access to health care between African American and non-Hispanic white adult males in the US. A reform-oriented government-sponsored single-payer plan modeled after the Canadian health care system is recommended for the United States. A national health insurance plan is most likely to ensure equity of access, compared to others, in the sense that it is founded on the premise that everyone will be covered in a similar fashion. Considering the role of Community Health Centers in serving Medicaid and Medicare recipients, low-income uninsured and insured, the underinsured, as well as high-risk populations and the elderly, in the interim, they should be extended to every community in the United States.

University of Macau / Institute of Chinese Medical Sciences

An advance directive is an instruction made by a competent person about his or her preferred health care choices, should the person become incapable to make treatment decisions. Legal recognition of advance directives has developed over the last half century in response to medical advances that can prolong the life of a patient who is no longer sentient, and who has decided to forego some or all treatment under such circumstances. Two types of directive have emerged in the law: an instructional directive, in which a person sets out treatment choices, and a proxy directive, which enables the person to appoint a proxy to make treatment decisions. Development of the law has been impeded by fear that advance directives diminish regard for the sanctity of life and potentially authorize euthanasia or assisted suicide. In Canada, this fear explains the continued existence of outdated criminal law prohibitions and contributes to provincial advance directive legislation that is disharmonized and restrictive, in some provinces limiting personal choice about the type of advance directive that can be made. The British Columbia Representation Agreement Act (RAA)1 is an example of such restrictive legislation. The RAA imposes onerous execution requirements, is unduly complex and restricts choice of planning instrument. Respect for patient autonomy requires that health care providers honour patients' prospective treatment preferences. Capable persons must have ready access to a choice of health care planning instruments which can be easily executed. B.C. should implement advance directive legislation that meets the needs and respects the autonomy of B.C. citizens. The Criminal Code must be amended to eliminate physicians' concern about potential criminal liability for following an advance directive. Advance directive legislation across Canada should be harmonized. Finally, health care providers should receive training on effective ways to communicate with patients about end-of-life treatment decisions to ensure that patients' health care choices are known and respected. / Law, Peter A. Allard School of / Graduate

No description available.