Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.     

Current concepts in milieu treatment of seriously disturbed children and adolescents.

In a variety of treatment settings, a therapeutic milieu provides intensive psychotherapeutic and psychoeducational experiences for disturbed children and young adolescents. It is generally agreed that effective psychosocial treatment requires a developmentally based treatment approach, collaborative parental involvement, and provision for ongoing staff support and training. In such settings, the treatment plan for each child reflects developmental, psychosocial, biological, cognitive, and neurointegrative aspects of the child's problems and identifies specific roles for psychotherapists, caseworkers, educators, occupational and recreational therapists, and parents (Alt, 1961; Pfeffer, 1979; Redl, 1959; Trieschman, 1969). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AB PLC与ABB传动装置的ProfiBus-DP通讯实现

说明了AB PLC与ABB传动装置的ProfiBus-DP通讯实现之意义,并论述了设计方案,列出了具体的PLC硬件配置和软件设置方法,以及传动装置的参数设置等,较详细地阐述了AB PLC与ABB传动装置的ProfiBus-DP通讯实现方法。     

Using active supervision and precorrection to improve transition behaviors in an elementary school.

Investigated the effect of a school-wide intervention plan, consisting of precorrection and active supervision strategies, on the social behavior of elementary students in major transition settings. Three transition settings were targeted in an elementary school: (1) entering the school building, (2) moving to the cafeteria for lunch, and (3) exiting the school building. A multiple baseline design across the 3 transition settings was used. An analysis of baseline data indicated high rates of student problem behavior, especially running, hitting, and yelling, and low rates of precorrection and active supervision behaviors by staff. Results showed increases in precorrection and active supervision behaviors by staff with concomitant, substantial reductions in student problem behavior. Details of the methodology and results, and practical implications and directions for future research are described and discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An efficient method of ensuring program quality for adults with developmental disabilities in community-based apartments.

Evaluated a supervision program that was designed to improve the quality of engagement of activities for adults with severe disabilities who are living in community based apartments. Ss were adults (aged 24–44 yrs) diagnosed with severe mental retardation, autism, childhood schizophrenia, personality disturbance, organic bipolar affective disorder, attention deficit disorder, or recurrent depression. A program involving feedback was implemented in a multiple-baseline design across individuals. Results show that after the supervision program was implemented, adult participation increased across activities related to learning short-term objectives as designated on the person's individualized habilitation plan, scheduled activities, activities promoting independence, and age-appropriate activities. Feedback provided once a week was equally as effective as feedback provided 3 times a week in the community-based settings. Follow-up done 1 yr later revealed maintenance of these gains in the community settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Domestic violence. Reality for some of your toughest patients

Until recently, domestic violence was considered a criminal justice or social service problem. However, physicians see victims in emergency settings and clinics with complaints and symptoms that go beyond physical injuries. A study by a Minnesota health plan shows that, on average, a victim of domestic violence costs the health care system $1,434 more per year than a nonvictim. This article discusses the prevalence of domestic violence and the variety of presentations. Guidelines for screening, what to do with a positive response, when to call the police, and how to document and code are reviewed, as are issues unique to older victims of domestic violence.     

Use of a content methodology process to enhance feeding abilities threatened by ideational apraxia in people with Alzheimer's-type dementia

Self-feeding behavior is often the first of a chain of self-maintenance skills to deteriorate in people with Alzheimer's-type dementia and is a major determinant of institutionalization. Moreover, nurses working in geriatric settings report the feeding of patients as a most difficult management problem. Of the various features of Alzheimer's-type dementia that can affect a person's ability to feed him- or herself, ideational apraxia can explain the loss of ability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects necessary for feeding. In this article, a systematic process is used to review the research literature to develop substantive content for nurses caring for people with feeding problems related to ideational apraxia. Ideational apraxia is a condition in which an individual is unable to plan movement related to an object because he or she has lost the perception of the object's purpose. The specific abilities necessary for feeding that are threatened by ideational apraxia are identified. A tool to assess these abilities is described, and nursing interventions aimed at enhancing or preserving existing abilities, preventing excess disability, or compensating for lost abilities are presented.     

Comment on Turner (2000).

Field research like that of A. L. Turner (see record 2000-03669-001) has the potential to develop theory about coping and treatment processes. We discuss theoretical concepts from social support research, social comparison theory, and emotional processing models, which can help to understand what is happening in group-based interventions and to plan interventions that address the interface between socially supportive processes and individual differences in anxiety reactions. We discuss methodological approaches that can be used to assess how treatment effects are mediated and suggest settings where controlled evaluations are possible. Such research can enrich theory about group processes and build the effectiveness of group-based interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treatment Planning in Psychotherapy: Taking the Guesswork Out of Clinical Care.

Reviews the book by Woody et al (see record 2002-06426-000, which outlines a step-by-step simple method by which clinicians can plan and evaluate the course and outcome of therapy. The authors outline their rationale for their "Planning and Assessment in Clinical Care (PACC)" system. Differences in clinical practice between university and health care settings can be quite surprising and possibly overwhelming, especially for the new clinician. The book has a number of strong points that will likely aid not only the individual therapist interested in planning and evaluating the course and outcome of their therapy with clients and patients, but also should help to increase the research productivity of psychologists working in a variety of service settings. Benefits that clients and patients are likely to receive as a result of therapy that is complemented by thorough, yet simple, planning and evaluation strategy. The book is comprised of 7 easy-to-read chapters with a valuable appendix containing a number of well-validated assessment measures. The reviewer believes the book to be well-suited for graduate students as an introductory textbook for a course in psychotherapy planning and evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is rehabilitation psychology in need of rehabilitation?

Discusses the "Golden Age" of rehabilitation psychology, when rehabilitation of persons with traumatic brain injury was the fastest growing areas in all health care, and comments on the current state and possible future directions of the field. The author's care plan for the future includes a focus on chronic conditions in addition to the field's current primary focus on end results (disability). The new focus would involve branching out beyond the field's traditional work in inpatient and outpatient rehabilitation facilities. The author points out rehabilitation psychology's unique focus on a team approach to treatment, and notes that this model can be transported to treating other chronic conditions, typically seen in more acute or primary settings. In an effort to introduce their model into hospitals around the country, rehabilitation psychologists need to expand their clinical practices, modify their training model, and broaden the scope of their research efforts. As corporations are concerned about disability and chronic illness and are largely unaware of what rehabilitation psychology could offer them, a logical step in their care plan is to work more closely with corporations and employee benefit services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying chronic affective disorders in outpatients: Validation of the General Behavior Inventory.

The validity of the General Behavior Inventory (GBI) in screening outpatients for chronic unipolar and bipolar affective conditions was evaluated. The GBI was administered to 492 consecutive patients at a university clinic and a community mental health center. Using a stratified random sampling plan, 167 patients were selected and administered blind structured diagnostic interviews. In addition, unipolar depressives were followed up 6 months after the initial evaluation. Overall, the GBI exhibited fair-to-good positive predictive power and good-to-excellent negative predictive power. In addition, GBI scores in the case range were consistently associated with poor outcome at the 6-month follow-up. These findings suggest that the GBI may provide an economical means of screening for chronic unipolar and bipolar affective conditions in outpatient settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Stirling County Study: A research program on relations between sociocultural factors and mental illness.

"Stirling County, located in one of the Canadian Atlantic Provinces, has a population of about 20,000." The Stirling County project "is a research program for the investigation of relations between sociocultural environment and mental illness. The research effort is interdisciplinary and combines extensive with intensive study of both the sociocultural environmental and mental disorder. The subjects of the research are persons who are not undergoing treatment as well as those who are; mental health and mental illness are investigated in the societal as well as in the individual settings in which they develop." The theoretical framework, the primary and subsidiary research operations, and the plan of analysis are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of daily living tasks: the home care advantage

Occupational therapists working in home care have an advantage over those working in other settings because they can observe the influence of the naturalistic context on task performance. However, to use this advantage, therapists working in home care must use an evaluation approach that enables them to capture the client-task-context transaction. In this article, we discuss the ability of four "evaluation approaches"--norm-referenced, criterion-referenced, dynamic, informal--to provide information about the client-task-context transaction that therapists need in order to plan effective intervention. The potential of each approach for identifying clients' performance problems, suggesting etiologies, determining rehabilitation potential, and guiding intervention is analyzed, and the appropriateness of each approach for application in the home is appraised. This analysis highlights the utility of combining the criterion-referenced and dynamic assessment approaches for use in home care. A sequential process for integrating these two approaches is provided, and the proposed outcomes to be obtained from this process are identified.     

Economics and psychology practice: What we need to know and why.

Economic contexts and trends relevant to the practice of psychology in mental health and health settings are presented to help practitioners plan better for the future. Professional skills alone are no longer sufficient to thrive and deliver quality services in the current economic climate. A greater focus on understanding the economic indicators for psychology is necessary too. This includes the cost-driven policies, health and behavioral health financing, demands for accountability, losses, and opportunities inherent in the major systemic health care changes occurring in the United States. Practical questions with economic implications about the direction of psychology practices are raised, and the role of psychology initiatives designed to advance practice, which take both professional and economic factors into account, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems.

For more than a decade, health care systems have attempted to implement evidence-based practices and guidelines. These efforts have demonstrated the difficulty in making practice changes in complex systems of care. Many health care systems, including the Department of Veterans Affairs (VA) and state community mental health systems, have made adoption of evidence-based treatments, especially psychotherapies, a priority. Psychologists, as behavioral change experts and clinical leaders, are positioned to aid local implementation efforts but may have limited knowledge of the “implementation science” literature. This article provides a brief introduction to the implementation literature and offers a guide for developing an implementation plan to adopt evidence-based psychotherapies in local health care settings illustrated by a hypothetical example. Challenges to implementation are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effectiveness of Cognitive-Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy (M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Listening to parents' voices: Participatory action research in the schools.

How can schools and parents work together more effectively? This article describes a participatory action research (PAR) project with a group of parents whose children had been classified as having emotional disabilities. As the parents shared their stories of trying to navigate the special education system, they developed critical consciousness about their experiences of stress, powerlessness, and alienation. They became mobilized and obtained information about testing, diagnostic classification, and educational options for their children. Armed with this information, they developed and implemented an action plan to improve family-school relationships at the local, community, and state levels. The article concludes with an example of how the PAR model can be exported to a variety of mental health settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability Buffering for Construction Projects

Buffering is a common practice in project planning. Project managers or schedulers have used a time contingency to guarantee the completion time of either an activity or a project. This traditional buffering, however, often fails to protect the project schedule performance, resulting in an unnecessary resource idle time. To deal with this problem, reliability buffering, a simulation-based buffering strategy, is presented. Reliability buffering aims to generate a robust construction plan that protects against uncertainties by reducing the potential impact of construction changes. The effectiveness of reliability buffering is examined by simulating a dynamic project model that integrates the simulation approach with the network scheduling approach. The research results indicate that reliability buffering can help achieve a shorter project duration without driving up costs by pooling, resizing, relocating, and recharacterizing contingency buffers. A case study of bridge construction projects also demonstrates how construction projects can benefit from reliability buffering in real world settings. Although further validation is needed, reliability buffering can potentially impact the planning and control of construction projects by improving the consideration of construction feedbacks and characteristics in buffering, and serving as an input to a dynamic project model.     

Good practice in the management of adults with malignant cerebral glioma: clinical guidelines. Working Group, Royal College of Physicians

This paper proposes guidelines for good practice in the management of adults with malignant cerebral glioma. These guidelines were developed by a working group comprising representatives of the medical specialties involved in patient care, specialist nursing staff, purchasers, charitable bodies, and patient and relative representatives. Both the research literature on the effectiveness of medical intervention, and the views of patients and relatives about the care they had received were considered. The document proposes a consensus view about ways to improve patient care and considers several stages of the illness and its care: I, the diagnostic phase; II, deciding on an appropriate treatment plan; III, the organization of follow-up services; IV, the management of transitions from hospital to community settings; and V, purchasing care for patients with malignant brain tumours. An audit package derived from the guidelines is available which will enable staff within a treatment centre to compare their practice against these standards. A final section suggests topics which require further research, and sets out the core requirements for studies that will help answer questions about treatment and the benefits for patients in terms of improved quality of life.