Health and social care in aging population: an integrated care institution for the elderly in Greece
International Journal of Integrated Care, 22 October 2003
Purpose: To describe the nature of the services actually offered to the elderly in Greece by an institution of integrated care, as opposed to those that should be offered according to the relevant law, and to investigate the factors influencing the supply of those services.
Background: By the year 2020 about 20 million people will be aged 80 and over in the European Union. People of third age consist 16,9% of the total Greek population. Population aging has major implications on health services, employment and society as a whole. "Open Care Centres for the Elderly" (KAPI) is a rapidly developing and expanding institution providing integrated care for the elderly.
Methods: A questionnaire to be completed by the staff was sent to all 370 KAPI. Response rate reached 66%. For the analysis of the data multiple logistic regression analysis was performed using SPSS 10.0.
Results: Both medical and social care is provided by the KAPI to the elderly with different magnitude all over the country. Factors such as number of members, medical, paramedical and non-medical staff and fund availability in the KAPI mainly influence the supply of services.
Conclusions: Integrated care services are offered by the KAPI. However, more steps need to be taken towards the direction of other European countries' integrated care schemes, in order to improve both quality and quantity of the services provided.
Is there a relationship between service integration and differentiation and patient outcomes?
International Journal of Integrated Care, 10 November 2003
Objective. To examine the level of service integration within Maryland hospitals and service differentiation across the hospital system or network and its affect on heart failure patient clinical and economic outcomes.
Data Sources/ Study Setting. Maryland Health Services Cost Review Commission Inpatient Data for 1997 and 1998 were used for secondary data analysis.
Study Design. Retrospective cross sectional. Independent variables were the level of service integration and differentiation created from the 1998 American Hospital Association Annual Survey based on the work of Bazzoli et al. [1] The primary dependent variables were readmission, in-hospital mortality, length of stay and costs.
Data Collection/Extraction Methods. Patients discharged from Maryland hospitals with a diagnosis that grouped to DRG 127 (heart failure) were extracted. Multivariate linear and logistic models clustered by hospital were used to analyse results at the patient level.
Principal Findings. A higher likelihood of readmission was found as the level of Community Differentiation increased. Although costs were higher as Total Differentiation increased in 1998, these results were not validated by 1997 data. No significant relationship was found between integration of services and outcomes.
Conclusions. Similar outcomes were achieved regardless of the level of service integration or differentiation. Community hospitals produce similar patient outcomes at the same cost for this diagnosis.
The Health System of the Future
Healthcare and Informatics Review Online 1 December 2003The current round of health reform in New Zealand is building a new way of delivering health care. Government strategies and Ministry of Health (MoH) policies describe at a high level the start of a journey to a "Health System of the Future", a system focused on wellness rather than illness, on promotion of collective responsibility for population health and on sensible co-ordination of individual patient's treatment. This paper proposes practical models for making the health system of the future work, in terms of both structure and information systems. It proposes a guide through which all parties in the health sector might deploy information system tools that could enable, support and drive the new health strategies, and achieve the gains in population health status which those strategies are designed to provide. This guide is based on many years' experience at Counties Manukau District Health Board (DHB), Auckland, New Zealand and carries the strong recommendation of broader uptake of proven, successful, practical methods and solutions Emphasis is placed on the need for a co-ordinated and common approach to information systems investment and to information sharing technology. Large and often unsuccessful IT investments have been made in the past in the health sector by organisations that took little notice of the experiences or requirements of other health care organisations. Experience in Counties Manukau DHB has demonstrated that collaboration and an incremental approach are the critical success factors to achieving the New Zealand Health Strategy. All organisations within the sector are urged to continue their efforts to fully embrace the principles of information sharing and trusted partnership to make the Health System of the Future a reality of today.
An epidemiological study of pleuropulmonary paragonimiasis among pupils in the peri-urban zone of Kumba town, Meme Division, Cameroon
BMC Public Health 2003, 3:40 (published 16 December 2003)
Background
Paragonimiasis had previously been reported in two zones of the Southwest Province of Cameroon including the Kupe mountain and Mundani foci. The aim of this study was to investigate the presence and epidemiology of paragonimiasis in the peri-urban zone of Kumba, Meme Division, located about 50 km away from the Kupe mountain focus.
Methods
Pupils of some government primary schools in 5 villages around Kumba underwent both parasitologic and clinical investigations in search of signs and symptoms of paragonimiasis. Mycobacterium tuberculosis was also searched for, in the differential diagnosis. Freshwater crabs from neighbouring streams in the five villages were dissected in search of paragonimus metacercariae.
Results
Out of a total of 1482 pupils examined in all five villages, 309 individuals (147 males and 162 females) were recruited for this study based on the presence of one or more signs or symptoms of paragonimiasis. Eggs of Paragonimus africanus were found in stools and/or sputum of pupils from all five villages, giving an overall paragonimus prevalence of 2.56%. There was no significant difference in the disease prevalence between the villages (X2 = 8.36, P = 0.08). The prevalence of Paragonimus africanus eggs amongst pupils with symptoms of paragonimiasis was 12.3% (38 of 309). Males were infected more than females (17.0% versus 8.0%), but the difference was not significant (X2 = 5.76, P = 0.16). All the 38 paragonimus egg - positive subjects presented with cough, 23 (60.53%) complained of chest pain while 16 (42.11%) had haemoptysis. Stool examinations also detected some intestinal parasites including Ascaris lumbricoides (29.45%), Trichuris trichiura (6.47%), Necator americanus (2.27%), Strongyloides stercoralis (1.62%), Enterobius vermicularis (0.65%), and Entamoeba histolytica (4.53%). No case of M. tuberculosis was noted. Out of a total of 85 dissected crabs (Sudanonautes africanus), 6.02 % were infected with paragonimus metacercariae.
Conclusion
In addition to the two previously described paragonimiasis foci of Kupe mountain and Mundani, the identification of autochthonous cases of paragonimiasis in the peri-urban zone of Kumba town, makes the South West Province the most endemic zone of paragonimiasis in Cameroon at present.
