RESUMEN
HIV prevalence in the American Deep South has reached crisis proportions and greater numbers of patients are enrolling in clinical care and beginning antiretroviral therapy (ART). In order to gain maximum benefit from ART, patients must sustain high levels of adherence to demanding regimens over extended periods of time. Many patients are unable to maintain high rates of adherence and may need assistance to do so, which may be based upon an understanding of barriers to adherence for a given population. The current study sought to gain understanding of barriers to adherence for a mixed urban/rural HIV-positive patient population in Mississippi and to determine whether barriers to adherence may be specific to gender, employment, depressive symptoms or educational attainment status. Seventy-two patients who missed a dose of ART medication over the last three days endorsed the top five reasons for missing a dose as: (1) not having the medication with them, (2) sleeping through the dose time, (3) running out of the medication, (4) being busy with other things and (5) other. Reported barriers were fairly consistent across different groups, although women and those classified as having moderate to severe depressive symptoms reported different patterns of adherence barriers. Results suggest that adherence interventions implemented in the Deep South must take into account specific barriers faced by individuals within this region, where stigma, gender disparities and limited resources are prevalent.
Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Negativa del Paciente al Tratamiento/psicología , Actitud Frente a la Salud , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Mississippi , Factores SocioeconómicosRESUMEN
A pilot study was conducted to assess the feasibility of using, in a multiply disadvantaged population, an electronic daily diary to test hypotheses linking affective states to variability in psychosocial determinants of condom use. Twenty-one mostly non-Caucasian individuals reporting profound economic disadvantage, heavy alcohol use and HIV infection completed a 5-7 minute interactive voice response (IVR) telephone-based survey daily for three weeks. Potentially affect-related within-person variability was observed in HIV-preventive attitudes, intentions and self-efficacy. Surprisingly, in this sample, HIV-preventive attitudes, intentions and self-efficacy exhibited as much, or greater, variability within persons as compared to between persons. Positive affect was found to significantly co-vary with self-efficacy to practice safer sex B=0.20, t((199))=2.14, p=0.03. For each unit increase in daily positive affect, daily self-efficacy increased by 0.20. Results suggest that a daily diary methodology is both feasible in a high-risk population and may offer new insights into understanding unprotected sexual behavior.
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Adulto , Estudios de Factibilidad , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Proyectos Piloto , Asunción de Riesgos , Conducta Sexual/psicología , SexualidadRESUMEN
Dementia with frontotemporal lobar degeneration (FTLD) is clinically characterized by the occurrence of various psychiatric symptoms. In a recent study, the hospital-based prevalence of FTLD and the circumstances of the patients' admission to German psychiatric state hospitals were estimated. On the basis of further continuous assessment, this original FTLD group (n = 33) has been enlarged to 58 patients. The authors here present demographic and clinical data, and reasons for admission to geriatric psychiatry hospitals in comparison with 17 patients, who primarily attended the Memory Disorders Clinic of the University of Regensburg. The results implicate that both institutions see patients with different clinical syndromes: (1) patients were primarily referred to the Memory Disorders Clinic presenting memory and/or speech difficulties as the leading symptoms; (2) major reasons for hospitalisation of patients with FTLD in geriatric psychiatry hospitals were behavioural disturbances; (3) late-onset FTLD (>65 years) was more common than previously assumed in both institutions, and (4) increasing age at admission increased the likelihood to obtain a limited diagnostic approach of brain imaging (only cranial computer tomography) to evaluate the cause of dementia.
Asunto(s)
Instituciones de Atención Ambulatoria , Demencia/diagnóstico , Hospitalización , Hospitales Psiquiátricos , Derivación y Consulta , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/etiología , Afasia Progresiva Primaria/etiología , Demencia/psicología , Demografía , Femenino , Alemania , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Admisión del Paciente/estadística & datos numéricos , Tomografía Computarizada de Emisión , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
AIM: To evaluate the method for comparison of average length of stay in hospitals as defined in a contract between German health insurance companies and the "Deutsche Krankenhausgesellschaft" (German Hospital Association). METHOD: Simulation study executing the algorithm agreed upon in different scenarios, which varied the number of hospitals to be compared, the dispersion of diagnostic specialization over hospitals, and the distribution of hospitals' sizes. Scenarios were constructed to realistically reflect the situation in German inpatient treatment of mentally ill patients. RESULTS: By fixing casemix adjustments only on diagnoses of patients and by doing so aggregated on the level of hospitals, the method for comparison yielded artificial differences between hospitals even in a situation where each patient is treated with exactly the same amount of resource allocation (given the individual needs defined for all scenarios). Results of artificial differences were heavily biased against or in favour of the reference hospitals according to the specific condition of the scenario parameters. CONCLUSION: The contracted method is not capable of achieving fair hospital comparisons, at least not for psychiatric hospitals.
Asunto(s)
Algoritmos , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Tiempo de Internación/legislación & jurisprudencia , Trastornos Mentales/rehabilitación , Programas Nacionales de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Alemania , Hospitales de Distrito/legislación & jurisprudencia , Humanos , Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/clasificación , Trastornos Mentales/epidemiología , Grupo de Atención al Paciente/legislación & jurisprudencia , Grupo de Atención al Paciente/estadística & datos numéricos , Servicio de Psiquiatría en Hospital/legislación & jurisprudencia , Asignación de Recursos/legislación & jurisprudencia , Asignación de Recursos/estadística & datos numéricosRESUMEN
Hospital financing via case-related prospective payment sometimes is suspected to be responsible for accelerating the "revolving-door"-phenomenon in psychiatry. According to this reasoning, establishing diagnoses-related groups (DRGs) ruling a prospective payment system could not only reduce lengths of stay but could also simultaneously raise hospitalization and readmission rates. This study analyses the Austrian experience after the implementation of such a payment system, the "performance-oriented financing of hospitals" (leistungsorientierte Krankenanstalten-Finanzierung, LKF) in 1997. Time series analyses based on the complete hospital discharge statistics of the Salzburg province were used as methods. Results showed that neither length of stay, nor hospitalization or readmission rates in psychiatry have substansially changed or deviated from their long-term trends after implementation of the LKF system. Other medical disciplines have experienced statistically significant changes. The possibility to transfer these results to the German psychiatric health care system is discussed.
Asunto(s)
Grupos Diagnósticos Relacionados/economía , Administración Financiera de Hospitales/métodos , Hospitalización/estadística & datos numéricos , Sistema de Pago Prospectivo , Servicio de Psiquiatría en Hospital/economía , Psiquiatría/economía , Austria , Femenino , Alemania , Hospitalización/economía , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Evaluación de Resultado en la Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
The Johns Hopkins Hospital has initiated an ambitious program to apply modern technologies to the development of a new, comprehensive clinical information system. One component of this system is a networking technology for supporting the integration of diverse and functionally distinct information systems. This paper discusses the selection of the networking technology implemented at JHH, issues and problems, networking concepts, protocols, and reliability.