RESUMEN
This paper describes a community-based agency's approach to reducing perinatal risk among populations at high medical, familial and environmental risk. Following a descriptive analysis of 96 families enrolled in a maternal outreach program, a case study illustrates how client-sensitive strategies are applied to successfully engage a traumatized population. The intensity and duration of the interventions, the extensive outreach efforts to the family and the dedication and commitment of the staff are not easily replicated but invaluable in helping providers and researchers understand to what extent the impact of severe deprivations and risk can be mediated and potential damage to the newborn prevented. The paper concludes that community-based agencies in partnership with social and clinical researchers from a tertiary care setting provide the key for developing more effective, integrated perinatal care by virtue of the critical density of hard-to-reach patients who can be followed by providers and clinical researchers.
Asunto(s)
Servicios de Salud Comunitaria/normas , Perinatología , Adulto , Actitud Frente a la Salud , Servicios de Salud Comunitaria/organización & administración , Salud de la Familia , Femenino , Conductas Relacionadas con la Salud , Humanos , Conducta Materna , Pobreza , Embarazo , Factores de Riesgo , Servicio SocialAsunto(s)
Centros Médicos Académicos/organización & administración , Práctica de Grupo/organización & administración , Atención Primaria de Salud/organización & administración , Ciencias Sociales , Eficiencia , Hospitales con más de 500 Camas , Planificación Hospitalaria/métodos , Humanos , Ciudad de Nueva York , Innovación Organizacional , Derivación y ConsultaAsunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Sistemas de Información , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Hospitales con más de 500 Camas , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/terapia , Masculino , Ciudad de Nueva York , Pediatría , RiesgoRESUMEN
We studied 779 walk-in psychiatric patients presenting to 32 first- or second-year residents and 772 patients presenting to 25 third-year residents or attending physicians as to the decision to admit to the hospital or to administer medication to those not admitted. There were no significant demographic or clinical differences between patients presenting to the two groups. The more experienced staff admitted half as many patients and treated serious depression with tricyclics twice as frequently. Inexperienced psychiatrists used hospitalization more frequently when these patients suffered from suicidal ideation, hallucinations, delusions, and inability to cope. When the training procedure was modified and second-year residents were introduced into a more structured setting, their decision-making quickly approached that of third-year residents and attending physicians. We suggest that specific training can modify decision-making, where general clinical experience may not. Implications for resident and medical student training are discussed.