A comparison of expectations for selected physician and managed health care services between Medicare-eligible and the next Medicare-eligible generation.

The year 1998 marks the beginning of a major turning point in the composition of the Medicare-eligible population, making the next few years a significant watershed for those concerned with the provision of health care to seniors. For approximately the next 12 years, those seniors entering the Medicare-eligible health care market, the so-called Swing generation, will have different characteristics and expectations from those generations that precede or follow it. Through standard survey methods, this study explores and compares the differences in selected health services expectations between the current generation of Medicare-eligible seniors and the next Medicare-eligible generation. Significant differences were found between the two groups on variables related to wait time, medical preparedness, communication, and expectations of managed care coverage. The authors discuss the implications of the findings for health care service providers and managed care organizations.

Total quality management and the reduction of inpatient violence and costs in a forensic psychiatric hospital.

OBJECTIVE: The study evaluated the effects of using the principles of total quality management (TQM) to reduce aggressive incidents in the dining rooms at a state forensic hospital. METHODS: A ten-member, multidisciplinary team, which included a patient representative and a private-sector mentor, used the TQM FADE method (focus, analyze, develop, and execute) to address the problem. The team analyzed violent mealtime incidents, reviewed mealtime policies and procedures, and conducted a patient survey. Five recommendations were made: substitute plastic utensils for silverware, play music selected by the hospital's music therapists, allow patients at the highest privilege levels to leave the dining room after eating, open the main courtyard and gym during meals, and train food service workers in therapeutic communication. RESULTS: One year after implementation of the recommendations, aggressive incidents in the dining rooms were reduced by 40 percent, assaults using silverware were eliminated, and a total of 70 nursing staff hours a day were saved by eliminating silverware control procedures in the dining rooms. The milieu in the dining rooms has been improved by the addition of music and more flexible procedures. CONCLUSIONS: TQM techniques can be effectively applied in public-sector institutions to analyze and solve problems such as mealtime violence.

Violence in public sector psychiatric hospitals. Benchmarking nursing staff injury rates.

1. Violence toward healthcare workers, particularly psychiatric nursing staff, has only recently been identified as a workplace health hazard. An occupational health perspective underscores the need for proactive monitoring and heightens incentives for prevention through the introduction of external regulation. 2. Nursing staff injury rates from violence alone are higher than injuries seen in industries traditionally considered high risk such as mining, lumber, and heavy construction. Nursing employment categories at particular risk include psychiatric technicians, male staff, and on-unit supervisory personnel. 3. It is exceedingly difficult to accurately measure the extent of violence in a given facility and injury rates are known to underestimate the actual number of violent events that occur. Nursing staff, labor organizations, and managers must work toward more reliable monitoring and risk prevention programs.

Types of weapons and patterns of use in a forensic hospital.

OBJECTIVE: The purpose of this study was to describe types of weapons and weapon use patterns among inpatients at a state forensic hospital to assist staff in evaluating the weapon-screening program. METHODS: Data for a five-year period were drawn from special incident reports, hospital police crime reports, and supervisory logs to document weapon use in a 973-bed, all-male maximum security forensic hospital. Weapons were categorized as weapons of opportunity (objects available at the site of the attack) and manufactured or contraband weapons. Repeat use of weapons by a patient was documented. RESULTS: Weapon use was relatively rare. During the five-year period less than 3 percent of inpatients used weapons, and less than 3 percent of violent incidents involved weapon use. Available objects were used in most attacks. Only 17 patients were responsible for a fourth of all weapons assaults, and these patients repeatedly used the same types of available objects, particularly furniture. Staff and patients were targeted equally in the weapon assaults. CONCLUSIONS: Weapon-screening programs may prevent weapon carrying but not weapon use. Detailed histories of weapon use should be part of each patient's assessment and should be made known to staff.

The use of hypnosis in a family practice setting.

For the Family Physician/General Practitioner, there are many locales in which hypnosis is a valuable adjunct to treatment. In this chapter the author describes some of the opportunities for using hypnosis according to the site of practice, rather than in the usual pattern of describing its use in each physiological system (e.g. digestive system, reproductive system) or division of medicine (pediatrics, gynecology etc.) The areas chosen are: the office examining room, the counselling or consulting room, the emergency room, the Intensive Care and Coronary Care Units, the case room, the operating room, the home visit, at the scene of an accident, and in the palliative care unit.

What do family physicians see in practice?

Health care problems dealt with in their practices were recorded by seven family physicians over a period of 1 year (two others recorded for 3 months), each diagnosis being coded according to the Canuck Disease Classification Index. Problems were classified into four types: physical, psychosocial, diseases of choice (or lifestyle) and diseases of social impact. More than 85% of the 23 108 problems recorded were physical in origin and had physical manifestations. More time was spent on routine checkups and treatment of respiratory disease than on any other activity. Venereal disease and alcoholism were infrequent problems. The family physician is in a favourable position to act as health educator and counsellor and must be throughly trained in the physical aspects of disease.

Applications for abortion at a community hospital.

Applications for therapeutic abortion over a 44-week period in a 647-bed community hospital are reviewed with reference to age, marital status, gestational age, parity, contraceptive use and reasons for application for abortion.The largest age group consisted of those 20 to 29 years old; it accounted for more than twice as many applicants as any other decade. Fifty-four percent were single; married women or those living in stable common-law relationships accounted for 31.7%. Gestational age at application was 8 weeks or less in 68.3%. Those presenting late (i.e. after 14 weeks) were mostly in the younger age groups. No contraceptive measures were being employed at the time of conception by 69.7%. Less than one sixth of the patients were applying because of severely adverse social, psychological or medical reasons.