ABSTRACT
This paper presents the results of research on a program that trains family members to serve as case managers for their elderly relatives. The effectiveness of the training program was evaluated using a randomized experimental design. Data were collected in an urban hospital setting about two groups of elderly patients: those with dementia and those needing hemodialysis. Family members of both types of patients were assigned randomly to an experimental group, which received systematic training in performing case management activities, or to a control group, which received only the services ordinarily provided by the hospital social work department. Post-test comparisons revealed that the experimental group family members performed significantly more case management tasks on behalf of their elderly relatives than did family members in the control group. Although trained family members assumed more responsibility for case management, there was no increase in the level of their subjective or objective caregiving burden. Implications for social work practice are presented.
Subject(s)
Ambulatory Care/organization & administration , Caregivers/organization & administration , Patient Care Planning/organization & administration , Professional-Family Relations , Aged , Boston , Dementia/nursing , Female , Health Services Research , Humans , Male , Middle Aged , Outpatient Clinics, Hospital , Renal Dialysis/nursing , RoleABSTRACT
An intervention model has been developed which teaches family members, in partnership with social workers, to obtain and monitor services for their chronically ill elderly relatives. The research site is a Boston teaching hospital with a patient population that is ethnically and racially diverse. Initial results of the study reveal that case management is easily accepted by most families, and the partnership between the family member and social worker enhances the delivery of needed services.
Subject(s)
Chronic Disease , Family , Health Services for the Aged , Patient Care Team , Social Work , Aged , Humans , Patient Care Planning/methodsABSTRACT
Examined was the extent to which 373 programs in eight types of services provided by the aging network in Massachusetts were utilized by elderly persons with mental retardation. Based on a mailed survey, it was found that over half the programs (52%) had served such clients in 1987. In 2 of the 8 types of services, clients with mental retardation constituted at least 10% of the caseload. Characteristics that differentiated programs that provided services to persons with mental retardation and programs that did not were reported. The policy implications of the findings were discussed.
Subject(s)
Health Services for the Aged/statistics & numerical data , Intellectual Disability , Humans , Massachusetts , Sampling StudiesABSTRACT
Automatic blood pressure recorders have gained acceptance in many clinical settings. New devices have usually been validated with invasive monitoring as the "gold standard." There is a lack of sound empirical evidence, however, supporting the routine use of these monitors in ambulatory settings. This study evaluated the DINAMAP 8100, an oscillometric automated blood pressure monitor, using the Hawksley Random-Zero Sphygmomanometer as the standard. A sample of 80 normotensive and hypertensive ambulatory patients from the Department of Family Medicine at the Medical University of South Carolina were studied. A clinical trial was conducted in which readings from the DINAMAP 8100 were compared with those from the Hawksley Random-Zero Sphygmomanometer, in a 2 (instrument) X 2 (arm) X 2 (investigators) X 4 (pairs of simultaneous measurements) factorial design. The DINAMAP 8100 overestimated systolic readings (mean difference = 7.6 +/- 9.1 mmHg, P less than .0001, paired t test). More than one third of systolic measurements and one quarter of diastolic measurements were greater than 10 mmHg discrepant from the standard. The results of this study suggest that routine use of the DINAMAP 8100 would lead to serious misclassification errors in screening for hypertension and in the follow-up of known hypertensive patients. The DINAMAP 8100, therefore, is not an appropriate instrument for routine use in primary care settings.
Subject(s)
Blood Pressure Determination/instrumentation , Monitoring, Physiologic/instrumentation , Primary Health Care/methods , Adult , Ambulatory Care , Evaluation Studies as Topic , Female , Humans , Male , Random AllocationSubject(s)
Family , Health Services for the Aged , Social Environment , Social Support , Aged , Aged, 80 and over , Female , Humans , Male , Social WorkABSTRACT
Six hundred fifty-four Papanicolaou smears were studied prospectively to determine the yield of endocervical cells within specific fertility states by technique used. Smears from postmenopausal women had the lowest yield of endocervical cells (32 percent, P less than 0.01). Smears from postpartum women had a higher yield of endocervical cells than those from pregnant women (69 percent vs 59 percent, P greater than .05). Swabbing excess mucus from the cervix prior to scraping uniformly improved the yield of endocervical cells (70 percent vs 62 percent, P less than .02). In swabbed postmenopausal women, use of a Milex spatula had a significantly higher yield than the use of a wooden spatula and a cotton-tipped applicator (43 percent vs 27 percent, P less than .03).