Alternative tertiary care pathways for a rural Department of Veterans Affairs Medical Center.

This study addresses the cost of rural health care delivery where veterans do not have ready access to tertiary Department of Veterans Affairs Medical Centers (VAMCs) but where local community health care is available. The study sample was 209 patients referred for tertiary care to a VAMC 50 miles distant from the referring rural VAMC. The cost of tertiary referral VAMC care was retrospectively compared with the cost had the patients received the tertiary care in the local community hospital located in the immediate vicinity. In addition, the cost of travel resulting from the remote access was also computed. Findings indicate that a savings of +309,293 could have been obtained had a local community hospital provided the tertiary care utilizing the Health Care Financing Administration Medicare rate. Data generated by the methodology of this study are expected to provide a baseline for policy decisions relating to alternative pathways for tertiary care in the Department of Veterans Affairs.

Medico-psychological interventions in male asthmatic children: an evaluation of physiological change.

The purpose of this study was systematically to evaluate the effectiveness of several modes of psychological intervention used with male asthmatic children being treated in the Allergy Outpatient Clinic. Therapeutic effectiveness was measured by large airway changes in respiratory function, and the number of recurrent asthmatic attacks. The psychotherapeutic modes used were Relaxation Training, Assertive Training, and combined Relaxation plus Assertive Training. All patients were administered medication by the responsible physician. The group psychotherapy experiences were controlled by using patients who received medication alone and by patients who received medication and met in a leaderless group. The effectiveness of the therapeutic interventions was determined by comparisons between pretreatment measures and measurements taken during and after the eight-week treatment program. Both Relaxation Training by itself and combined Relaxation plus Assertive Training increased respiratory functioning and reduced the number of attacks. Assertive Training alone failed to improve respiratory function and had a tendency to increase the frequency of asthmatic attacks. It was concluded that the most effective management in male asthmatic children was achieved by the combination of medical and psychological treatments.