Medicaid managed care and community providers: new partnerships

Growing enrollment in managed care plans among Medicaid recipients represents a new market for these plans but presents challenges to those providers that traditionally have served this population. To continue serving Medicaid patients, community-based providers must develop contracts or other types of partnerships with Medicaid-contracting health plans. This paper reviews the challenges to such collaboration and discusses the practical issues that plans and community-based providers must resolve to develop productive working relationships. Keys to successful collaboration are identified. Ways in which federal and state governments can help the collaborative process are suggested.     

Retaining registered nurses in rural community hospitals

In rural practice settings where the task of recruiting new employees is exceedingly difficult, the first step in surviving the nursing shortage should begin with maintaining existing resources. Based on a survey of 2,488 staff registered nurses working in rural community hospitals, the authors compare personal, demographic, and practice characteristics of nurses by their self-reported intentions to stay in their present positions. Specific areas of job dissatisfaction that best distinguish those who anticipate leaving in 1 year from those committed to remaining in their present job for 5 years or more are identified.     

Susanville: A community helps itself in mobilization of community resources for self-help in mental health.

Trained 18 adults to work with 7 families selected for having problem children in schools or being under stress, and 14 high school students to work with 4 boys with academic or behavioral problems in school. The trainees were selected for being good listeners, for not being opinionated, and for showing empathy. Training consisted of 70 hr. of role play and supervised practicum work (7 wk.) and was based on a communication model, under the assumption that all members of a family contribute toward the problems. Trainees learned to interrupt the reinforcement pattern which maintained a family's problems. Evaluation of project and community-wide measures applicable for future efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventability of infant mortality in a rural community

Preventability of infant mortality in a rural southern county was examined with a Delphi technique using case summaries of infant deaths during a selected four-year period. The first two rounds were aimed at developing a consensus of panelists' opinions about problems leading to the high infant mortality rate in the study area. From these opinions, an Infant Mortality Preventability Decision Tree and a Problem List was developed. Panelists used these in Rounds III and IV to evaluate the case summaries. There were significant differences in the preventability ratings between physicians and nurses, indicating the importance of assessing individuals' philosophies of preventability when working with an interdisciplinary team of health care providers.     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rural vision of a healthy community

The planimetric Z-plasty proposed by Roggendorf provides elongation by excision of a pair of triangular pieces of tissue. The application of planimetric Z-plasties has been modified by making the vertical angle flexible, and making them continuous in the same or in opposite directions. Continuous planimetric Z-plasties in the same direction elongate an oblique contracture in the longitudinal direction. Continuous planimetric Z-plasties in an alternative direction elongate a disproportioned scar contracture in the longitudinal direction. Both techniques partially reduce unsightly scarring. Furthermore, they can be used in combination with V-Y-plasties. These modifications permit rational planing of the treatment of complicated scars with contracture.     

Barriers to nutritional well-being for rural elders: community experts' perceptions

Older adults use public and private services, as well as personal resources, to meet nutritional needs. In-depth interviews conducted with 73 service providers and community experts in two rural North Carolina counties were analyzed for these experts' perceptions of barriers to adequate nutrition for older adults. Perceived barriers included characteristics of the county and programs, transportation, and kin, as well as older adult medical and economic conditions, food habits, knowledge, and attitudes. The importance given each of these domains varied by respondents' area of expertise. Community experts and providers may not see the connection between their services and nutritional well-being of older adults.     

Decisions and justifications by community mental health providers about hypothetical ethical dilemmas

OBJECTIVE: Community-based treatment of persons with serious mental illness requires providers to become involved in clients' personal lives to a greater degree than does hospital-based treatment. The study examined attendant ethical dilemmas, especially for staff who lack professional training or work in rural communities. METHODS: A total of 95 staff members from five community mental health centers read 14 vignettes describing ambiguous ethical dilemmas involving professional role boundaries or client confidentiality. Twenty-seven staff members were from rural agencies, and 68 from urban-suburban agencies; 60 were direct care staff, and 35 were supervisory. Participants were asked to make and justify a more conservative or a less conservative decision in response to each dilemma. RESULTS: Years of experience as a mental health provider and previous ethics training correlated positively with staff having experienced more situations similar to those in the vignettes; however, these variables were not related to the decision made or the type of ethical justification for it. When the analysis controlled for experience and previous ethics training, staff made fewer conservative decisions in boundary dilemmas than in confidentiality dilemmas. Compared with nonrural providers, rural providers had experienced more boundary dilemmas and made fewer conservative decisions in response to them. CONCLUSIONS: Boundary problems occur frequently in community-based services, especially in rural settings, and may or may not be handled conservatively. With the expansion of case management and other in vivo services, better understanding of ethical risks and informal practices will help improve services and provide appropriate training and supervision of staff.     

福州市社区卫生资源配置公平性分析

利用2009年福州市卫生局调查的社区卫生服务中心相关统计资料,通过Gini系数分析福州市社区卫生资源配置的公平性.结果显示,福州市社区卫生资源配置公平性较高,护理人员配置公平性最优,医师次之,药剂人员和现有业务用房总面积公平性相对较差.另外,社区卫生资源空间配置不均衡,七县市公平性相对较差.针对存在的问题,提出了坚持政府主导,提高配置水平,规范落实用房面积等建议.     

Antimicrobial susceptibility of Shigella from a rural community in Bangladesh

Of the 63 Shigella strains isolated from stool cultures from 200 patients who attended a district hospital in Bangladesh with bloody diarrhoea, 37 (59%) were S. dysenteriae type 1, 25 (39%) were S. flexneri and only one (2%) was S. sonnei. Over half (54%) of the Shigella isolates came from children aged < 10 years. Most (89%) of the isolates of S. dysenteriae type 1 were resistant to ampicillin, cotrimoxazole, nalidixic acid, tetracycline and chloramphenicol. Although many (60%) of the isolates of S. flexneri were resistant to ampicillin and cotrimoxazole, only 4% of them were resistant to nalidixic acid. However, all of the S. dysenteriae and S. flexneri were sensitive to ciprofloxacin. The need for periodic monitoring to determine the resistance pattern in remote areas is emphasised.     

Oral health assessment of an adult rural community

A pneumatic indentation system using a copper bellows has been developed for physiological studies where a controlled uniaxial compressive force is required to be applied to the surface of the skin. Such a system is useful for studies where the physiological response of the tissues is to be monitored following a known loading history. The indentation system is driven by a vacuum/compression pneumatic pump through solenoid valves under closed-loop computer control. A load cell placed between the indentor and bellows monitors the applied force providing a feedback signal to the computer. The signal from the computer activates the valves supplying air pressure to the bellows, and the applied force is controlled using a digital closed-loop protocol. This system can be used to provide a controlled loading sequence to the skin without utilizing gravitational forces, which allows the subject to keep a more natural position during the experiment.     

Participatory health development in rural Nepal: clarifying the process of community empowerment

Community-based participatory development empowers villagers to develop community cohesion and confidence, increase their ability to identify, analyze, and priorize their own needs, and organize the resources to meet these needs. An important first step in the process involves establishing a cohesive and functional community group. The authors believe that this is best accomplished through villagers' critical examination of their experiences with development including their understanding of reasons for success or failure, and the gradual emergence of a model of working together that acknowledges and builds on participation and collective expertise. This approach to development is demonstrating encouraging results in a rural area of western Nepal in a university affiliated Canadian/Nepali Health Development Project. This paper describes two mini-projects to illustrate the evolution of group formation through reflection, analysis, and action, and identifies outcomes that could serve as indicators of community empowerment. The paper also presents a generic model of empowerment, and offers lessons learned by the project through the application of the empowerment process to sustainable health development.     

Cancer early-detection services in community health centers for the underserved. A randomized controlled trial

BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.     

Networking rural health resources. The woman who cried wolf

OBJECTIVE: To study the genetic stability and to establish a method for detection of micrometastasis using microsatellite DNA in human breast cancer xenograft in nude mice. METHODS: Fresh tissue of human breast cancer was xenotransplanted in nude mice or thotopically. Genomic DNA extracted from tissues of human breast cancer, xenotransplanted tumors and metastatic foci in nude mice were PCR amplified at three microsatellite loci (D14S68, D18S69, D20S199) and were analysed by electrophoresis and silver stain on PAGE. RESULTS Microsatellite DNA in genome of the xenotransplanted tumors and metastatic foci in nude mice were identical with that of the human breast cancer. CONCLUSION: This study has demonstrated in nude mice the xenotransplanted tumors and metastatic foci that originated from human breast cancer. The genetic stability in human breast cancer is evident in the processes of xenotransplantation, serial passages in nude mice, metastasis and in vitro culture. This method is sensitive and specific for the discrimination of metastatic tumor cells.     

Perceptions of children and community members concerning the circumstances of orphans in rural Zimbabwe

This study examined two groups of people who were pursuing treatment for obesity: either medical intervention (a hospital group; N = 20) or support for dietary restriction (a community group; N = 18). This study addressed four questions: (1) Were there differences between the two groups in terms of their psychological distress (as measured by the Symptom Checklist)? (2) Does binge eating moderate psychological distress? (3) Do feelings of ineffectiveness moderate psychological distress? and (4) Which variables best accounted for group membership (i.e., type of treatment sought)? Results suggested that the hospital group was significantly more distressed than the community group. However, there were no differences between the two groups with respect to binge eating or feelings of ineffectiveness. These findings suggest that it is the effects of morbid obesity that are most likely to moderate psychological distress.