Articles: community-health-services.
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To evaluate the effectiveness of continuing medical education seminars in changing physician attitudes and practice approaches to the provision of home health care and use of community resources, to increase physician awareness of the needs of homebound older adults, and to teach physicians appropriate medical management in the home. ⋯ The seminars achieved the intended outcomes of bridging the gap in the awareness and provision of geriatric home health care and of producing physician attitude and behavior change.
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To describe and evaluate a lay worker project designed to enhance the effective control of tuberculosis in a rural/farm setting. ⋯ This farm worker project appears to be a model of a well-designed and expertly managed community-based project for tuberculosis control in rural/farm areas.
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Information gained from elderly people regarding their needs for community-based long-term care is necessary for informed and responsive policy development. Informed policy development is essential given demographic projections and the need to develop cost-effective alternatives to institutionalization. The purpose of this study was to understand the context within which elderly people would be able to continue residing in their communities. ⋯ Findings of the study indicated that the desire of elderly people to stay at home is motivated by their need to maintain control over their daily lives and have their individualized needs addressed. Perceptions related to nursing homes, roles of family, essential services, and future needs for assisted living emerged as major themes. The findings suggest policy implications for professional nurses related to the long-term care system, providers, and nursing homes.
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Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. ⋯ Many of the components vital to high-quality ambulatory care can take years to develop, and significant investments of capital. Increased primary care capacity, new specialty group practices, state-of-the-art equipment for diagnosis and treatment, advanced information technology to manage and coordinate care and link services at multiple locations, and highly trained clinical and support staff all require strong commitment and support from a team of senior management executives and medical staff leaders, sufficient staffing resources, and outside expertise. Once the infrastructure is in place, hospitals must continue to reach out to their communities, helping people to understand the health care system and use it effectively.
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National welfare reform is predicted to increase the number of homeless persons. This will affect the health care system by increasing the number of uninsured people and by multiplying the number of homeless persons seeking care in hospital emergency departments. ⋯ The authors provide an overview of the homeless population, outline the barriers to health care for persons who are homeless, and highlight the major health care needs of this population. Finally, a community-based service delivery system developed by one agency in responding to the need of homeless persons is provided as a model of care.