Health Services Research Commons^™

Patient Satisfaction Among Users Of The After Hours Program, Helen L. Larocco

Community & Environmental Health Theses & Dissertations

The problem of increasing health care costs and decreasing access to health care services is a major crisis in the U.S. today. One factor contributing to the rising cost of health care is the inappropriate use of emergency rooms, (ERs). In response to escalating costs a local health care corporation implemented a telephone triage program called the After Hours Program, (AHP). The goal of the program was to reduce inappropriate utilization of emergency rooms, and to educate patients to recognize and treat specific health problems independently, i.e., home treatment.

A program evaluation was completed in which different dimensions of patient …

Effect Of Nutrition Intervention On The Outcomes Of Pregnancy: A Rural Urban Comparison, Ranjita Misra

Health Services Research Dissertations

The present study examines the effect of nutritional intervention on two outcomes of pregnancy: birth weight of the baby and gestational age. The study further examines the difference in nutritional intervention in rural and urban areas. The research method used is ex-post facto design. Data for the study is extracted from the health records and tracking sheets of women participating in the Nutrition Intervention Project in Virginia Department of Health. Path analysis and effects analysis are used to analyze the causal and direct effect of the independent variables and each of the outcome variables. A model has been developed grounded …

Quality Of Care In Family Planning Service Delivery In Kenya: Clients' And Providers' Perspectives, Lewis Ndhlovu

Reproductive Health

In recent years, the increasing number of organizations that have studied quality of care in international family planning (FP) programs demonstrates the importance the topic has acquired. To define quality of care in FP, the Bruce–Jain framework of six elements of care (choice of methods, information given to clients, technical competence, interpersonal relations, continuity and follow up, and appropriate constellation of services) have been used as the standard. However, what has been overlooked in this approach is the clients' perspectives of service quality. This study sought to narrow the gap in knowledge about the comparability and consistency in views between …

Report On Norplant® Implants In Indonesia, Andrew A. Fisher, Soledad Diaz, Alejandro N. Herrin, Joedo Prihartono

Reproductive Health

At the request of the Indonesian National Family Planning Coordinating Board, the Population Council’s consultant team reviewed issues related to Norplant® implant service delivery in Indonesia and recommended specific areas for new initiatives, improvements, and further research. The team reviewed secondary sources on the subject and visited Indonesia from April 17–28, 1995. They talked with family planning (FP) officials and observers and made field visits to West Java and Yogyakarta. This report reviews important issues facing the national FP program, particularly regarding Norplant insertions and removals. Program approaches are included, as are an outline for a national assessment study that …

Dmpa Monitoring Study: Findings On Use And Continuation Rates, Population Council

Reproductive Health

This report presents the results of the DMPA Monitoring Study undertaken by Population Council, Manila, as a technical assistance project for the DMPA Reintroduction Program of the Department of Health. The primary objective of the study is to provide data on DMPA (injectable contraceptive) utilization and continuation rates that may be used to project the logistical needs of the program for the next four years (1995–1998). Availability of DMPA supplies, and information, education, and communication (IEC) materials on DMPA in the facilities were also monitored to provide some measure of the effectiveness of the distribution system. The study covers a …

Improving The Counseling And Medical Care Of Postabortion Patients In Egypt, Population Council, Egyptian Fertility Care Society

Reproductive Health

This pilot study conducted in Cairo and Minya examined the effects of improving the medical care and counseling of post-abortion patients in Egypt. A pre-test/post-test, no control group study design was used to measure the effects of an intervention that upgraded physicians' clinical and interpersonal communication skills for the care of post-abortion patients, including counseling and family planning (FP). The study's surveys utilized direct interviews with staff working in the OB/GYN wards, structured observations of treatment procedures and counseling of post-abortion patients, and interviews with patients prior to discharge. Changes in the clinical management of post-abortion patients were introduced through …

A Model Of Costs Of A Cbd Programme, Saumya Ramarao, John Townsend, M.E. Khan

Reproductive Health

This study is a collaborative effort of the Population Council, New Delhi, and the Centre for Development and Population Activities, New Delhi. Cost analysis is an analytical tool that provides program managers and planners with information about existing and potential programs. Existing programs can be evaluated for efficiency and effectiveness, while the resource requirements of future programs can be estimated. In the context of family planning (FP) programs, cost analysis provides policymakers and program managers with sufficient data on efficient ways to meet the demand for FP services with available resources. As FP programs mature and requirements for the resources …

An Overview Of The Effectiveness And Efficiency Of Hiv Prevention Programs, D. R. Holtgrave, Noreen L. Qualls, J. W. Curran, Ronald O. Valdiserri, Mary Guinan, William C. Parra

Public Health Faculty Publications

Because of the enormity of the HIV-AIDS epidemic and the urgency for preventing transmission, HIV prevention programs are a high priority for careful and timely evaluations. Information on program effectiveness and efficiency is needed for decision-making about future HIV prevention priorities. General characteristics of successful HIV prevention programs, programs empirically evaluated and found to change (or not change) high-risk behaviors or in need of further empirical study, and economic evaluations of certain programs are described and summarized with attention limited to programs that have a behavioral basis. HIV prevention programs have an impact on averting or reducing risk behaviors, particularly …

The Dmpa Service Provider: Profile, Problems And Prospects, August 1995, Maria Carmela Patron, Marilou P. Costello

Reproductive Health

This report presents the results of interviews conducted with 60 trained DMPA service providers from seven of the ten local government units (LGUs) covered by Phase I of the Philippine Department of Health's DMPA Reintroduction Program. DMPA, or Depot-medroxyprogesterone acetate, is an injectable contraceptive commonly known as Depo-Provera. The interviews were undertaken as part of the DMPA Monitoring and Follow-up Studies sponsored by the Population Council under the Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project. While the monitoring study and the follow-up survey focused on DMPA users and dropouts, this study centered on the service …

Improving Community Based Family Planning Services And The Potential For Increasing Contraceptive Prevalence In Bangladesh, Amy Gale Dunston, Peter C. Miller

Reproductive Health

This report contains descriptions of 13 family planning (FP) projects recently implemented in Bangladesh. The results in terms of the contraceptive prevalence rate (CPR) are analyzed to investigate the degree to which improved FP service delivery in Bangladesh can increase contraceptive use in the present status of demand, investigate the programmatic factors most associated with increased prevalence, and make these projects more widely known. Criteria for inclusion included coverage of a geographic area where household distribution of contraceptive supplies was available, and where at least one measurement of CPR has been made through credible survey efforts since July 1988. The …

Support For Research, Dissemination, Utilization, And Policy In Bangladesh, Ubaidur Rob, Donna Nager

Reproductive Health

Through the initiative of the Family Planning Fortnight: Meeting the Future Challenges, held in December 1993, the Government of Bangladesh made a policy statement about the critical importance of dealing with the nation's population problem. The Fortnight provided the strategic framework for developing actions to strengthen the National Family Planning Program that would meet the country's population challenges. To initiate rapid action, the Family Planning Fortnight Steering Committee, under the chairmanship of the Secretary, Ministry of Health and Family Welfare, formed a working group to prepare a report that would capitalize on all earlier efforts and lay out a plan …

Organizational Slack, Efficiency, And Quality Of Care In Acute Care Hospitals, Kyung Ii Youn

Theses and Dissertations

The relationship between technical efficiency and quality of care in hospitals is studied in the context of resource availability in hospital organizations. The resource availability of hospitals is conceptualized by organizational slack.

An integrated model is developed encompassing the source of organizational slack, its impact on technical efficiency and on quality of care, and its impact on the relationship between efficiency and quality. Organizational threat as an environmental factor affecting the level of slack is measured by the level of competition and regulation. Organizational slack is measured using financial and operational indicators of the hospitals. Technical efficiency is estimated by …

Experience With The Dmpa Injectable Contraceptive: Findings From A Survey Of Dmpa Acceptors, Maria Carmela Patron, Marilou P. Costello

Reproductive Health

This report presents the results of a survey of 899 DMPA acceptors who availed of injectable contraceptive services from public health facilities under the Philippine Department of Health's (DOH) DMPA Reintroduction Program. The survey is part of the DMPA Monitoring and Follow-up Studies sponsored by the Population Council’s Manila office in response to a request by the DOH to provide operations research support to the program. Depot-medroxyprogesterone acetate (DMPA), commonly known as Depo-Provera, is a three-month injectable contraceptive. It was recently officially endorsed as a family planning (FP) program method by the DOH, following its approval by the Philippine Bureau …

An Exploratory Study Of The Psycho-Social Stress Associated With Abortions In Egypt, Dale Huntington, Laila Nawar, Dalia Abdel Hady

Reproductive Health

An operations research study was conducted to investigate the concerns of postabortion patients in Egypt to improve counseling that women receive. A corollary use of the study results is the development of sensitive survey research questions for measuring incidence of induced abortion. This study utilized qualitative research methods by conducting in-depth interviews with postabortion patients in El Galaa and El Menia University Hospitals and focus group discussions with family planning clients and noncontracepting women. For all types of postabortion patients the most salient issue was physical survival of an extremely painful experience. All postabortion patients were acutely concerned about their …

Operations Research For Program Planning And Management, Alejandro N. Herrin

Reproductive Health

The Family Planning Operations Research and Training Program of the Philippines was established in 1992 to strengthen the nation's capacity to carry out and utilize operations research (OR) for program planning and management. It has sponsored training workshops and funded OR studies on issues of priority to both national and local program managers. The program’s recent activities, culminated in the National Research Utilization Conference held in September 1994, were designed to assist in the institutionalization processes. However, more needs to be done to determine how these processes will actually work in specific national and local government agencies and academic and …

Development Of Approaches To Community Based Family Planning Outreach In Egypt: Assessment Of Raidats Rifiats Program, Population Council

Reproductive Health

Egypt’s family planning program officially began in 1965. Impressive gains in contraceptive use have been made since 1980, and the contraceptive prevalence rate increased from 24 percent in 1980 to 47 percent in 1992. Egypt’s National Population Policy addresses the nation’s population growth through multiple interventions designed to reduce fertility, including family planning (FP) services. FP accessibility is promoted through a network of public and NG0 FP clinics. A number of years ago, the Egyptian Family Planning Program began using the Raidats Rifiats program to extend services into rural communities. There is concern regarding the program’s ability to recruit women …

Current Experiences With Community-Based Distribution Of Family Planning In Kenya: A Review Prepared For Usaid/Kenya, Population Council

Reproductive Health

Kenya has been one of the leading countries worldwide in developing and implementing community-based distribution (CBD) programs as part of the national family planning (FP) program. CBD activities in Kenya are coordinated by the National Council for Population and Development, with support from USAID and other donor agencies. Kenya’s CBD program has been widely publicized because of its success in improving access to FP information and services, and its diversity of organizational structures. USAID would like to review the current situation and possible future directions before designing its CBD strategy for the next five-year bilateral project. The Africa OR/TA II …

Knowledge, Attitudes And Practice Of The Dmpa Injectable Contraceptive: Data From Focus Group Discussions, Maria Carmela Patron, Marilou P. Costello

Reproductive Health

This report is based on data from 12 focus group discussions conducted throughout the Philippines as part of the DMPA Monitoring and Follow-up Studies. The DMPA Monitoring and Follow-up Studies are part of a technical assistance project undertaken by the Population Council in support of the Department of Health’s DMPA Reintroduction Program. The project provides data on DMPA (depot-medroxyprogesterone acetate) acceptance and continuation rates as well profiles of DMPA users and dropouts to serve as bases for decisions and policies that will ensure quality services. The project draws information from several sources including a 15-month monitoring of DMPA acceptors; surveys …