Quality improvement in patient distribution at a major university student health center

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

A Pilot for Improving Depression Care on College Campuses: Results of the College Breakthrough Series–Depression (CBS-D) Project

Abstract

Objective: To implement a pilot quality improvement project for depression identification and treatment in college health. Participants: Eight college health center teams composed primarily of primary care and counseling service directors and clinicians. Methods: Chronic (Collaborative) Care Model (CCM) used with standardized screening to identify, treat, and track depressed students for 12 weeks to monitor predetermined process and clinical outcomes. Results: Of all students receiving primary medical care services between January 2007 and May 2008, 69% (n = 71,908) were screened for depression. A total of 801 depressed students were treated and tracked; most predetermined treatment process and clinical outcome targets were achieved. Conclusion: The CCM for depression shows promise for improving depression identification and care for college students.     

Awareness and attitude of medical personnel in Kerala,India to transgender persons

IntroductionBeing one of the first Indian states to come out with a transgender bill in 2015, Kerala's Social Justice Department also implemented various health-based provisions for transgender individuals catering to their physical, mental, and gender-based health. Many of these are still in the process of being set up and transgender individuals will have to wait for smoother access to healthcare.AimThis study aims to assess the awareness regarding general transgender issues and health as well as the attitude towards transgender persons among the medical community- especially medical students and doctors who are a critical link for the integration of the transgender community into society.MethodResponses were collected from 452 medical doctors and students from Kerala through scales that measured awareness level and attitude, including transphobia. The relation of gender, age, years of experience, and specialty of medical personnel to the level of transphobia and awareness about transgender issues was also analyzed using statistical methods.Result and DiscussionTransphobia levels were moderate in the sample. Women and medical students had lower levels of transphobia than men and practicing doctors respectively. Awareness levels were average for general information about the transgender community, such as its core features and difference from other similar categories but were low on health-related aspects of transgender persons (such as their physical and mental health issues, healthcare provisions, and knowledge on gender affirmation surgery).ConclusionMore inclusive actions are needed in medical education, legislative actions, advocacy groups, and the formation of multidisciplinary surgical teams to further the cause of the transgender community.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

Antimicrobial Resistance of Urinary Tract Isolates in Acute Uncomplicated Cystitis Among College-Aged Women: Choosing a First-Line Therapy

Objective and Participants The authors of this retrospective case study focused on antimicrobial susceptibility of urinary tract isolates in cases of acute uncomplicated cystitis in college-aged women, aged 18 to 24 years, diagnosed at a major south-central university student health center. Methods The authors obtained pertinent data from patient medical and laboratory records, including, diagnoses, urine culture, and susceptibility results. Results Of 179 isolates, 161 (90%) were Escherichia coli (E. Coli) isolates, of which 23% were resistant to trimethoprimsulfamethoxazole, < 1% were resistant to Ciprofloxacin, and < 1% were resistant to nitrofurantoin. Sixty-eight (42%) E. Coli isolates were multidrug resistant. There were 18 isolates cultured in the study group that were significant organisms other than E. coli. For all organisms in the study group, there was a combined resistance rate of 22% to trimethoprim-sulfamethoxazole, < 1.0% for Ciprofloxacin, and 7% for nitrofurantoin. Conclusions The findings suggest that both Ciprofloxacin and Nitrofurantoin are acceptable choices for empiric therapy of acute uncomplicated urinary tract infection in this study population, keeping in mind the potential for rising resistance rates to Ciprofloxacin in the community setting.     

Self-rated Health in Relation to Rape and Mental Health Disorders in a National Sample of College Women

Abstract

Objective: The purpose of this study was to employ a multivariate approach to examine the correlates of self-rated health in a college sample of women, with particular emphasis on sexual assault history and related mental health outcomes. Participants: A national sample of 2,000 female college students participated in a structured phone interview between January and June 2006. Methods: Interview modules assessed demographics, posttraumatic stress disorder, major depressive episode, substance use, rape experiences, and physical health. Results: Logistic regression analyses showed that poor self-rated health was associated with low income (odds ratio [OR] = 2.70), lifetime posttraumatic stress disorder (OR = 2.47), lifetime major depressive episode (OR = 2.56), past year illicit drug use (OR = 2.48), and multiple rape history (OR = 2.25). Conclusions: These findings highlight the need for university mental health and medical service providers to assess for rape history, and to diagnose and treat related psychiatric problems in order to reduce physical morbidity.     

Primary care teams

SUMMARY. Northern Ireland has a health and social services structure which should lead to the easier establishment of effective primary care teams. Following an analysis of constraints on interprofessional collaboration, various models of practice in Northern Ireland and in England and Wales are discussed to demonstrate potential solutions. Child abuse in particular is used to identify both problems and ways forward, especially concerning the general practitioner's key role in the primary care team     

Assessing Child Well-Being in Non-Relative Foster Care with a New Outcome Measurement Tool

ABSTRACT

The Child Health and Illness Profile–Adolescent Edition (CHIP-AE), a recently developed standardized instrument, was administered to 49 adolescents living in non-relative family foster care under the auspices of the child welfare system in Illinois. Youth reported high levels of satisfaction with their health, academic progress, resiliency and risk resistance, but low levels of work performance. These youth also reported higher levels of psychosocial problems, major and minor adverse effects from injuries, migraines, and chronic medical conditions such as epilepsy, diabetes and sickle-cell anemia. This study demonstrated the potential usefulness of the CHIP-AE as a tool for involving youth living in non-relative foster care in assessing their own health and well-being. Suggestions for future use of the CHIP-AE are discussed.     

Feasibility of a Telephone Follow-Up on Use of Emergency Contraceptive Pills in a College Health Center

Abstract

The authors examined the feasibility and effectiveness of a telephone follow-up procedure on use of emergency contraceptive pills (ECP) at a college health center. They made 264 telephone calls to the 97 women who had received ECPs during one 16-week academic semester and were successful in reaching 65 (67%) of the women, who responded with information about their experiences with ECPs. The women demonstrated a high rate of adherence to the medical regimen and reported very few side effects from ECPs; a majority said that ECPs did not affect their ability to carry out daily activities. On weighing the relative absence of problems following ECP distribution against the time, effort, and cost required to reach just over two thirds of the women, the researchers concluded that an ECP telephone follow-up procedure was neither cost-effective nor particularly useful.     

Developing a Personal Program for Continuing Education

Abstract

The increasing number of field expeditions studying or working abroad each year is currently unparalleled by medical research efforts or data from which health professionals can make meaningful recommendations about how to keep personnel in the field healthy. The medical planning, organizing, and data are presented from a geology expedition to Guatemala involving 25 persons. Only minor medical problems were encountered, and less than 1% of the total person days at risk were lost due to illness. Eight guidelines are presented as a tool to assist any health professional in the planning and preparing of a team for the field.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

Youth outside the labour force — Perceived barriers by service providers and service users: A mixed method approach

BackgroundYoung people who are neither in employment nor in education or training (NEET) have received increasing attention in Western countries. While some young people in the labour force are unemployed because of a shortage of jobs, others would be without employment even in periods of economic growth, when more jobs are available. The latter group is referred to as neither in the labour force nor in education or training (NLFET), and such people need intervention to improve their chances of work participation. However, this group is poorly understood, and more knowledge is needed to develop efficient measures. The purpose of the study is to investigate the NLFET population and to identify barriers to education or employment.MethodInterviews were conducted at all labour and welfare offices in a representative county in Norway, and an internet-based survey among 586 persons aged 18–29 years who met the NLFET criteria was conducted. Sixty case managers of young service users and 30 managers/assistant managers were interviewed at the 25 offices in the county.ResultsThe local labour and welfare offices prioritize young clients, and some have designated follow-up teams for young service users. Three main barriers to education or employment were identified through the interviews at the offices: client motivation, the sense of lack of achievement/defeat, and unrealistic expectations about working life. A survey of the young people revealed other barriers, such as health problems (60%), low education (55%), lack of work experience (41%), the feeling of being exhausted (38%), low self-esteem (36%), feeling depressed (35%), sleeping problems (35%), and very often a combination of these barriers.ConclusionsHealth problems, social and other problems are highly prevalent among the NLFET population. The majority of the population wanted to find a job or to complete their education. We conclude that mental health problems often camouflage social problems. Treatment of complex problems should not be left to mental health services. Given the nature of the barriers identified, follow-up by strong multi-professional teams, including social work and health professions, should be part of the measures allocated to the NLFET population.     

Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities

Abstract

Objective: On US college campuses, mental health problems are highly prevalent, appear to be increasing, and are often untreated. Concerns about student mental health are well documented, but little is known about potential variations across the diversity of institutions of higher education. Participants: Participants were 43,210 undergraduates at 72 campuses that participated in the Healthy Minds Study from 2007 to 2013. Methods: Multivariable logistic regressions focus on associations between institutional characteristics and student mental health and treatment utilization. Results: The following institutional characteristics are associated with worse mental health: doctoral-granting, public, large enrollment, nonresidential, less competitive, and lower graduation rates. Among students with apparent mental health problems, treatment utilization is higher at doctorate-granting institutions, baccalaureate colleges, institutions with small enrollments, and schools with strong residential systems. Conclusions: Although high rates of mental health problems and low treatment utilization are major concerns at all types of institutions of higher education, substantial variation occurs across campuses.     

Abstracts of the Scientific Programs of the American College Health Association Fifty-Seventh Annual Meeting May 22-25, 1979, Washington,D.C.

Abstract

This article focuses on a therapeutic approach to help women deal with the feelings of grief and guilt they may feel as a result of a voluntary termination of a pregnancy. Available medical and psychological literature indicates that, from a public health perspective, significant psychological problems related to an abortion are “minuscule.” Several women the author saw during the 1992/93 academic year who considered themselves to be extremely religious and prolife had undergone elective abortion. They experienced tremendous guilt and grief 4 to 6 months after the procedure. The author recommends that college health center medical and counseling providers who must deal with this issue help the woman validate her loss by revisiting the site of her abortion to reflect upon the experience and to hold a Gestalt dialogue with the fetus to end the relationship. The provider or someone else should accompany the woman to the site because of the increasing potentiality for violence on the part of prolife protesters.     

The Patient Transit Assistance Scheme: A case for social work advocacy!

Abstract

The Patient Transit Assistance Scheme is one of Queensland Health's initiatives designed to facilitate equity of access for Queensland residents to essential health care services. The purpose of the scheme is to help all Queenslanders, irrespective of where they live, to have access to specialist medical services. It provides direct financial assistance to patients and in some cases their carers, to facilitate access to specialist medical services irrespective of geographic location.

The findings of recent research conducted on social worker involvement with PTAS for patients diagnosed with leukaemia and associated haematological disorders will be used to argue that the problems in relation to the administration of this scheme require serious attention at the level of patient care and health policy.     

Mental Health Treatment Barriers Among Racial/Ethnic Minority Versus White Young Adults 6 Months After Intake at a College Counseling Center

Abstract

Objective: This study examined mental health treatment barriers following intake at a counseling center among racially/ethnically diverse college students. Methods: College students (N = 122) seen for intake at a college counseling center in 2012–2013 completed self-reports of depressive symptoms, suicidal ideation, and mental health treatment barriers 6 months later. Results: Racial/ethnic minority students less often reported previous mental health treatment and treatment after being seen at the counseling center, compared with white students. They also endorsed more treatment barriers—most commonly, financial concerns and lack of time—and more often endorsed stigma-related concerns. Treatment barriers were associated with not following through with counseling center recommendations and with greater depressive symptom severity but not with suicidal ideation during follow-up. Conclusions: Improving mental health treatment seeking among racial/ethnic minority college students should involve decreasing treatment barriers, improving access to affordable options, providing flexible scheduling or time-limited options, and decreasing stigma.,     

College Health as a Partner in the Care of Pediatric Cancer Survivors

Abstract

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. Participants: Participants were University of Georgia (UGA) college health providers. Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.