Moving to paperlessness: a case study from a large general practice

This case study reports the reasons why this large, multi-site general practice decided to move towards paperless practice in late 2001, and describes the progress and lessons learned to date. The principal operational reasons for this decision were problems associated with moving paper medical records between surgeries, and the realisation that resources to improve the computerised medical record could only come from redeploying the time spent handling paper records. A comprehensive plan was put in place to shift toward paperlessness. Motivating and changing working practices for clinical and support staff was as a great a challenge as upgrading the technology. The practice upgraded its computer system, and has installed scanning and automated generation of referral and other letters. The support staff skills have evolved from moving records to scanning documents and coding data. All clinical staff now consult on their computer, and code diagnoses and key clinical data. A networked digital dictation system allows typing to be centralised at one location, with the networking allowing printing at any site. Audit and quality improvement activities have increased, as the output from computer searches increasingly represents the quality of care provided. The implications of this case study are that a committed general practice can achieve a largely paperless environment in approximately two years. The practice is now fit to be part of any move towards integration of records within its local health community, and can demonstrate from its computer records that it meets the quality targets for primary care.

Health and lifestyle needs assessment of medical students in the United Arab Emirates

Medical students represent a significant community investment and promoting their health preserves this investment. In order to design health promotion programs for medical students in the United Arab Emirates, students' needs were assessed by means of a cross-sectional self-administered questionnaire survey. Major findings of the survey included: 14% of students were underweight while 24% of students were overweight or obese; the majority believed their activity levels were insufficient (77%), their stress levels too high (65%) and their diet unhealthy (50%); 33%were not sufficiently active to meet minimum recommended levels; few students (22%) had seen a doctor in the past year and many were unaware of important personal health parameters. When presented with hypothetical health situations, many made inappropriate choices. This survey identified significant health-promotion opportunities for these students that can be carried out during medical school in order to establish a healthier physician population.

Students' opinion of tobacco control policies recommended for US colleges: a national survey

OBJECTIVE

Comprehensive tobacco control policies for US colleges and universities have been proposed by several groups in order to counter the rising use of tobacco by students enrolled in these institutions. Student opinion of these policies is not known, and concern about student opposition is one barrier that deters administrators from adopting the policies. This study measured student support for recommended college tobacco control policies.

DESIGN

Mailed survey of US college students (2001 Harvard School of Public Health College Alcohol Study).

SETTING

119 nationally representative, four-year colleges and universities in the USA.

PARTICIPANTS

10,904 randomly selected undergraduate students enrolled at participating schools.

MAIN OUTCOME MEASURES

Students' opinion of 7 proposed tobacco control policies.

RESULTS

A majority of students supported each policy. Over three quarters of students favoured smoke-free policies for all college buildings, residences, and dining areas, while 71% supported prohibiting tobacco advertising and sponsorship of campus social events, 59% favoured prohibiting tobacco sales on campus, and 51% supported smoke-free campus bars. All policies had more support among non-smokers than smokers (p < 0.001). Among smokers, support for policies was inversely related to intention to quit and intensity of tobacco consumption. Because college students' tobacco consumption is low, a majority of smokers favoured banning smoking in college buildings and dining areas and prohibiting tobacco marketing on campus.

CONCLUSIONS

Student support for proposed campus tobacco control policies is strong, even among smokers, and broadly based across demographic subgroups. These findings should provide reassurance to college administrators who are considering adopting these policies.

Providing medical information to college health center personnel: a circuit Librarian Service at the University of Illinois

College health center personnel are no different from other health practitioners in their need for medical information. To help meet this need, the McKinley Health Center, University of Illinois Urbana-Champaign, developed a partnership in 1997 with the Library of the Health Sciences-Urbana, a regional site library of the University of Illinois at Chicago campus. This partnership led to the adoption of circuit librarianship, a dynamic outreach model, to enhance access to health information for McKinley Health Center personnel. A circuit librarian consults with health center personnel during regularly scheduled on-site visits to the center and its satellite office. Upon returning to the resource library, the circuit librarian conducts research for clinical information on behalf of the center's personnel, then sees that articles, books, and relevant Web sites are identified and delivered to assist in answering questions regarding disease management, drug therapy, wellness, and health administration.

Patient preferences for physician characteristics in university-based primary care clinics

OBJECTIVE

To examine patient preferences for age-,gender-, and racial/ethnic-concordant primary care physicians.

DESIGN

Focus group interviews.

PATIENTS AND SETTING

Forty-nine adults (African Americans, Caucasians, and Latinos) receiving their outpatient medical care in university-based primary care clinics in Northern California.

MAIN MEASURES AND RESULTS

Guiding questions were designed to elicit information about what patients look for in establishing and maintaining a therapeutic relationship with a primary care physician. Patients were prompted to provide examples and to discuss demographic-concordance factors. Many participants felt that their continuity of care was poor and that they could not choose their own primary care physicians in the academic system. Most reported tolerating these inconveniences for what they perceived to be a higher quality of care linked to medical innovations at academic medical centers. Patients' views regarding age concordance were varied and unrelated to gender or racial/ethnic group. Women in all English-proficient groups described gender concordance as important to their relationships with primary care physicians. Spanish-speaking participants uniformly preferred Spanish-speaking providers. African-American participants and Spanish-speaking Latino men felt that race/ethnic concordance contributed to a practitioner's empathy, and some were concerned by the lack of race/ethnic- or language-concordant doctors.

CONCLUSIONS

Examining patients' preferences for patient-physician demographic concordance provides insight into the patient-physician relationship. Addressing areas where these preferences affect communication patterns and perceptions of quality of care may lead to overall improvements in patient-physician relationships and health outcomes.

Using a social marketing approach to advertise Sexual Assault Nurse Examination (SANE) services to college students

The authors report on an advertising campaign to communicate the availability and desirability of using Sexual Assault Nurse Examination (SANE) services. They used social marketing precepts to develop posters to educate college students about using SANE as a health service and as an arm of prosecution. After 2 advertising campaigns, they conducted an anonymous survey of 1,051 college students. The findings indicated that posters placed in residence halls and public bathrooms reached students, produced a statistically significant increase in students' understanding of SANE services, and were significantly associated with their hypothetical encouragement of others to use SANE. Gender mediated some results. Posters placed in private viewing spaces were found to be a viable way to communicate information about SANE. Funding to combat violence against women on campus should be aimed at increasing students' access to SANE and should include the costs of advertising the program.

Beijing health promoting universities: practice and evaluation

The aims of this study were to create a health promoting university within the framework of the Ottawa Charter for Health Promotion. Strategies included reforming and issuing healthy policies, creating a healthy physical and social environment, developing personal health skills, reorienting the health services, and implementing intervention activities. To evaluate the study, 180 students and 120 teaching/administrative staff were sampled for an in-depth interview with open-ended questions administered 1 year after the launch of the project. To assess health knowledge and behavior, 2500 students were sampled to answer a questionnaire, both prior to and following project implementation. With respect to policies, environment and health services, 166 students and 117 teaching and administrative staff participated in the in-depth interview. Approximately three-quarters (75.90%) of university students considered that the physical environment of the campus had improved significantly and 83.73% reported they had a good social environment. All university administration departments made commitments to health promotion. Consultations on mental health, smoking cessation and STD/AIDS prevention were provided all year round. Health education was included in a curriculum as a selective course with 1-2 credits. Almost two-thirds (60.66%) of teaching/administrative staff reported that they had had a yearly physical examination. In the final stages of the research, significantly more college students reported improved mental health (38.25% compared with 17.93% at baseline) (p < 0.01) and more were knowledgeable about transmission of STDs/AIDS (57.00/35.50% compared with 51.66/28.20% at baseline, respectively) (p < 0.01). Significantly less regular smokers were found (45% compared with 15.81% at baseline) (p < 0.01). However, there was a significant increase in high-fat food intake (44.81% compared with 49.50%) (p < 0.01) and pre-marital sex (5.11% compared with 14.00%), and a significant decrease in physical exercise participation (29.41% compared with 23.50%) (p < 0.01). As a health promotion setting, the university community can benefit greatly from implementing health promotion campaigns based on the principles of the Ottawa Charter.

Who manages the care of students with Attention Deficit Hyperactivity Disorder (ADHD) in higher education?

OBJECTIVE

To identify who provides medical support to students with Attention Deficit Hyperactivity Disorder (ADHD) while in higher education.

METHODS

A questionnaire pack was sent to 50 undergraduate student health centres attached to higher education colleges/universities.

RESULTS

Eighty-two per cent of practices returned questionnaires. Forty-nine per cent had undergraduate students with ADHD, of those 76% were on methylphenidate. Fifty-two per cent saw only their general practitioner (GP) for follow up and the rest were jointly managed by GP with: psychiatrists, paediatricians, psychologists or physicians. Eighty-seven per cent of GPs had not attended recent courses or training on ADHD.

CONCLUSION

Those caring for undergraduate students with ADHD are still largely unfamiliar with the condition. Guidelines need to be drawn up to establish handover from paediatric to adult care.

Storming the Ivory Towers

1. Organizations should establish workplace violence prevention policies and education programs. 2. Multidisciplinary teams should be established to address potentially violent situations. 3. Law enforcement or other experts should be consulted in stalking cases.

A university-wide health fair: a health promotion clinical practicum

Can sophomore baccalaureate students in their first clinical experience develop a health promotion activity to meet the needs of a university community? The authors describe how students, focusing on wellness and the nursing process, developed a university-wide health fair; the learning experiences, both planned and serendipitous; the importance of collaboration in health promotion and disease prevention activities; and the promotion of nursing's presence on a university campus.

A program to increase seat belt use along the Texas-Mexico border

A school-based, bilingual intervention was developed to increase seat belt use among families living along the Texas-Mexico border. The intervention sought to increase seat belt use by changing perceived norms within the community (i.e., making the nonuse of seat belts less socially acceptable). The intervention was implemented in more than 110 classrooms and involved more than 2100 children. Blind coding, validity checks, and reliability estimates contributed to a rigorous program evaluation. Seat belt use increased by 10% among children riding in the front seat of motor vehicles in the intervention community, as compared with a small but nonsignificant decline in use among control community children. Seat belt use among drivers did not increase.

The association of campus resources for gay, lesbian, and bisexual students with college students' condom use

The author and colleagues examined campus resources for gay, lesbian, and bisexual (GLB) students at 119 US colleges to determine how the presence of such resources affected sexually active students' condom use. A random sample of unmarried, sexually active college students surveyed in 1999 completed questionnaires. Condom use was compared across schools with different levels of GLB resources. Condom use rates, analyzed by sex and sex-partner groups, ranged from 32% to 52%. With additional college variables controlled for, GLB resources were positively associated with the proportion of sexually active students who used condoms (p < .001). This association existed primarily for students with only opposite-sex partners. The author's findings suggest that campus resources for GLB students may be associated with college students' condom use.

Smoking among female college students: a time for change

The transition from high school to college begins a time of personal growth accompanied by normal developmental stressors. Some young women use smoking as a coping mechanism. The immediate danger for these students is nicotine dependence, with subsequent maternal and child morbidities. College provides an optimal time to break this devastating trajectory. With an understanding of psychosocial development, nurses who care for college-age women can effect changes in smoking behavior.

[Evaluation of student participation in the management of the activities of the medical service of the Centre des Oeuvres Universitaires of Dakar (COUD]

The students of Centre des Oeuvres Universitaires de Dakar (COUD) do not seem to participate to the management of their own health status in spite of their financial participation in some services. The aim of this study is to evaluate the students's participation in their own health status. The results obtained from documents and archives, COUD'S responsible and student's opinion have shown a financial participation of 8% from the COUD medical service budget. The students wish to participation actively to the management of the medical service while COUD's responsible have opposite opinion. For an efficiency management of their own health status, students must necessary participate.