The program implications of administrative relationships between local health departments and state and local government.

A typology of organizational arrangements between state and local public health agencies was used as a framework within which the organizational environment of the local health department was studied for its effects on progam development and implementation by local public health departments. Data collected in a national sample of local health officers were used in measuring the effect of four different patterns of administrative relationships on the selected characteristics of local health department programs. Important differences were observed among the four organizational types with regard to constraints on programs and program priorities, and health officers' perceptions of the primary functions of local health departments and sources of local health department funding. These findings were then used as a baseline from which to consider the possible impact of recent federal health budgetary proposals (specifically, block grants) both on existing patterns of intergovernmental relations and on the funding and operation of local health department programs. It was determined that the most likely general development arising from these proposed changes in federal budgetary policy is that the administrative control of state health agencies over those at local level is likely to be enhanced. Other likely developments include changes in the programs and priorities of local health departments related to reductions in overall funding levels for human services and forced competition for fewer dollars by an enlarged constituency

From theory to practice: improving the impact of health services research

BACKGROUND: While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. DISCUSSION: Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. SUMMARY: Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care

Career Resourcing and the Process of Professional Emergence

We theorize a career resourcing process that explains how individuals can create a new profession. Using historical archives, we trace the emergence of health services research as a new research profession through the career actions of early practitioners. We find that career resourcing can lead to the institutionalization of a new profession by: 1) a process of accretion, where people pursuing fulfilling careers generate resources that contribute to institutionalization, or 2) institutional work to deliberately build the professional community and infrastructure. We contribute to research on institutional change by specifying career actions that can lead to the institutionalization of a new profession, and by developing theory that accounts for the motivations and the means of individuals to act in ways that result in the institutionalization of a new profession

Health promotion through self-care and community participation: Elements of a proposed programme in the developing countries

BACKGROUND: The concepts of health promotion, self-care and community participation emerged during 1970s, primarily out of concerns about the limitation of professional health system. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in infancy in the developing countries. There is a window of opportunity for promoting self care and community participation for health promotion. DISCUSSION: A broad outline is proposed for designing a health promotion programme in developing countries, following key strategies of the Ottawa Charter for health promotion and principles of self care and community participation. Supportive policies may be framed. Self care clearinghouses may be set up at provincial level to co-ordinate the programme activities in consultation with district and national teams. Self care may be promoted in the schools and workplaces. For developing personal skills of individuals, self care information, generated through a participatory process, may be disseminated using a wide range of print and audio-visual tools and information technology based tools. One such potential tool may be a personally held self care manual and health record, to be designed jointly by the community and professionals. Its first part may contain basic self care information and the second part may contain outlines of different personally-held health records to be used to record important health and disease related events of an individual. Periodic monitoring and evaluation of the programme may be done. Studies from different parts of the world indicate the effectiveness and cost-effectiveness of self care interventions. The proposed outline has potential for health promotion and cost reduction of health services in the developing countries, and may be adapted in different situations. SUMMARY: Self care, community participation and health promotion are emerging but dominant areas in the developed countries. Elements of a programme for health promotion in the developing countries following key principles of self care and community participation are proposed. Demonstration programmes may be initiated to assess the feasibility and effectiveness of this programme before large scale implementation

Primary health care in rural areas: an agenda for research.

The confluence of forces slowing the growth of the physician supply despite a continued shortage of primary care physicians, the encouragement of competitive medical practices that centralize resources in larger places, and the changing of the rural population's character to one of more dependence on medical care may bring on another "rural health crisis" in the decade ahead

Self care in later life : research, program, and policy issues/ Edit.: Marcia G. Ory

xxvi, p. 267.; 25 c

The hospital and medical practice: a study of physician staff appointments among specialists and generalists.

The names, specialties, and appointment status of physicians with privileges in 161 North Carolina hospitals were obtained and compared to the file of licensed, active, patient-care physicians practicing in the State for the year 1978. The listings were examined to determine the number of physicians without a hospital privilege by age, race, sex, specialty, and geographic location. Overall, only 11 percent of all active physicians did not have some form of hospital appointment. Among family and general practitioners, 29 percent had either a restricted hospital privilege or no hospital appointment at all. A greater number of nonwhite and female physicians were also without privileges. These data have implications for the training of physicians in a system that emphasizes hospital care and includes inpatient treatment within the purview of primary care