Social science & medicine
-
Analysis of a subset of data from a survey of 3696 relatives, friends and others who knew a sample of people dying in 1990 who lived in 20 areas of the United Kingdom (the Regional Study of Care for the Dying) is reported. Using the typology of awareness contexts developed by Glaser and Strauss [(1965) Awareness of Dying, Aldine, Chicago], the prevalence of different awareness contexts is described and compared with an earlier survey done in 1969. Open awareness of dying, where both the dying person and the respondent knew that the person was dying, is the most prevalent awareness context. ⋯ If dying from cancer, people in full open awareness are more likely to have received hospice care. It is suggested that underlying these patterns, and in contrast with some other cultures where awareness of dying is seen as less desirable, people dying in Anglophone countries are particularly concerned to maintain control over projects of self-identity. Their approach to death is a reflection of this individualism.
-
Social science & medicine · Aug 1997
Economic evaluation in support of national health policy: the case of The Netherlands.
This article focuses on economic evaluation as an instrument to support national health policy in the Netherlands. National health policy concerns decision-making on which technologies may enter the health care market, which health care services are included in the package of health care benefits and under what conditions, and what the geographical distribution of medical services and facilities should be. Regarding the latter two issues in particular, the actual and potential role of economic evaluation in health policy is discussed. From the Dutch experience we can learn that a close cooperation between researchers and policy-makers helps to enlarge the impact of economic appraisal on policy-making and that incorporation of the right (financial) incentives is vital to the use of economic appraisal in health care decision-making.
-
Social science & medicine · Jul 1997
Comparative StudyHealth care and consumer choice: medical and alternative therapies.
This paper reports on research conducted in a large Canadian city during 1994-1995. The study examines the motivations of patients who choose to seek care from one of five different types of practitioners: family physicians, chiropractors, acupuncturists/traditional Chinese doctors, naturopaths and Reiki practitioners. We use the Andersen socio-behavioural model to help explain why people choose orthodox medicine or a type of alternative care. ⋯ The findings demonstrate that this model can explain the use of alternative as well as orthodox medical services. Patients choose specific kinds of practitioners for particular problems, and some use a mixture of practitioners to treat a specific complaint. The choice of type of practitioner(s) is multidimensional and cannot solely be explained either by disenchantment with medicine or by an "alternative ideology".
-
Social science & medicine · Jun 1997
Long-term benzodiazepine use: factors of importance and the development of individual use patterns over time--a 13-year follow-up in a Swedish community.
Using data from a research registry of prescriptions, we studied benzodiazepine use in a Swedish community with a general population of 20,000. A sample of benzodiazepine users in 1976 (n = 561) aged 15 years and older was identified and followed for 13 years with respect to continued benzodiazepine use. A strong tendency towards continued use was observed. ⋯ Because repeated measurements for the same individuals were analyzed, the generalized estimating equations (GEE) method was chosen for the multivariate analyses. Among long-term users, age, a combined use of tranquilizers and hypnotics, and prescriptions from more than one of the prescriber categories studied (i.e. doctors working at health centers, hospital doctors, and private doctors) were significant factors in frequent or daily use. The study also showed that frequent/daily use increased among the identified long-term users during the time period analyzed.
-
Contrary to the common view that older women (65+) in the United States use suicide methods that have relatively low potential for death, firearms have become the most common suicide method in this group. The present study examines the association between demographic and geographic factors and the use of firearms vs other suicide methods. ⋯ The following characteristics among women were significantly more likely to be associated with the use of firearms as a suicide method: ages 65-74, married, of lower educational attainment, in nonmetropolitan areas, and in the South. Research is needed to assess the effects of limiting firearms on the growing proportion of firearm-related suicides among older women.