Increased use of emergency services by older people after health screening

Background: evaluation of the 'Keep Well At Home' (KWAH) Project in West London indicated that a programme of screening persons aged 75 and over had not reduced rates of emergency attendances and admissions to hospital. However, coverage of the target population was incomplete. The present analysis addresses 'efficacy'-whether individuals who completed the screening protocol as intended did subsequently use Accident & Emergency (A&E) services less often. Methods: the target population was divided into five groups, depending on whether an individual had completed none, one or both phases of screening, and whether deviations from the protocol related to incomplete coverage or refusal to participate further. We ascertained use of emergency services before screening and for up to 3 years afterwards by linkage of records from KWAH to those of local A&E Departments. Patterns of emergency care were examined as crude races and, via proportional hazards models, after adjustment for available confounders. Results: there was an increase of 51% (95% CI 22-86%) in the crude rate of emergency admissions in the year after first-phase screening compared with the 12 months before assessment. This was most obvious in individuals deemed at high risk who also underwent the second-phase assessment (adjusted hazard ratio relative to individuals not 'at risk'= 2.33; 95% CI 1.59-3.42). Conclusions: the available data do not allow us to distinguish between several possible explanations for the paradoxical increase in use of emergency services. However, what seem to be sensible policies do not necessarily have their intended effects when implemented in practice.

Psychology in practice: Guidelines for the provision of psychological services for older adults

The practice of psychology covers the range of ages from conception through to the end of life and palliative care. Psychologists practice in a variety of roles, but the majority of these roles involve interactions with nonprofessionals of varying ages. These interactions are governed by codes of ethical practice, whether these are developed by the funding bodies for research activities, professional associations, or regulatory bodies. Ethical codes vary in their format and emphasis, but all have the protection of the public as a major purpose. Often there are special provisions in these codes for particular populations or circumstances. Here we describe the development of ethical guidelines for the practice of psychology with older adults in Australia and report on those guidelines and their supporting literature.

Examination of the influence of personal attributes on consumer use of m-services

The rapid uptake of mobile devices has created the capacity to provide services to consumers while they are on the move, and new mobile services (m-services) are constantly emerging. In past research, personal attributes have been found to be important in the adoption and use of information and communication technology. However, little research has been conducted in the area of m-services. To explore factors influencing the use of these services, this paper examines personal attributes in terms of motivational, attitudinal and demographic characteristics. Specifically, it investigates the influence of innovativeness, self- efficacy, involvement and impulsiveness, as well as age and gender on m-services use. Data were collected from a convenience sample of 250 respondents using an online survey and a modified snowball procedure. Age and gender were quite well balanced in the sample. The multiple regression model was significant and the hypotheses relating to the positive relationship between impulsiveness, involvement and gender and m-services were supported. Findings are discussed, further implications for managers are suggested and directions for future research are proposed.

Uptake of dental services

Previous research has indicated that the majority of the UK dentate population suffers from dental disease. This problem was examined in terms of the supply of, and demand for, dental treatment: how might the uptake of dental services be increased and dental health improved? The target population for the main survey was adolescents among whom demand for dental treatment has decreased. In 524 adolescents surveyed, fear of pain was the major deterrent to regular dental visits. The theoretical literature was explored for illuminating and practical approaches to the problem. The theory of reasoned action developed by Fishbein seemed the most promising. This theory was tested and validated on the adolescent sample identifying clear differences between regular and irregular dental attenders which could be usefully exploited by dental health education. A repertory grid analysis study further illuminated perceptions of dental treatment. A survey of a random sample of 716 dentists revealed that most dentists were in favour of delegating work to auxiliary help but few could do so. Auxiliary help would increase supply of services: data revealed an encouraging trend for younger dentists to be more in favour of delegation than older dentists. A survey was carried out of computer systems available for dentists suggesting that this might reduce the need for clerical assistance but would not ususally affect the supply of treatment. However in some dental practices computerisation might increase demand. For example a personalised reminder was developed and evaluated in a controlled study of 938 appointments demonstrating an uptake in dental services. Conclusions are that demand for treatment can be increased in various ways especially by teaching dentists' behavioural strategies to deal with fear and pain. Various recommendations on this are made. If demand were to outstrip supply increased delegation to auxiliary help could provide a viable way of increasing supply.

Servitization within manufacturing:exploring the provision of advanced services and their impact on vertical integration

Purpose – The debate about services-led competitive strategies continues to grow, with much interest emerging around the differing practices between production and servitized operations. The purpose of this paper is to contribute to this discussion by investigating the vertical integration practice (in particular the micro-vertical integration, otherwise known as the supply chain position) of manufacturers who are successful in their adoption of servitization. Design/methodology/approach – To achieve this the authors have investigated a cross-section of four companies which are successfully delivering advanced services coupled to their products. Findings – Manufacturers who have embraced the servitization trend tend to retain capabilities in design and production, and do so because this benefits their speed, effectiveness and costs of supporting assets on advanced services contracts. Research limitations/implications – These are preliminary findings from a longer term research programme. Practical implications – Through this research note the authors seek to simultaneously contribute to the debate in the research community and offer guidance to practitioners exploring the consequences of servitization. Originality/value – Successful servitization demands that manufacturers adopt new and alternative practices and technologies to those traditionally associated with production operations. A prevailing challenge is to understand these differences and their underpinning rationale. Therefore, in this research note, the authors report on the practices of four case companies, explore the rationale underpinning these, and propose an hypothesis for the impact on vertical integration of successful servitization.

Follow the money:the Audit Commission, Public Money and the Management of Public Services, 1983-2008, Duncan Campbell-Smith

Book review: Duncan Campbell-Smith. Allen Lane, 2008, 744 pp., £ 25 (hb), ISBN: 9781846140686