Carolinda Douglass

Temporal Changes of Access to Primary Health Care in Illinois (1990–2000) and Policy Implications

This paper examines temporal changes of access to primary health care in Illinois between 1990 and 2000 in a Geographic Information System (GIS) environment. Census data at the census tract level in 1990 and 2000 were used to define the population (demand) distribution and related socioeconomic attributes, and the Physician Masterfile of American Medical Association in corresponding years was used to define the physician (supply) distribution at the zip code level. A two-step floating catchment method was employed to measure the spatial access, considering locations of physicians and population and travel times between them. Various socioeconomic and demographic variables were consolidated into three factors (i.e., socioeconomic disadvantages, sociocultural barriers, and high healthcare needs) for measuring the nonspatial access. Spatial and nonspatial factors were finally integrated together to assess the primary care physician shortage areas. The study shows that spatial accessibility to primary care physician for the majority of the state improved from 1990 to 2000. Areas with worsened spatial accessibility were primarily concentrated in rural areas and some limited pockets in urban areas. The worst among these worsened areas appeared to be associated with populations with high scores of socioeconomically disadvantages, sociocultural barriers, and healthcare needs. Improving the accessibility of those socioeconomically disadvantaged population groups is critical for the success of future policies.

An Aging Game Simulation Activity for Allied Health Students

The Aging Game, a simulation activity, has been used successfully with medical students in the development of empathetic attitudes toward older adults. To date, the Aging Game has not been used extensively with allied health students. It has been viewed as too costly, time-consuming and labor-intensive. The purpose of this study was to examine the administrative feasibility of implementing a modified version of the Aging Game for use with allied health students. The study showed that the Aging Game can be easily modified for use with allied health students, and it can deliver positive results for improving empathetic attitudes toward older adults.

The development and evolution of geriatric assessment teams over the past 25 years: a cross-cultural comparison of the US and the UK

Findings from a literature synthesis and content analysis of the geriatric assessment team literature from the US and the UK over the past 25 years (1974-1999) are presented. Eighty-one geriatric assessment teams identified from the literature are analyzed (52 from the US and 29 from the UK). Geriatric assessment team characteristics are examined including team purpose, team setting, treatment link, team orientation, team composition, team size, and the client group targeted. The results show that teams in both the US and UK primarily have testing treatment effectiveness as their stated purpose, have strong treatment links, and are patient-oriented. Significant differences exist between the US and UK in terms of team setting, team composition, team size, and patients targeted by team. The US teams examined are more likely to operate in inpatient settings, include more disciplines and have more members on the team, and target specific subgroups of older people than those from the UK.

Health Care Utilization Among Clients With Alzheimer's Disease: Public Policy Implications From the California Alzheimer's Disease Diagnostic and Treatment Center Program

This study examines health and social service utilization among Alzheimers disease clients of the California Alzheimers Disease Diagnostic and Treatment Center (ADDTC) Program. This longitudinal study includes a nonrandom sample of program participants from 1988 to 1992 with a diagnosis of Alzheimers disease (N = 737). Sample characteristics, service utilization rates, and recommendations for service use by ADDTC staff are described. Comparisons of service utilization at baseline assessment and first-annual assessment are made for 10 health and social services—physician services, senior center services, congregate or home-delivered meals, home health care, homemaker-chore services, adult day care, case management, transportation services, residential care, and nursing home care. The influence of ADDTC staff recommendations on subsequent service utilization is assessed and policy implications regarding the efficacy of these recommendations are discussed.

Cross-Cultural Comparison of the Perceptions and Experiences of Dementia Care Mapping “Mappers” in the United States and the United Kingdom:

Objectives: Survey results from 161 respondents trained in dementia care mapping (DCM) in the United States and United Kingdom (82 and 79 respondents, respectively) addressed the following: (a) To what extent are mappers using DCM? (b) How satisfied are mappers with DCM? (c) What affect does DCM have on mappers’ attitudes toward their dementia practice? and (d) What challenges are encountered by mappers in the use of DCM? Method: Analyses using odds ratios were used to make international and training-level (basic vs. advanced) comparisons. Results: Differences across countries were found in use of DCM and lack of satisfaction using DCM codes. Similarities were found with positive affects of DCM on attitudes and lack of time for DCM. Discussion: Differences in mappers’ experiences and perceptions exist across the two countries, warranting increased attention to the cultural contexts within which mappers are situated and how these affect the implementation of DCM within a country.

The Impact of External Funding on Independent Living Centers and Their Organizational Partners A Longitudinal Case Study

This article describes a longitudinal case study of 11 independent living centers (ILCs) that received funding in the early 1990s from the Robert Wood Johnson Foundation for the purpose of improving service systems for people with disabilities. The article examines the changes that occurred in the organizational networks of each of the 11 ILCs over the funding period. Changes in specific organizational partners, exchanges of resources between the ILCs and their partners, and perceptions of the ILCs by their partners are analyzed. Particular attention is given to changes in partnerships related to health-care and revenue-generating activities. These issues are addressed in an effort to understand (a) in what ways the conventional ILC model might be challenged by the influx of external funding and (b) how the 11 ILCs managed to adapt to the funding in a manner that was conducive to their philosophies and missions.