950 Book Reviews

Thirdiy, they illustrate points with personal experiences in the health services.

The authors address themselves to the National Health Service in Britain and to the need to develop good evaluation techniques in light of its restructuring. The book begins with an introduction to evaluation, it’s definition, it’s theoretical constructs and it’s scope. Chapter 2 describes the key concepts and provides an clear discussion about objec- tives. Chapter 3 examines the implementation of an evalu- ation plan while Chapters 4 and 5 look at data sources and analysis. Chapter 5 concentrates on the role of economic analysis in evaluation trying to keep simple some fairly difficult but critical economic concepts. Chapters 6 and 7 describe the various types of studies i.e. case control, case studies, that can be used for evaluation and lists advantages and disadvantages of each. A whole chapter (7) is devoted to intervention studies which the authors believe are valuable as a concept for evaluation of health services effectiveness but are clearly difficult to carry out and to interpret. The next 3 chapters look at the application of these techniques to assessing patient satisfaction, evaluating disease prevention services and making technology assessment. Chapter 11 examines important methodological issues such as measure- ment, sampling and sensitivity analysis. The final chapter addresses issues of how to make evaluation work.

I found the book clear and helpful on specific points. For example, I found the discussions about the potentials and limitations of intervention studies very helpful. The chapter on technological assessment clearly and directly investigates the political and ideological environment and its influence on choices of expenditures. In addition, I appreciated the way in which the authors, with the feeling of those who have weathered storms, articulate problems of having evaluation of health services taken seriously when cost is not a major consideration.

However, I came away with the feeling that I did not know whether the book was about evaluation of health services orfor evaluation of health services. In other words, I could not decide whether to treat this book as a ‘how to do it’ manual or as a descriptive and analytical overview about why we need this type of evaluation. This ambiguity might be acceptable to those who wish to dip into chapters to clarify some concepts or to try one technique for some study. However, it is frustrating for those who really are seeking an integrating framework for both conceptualis- ation and techniques for evaluating the effectiveness of health services.

This weakness is most apparent in the chapter on health economics. After defining very clearly both the concerns and terminology of these types of assessment, the authors rarely refer to these concepts again. The main purpose of the chapter seemed to be to present terminology rather than presenting techniques for evaluation.

I found the strength of the book in its clarity and its provision of a map for the uninitiated in the morass of evaluation approaches. I also found the strength in defi- nitions and descriptions of techniques and problems that can be used in research other than evaluation studies. I would recommend the book to those who are about to undertake health services research of any kind in any country. It discusses clearly the issues which surround this type of research and gives conceptual clarity to some very sticky inherent problems.

Institute of Tropical Hygiene and Public Health

University qf Heidelberg Germany

SUSAN B. RIFKIN

Muscular Dystrophy and other Neuromuscular Diseases: Psychosocial Issues, edited by LEON I. CHARASH, ROBERT LOVELACE, CLAIRE F. LEACH, AUSTIN H. KUTSCHER, RABBI JACOB GOLDBERG and DAVID PRICE ROVE JR. The Haworth Press, New York, 1991. 25Opp., hardback: $34.95.

professionals who have been intimately involved in the management of patients with neuromuscular disorders over many years, to raise the public consciousness. A number of the chapters are successful in doing this.

This is a useful addition to the rehabilitation literature, focusing specifically on the psychosocial issues relating to the major neuromuscular diseases. The book is divided into three sections. Section I looks at psychosocial aspects of neuromuscular disorders; Section II examines clinical and research considerations; and Section III considers the importance of social support.

It is primarily a medical text, although the editors include a dentist, a rabbi, and a social worker. The text itself is something of a rattle-bag. In Section I, for example, there is a general chapter on the impact of illness on life-style, followed by a series of chapters on specific clinical con- ditions and discussions of their emotional and psychosocial implications, with no clear rationale or criteria for the selection. Poems by Ed Gallagher. who is an independent scholar at the Foundation of Thanatology in New York, provide the postcript to Sections I and II. Section III has a primarily psychological and health service orientation to social support, but also contains a short, tourist-style account of China’s care for the disabled.

The book, being edited by professionals, has the strengths and limitations that one might expect. It has some useful insights, based on detailed clinical work, into the struggles involved in living with chronic illness-from a professional point of view, in spite of the use of patients’ words from time to time. It deals quite sensitively with issues of identity and relationships, the role of the family and so on, but rarely if ever relates these problems in any systematic way to the social, and particularly the economic, context within these daily struggles are lived out. What it lacks is a grasp of the broader sociological issues to do with living with chronic illness that have been developed over the last ten years and more. It also lacks a political vision of where we should go in terms of the organization of our society and its institutions-but they are not alone in that.

All in all, however, it is a sympathetic book which will be of some use to people doing sociological and psychological research in this area. It will probably be of less use to the hard pressed practitioner working in the under-resourced frontline of health and community care in the late twentieth century.

Some of the chapters are analytical, others are empirical. Centre for Health Studies The latter draw on a variety of quantitative and qualitative Department of Sociolog) data, though the reportmg of research is not the primary University of Saljkd aim of the book. What this seems to be is an attempt, by Salford A45 4WT, U.K.

GARETH WILLIAMS