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Service Utilization (service + utilization)
Kinds of Service Utilization Terms modified by Service Utilization Selected AbstractsReductions in Costly Healthcare Service Utilization: Findings from the Care Advocate ProgramJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2006George R. Shannon PhD OBJECTIVES: To determine whether a telephone care-management intervention for high-risk Medicare health maintenance organization (HMO) health plan enrollees can reduce costly medical service utilization. DESIGN: Randomized, controlled trial measuring healthcare services utilization over three 12-month periods (pre-, during, and postintervention). SETTING: Two social service organizations partnered with a Medicare HMO and four contracted medical groups in southern California. PARTICIPANTS: Eight hundred twenty-three patients aged 65 and older; eligibility was determined using an algorithm to target older adults with high use of insured healthcare services. INTERVENTION: After assessment, members in the intervention group were offered mutually agreed upon referrals to home- and community-based services (HCBS), medical groups, or Medicare HMO health plan and followed monthly for 1 year. MEASUREMENTS: Insured medical service utilization was measured across three 12-month periods. Acceptance and utilization of Care Advocate (CA) referrals were measured during the 12-month intervention period. RESULTS: CA intervention members were significantly more likely than controls to use primary care physician services (odds ratio (OR)=2.05, P<.001), and number of hospital admissions (OR=0.43, P<.01) and hospital days (OR=0.39, P<.05) were significantly more stable for CA group members than for controls. CONCLUSION: Results suggest that a modest intervention linking older adults to HCBS may have important cost-saving implications for HMOs serving community-dwelling older adults with high healthcare service utilization. Future studies, using a national sample, should verify the role of telephone care management in reducing the use of costly medical services. [source] Dental Service Utilization among Urban and Rural Older Adults in China , A Brief CommunicationJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007Bei Wu PhD Abstract Objectives: China's health care system is bifurcated in nature between rural and urban areas. In addition, there is a huge gap in socioeconomic status between rural and urban residents. The purpose of the study was to examine the factors related to dental visits among elders in rural and urban areas of Shanghai, China. Methods: Using a stratified random sampling method, a cross-sectional, face-to-face survey was conducted among elders aged 60 years and above in Shanghai during 2003-04. A total of 1,044 older respondents were included in the sample. Results: There was a significant urban and rural difference in dental visit rates over the 12-month period of the study. Results from the logistic regression analysis suggested that residing in urban areas was a significant positive factor related to dental visits. In addition, being younger, being able to pay out-of-pocket medical expenses, having had regular medical checkups, having a higher number of limitations because of chronic conditions, and being more concerned about eating a healthy diet were associated with increased odds of dental visits. Conclusions: Results suggest that urban,rural differences, as reflected in the socioeconomic status gap, disparity in medical insurance coverage, and access to dental care, have a significant impact on the use of dental services by Chinese elders. Individual sociodemographic characteristics, health status, and health attitude are important explanatory variables. [source] Practical and Policy Implications of Using Different Rural-Urban Classification Systems: A Case Study of Inpatient Service Utilization Among Veterans Administration UsersTHE JOURNAL OF RURAL HEALTH, Issue 3 2009Ethan M. Berke MD ABSTRACT:,Context: Several classification systems exist for defining rural areas, which may lead to different interpretations of rural health services data. Purpose: To compare rural classification systems on their implications for estimating Veterans Administration (VA) utilization. Methods: Using 7 classification systems, we counted VA health care enrollees who lived in each category, and number admitted to VA hospitals or non-VA hospitals under Medicare. For dual VA-Medicare enrollees over age 65, we compared VA and private sector hospitalizations on numbers of admissions and bed-days of care. We compared VA enrollees' relative proportions across rural to urban categories for each classification system and evaluated discordance between systems at the veterans-integrated service networks (VISN) level. Findings: Enrollment and inpatient utilization counts for rural veterans vary considerably from one classification system to another, though the systems generally agree that admission rates, length of stay, and reliance on the VA for care are lower for rural veterans. Among older dual VA and Medicare enrollees, rural residents rely on non-VA facilities more, though this effect also varies widely depending on the classification scheme. VISNs vary greatly in the proportions of patients who are rural residents, and in the degree to which classification systems are discordant in designating patients as rural. Conclusions: Decisions about allocating VA health care resources to target "rural" patients may be affected greatly by the rural classification system chosen, and the impact of this choice will affect some hospital networks much more than others. [source] Cancer and men from minority ethnic groups: an exploration of the literatureEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2000S. Lees The authors reviewed literature which has been published in the last 20 years. Cancer is the second leading cause of death in developed countries and is expected to become a significant cause of death in developing countries. Whilst there are a large number of studies on cancer and men, there is a paucity of data on men from minority ethnic groups. In the USA, African Americans are more likely to develop cancer than any other ethnic group. Although cancer rates amongst minority ethnic groups in the UK are thought to be low, 11% of Indian and African men and 19% of Caribbean men died from cancer during 1979,1983. There is also further evidence in the USA that African American, Filipinos and Native Americans have the lowest cancer survival rates. Service utilization, especially tertiary care, is also thought to be low amongst minority ethnic groups from the USA and the UK. Reasons for these variations include artefactual, cultural, materialist and social selectivist explanations as well as the effects of migration, racism and genetic disposition. This area is under-researched, in particular cultural beliefs about cancer. Further research into this area should apply culturally competent methods to ensure valid data to inform cancer policy, education and practice. [source] Co-morbidity and the utilization of health care for Australian veterans with diabetesDIABETIC MEDICINE, Issue 1 2010Y. Zhang Diabet. Med. 27, 65,71 (2010) Abstract Objective, To examine the impact of co-morbidity on health service utilization by Australian veterans with diabetes. Methods, A retrospective cohort study was undertaken including veterans aged , 65 years dispensed medicines for diabetes in 2006. Data were sourced from the Australian Department of Veterans' Affairs health claims database. Utilization of preventive health services for diabetes was assessed, including claims for glycated haemoglobin (HbA1c) test, microabuminuria, podiatry services, diabetes care plans, medication reviews, case conferences, general practitioner (GP) management plans and ophthalmology/optometry services. Results, Among the 17 095 veterans dispensed medicines for diabetes, more than 80% had four or more co-morbid conditions. Those with a higher number of co-morbidities were more likely to have had claims for optometry/ophthalmology services and podiatry services, but not for other services. Veterans with at least one diabetes-related hospital admission had no more claims for diabetes health services than those who had no diabetics-related hospital admission, except for endocrinology services (relative risk = 1.26, 95% confidence intervals 1.15,1.37). Veterans with dementia were less likely to have had claims for diabetes health services while patients with renal failure were more likely to have had claims for the services. Conclusions, Low utilization of preventive diabetes care services is apparent in all co-morbidity groups. Patients with renal failure or dementia used more and less health services resources, respectively. Given the high mean age of this population, there may be valid reasons for the low use, such as competing health demands and patients' preferences. [source] Substance use disorders in an Australian community surveyDRUG AND ALCOHOL REVIEW, Issue 3 2002MAREE TEESSON Abstract A community survey of the common mental disorders in a geographically defined treatment service area was used to explore the socio-demographic correlates and service utilization of people with alcohol and drug use disorders living in the area. These data represent the most comprehensive data on substance use disorders in a defined geographic region in Australia. Alcohol and drug use disorders were most likely to be found in the young, with those aged 18,34 uyears being three times more likely to have an alcohol use disorder than those aged 55 years and over. A third (33%) of those people with an alcohol use disorder and 42% of those with a drug use disorder had consulted a health professional in the past 12 months for their substance use disorder. [source] Intensity of drug injection as a determinant of sustained injection cessation among chronic drug users: the interface with social factors and service utilizationADDICTION, Issue 6 2004Julie Bruneau ABSTRACT Aims The objective of this study was to identify factors associated with sustained injection cessation and to examine further the relationship between the occurrence of sustained injection cessation of injection drug users (IDUs) and prior injection frequency. Design and setting IDUs in the Montreal St Luc Cohort who had at least three consecutive interviews between 1995 and 1999 were included. Sustained injection cessation was defined as a period of at least 7 consecutive months without injection. All IDUs completed interview-administered questionnaires on socio-demographic characteristics, drug and sexual behaviours and health-related issues. Logistic regression was used for analyses. Findings A total of 186/1004 (18.5%) IDUs reported a period of sustained injection cessation during the study period. In multivariate analysis, HIV-positive status, ,booting' and cumulative time spent in prison were negatively associated with injection cessation, while injection initiation after 35 years of age and frequent crack use were positively associated with injection cessation. We found a negative association between the occurrence of injection cessation and the frequency of injection; the odds ratios (OR) for cessation were 0.49 [95% confidence interval (CI): 0.03, 0.78] for IDUs who injected 30,100 times and 0.21 (95% CI: 0.10, 0.46) for IDUs who injected more than 100 times in the previous month. Attending needle exchange programmes (NEPs) or pharmacies appeared to be a modifier of the relation between cessation and prior injection frequency. The OR was 0.68 (95% CI: 0.42, 1.12) for IDUs who injected 30,100 times prior to injection and attended NEPs or pharmacies and was 0.07 (0.01, 0.30) for IDUs who did not use these services. Conclusions Overall, a fifth of IDUs experienced at least one episode of injection cessation of 7 months or more during a period of 4.5 years. Our data suggest that NEPs and pharmacies may have played a role in inducing injection cessation episodes in a subgroup of IDUs. Research is needed to better identify the characteristics of IDUs who could benefit from an injection cessation intervention strategy. This information is important for social and health policy planning. [source] Emergency Department Utilization by Noninstitutionalized EldersACADEMIC EMERGENCY MEDICINE, Issue 3 2001Manish N. Shah MD Abstract. Objectives: To the best of the authors knowledge, no nationally representative, population-based study has characterized the proportion of elders using the emergency department (ED) and factors associated with ED use by elders. This article describes the proportion of elder Medicare beneficiaries using the ED and identifies attributes associated with elder ED users as compared with nonusers. Methods: The 1993 Medicare Current Beneficiary Survey was used, a national, population-based, cross-sectional survey of Medicare beneficiaries linked with Medicare claims data. The study population was limited to 9,784 noninstitutionalized individuals aged 66 years or older. The Andersen model of health service utilization was used, which explains variation in ED use through a combination of predisposing (demographic and social), enabling (access to care), and need (comorbidity and health status) characteristics. Results: Eighteen percent of the sample used the ED at least once during 1993. Univariate analysis showed ED users were older; were less educated and lived alone; had lower income and higher Charlson Comorbidity Index scores; and were less satisfied with their ability to access care than nonusers (p < 0.01, chi-square). Logistic regression identified older age, less education, living alone, higher comorbidity scores, worse reported health, and increased difficulties with activities of daily living as factors associated with ED use (p < 0.05). Need characteristics predicted ED use with the greatest accuracy. Conclusions: The proportion of elder ED users is slightly higher than previously reported among Medicare beneficiaries. Need (comorbidity and health status) characteristics predict ED utilization with the greatest accuracy. [source] Oral disease experience of older adults seeking oral health servicesGERODONTOLOGY, Issue 2 2010Kavita P. Ahluwalia doi:10.1111/j.1741-2358.2009.00311.x Oral disease experience of older adults seeking oral health services Objective:, The objective of this investigation was to describe the dental disease (dental caries and alveolar bone loss) experience in a sample of community-dwelling older adults who regularly utilize dental services in New York City. Background:, Public financing for dental care directed at older adults in the United States is minimal. Improved preventive methods, primarily the use of fluorides, have resulted in declines in tooth loss, and concomitant increase in risk for dental diseases among older adults. While the oral disease burden in institutionalized elderly and those unable to access services is well-documented, the dental care needs of older adults who access dental services are not well documented. Materials and Methods:, Radiographic and record review were used to determine prevalence of dental caries, alveolar bone loss, frequency of service utilization, and medical status in this cross-sectional investigation of a sample of older adults (N = 200) using dental services at Columbia University College of Dental Medicine. Results:, Only 9% of the sample was completely edentulous, the mean DMFT was 19.9 and mean alveolar bone loss was 3.6 mm. Missing and Decayed Teeth accounted for 57.8% and 6.5% of the total caries burden respectively. Missing Teeth and alveolar bone loss increased with increasing age, but there was no increase in Decayed Teeth. Conclusions:, While access to and utilization of dental services may result in improved tooth retention, older adults who use dental services continue to have dental care needs, especially periodontal care needs. [source] Progressive segmented health insurance: Colombian health reform and access to health servicesHEALTH ECONOMICS, Issue 1 2007Fernando Ruiz Abstract Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright © 2006 John Wiley & Sons, Ltd. [source] Sometimes more equal than others: how health inequalities depend on the choice of welfare indicatorHEALTH ECONOMICS, Issue 3 2006Magnus Lindelow Abstract In recent years, a large body of empirical work has focused on measuring and explaining socio-economic inequalities in health outcomes and health service use. In any effort to address these questions, analysts must confront the issue of how to measure socioeconomic status. In developing countries, socioeconomic status has typically been measured by per capita consumption or an asset index. Currently, there is only limited information on how the choice of welfare indicators affect the analysis of health inequalities and the incidence of public spending. The purpose of this paper is to illustrate the potential sensitivity of the analysis of health related inequalities to how socioeconomic status is measured. Using data from Mozambique, the paper focuses on five key health service indicators, and tests whether measured inequality (concentration index) in health service utilization differs depending on the choice of welfare indicator. The paper shows that, at least in some contexts, the choice of welfare indicator can have a large and significant impact on measured inequality in utilization of health services. In consequence, we can reach very different conclusions about the ,same' issue depending on how we define socioeconomic status. The paper also provides some tentative conclusions about why and in what contexts health inequalities can be sensitive to the choice of living standards measure. The results call for more clarity and care in the analysis of health related inequalities, and for explicit recognition of the potential sensitivity of findings to the choice of welfare measure. The results also point at the need for more careful research on how different dimensions of SES are related, and on the pathways by which the respective different dimensions impact on health related variables. Copyright © 2005 John Wiley & Sons, Ltd. [source] The Effects of Child-Only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings among Low-Income Children in CaliforniaHEALTH SERVICES RESEARCH, Issue 1 2006Sylvia Guendelman Objective. To compare the extent with which child-only and family coverage (child and parent insured) ensure health care access and use for low income children in California and discuss the policy implications of extending the State Children's Health Insurance Program (California's Healthy Families) to uninsured parents of child enrollees. Data Sources/Setting. We used secondary data from the 2001 California Health Interview Survey (CHIS), a representative telephone survey. Study Design. We conducted a cross-sectional study of 5,521 public health insurance,eligible children and adolescents and their parents to examine the effects of insurance (family coverage, child-only coverage, and no coverage) on measures of health care access and utilization including emergency room visits and hospitalizations. Data Collection. We linked the CHIS adult, child, and adolescent datasets, including the adolescent insurance supplement. Findings. Among the sampled children, 13 percent were uninsured as were 22 percent of their parents. Children without insurance coverage were more likely than children with child-only coverage to lack a usual source of care and to have decreased use of health care. Children with child-only coverage fared worse than those with family coverage on almost every access indicator, but service utilization was comparable. Conclusions. While extending public benefits to parents of children eligible for Healthy Families may not improve child health care utilization beyond the gains that would be obtained by exclusively insuring the children, family coverage would likely improve access to a regular source of care and private sector providers, and reduce perceived discrimination and breaks in coverage. These advantages should be considered by states that are weighing the benefits of expanding health insurance to parents. [source] The Cost-Effectiveness of Independent Housing for the Chronically Mentally Ill: Do Housing and Neighborhood Features Matter?HEALTH SERVICES RESEARCH, Issue 5 2004Joseph Harkness Objective. To determine the effects of housing and neighborhood features on residential instability and the costs of mental health services for individuals with chronic mental illness (CMI). Data Sources. Medicaid and service provider data on the mental health service utilization of 670 individuals with CMI between 1988 and 1993 were combined with primary data on housing attributes and costs, as well as census data on neighborhood characteristics. Study participants were living in independent housing units developed under the Robert Wood Johnson Foundation Program on Chronic Mental Illness in four of nine demonstration cities between 1988 and 1993. Study Design. Participants were assigned on a first-come, first-served basis to housing units as they became available for occupancy after renovation by the housing providers. Multivariate statistical models are used to examine the relationship between features of the residential environment and three outcomes that were measured during the participant's occupancy in a study property: residential instability, community-based service costs, and hospital-based service costs. To assess cost-effectiveness, the mental health care cost savings associated with some residential features are compared with the cost of providing housing with these features. Data Collection/Extraction Methods. Health service utilization data were obtained from Medicaid and from state and local departments of mental health. Non-mental-health services, substance abuse services, and pharmaceuticals were screened out. Principal Findings. Study participants living in newer and properly maintained buildings had lower mental health care costs and residential instability. Buildings with a richer set of amenity features, neighborhoods with no outward signs of physical deterioration, and neighborhoods with newer housing stock were also associated with reduced mental health care costs. Study participants were more residentially stable in buildings with fewer units and where a greater proportion of tenants were other individuals with CMI. Mental health care costs and residential instability tend to be reduced in neighborhoods with many nonresidential land uses and a higher proportion of renters. Mixed-race neighborhoods are associated with reduced probability of mental health hospitalization, but they also are associated with much higher hospitalization costs if hospitalized. The degree of income mixing in the neighborhood has no effect. Conclusions. Several of the key findings are consistent with theoretical expectations that higher-quality housing and neighborhoods lead to better mental health outcomes among individuals with CMI. The mental health care cost savings associated with these favorable features far outweigh the costs of developing and operating properties with them. Support for the hypothesis that "diverse-disorganized" neighborhoods are more accepting of individuals with CMI and, hence, associated with better mental health outcomes, is mixed. [source] Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based ApproachesHEALTH SERVICES RESEARCH, Issue 5 2003Chuan-Fen Liu Objective. To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings. Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions. Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. [source] Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector ProgramsHEALTH SERVICES RESEARCH, Issue 4 2002M. Susan Ridgely Objective. To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and ,unmanaged" care and among managed care arrangements. Study Design. The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data Collection Methods. Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. Principal Findings This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. Conclusions. If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary. [source] Health service utilization for eating disorders: Findings from a community-based study,INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2007Jonathan M. Mond PhD Abstract Background: Prior use of health services was examined in a community sample of women with bulimic-type eating disorders. Method: Participants (n = 159) completed a structured interview for the assessment of eating disorder psychopathology as well as questions concerning treatment-seeking and type of treatment received. Results: Whereas a minority (40.3%) of participants had received treatment for an eating problem, most had received treatment for a general mental health problem (74.2%) and/or weight loss (72.8%), and all had used one or more self-help treatments. Where treatment was received for an eating or general mental health problem, this was from a primary care practitioner in the vast majority of cases. Only half of those participants who reported marked impairment associated with an eating problem had ever received treatment for such a problem and less than one in five had received such treatment from a mental health professional. Conclusion: Women with bulimic-type eating disorders rarely receive treatment for an eating problem, but frequently receive treatment for a general mental health problem and/or for weight loss. The findings underscore the importance of programs designed to improve the detection and management of eating disorders in primary care. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] An audit of service utilization by graduates attending an old age psychiatry serviceINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006Brian A. Lawlor No abstract is available for this article. [source] A sustainability assessment of a health equity fund initiative in CambodiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2007Bart Jacobs Abstract All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda-managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings. Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and government support), the pagoda-managed equity fund initiative scores well. However, it is evident that some external financial support is needed to allow the HEFs to function effectively. We conclude with recommendations for replicating the initiative, which include working innovatively with indigenous grassroots organizations to enhance community HEF ownership and to keep administrative overheads low. Copyright © 2007 John Wiley & Sons, Ltd. [source] Considering context, place and culture: the National Latino and Asian American StudyINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2004Margarita Alegria Abstract This paper provides a rationale for, and overview of, procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization by Latinos and Asian Americans in the US. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication) (NCS-R) and African Americans (from the National Survey of American Life) (NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research. Copyright © 2004 Whurr Publishers Ltd. [source] Reductions in Costly Healthcare Service Utilization: Findings from the Care Advocate ProgramJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2006George R. Shannon PhD OBJECTIVES: To determine whether a telephone care-management intervention for high-risk Medicare health maintenance organization (HMO) health plan enrollees can reduce costly medical service utilization. DESIGN: Randomized, controlled trial measuring healthcare services utilization over three 12-month periods (pre-, during, and postintervention). SETTING: Two social service organizations partnered with a Medicare HMO and four contracted medical groups in southern California. PARTICIPANTS: Eight hundred twenty-three patients aged 65 and older; eligibility was determined using an algorithm to target older adults with high use of insured healthcare services. INTERVENTION: After assessment, members in the intervention group were offered mutually agreed upon referrals to home- and community-based services (HCBS), medical groups, or Medicare HMO health plan and followed monthly for 1 year. MEASUREMENTS: Insured medical service utilization was measured across three 12-month periods. Acceptance and utilization of Care Advocate (CA) referrals were measured during the 12-month intervention period. RESULTS: CA intervention members were significantly more likely than controls to use primary care physician services (odds ratio (OR)=2.05, P<.001), and number of hospital admissions (OR=0.43, P<.01) and hospital days (OR=0.39, P<.05) were significantly more stable for CA group members than for controls. CONCLUSION: Results suggest that a modest intervention linking older adults to HCBS may have important cost-saving implications for HMOs serving community-dwelling older adults with high healthcare service utilization. Future studies, using a national sample, should verify the role of telephone care management in reducing the use of costly medical services. [source] When Home Care Ends,Changes in the Physical Health of Informal Caregivers Caring for Dementia Patients: A Longitudinal StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2002Elmar Gräsel MD OBJECTIVES: To verify the change in health variables and parameters of health service utilization in a group of active caregivers for older persons with dementia in comparison with former caregivers who had ceased to provide home care for at least 6 months (death of the patient or institutionalized care). DESIGN: A prospective longitudinal study with 1-year follow-up. Active and former caregiver groups originated from a sample of active caregivers at baseline. SETTING: Participants were recruited mainly via advertisements placed in two magazines with large, nationwide circulation. The questionnaires were sent on request. PARTICIPANTS: Seven hundred twenty primary caregivers of dementia patients living in the community. All patients had a medical diagnosis of dementia and had a score of 20 or greater on the mental-mnestic disturbances factor of the Sandoz Clinical Assessment,Geriatric scale. Their care needs covered at least one of four activities of daily living (personal hygiene, eating, toilet use/excretion, mobility). After 12 months, 681 caregivers were reinterviewed. MEASUREMENTS: The physical complaints were assessed with the 24-item Giessen Symptom List (subscales: aching limbs, stomach complaints, heart complaints, physical exhaustion). Other key variables were the number of illnesses, number of somatic and psychotropic medications, and number of physician visits. RESULTS: Although the somatic symptoms of the active caregivers (n = 427) remained stable at a high level, they decreased significantly (24%) in the group of former caregivers (n = 121). Simultaneously, the number of visits former caregivers made to physicians almost doubled. The reason why home care was terminated (death or institutionalization) did not influence health variables or health service utilization. CONCLUSION: The physical health of former caregivers improves in the long term once they cease to provide home care. The fact that former caregivers go to the doctor much more frequently is to be interpreted as an indication that they take the time to attend to their own physical and medical needs. [source] Nurse discharge planning in the emergency department: a Toowoomba, Australia, studyJOURNAL OF CLINICAL NURSING, Issue 8 2006Desley Hegney BA Aim., This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives., The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design., The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 (51·5%) were admitted and 246 (11·5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results., There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5·5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6·17 days per patient in October 2002 to 5·37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as ,frequent flyers'). Conclusions., Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice., It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient. [source] Self-preventive oral behavior in an Italian university student populationJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2001Lia Rimondini Abstract Background, aim: The aim of this study was to assess the oral hygiene attitude and the professional preventive examination compliance in Italian university students. Method: A sample of 202 students attending the University of Bologna was randomly selected and interviewed about their preventive oral health attitude and compliance. All students reported using toothpaste and most of them (92.1%) brushed their teeth at least 2× a day using artificial, medium stiffness bristles. The toothbrush was generally (81.6%) replaced within 3 months. Few subjects (14.9%) said they used dental floss daily or utilized other devices. A majority of subjects (59.9%) had a dental examination within the year previous to the interview. Cluster analysis was performed. Results: 4 groups were identified with homogeneous oral hygiene behavior and compliance toward professional preventive examination. Only one cluster, representing 33.6% of the sample, showed consistent frequency and modalities of oral hygiene habits. The other clusters seemed to be defective with interproximal cleaning procedures and compliance toward professional preventive care. Since the sample was characterized by a young, urbanized, homogeneous group with a high educational level and frequently from an upper middle class social status, the analysis probably gives a supra-estimation of the positive behavior. Conclusion: It is rational to suppose that strategies to promote dental service utilization, patients' compliance and a professional style oriented toward prevention may be useful to improve the oral health condition in the young adult Italian population. Zusammenfassung Das Ziel dieser Studie war es bei Studenten einer italienischen Universität die Einstellung zur Mundhygiene und die Compliance mit einer professionellen Vorsorgeuntersuchung zu bestimmen. Eine Gruppe von 202 Studenten, die die Universität von Bologna besuchten wurden randomisiert ausgewählt und hinsichtlich ihrer Einstellung zur Mundhygiene und Compliance befragt. Alle Studenten berichteten, dass sie Zahnpasta gebrauchten und die meisten (92.1%) putzten ihre Zähne wenigstens 2× täglich und verwendeten eine Zahnbürste mit mittelharten Kunststoffborsten. Im Allgemeinen wurde die Zahnbürste innerhalb von 3 Monaten (81.6%) ersetzt. Wenige Personen berichteten, dass sie täglich Zahnseide benutzen oder andere Hilfsmittel verwenden. Die Mehrheit (59.9%) hatte innerhalb des zurückliegenden Jahres eine zahnärztliche Untersuchung. Es wurde eine Clusteranalyse durchgeführt. 4 Gruppen mit homogenem Mundhygieneverhalten und Compliance bezüglich professioneller präventiver Untersuchung wurden identifiziert. Nur ein Cluster, welches 33.6% der Gruppe repräsentiert zeigte eine Konsistenz in der Häufigkeit und Art der Mundhygienegewohnheiten. Die anderes Cluster schienen Defizite bei der Approximalraumreinigung und der Compliance mit professionellen Präventionsmaßnahmen zu haben. Da die Population charakterisiert war durch eine junge, städtische homogene Gruppe mit einem hohen Bildungsniveau und häufig den Sozialstatus der gehobenen Mittelklasse aufwies, gibt die Analyse wahrscheinlich eine Überbewer+tung des positiven Verhaltens wieder. Es ist vernünftig anzuhenmen, dass Strategien zur Förderung der zahnärztlichen Behandlung, der Patienten-Compliance und einer professionellen Ausrichtung hin zur Prävention nützlich sein können um in einer Population von jungen italienischen Erwachsenen den Zustand der Mundgesundheit zu verbessern. Résumé Le but de cette étude a été de vérifier l'attitude vis-à-vis de l'hygiène buccale et l'attitude vis-à-vis d'un examen préventif professionnel d'étudiants universitaires italiens. 202 étudiants de l'Université de Bologne ont été sélectionné au hasard et interviewéà propos de leur attitude préventive et leur complaisance vis-à-vis de leur santé buccale. Tous les étudiants disaient utiliser du dentifrice et la plupart d'entre eux (92%) brossaient leurs dents au moins 2× par jour avec une brosse à dents à poils artificiels de souplesse moyenne. La brosse à dents était géneralement (81.6%) remplacée tous les 3 mois. Peu d'entre eux (15%) disaient utiliser le fil dentaire tous les jours ou d'autres systèmes interdentaires. La plupart d'entre eux (60%) avaient passé une visite chez leur dentiste dans l'année précédent l'interview. L'analyse par groupe a été effectuée. 4 groupes ont été identifiés avec un comportement homogène vis-à-vis de l'hygiène buccale et une complaisance envers l'examen préventif professionnel. Seul un groupe représentant 34% de l'échantillon montrait une fréquence constante vis-à-vis de l'hygiène buccale. Les autres groupes semblaient porter moins d'attention au processus de nttoyage interdentaire et avoir une complaisance vis-à-vis des soins de prévention professionnels. Comme l'échantillon était caractérisé par un groupe homogène de jeunes des villes avec un niveau d'éducation élevé et provenant fréquemment d'une classe sociale assez élevée, l'analyse donne probablement une surestimation du comportement positif. Il semble logique de supposer que les stratégies visant à promouvoir l'utilisation des services dentaires, la complaisance des patients et un style professionnel orienté vers la prévention peuvent être utiles pour améliorer la condition de la santé buccale des jeunes adultes de la population italienne. [source] Help seeking and satisfaction among Latinas: The roles of setting, ethnic identity, and therapeutic allianceJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2005Manuel Paris Jr. This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith-based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299,312, 2005. [source] A population-based cohort study of ambulatory care service utilization among older adultsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2010Jason X. Nie BSc (Hons) Abstract Rationale, aims and objectives, Age-related effects on ambulatory care service utilization are not well understood. We aim to measure the utilization patterns of ambulatory health care services (i.e. family physician visits, specialist physician visits and emergency room visits) in the late life course (65 years and older). Methods, A population-based retrospective cohort study was conducted for the period 1 April 2005 to 31 March 2006. All Ontario, Canada, residents aged 65+ and eligible for government health insurance were included in the analysis. Results, This population-based cohort study demonstrates considerable increase in utilization rates and variability of ambulatory services as age increases. Variations in utilization were observed by gender as overall women were more likely to consult a family physician, and men more likely to visit specialists and the emergency room. A small group of high users, constituting 5.5% of the total population, accounted for 18.7% of total ambulatory visits. Finally, we report socio-economic status (SES) based disparity for specialist services in which high users were more likely to have higher SES. Conclusions, There is increasing utilization and variability in ambulatory service utilization with increase in age. Further research is required to explain the gender and SES differences reported in this study. [source] Brief Motivational Interviewing for DWI Recidivists Who Abuse Alcohol and Are Not Participating in DWI Intervention: A Randomized Controlled TrialALCOHOLISM, Issue 2 2010Thomas G. Brown Background:, Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6- and 12-month follow-up compared to an information-advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Methods:, Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30-minute BMI session or information-advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., ,3 standard drinks/d for males; ,2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse-related behaviors using the MMPI-Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Results:, Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12-month follow-up, which compared to the control intervention (n = 92) represented a significant decline from 6-month levels. Exposure to BMI also produced significantly greater improvement at 6-month follow-up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Conclusions:, Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings. [source] Awareness of early warning signs and help-seeking behaviours among patients with schizophrenia who utilize social rehabilitation facilities in JapanJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2009R. KOICHI rn phn ms Accessible summary ,,Schizophrenia is characterized by the occurrence of psychotic relapses. When this happens, early warning signs such as delusions, hallucinations, thought incoherencies and serious chaotic behaviours occur. ,,In this study, 56.5% of participants who had a history at least one early help-seeking behaviour when they deteriorated was recognized from the following signs: sleep disorders, depression, hallucinations, nervousness, anxiety, fatigue, delusions, illusions and suicidal ideation. ,,Early help-seeking behaviours were related to the following factors: recognition of early warning signs during deterioration, consultation with non-professional and professional support persons during deterioration; consulting with public mental health workers; and living with family. Abstract The purpose of this study was to examine the relationship between early warning signs (EWS) and early help-seeking behaviours (HSB) and to identify the characteristics of patients with schizophrenia who sought early help. A cross-sectional study was carried out in 2004 using a self-reported questionnaire. Participants were recruited from social rehabilitation facilities for the mentally ill; 224 subjects participated, 170 of whom had schizophrenia. The survey included questions about demographic characteristics, self-care behaviours (HSB, recognition of EWS and others) and current service utilization and satisfaction. Fisher's exact test and Student's t -test were used to compare the characteristics of study participants. Logistic regression analyses were used to examine the association between recognition of EWS and early HSB. We found that 96 (56.5%) of 170 patients with schizophrenia reported at least one occasion of early HSB during their deterioration. Early HSB were related to the following factors: recognition of EWS, consultation with non-professional and professional support persons during deterioration, consulting with public mental health workers and living with family. Care and support should be offered to patients with schizophrenia to enable them to recognize their own mental deterioration. [source] Assessment of Dental Caries Predictors in a Seven-year Longitudinal StudyJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2006Elaine Pereira da Silva Tagliaferro DDS Abstract Objective: To identify, in a group of 6,8-year-old schoolchildren, risk factors for dental caries increment in permanent dentition. Methods: Two hundred and six children from three different schools in Piracicaba, Brazil, were examined at baseline and after 7 years by the same two calibrated dentists. Data on dental caries (dmfs, DMFS, presence of initial lesions), fluorosis, oral hygiene and presence of sealant were collected at the clinical examination that was performed in an outdoor setting, under natural light, using a dental mirror and probe following the WHO recommendations. Information on socioeconomic level, fluoride usage, dental service utilization, dietary and oral hygiene habits was also obtained at baseline in a semi-structured questionnaire sent to the parents. The dependent variable was the 7-year DMFS increment. A univariate analysis was performed to test the association of independent variables in caries increment. Then a logistic regression model was used to estimate the adjusted Odds Ratio for caries increment. Results: Clinical (dmfs, DMFS) and non-clinical variables (daily toothbrushing, use of preventive topical methods, parents' educational level) were entered in the multiple logistic regression analysis. The prediction model included the clinical and socioeconomic variables, DMFS, dmfs and mother's educational level. The best caries predictor was the dmfs variable. Conclusion: Caries experience and mother's educational level were predictors of caries increment in permanent dentition. [source] Demographic Factors Associated with Dental Utilization Among Community Dwelling Elderly in the United States, 1997JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2006Daniel D. Skaar DDS Abstract Objectives: The purpose of this study was to characterize dental service utilization in 1997 by community dwelling Medicare beneficiaries. Methods: The Medicare Current Beneficiary Survey, or MCBS, is a continuous annual series of nationally representative surveys of Medicare beneficiaries. Univariate comparisons were made between dependent variables (dental utilization and types of dental services) by each of the independent variables (age group, gender, race, income, education, population density, marital status and US Census Bureau regions using weighted proportions to test for independence between dependent and independent variables. Results: Overall, an estimated 41% of the population had a dental visit. Although utilization declined with aging, 24% of those 85 and older visited a dentist. Conclusions: This descriptive study provides important information about dental utilization and services in the American elderly population. Younger, high income, white or educated elderly Americans had higher dental utilization. [source] Screening for Alcohol Problems in the U.S.ALCOHOLISM, Issue 11 2002Ethnicity, General Population: Comparison of the CAGE, RAPS, RAPS4-QF by Gender, Service Utilization Background The purpose of this study was to compare the performance (sensitivity and specificity) of two brief screening instruments, CAGE and the Rapid Alcohol Problems Screen 4 (RAPS4), against ICD-10 and DSM-IV criteria for alcohol dependence and abuse in a representative sample of the U.S. adult household population by gender, ethnicity, and service utilization (emergency room and primary care) in the last year. Methods Data are from the Alcohol Research Group's 2000 National Alcohol Survey (n= 7612), which is a computer-assisted telephone interview survey of the U.S. general population 18 and over in all 50 U.S. states and the District of Columbia. Results Sensitivity of the RAPS4 (0.86) was better than the CAGE (0.67) given similar specificity (0.95 vs. 0.98) and outperformed the CAGE for alcohol dependence across all gender, ethnic, and service utilization groups, except among blacks and Hispanics. The RAPS4 also performed equally well for females and males (0.88 vs. 0.85), whereas sensitivity of the CAGE was lower for females. Although sensitivity of the RAPS4 was better than the CAGE for alcohol abuse, sensitivity was low for both (0.56 and 0.36, respectively). When quantity-frequency (QF) questions (drinking five or more drinks on at least one occasion during the last year and drinking as often as once a month during the last year) were added to the RAPS4, the RAPS4-QF performed significantly better for alcohol abuse and outperformed the CAGE at a cut point of one across all gender, ethnic, and service utilization groups. The RAPS4-QF appeared to be most sensitive for alcohol abuse among both males and females reporting emergency room use (0.90). Conclusions The data suggest that the RAPS4 outperforms the CAGE in this general population sample. The addition of a QF question to the RAPS4 improves performance in relation to sensitivity for alcohol abuse, and the RAPS4 and RAPS4-QF may be the instruments of choice in brief screening for alcohol use disorders. Additional research is needed to further explore these issues. [source] | |||||||||||||||||||||||||||||||