Rates Of Health Service Utilization Research Articles

Comparing the effectiveness and cost-effectiveness of alternative Type 2 Diabetes monitoring intervals in resource limited settings.

Type 2 Diabetes (T2D) represents a growing disease burden in South Africa. While glycated haemoglobin (HbA1c) testing is the gold standard for long-term blood glucose management, recommendations for HbA1c monitoring frequency are based on expert opinion. This study investigates the effectiveness and cost effectiveness of alternative HbA1c monitoring intervals in the management of T2D. A Markov model with three health states (HbA1c <7%, HbA1c ≥ 7%, Dead) was used to estimate lifetime costs and quality-adjusted-life-years (QALYs) of alternative HbA1c monitoring intervals among patients with T2D, using a provider's perspective and a 3% discount rate. HbA1c monitoring strategies (three-monthly, four-monthly, six-monthly, and annual tests) were evaluated with respect to the incremental cost-effectiveness ratio (ICER) assessing each comparator against a less costly, undominated alternative. The scope of costs included the direct medical costs of managing diabetes. Transition probabilities were obtained from routinely collected public sector HbA1c data, while health service utilization and health-related-quality-of-life (HRQoL) data were obtained from a local cluster randomized controlled trial. Other parameters were obtained from published studies. Robustness of findings was evaluated using one-way and probabilistic sensitivity analyses. A South African indicative cost-effectiveness threshold of USD2,665 was adopted. Annual and lifetime costs of managing diabetes increased with HbA1c monitoring, while increased monitoring provides higher QALYs and Life Years. For the overall cohort, the ICER for six-monthly vs annual monitoring was cost-effective (USD 2,322.37 per QALY gained), whereas the ICER of moving from six-monthly to three-monthly monitoring was not cost-effective(USD 6,437.79 per QALY gained). The ICER for four-monthly vs six-monthly monitoring was extended dominated. The sensitivity analysis showed that the ICERs were most sensitive to health service utilization rates. While the factors influencing glycaemic control are multifactorial, six-monthly monitoring is potentially cost-effective while more frequent monitoring could further improve patient HrQoL.

Mental health priorities and cultural-responsiveness of the Mental Health First Aid (MHFA) training for Asian immigrant populations in Greater Boston, Massachusetts

BackgroundAsians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 − 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond.MethodsThis is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews.ResultsIn total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese).ConclusionCultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.

Developing the Social Cognitive Factor Scale (SCFS) to analyze the determinants influencing the utilization of traditional chinese medicine preventive health services among older adults

IntroductionTraditional Chinese medicine (TCM) boosts immunity, aids self-repair, and supports elderly health. Despite government efforts, older adults underutilize TCM preventive health services. This study aimed to develop a reliable and valid Social Cognitive Factor Scale (SCFS) to understand this from a behavioral psychology perspective. MethodsThe SCFS, a self-report questionnaire rooted in Bandura's social cognitive theory, was developed by an expert panel using insights from current literature, focus group qualitative research, and scale testing. Twenty experts in TCM public health research and 840 community-dwelling older adults were included in this study. Scale development involved a literature review to establish the initial item pool, two Delphi expert consultations for item screening and revision, and comprehensive testing for reliability and effectiveness. ResultsThe SCFS consisted of 22 items classified into six dimensions: perceived environment, social support, belief and knowledge, self-efficacy, outcome expectations, and self-regulation. The overall Cronbach's alpha of the scale was 0.946, and the split-half reliability of the total scale was 0.828, showing good reliability. A total of six factors were extracted, explaining 78.85 % of the total variation. Exploratory factor analysis showed that the scale had good construct validity. Scores on the SCFS were significantly and positively correlated with the utilization rate of TCM preventive health services for older adults (r = 0.537, p < 0.01). ConclusionTCM plays a significant role in actively addressing the challenges of aging. The SCFS provides a reliable and valid tool for understanding the underutilization of TCM preventive health services among older adults. A positive correlation with service utilization rates highlights its potential for guiding interventions.

Chinese university students’ help-seeking behaviors when faced with mental health challenges

Background Mental illnesses and mental health challenges have become increasingly pervasive among Chinese university students. However, the utilization rate of mental health services is low among students. Aims We aimed to explore Chinese university students’ help-seeking behaviors to understand how they deal with mental health challenges and use the results to inform the development of effective mental health promotion initiatives. Methods In this study, we conducted 13 focus group interviews with students in six universities in Jinan, China, including 91 (62%) female students and 56 (38%) male students. We drew on the Theory of Planned Behaviors to guide our thematic analysis to gain a contextual understanding of participants’ accounts on help-seeking. Results Our results have depicted the help-seeking patterns of Chinese university students and show that there are four major behaviors which are self-reliance, seeking support from peers and families, seeking professional support, and accessing virtual mental health care. Conclusion Results from this study can be used to inform the development of mental health literacy programming for students in universities that share similar contexts, and the study has also opened up a new space for using qualitative approaches to study mental health needs and access to care in diverse populations.

Symptoms of depression and risk of emergency department visits among people aged 70 years and over.

Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged [Formula: see text]70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.

The action logic of the older adults about health-seeking in South Rural China

BackgroundThe Chinese government has invested significant resources to build many rural healthcare stations. However, in the face of convenient medical paths and accessible medical resources, the utilization rate of health services for older adults in rural areas is surprisingly low. This study explored why health-seeking behavior among older adults in rural China was not active.MethodsData were collected through participatory rural appraisal (PRA) with 108 participants in 12 villages in southern China. Daily schedule and social and resource mapping were employed to outline the range of activities and the routine of the older adults, as well as in-depth interviews to understand the logic of their healthcare choices. Data collected were analyzed by content analysis.ResultsThree themes were generated: (1) perceptions of health status (being healthy or sick): the rural older adults used the ability to handle routine chores as a measure of health status; (2) prioritization of solving symptoms over curing diseases: the older adults preferred the informal self-medication to cope with diseases, as long as there were no symptoms and no pain; (3) ‘unpredictable’ troubles: they tended to favor the ‘optimal’ solution of keeping their lives in order rather than the best medical treatment options.ConclusionThis study showed that the medical practices of the rural elderly were profoundly influenced by their perceptions of health and their life experiences. In the face of diseases, they tended to keep their lives in order, preferring self-treatment practices that address symptoms or selectively following medical advice rather than medical and science-based clinical solutions. In the future, the construction of rural health care should focus on changing the ‘inaccessibility’ of healthcare resources at the subjective level of the rural elderly and develop culturally adaptable health education.

Impact of Opt-Out Therapy Appointments on Resident Physicians' Mental Health, Well-Being, Stigma, and Willingness to Engage.

Background Health care professionals report higher levels of mental health symptoms, pandemic-related stress, personal health concerns, and reduced proactive coping, especially in recent years marked by the COVID-19 pandemic. As physician utilization rates of mental health and well-being services remain low, the need for preemptive care is crucial. Objective The present study sought to ascertain satisfaction, value, and attitude toward future mental health services among resident physicians. Methods Throughout the 2020-2021 academic year, resident physicians within 8 training programs at a large academic training hospital were offered single opt-out mental health appointments from hospital-funded, graduate medical education wellness staff at no cost to the resident. Appointments were conducted virtually during protected work time. A survey was sent to participants within 2 weeks following their appointment. Results A total of 153 residents (postgraduate years 1 to 7) were offered one-time opt-out appointments. Overall, 91 (59%) residents attended their opt-out appointments. Survey response rate was 57% (n=52). Respondents reported high levels of satisfaction (96%, 50 of 52), felt the appointment was worth their time (96%, 50 of 52), and felt that the opt-out appointments demonstrated training programs cared about their well-being (94%, 49 of 52). Nearly all residents (98%, 51 of 52) recommended appointments be offered to future residents. Most respondents (80%, 42 of 52) indicated that appointments increased their willingness to engage in mental health services. Conclusions Opt-out appointments increased resident willingness to engage in mental health services, positive attitudes toward future mental health services, perceived training program's care about their well-being, and reduced perceived mental illness stigma.

Effectiveness and impact of community-based health insurance on health service utilization in northwest Ethiopia: a quasi-experimental evaluation.

Addressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services' utilization and its impact in northwest Ethiopia. A quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically. The evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization. The CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.

Self-reported stressors experienced by migrant youth in Canada

BackgroundFirst-generation migrant youth experience higher levels of stress than their Canadian-born counterparts but have lower mental health service utilization rates. ObjectiveThe present study aims to report on the social context of migrant youth, focusing on their own experiences of post-migration stressors that impact their mental health. MethodsThe study utilized Concept Mapping in which participants responded to the open-ended question “What are the mental health stressors that you face?”. Youth participants then independently grouped responses made by all youth into concepts. ResultsParticipants grouped the statements into seven concepts, including stressors associated with family, isolation, communication, anxiety, overburdened, school difficulties and working with others. ConclusionsPost-migration stressors for migrant youth exist in a social context where they experience racism and discrimination. The stressors can intersect and accumulate, leading to the perceived necessity and associated pressure to meet others’ expectations.

Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance

This cross-sectional study examines telehealth, in-person, and overall pediatric mental health service utilization and spending rates from January 2019 through August 2022 among a US pediatric population with commercial insurance.

Comparative Analysis of Influencing Factors of Health Service Utilization Among Urban and Rural Residents in Tibet

To examine the differences and commonalities of factors influencing the utilization of health services among urban and rural residents in Tibet and to identify vulnerable populations in the utilization of health services, thereby providing references for the formulation of local health policies and the allocation of health resources. Using the Tibetan area data from the Sixth National Health Service Survey, we conducted statistical analysis of the health service utilization status of 8 297 residents of agro-pastoral areas and 2 179 residents of urban areas with χ 2 test and logistic regression model. The two-week outpatient visit rates of residents in agro-pastoral areas and that of the urban residents were 65.3% and 57.1%, respectively, and the one-year hospitalization rates were 8.3% and 8.9%, respectively. The influencing factors of two-week outpatient visits for rural and pastoral residents included urban and rural health insurance coverage, Three Guarantees in One coverage, distance to medical facilities, chronic disease status, physical examination, family doctor contract status, employment status, and health status self-assessment. The influencing factors of two-week outpatient visit for urban residents included chronic disease status, urban and rural medical insurance coverage, health status self-assessment, health records, and physical examination. The factors influencing hospitalization for agro-pastoral residents were sex, age, marital status, urban and rural medical insurance coverage, Three Guarantees in One coverage, critical illness insurance, health self-assessment, mobility, health records, physical examination, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The factors influencing the hospitalization of urban residents were sex, marital status, health status self-assessment, health records, urban employee medical insurance coverage, and chronic disease status. The urban and rural residents in Tibet have relatively poor health and their awareness of seeking early medical help after they fall ill is relatively weak. The health institutions concerned should dedicate more attention to the vulnerable populations who have difficulty accessing health services, focus on the commonly shared influencing factors of health service utilization among urban and rural residents, take into account the differences, rationally allocate health resources, and improve the effective utilization rate of health services among residents in Tibet.

Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022

This cohort study assesses trends in monthly telehealth vs in-person utilization and spending rates for mental health services among commercially insured US adults before and during the COVID-19 pandemic.

Suicide Prevention Training in the Anti-Human Trafficking Sector: An Evaluation Study

ABSTRACT Human trafficking survivors report high rates of suicidal ideation and behavior. However, limited training on suicide prevention among anti-human trafficking service providers, stigma, low utilization rates of mental health services, and lack of evidence-based, culturally-congruent interventions create barriers for survivors in receiving needed support. Prior research has identified capacity building in suicide prevention as a critical priority in the anti-trafficking sector. Yet, limited research has been conducted regarding the effectiveness of training programs. In this study, we evaluate a 14-week multi-modal suicide prevention training program, the Suicide Learning Sessions (SLS) series, which was implemented with service providers at an anti-trafficking nongovernmental organization in the Philippines. We analyzed qualitative data from focus group discussions and open-ended surveys to understand practitioners’ experiences in this training program and its impact upon their ongoing work with survivors (n = 12). Themes included: decreasing stigma and misconceptions, practical skill development, grounding and structure, benefits of multi-modal training, reduced fear and dread, and lessening emotional burdens. We conclude with recommendations for developing the capacity of anti-human trafficking service providers, particularly those who are non-mental health professionals, in suicide prevention and intervention.

Utilization Rate of Primary Health Services in the Diagnosis, Treatment, and Follow-Up of Patients Diagnosed with Rheumatic Disease

In this study, we aimed to investigate the utilization of primary health care in the diagnosis, treatment and follow-up of patients diagnosed with rheumatic disease. For this purpose, 350 patients with rheumatic disease were included in the survey and 26-question about the demographic information of the patients, utilization of primary health care during and afterwards the diagnosis process of the disease. The mean age of the participants was 48.67±13.26, and 73.7% (n=258) of them were female. The patients were diagnosed with rheumatic disease an average of 6.74±6.07 years ago. Joint pain was the most common complaint with a rate of 79.7%. 22% (n=77) of the patients were referred to first internal medicine outpatient department. First admission rate to a family physician was 12.3% (n=43) and 55.8% (n=24) of these patients were referred to higher care for diagnosis. 69.1% (n=242) of the patients were diagnosed in a tertiary healthcare institution. According to the analysis results, 47.7% of the patients had a prescription from their family physician for their rheumatic diseases, but only 6% (n=21) went to their primary care physician for check-ups for their rheumatic diseases. In our study, the rate of use of primary care services was high when patients' rheumatic disease symptoms first begin and were only prescribed prescription drugs after diagnosis. The tendency to prefer primary care for follow-up was low. Contributing to all processes of the rheumatic disease will reduce the workload of hospitals and contribute to a cost-effective approach. For this, the factors that will eliminate the negative perceptions of patients towards primary care can be reviewed and the rate of patients' preference for primary care can be increased.

Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students.

In the American Indian and Alaska Native (AIAN) population there is a discrepancy between high rates of mental health needs and low utilization rates of mental health services. This study sought to explore whether historical trauma and racial discrimination are associated with health care system (HCS) distrust and negative attitudes toward seeking mental health services. Participants were AIAN college students (n = 392) who completed a cross-sectional online survey. A sequential mediation analysis examined whether historical trauma (thoughts and associated symptoms) was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. A second mediation analysis examined whether perceived racial discrimination was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. Greater reported historical trauma (thoughts and associated symptoms) and racial discrimination were associated with greater distrust of the HCS, which in turn was associated with less favorable attitudes toward seeking mental health services. Perceived racial discrimination was also directly associated with less favorable attitudes toward seeking mental health services. Historical trauma and perceived racial discrimination appear to contribute to less favorable attitudes toward seeking mental health services through their association with distrust of the HCS. This suggests that attempts to address the underutilization of mental health services in the AIAN population should consider the potential roles of historical trauma, racial discrimination, and distrust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Unmasking hidden disparities: a comparative observational study examining the impact of different rurality classifications for health research in Aotearoa New Zealand

ObjectivesExamine the impact of two generic—urban–rural experimental profile (UREP) and urban accessibility (UA)—and one purposely built—geographic classification for health (GCH)—rurality classification systems on the identification of rural–urban health disparities in...

Prevalence of Mental Disorders and Associated Factors in Korean Adults: National Mental Health Survey of Korea 2021.

Mental health is a global concern and needs to be studied more closely. We aimed to estimate the prevalence of mental disorders and their associated factors among the general population in Korea. The National Mental Health Survey of Korea 2021 was conducted between June 19 and August 31, 2021 and included 13,530 households; 5,511 participants completed the interview (response rate: 40.7%). The lifetime and 12-month diagnosis rates of mental disorders were made using the Korean version of the Composite International Diagnostic Interview 2.1. Factors associated with alcohol use disorder (AUD), nicotine use disorder, depressive disorder, and anxiety disorder were analyzed, and mental health service utilization rates were estimated. The lifetime prevalence of mental disorders was 27.8%. The 12-month prevalence rates of alcohol use, nicotine use, depressive, and anxiety disorders were 2.6%, 2.7%, 1.7%, and 3.1%, respectively. The risk factors associated with 12-month diagnosis rates were as follows: AUD: sex and age; nicotine use disorder: sex; depressive disorder: marital status and job status; anxiety disorder: sex, marital status, and job status. The 12-month treatment and service utilization rates for 12-month AUD, nicotine use disorder, depressive disorder, and anxiety disorder were 2.6%, 1.1%, 28.2%, and 9.1%, respectively. Approximately 25% of adults in the general population were diagnosed with mental disorders during their lifetime. The treatment rates were substantially low. Future studies on this topic and efforts to increase the mental health treatment rate at a national level are needed.

Trends and correlated outcomes in population-level prescription opioid and transdermal fentanyl use in Israel

BackgroundIn the last twenty years, there was a documented increase in prescription opioid procurement in Israel. However, there is still little evidence of the association between opioid procurement rates, health service utilisation in secondary care, and enrollment rates to substance use disorder treatment programmes. In this study, we show trends in the reports of opioid-related hospitalisations, emergency department visits, enrollment to community-based outpatient treatment for Prescription Opioid Use Disorder and opioid-related mortality rates. Additionally, we examine potential correlations between these health service utilisation rates and prescription opioid procurement rates at the population level, with a focus on transdermal fentanyl.MethodsA longitudinal study at the population level. We used seven-year data on indicators of opioid-related morbidity, prescription opioid procurement data for 2015–2021, and six-year opioid-related mortality data for 2015–2020. We measure the correlation between procurement rates of prescription opioids in Oral Morphine Equivalent per capita, and aggregated rates obtained from hospital administrative data for hospitalisations, emergency department visits, and patient enrolment in specialised prescription opioid use disorder outpatient treatment in the community setting.ResultsBetween 2015 and 2021, procurement rates in primary care per capita for all prescription opioids increased by 85%, while rates of transdermal fentanyl procurement increased by 162%. We found a significant positive correlation at the population level, between annual opioid procurement rates, and rates per population of opioid-related visits to emergency departments (r = 0.96, p value < 0.01, [CI 0.74–0.99]), as well as a positive correlation with the rates per population of patient enrolment in specialised prescription opioid use disorder outpatient treatment (r = 0.93, p value = 0.02, [CI 0.58–0.99]). Opioid-related mortality peaked in 2019 at 0.31 deaths per 100,000 but decreased to 0.20 deaths per 100,000 in 2020.ConclusionData shows that all-opioid and transdermal fentanyl procurement has increased yearly between 2015 and 2021. This increase is positively correlated with a growing demand for community-based Prescription Opioid Use Disorder outpatient treatment. Efforts to reduce opioid-related morbidity may require effective approaches toward appropriate prescribing, monitoring, and further increasing access to prescription opioid outpatient treatment.

Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic

The COVID-19 pandemic has been associated with an elevated prevalence of mental health conditions and disrupted mental health care throughout the US. To examine mental health service use among US adults from January through December 2020. This cohort study used county-level service utilization data from a national US database of commercial medical claims from adults (age >18 years) from January 5 to December 21, 2020. All analyses were conducted in April and May 2021. Per-week use of mental health services per 10 000 beneficiaries was calculated for 5 psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD). Changes in service utilization rates following the declaration of a national public health emergency on March 13, 2020, were examined overall and by service modality (in-person vs telehealth), diagnostic category, patient sex, and age group. The study included 5 142 577 commercially insured adults. The COVID-19 pandemic was associated with more than a 50% decline in in-person mental health care service utilization rates. At baseline, there was a mean (SD) of 11.66 (118.00) weekly beneficiaries receiving services for MDD per 10 000 enrollees; this declined by 6.44 weekly beneficiaries per 10 000 enrollees (β, -6.44; 95% CI, -8.33 to -4.54). For other disorders, these rates were as follows: anxiety disorders (mean [SD] baseline, 12.24 [129.40] beneficiaries per 10 000 enrollees; β, -5.28; 95% CI, -7.50 to -3.05), bipolar disorder (mean [SD] baseline, 3.32 [60.39] beneficiaries per 10 000 enrollees; β, -1.81; 95% CI, -2.75 to -0.87), adjustment disorders (mean [SD] baseline, 12.14 [129.94] beneficiaries per 10 000 enrollees; β, -6.78; 95% CI, -8.51 to -5.04), and PTSD (mean [SD] baseline, 4.93 [114.23] beneficiaries per 10 000 enrollees; β, -2.00; 95% CI, -3.98 to -0.02). Over the same period, there was a 16- to 20-fold increase in telehealth service utilization; the rate of increase was lowest for bipolar disorder (mean [SD] baseline, 0.13 [16.72] beneficiaries per 10 000 enrollees; β, 1.40; 95% CI, 1.04-1.76) and highest for anxiety disorders (mean [SD] baseline, 0.20 [9.28] beneficiaries per 10 000 enrollees; β, 9.12; 95% CI, 7.32-10.92). When combining in-person and telehealth service utilization rates, an overall increase in care for MDD, anxiety, and adjustment disorders was observed over the period. In this cohort study of US adults, we found that the COVID-19 pandemic was associated with a rapid increase in telehealth services for mental health conditions, offsetting a sharp decline in in-person care and generating overall higher service utilization rates for several mental health conditions compared with prepandemic levels.

Integrality, absenteeism and resolubility of specialized care for pediatric patients: a cross-sectional study.

Dental Specialties Centers (CEOs) are clinics representing part of the secondary oral health care system of the Brazilian Unified Health System (SUS). Pediatric dentistry is not a requirement for service accreditation. However, the CEO of the Federal University of Rio Grande do Sul (CEO-UFRGS) has provided dental care for children aged 3-11 years since 2017. The utilization rates of health services are influenced by absenteeism. Therefore, evaluation of absences for dental appointments is of primary importance. This study aimed to evaluate referral characteristics, absenteeism, and resolubility of pediatric dentistry appointments at the CEO-UFRGS. This retrospective cross-sectional study was conducted at the Dental Teaching Hospital of the university and analyzed secondary data from referrals and medical records. From August 2017 to December 2019, 167 referrals and 96 medical records were reviewed, from which data of individual variables related to the referral process and treatment were collected. Data were collected by a single trained examiner and analyzed using SPSS software. The main reasons for referral to secondary care were dental caries and pulpal or periapical diseases associated with difficult-to-manage behavior. An absenteeism rate of 28.1% at the first pediatric dental visit and a resolution rate of 65.6% were found. Binary logistic regression analysis indicated that each day of waiting for specialized care resulted in a 0.3% of higher chance of absence for appointment. This also increased the chance by 0.7% in child who attended the first visit to complete treatment, suggesting that the waiting time for attendance was associated with absenteeism and resolubility. Public policies that expand providing child dental care in secondary care are recommended to improve access to and resolubility of services.