Patterns Of Service Use Research Articles

Predicting patterns of service utilization within children\u2019s mental health agencies

BackgroundSome children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns.MethodsLatent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit.ResultsFive patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children’s pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits.ConclusionsOptimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.

Service provision for depressed children and youth: a survey of the scope and nature of services in Ontario

BackgroundThe worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines.MethodsSeveral government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities.Results413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13–17 (70%) and transition aged youth (18–25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities.ConclusionsThis study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.

Using administrative data to understand the service interactions of people experiencing homelessness

It is recognized that people experiencing homelessness have complex trajectories through multiple agencies, including emergency health and homelessness services. Though there is a large body of quantitative evidence from the United States and some Scandinavian countries on the service interactions of people experiencing homelessness, the evidence base in the UK is mainly limited to qualitative studies and small scale surveys. This paper therefore addresses this evidence gap, by presenting initial findings from a longitudinal linked administrative data study, linking together data on people seeking assistance with homelessness in a single local authority in Wales along with routinely collected data from public services. In addition to exploring the overall patterns of service use by people experiencing homelessness, latent class analysis was used in order to generate a typology of service experience, in acknowledgement that not all homeless people are the same. Due to the movement of people through multiple institutional systems, administrative data are an ideal data source for researching this aspect of homelessness. It is hoped that through the creation of a typology of service, this can be used to provide a greater understanding of Welsh homelessness, thereby allowing for a more effective targeting of services and improving the pathways of people experiencing homelessness through public services.

Implementing and Evaluating the CYPHP Evelina London new care model to improve health, healthcare quality, and patterns of service use among children and young people

Background: Children and young people’s (CYP) health outcomes in England are variable and often poor. Health systems throughout high income countries are struggling to adapt to epidemiological transitions, social change, rising demand, and budget cuts. There was a 58% rise in CYP attending EDs between 2007 and 2016, projected to rise 50-60% more by 2030. CYP from the most deprived backgrounds are 60-70% more likely to go to A&E than the least deprived. The majority of ED attendances by CYP are manageable in primary care or integrated models, yet 85% of ED attendances are for minor illnesses, increasing 5% annually. The Children and Young People’s Health Partnership (CYPHP) is a health system strengthening initiative implementing and evaluating a new model of care. Methods: Health system strengthening using the WHO building blocks model included service design by analysis of population need, systematic literature reviews, and extensive patient and public involvement. An evidence-based implementation plan was agreed for a child population of 90,000 in London, and we are evaluating using a cluster randomised control trial (cRCT) design with nested process evaluation and qualitative studies to assess CYP health and wellbeing, healthcare quality, patterns of healthcare use, and cost effectiveness. Results: CYPHP’s comprehensive care includes health promotion and supported self-management, proactive case-finding, biopsychosocial assessment and self-referral via a patient portal, with care delivered by a multidisciplinary team. Services are integrated vertically and horizontally incorporating physical and mental healthcare. Implementation has taken two years longer than anticipated due to technical and cultural challenges of health system strengthening. Early results indicate a reduction of 72 ED contacts per 100 children with asthma, 30 for children with epilepsy, and 15 for children with constipation. We estimate cost savings per 100 asthma patients to be over £15,000, for epilepsy over £6,000, and for constipation over £3,000. Of the first 200 patients, most were from socially deprived areas and 68% were from black and minority ethnic groups. Families report more confidence in managing their child’s condition. Discussion: As a clinical academic partnership, CYPHP combines pragmatic quality improvement and rigorous health services research. CYPHP demonstrates that health system strengthening in high income countries is feasible and effective for implementing and testing new models of care to improve child health. Conclusions: Early results suggest encouraging impact on patterns of healthcare use and potential cost savings. CYPHP’s population health approach provides care for those with greatest health and social need. Lessons learned: Rigorous health services and systems research is feasible in large scale system change in the NHS. Health system strengthening is a new concept in high income countries. It is slow and difficult, but important for effective implementation of new models of care. Fully integrated comprehensive models of care for children may improve health and healthcare outcomes. Limitations: Results are preliminary and reflect early implementation. Suggestions for future research: Rigorously designed health services research for ongoing large-scale health systems changes are an important source of new knowledge. There are few examples of such opportunistic research, representing new avenues for opportunity.

New integrated care models to improve health, healthcare quality, and patterns of service use among children and young people

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia.

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

Disparities Based on Race, Ethnicity, and Socioeconomic Status Over the Transition to Adulthood Among Adolescents and Young Adults on the Autism Spectrum: a Systematic Review.

Few studies have examined disparities in autism services and functional outcomes over the life course. Transition to adulthood is an especially important developmental period, as it sets up trajectories of adult functioning. This systematic review summarizes patterns of service use and transition outcomes according to race, ethnicity, and socioeconomic characteristics over the transition to adulthood. Forty studies were included. Low-income and racial/ethnic minority youth on the autism spectrum were less likely to participate in transition planning meetings, enroll in postsecondary education, find competitive employment after high school, live independently, participate in social activities, and receive health care transition services than their White and higher income peers on the autism spectrum. Racial/ethnic minority and low-income youth on the autism spectrum were more likely to be disconnected from educational, occupational, and social activities upon entering adulthood. Future research should explore the mechanisms underlying these disparities as a first step to addressing them.

1817. Benchmarking Outpatient Antimicrobial Use in Manitoba Through Population-Based Research

BackgroundIn Canada, there is limited knowledge about benchmarking and trends in provincial outpatient antimicrobial prescribing. We used de-identified population-level data (including all outpatient prescription dispensations) to describe and analyze temporal trends in antimicrobial prescribing and to determine what population level indicators best assess quality of antibiotic prescribing in outpatients.MethodsThis population-based study used data from the Manitoba Population Research Data Repository, a comprehensive provincial collection of administrative, registry, and other data about residents of Manitoba, including health, education, and social services, all linked by a unique identifier. The first of three project objectives focused on examining prescription utilization trends for antimicrobials in the overall population by drug subclass as prescriptions/1,000 individuals/day between 2011 and 2016. Crude and age- and sex-adjusted rates as well as relative rates were calculated using SAS V9.4.ResultsThe adjusted prescription rates by RHA relative to the RHA with the lowest rates (Southern RHA) in 2016 showed substantial variation across regions, with one region’s rate 1.48 times greater than Southern RHA (P < 0.0001). In 2016, there were 878, 416 antibiotic prescriptions overall in the province of Manitoba. Of these, 86.33% (758,295) were from physicians, 9.42% (82, 778) were from dentists, 3.94% (34,611) from nurse practitioners, 0.26% (2315) from pharmacists, and 0.01% (81) from midwives. In 2016, the proportion of outpatient visits that resulted in an antibiotic prescription by age group, were 18.2% (1–4 years old), 15.3% (5–9 years), 11.1% (10–14), 8.2% (15–64), 5.3% (65+ years).ConclusionIn Manitoba, there is substantial variability in the rate of antimicrobial prescribing across regions, despite adjustment for differing age and sex distribution. There is a considerable amount of antimicrobial prescribing by nonphysicians. Future phases of this deliverable will focus on patterns of service use of antimicrobials across Manitoba, including appropriateness. The goal would be to develop a province-wide framework for prescriber prescribing feedback reporting, to our knowledge, the first of its kind in Canada.Disclosures All authors: No reported disclosures.

Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry.

Nursing home (NH) care is expensive and restrictive. Understanding trajectories to NH entry among people with multiple sclerosis (MS) could facilitate monitoring and early risk identification. We investigated 10-year trajectories of health care use in matched cohorts of people with MS who did and did not enter NH, the characteristics associated with trajectory group membership, and whether group membership predicted NH entry. We used population-based administrative (health claims) data from Manitoba, Canada, to identify 226 NH entrants with MS between January 2005 and December 2012 and 896 age-, sex- and geographically matched non-NH entrants with MS. Using semiparametric group-based trajectory approaches, we described trajectories for 5 measures of health care utilization: physician visits, medications, hospital days and their intensity, and home care days. Using multivariable logistic models, we determined whether membership in a trajectory group predicted NH entry. Mean (SD) age at MS diagnosis was 48.35 (13.25) years for NH entrants and 44.91 (11.58) for nonentrants. Most patients were female (NH entrant, 64%; nonentrant, 61%). Over the study period, trajectories for physician visits and medication use were relatively stable, while trajectories for hospital days and home care increased. High use trajectories for hospital days and medication use were associated with NH entry, while higher use of ambulatory physician visits was associated with a 40%-60% lower risk of NH entry. Complex patterns of service use and underlying need contribute to NH entry among people with MS. An increasing number of hospital days is strongly associated with NH entry.

Australian parents' use of universal child and family health services: A consumer survey.

This study aimed to explore Australian parents' use of universally available well-child health services. It used an online survey of 719 parents of children aged from birth to 5years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents' use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well-child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.

Trajectory of service use among young Albertans with complex needs

IntroductionYouth with complex-needs are vulnerable as a consequence of exposure to social adversity and/or chronic health conditions, and are at a high risk of school failure and justice involvement. Information about the patterns of service use across government sectors that influence the life outcomes of complex-needs youth is unknown.&#x0D; Objectives and ApproachYouth with complex needs often engage with multiple services across multiple government sectors for extended periods of time. Understanding the patterns and trajectory of their service use may inform programs, decision makers and government in the optimal allocation of resources to increase their life outcomes. It may reveal where and when interventions would be most effective to improve the life course for vulnerable youth. In this study, through a unique approach to link over 20 administrative longitudinal datasets and a novel trajectory clustering technique, the patterns of service use among complex-needs young Albertans is revealed and visualized.&#x0D; ResultsA trajectory clustering technique was applied to reveal patterns of service use among complex-needs individuals. Compared to the general population, higher proportions of youth with complex needs lived in low socio-economic neighborhoods, suffered from mental health issues, were high cost health service users, and had lower rates of high school completion. Furthermore, youth having complex needs for a longer period of time and who required multiple complex services in a given year had the poorest outcomes, in terms of high school completion, mental health issues, and other health problems. The majority of complex-needs youth came in contact with services via the education system, followed by child services/welfare.&#x0D; Conclusion/ImplicationsThe trajectories of service use among complex-needs youth reveals that these individuals are primarily identified through education. Consequently, educational supports would best address the development of effective programs including mental health supports and other needs.

Determinants of treatment of mental disorders in Lebanon: barriers to treatment and changing patterns of service use

To investigate for the first time the determinants and barriers of seeking help for mental disorders in the Arab world based on a national study: Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N). A nationally representative (n = 2857) and multistage clustered area probability household sample of adults ≥18 years and older was assessed for lifetime and 12 months mental disorders using the Composite International Diagnostic Interview. In addition, detailed information was obtained on help- seeking behaviour and barriers to treatment. In total, 19.7% of the Lebanese with mental disorders sought any type of treatment: 91% of those who sought treatment did so within the health sector. Severity and perceived severity of disorders predicted seeking help, the highest being for panic disorder. The greatest barrier to seek help was low perceived need for treatment (73.9%). Stigma was reported to be a factor only in 5.9% of those who thought about seeking treatment. Eighty per cent of the Lebanese reported they would not be embarrassed if friends knew they were seeking help from a professional. A small fraction of Lebanese seek help for their mental health problems: female gender, higher education and income are predictors of positive attitudes to help seeking. Severity and recognition of disorders, more than stigma, to get treatment seem to be the most important factors in determining help seeking. The findings underscore the importance of helping the public recognise mental health disorders.

The last possible resort: Latin American migrants’ rapport with Spanish healthcare

PurposeThe purpose of this paper is to analyze the relationship between Latin American migrants and the Spanish healthcare system, from the users’ perspective, in order to examine the socio-cultural determinants for access and attention, as well as the possible difficulties faced when attending institutional facilities.Design/methodology/approachThis work is based on qualitative ethnographic research with the Latin American community established in the region of Castile and León, Spain. Analysis was established through a thematic approach and illustrated with the testimonies of participants involved, to inspect personal meanings and interpretations, as well as specific practices regarding healthcare.FindingsThe encounter between foreigners and health services is frequently expressed with negative emotions, such as feelings of fear facing a system that is perceived as designed “for others.” For many Latin American immigrants in Spain, institutional healthcare is not considered their first choice for treating illness. This has been related to economic, bureaucratic, ideological and emotional factors.Originality/valueMost of the existing literature about immigrant healthcare in Spain has focused on sanitary conditions or patterns of service use from an institutional perspective and a quantitative approach. This paper highlights the perceptions of users to enrich comprehension of the rapport between migrants and medical care.

Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity.

The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA). Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD. Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent). OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.

Using administrative data to inform operational and policy developments relating to family homelessness in the Dublin Region

BackgroundSince 2014 Ireland has seen an unprecedented growth in the number of families being accommodated in emergency accommodation, particularly in the Dublin Region. Indeed, family homelessness has become an issue of concern across Europe but there is also a widespread lack of data about the specific situation of homeless families (Baptista et al., 2017).&#x0D; ObjectivesThis research uses administrative data to address this gap in knowledge and provide robust quantitative data on trends in family homelessness in the Dublin Region.&#x0D; MethodsThe research was compiled using a combination of PASS data and data recorded from assessment forms completed with homeless clients by the housing sections in the four local authorities across the Dublin region. PASS, the national shared services database for all state funded NGO and local authority homeless services has uniquely allowed for analysis of data relating to the entire population of families newly experiencing homelessness in the Dublin Region since January 2016.&#x0D; FindingsDedicated data collection and analysis of such administrative data has produced interesting findings covering not only profiles and reasons for family homelessness but also families’ rates of progression through homeless services. Of note was that one in six families departed homeless services without active engagement with support services, a figure previously unreported.&#x0D; ConclusionsThe combined use of administrative and PASS data gives a more complete picture of patterns of service use and engagement with homeless services among families newly experiencing homelessness. Detailed findings were passed on to operational staff to both plan for services to support families experiencing homelessness and to assist in developing a regional and national response to the issue of housing supply.

Participation in Early Psychosis Program May Reduce Risk of Death

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessParticipation in Early Psychosis Program May Reduce Risk of DeathNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:18 Apr 2018https://doi.org/10.1176/appi.pn.2018.4a18AbstractThe study of an early psychosis intervention program in Ontario also demonstrated how such programs help to keep patients with psychosis and psychiatrists connected over the long term.Numerous clinical studies have shown that early psychosis programs are effective at helping people who are experiencing psychosis for the first time to manage their symptoms and improve their quality of life. Less is known about how well these programs work for a large population once they are implemented within the broader health care system. A study published March 2 in AJP in Advance has now taken a closer look at health service use and health outcomes among patients who used one such established early psychosis program in the greater London, Ontario, region called the Prevention and Early Intervention Program for Psychoses (PEPP). Analyzing health data from a 17-year period, the investigators found that people who used PEPP services had more frequent contact with psychiatrists and substantially lower rates of mortality during their first two years in the program than people who did not use these services.The findings add to the growing evidence of the value of early psychosis intervention (EPI) services to connect patients with care and improve health outcomes.For the study, Kelly K. Anderson, Ph.D., of the University of Western Ontario and colleagues analyzed health administrative data from the Institute for Clinical Evaluative Sciences, which captures all medical visits covered under the universal Ontario Health Insurance Program. The researchers compared various health outcomes (such as self-harm, suicide, and all-cause mortality) and use of health services (including primary care, outpatient psychiatry, emergency department, and inpatient hospitalizations) in 530 people who were using EPI services between 1997 and 2013 with 922 matched controls who were not using these services. The authors found that in the first two years following admission, EPI service users were six times more likely to have had contact with a psychiatrist and reached out to a psychiatrist more quickly (an average of 13 days after admission compared with 78 days for EPI nonusers). EPI service users were also less likely to visit a primary care physician or the emergency department, but they were more likely to be hospitalized. Anderson told Psychiatric News that when she and her colleagues looked closer at the data, they saw that EPI service users were less likely to be involuntarily admitted to the hospital. She noted that patients who voluntarily arrive at an inpatient setting tend to have shorter stays and a lower risk of rehospitalization. “These findings can therefore be seen as a positive in a real-world system with constrained resources,” Anderson said. “London, like many places, has a shortage of inpatient units.”The increased use of inpatient services may have also contributed to the roughly 75 percent lower rate of all-cause mortality among EPI service users after two years compared with nonusers. There were no differences between the two groups in rates of self-harm or suicide; however, the total number of self-harm events in both groups was small. “[M]any of the observed benefits did not persist in the period from two to five years postadmission, when care is typically stepped down to medical management,” Anderson and colleagues wrote. “These changes in patterns of service use are likely a consequence of both reductions in the intensity of EPI services and improvements in the clinical status of nonusers, due to the natural trajectory of psychosis.”Anderson added, “A major theme of EPI research today is trying to find the optimal duration of intervention. Our findings provide some evidence that a longer duration of intensive care would lead to improved health outcomes.”This study was supported by a New Investigator Fellowship from the Ontario Mental Health Foundation. ■“Effectiveness of Early Psychosis Intervention: Comparison of Service Users and Nonusers in Population-Based Health Administrative Data” can be accessed here. ISSUES NewArchived

The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first

BackgroundHousing First is an effective intervention to stably house and alter service use patterns in a large proportion of homeless people with mental illness. However, it is unknown whether there are differences in the patterns of service use over time among those who do or do not become stably housed and what effect, if any, Housing First has on these differing service use patterns. This study explored changes in the service use of people with mental illness who received Housing First compared to standard care, and how patterns of use differed among people who did and did not become stably housed.MethodsThe study design was a multi-site randomized controlled trial of Housing First, a supported housing intervention. 2039 participants (Housing First: n = 1131; standard care: n = 908) were included in this study. Outcome variables include nine types of self-reported service use over 24 months. Linear mixed models examined what effects the intervention and housing stability had on service use.ResultsParticipants who achieved housing stability, across the two groups, had decreased use of inpatient psychiatric hospitals and increased use of food banks. Within the Housing First group, unstably housed participants spent more time in prison over the study period. The Housing First and standard care groups both had decreased use of emergency departments and homeless shelters.ConclusionsThe temporal service use changes that occurred as homeless people with mental illness became stably housed are similar for those receiving Housing First or standard care, with the exception of time in prison. Service use patterns, particularly with regard to psychiatric hospitalizations and time in prison, may signify persons who are at-risk of recurrent homelessness. Housing support teams should be alert to the impacts of stay-based services, such as hospitalizations and incarcerations, on housing stability and offer an increased level of support to tenants during critical periods, such as discharges.Trial registrationISRCTN. ISRCTN42520374. Registered 18 August 2009.

Access to and Use of Psychiatric Services by Migrants Resettled in Northern Italy.

The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.

Dental insurance, service use and health outcomes in Australia: a systematic review.

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check-up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.

Mental health service utilization and its associated social factors among elderly people with a mental disability in China: A national population-based survey.

This study explored patterns of service use and associated socioeconomic factors among Chinese elders with mental disabilities. Data from the second China National Sample Survey on Disability (CNSSD) were used in this study. Univariate and multivariate logistic regression models were used to calculate the odds ratios and 95% confidence intervals for factors associated with utilization of mental health services among Chinese elderly people with a mental disability. Among elderly people with a mental disability in the CNSSD, 46.35% had used mental health services. Urban residence, higher education level, being married, medical insurance coverage, and higher annual family income per capita were associated with more utilization of mental health services. This study revealed a low level of mental health service utilization among the Chinese population with mental disorders or a mental disability. Strategies to improve the insurance coverage of mental healthcare, to increase public awareness of mental disorders, and to reduce regional inequality of mental health resources are warranted.