Perceptions Of Healthcare Services Research Articles

Determinants of perinatal medical care at the ambulatory level in the conditions of the COVID-19 pandemic

It is important to determine mothers’ perceptions of health care services during the pandemic to ensure equity in the provision of such services in the future.The objective: to determine the determinants of pregnant women’s perception of perinatal care services during the COVID-19 pandemic.Materials and methods. An original sociological study was conducted to assess the state of perinatal care during the COVID-19 pandemic using a questionnaire. 110 questionnaires were included in the analysis. Group 1 included 45 female respondents were sick with COVID-19 during pregnancy, group 2 – 65 women were not sick with COVID-19 during pregnancy. All questionnaires were analysed both in the general sample and in the section of COVID-19 during pregnancy.Results. Certain shortcomings in the provision of perinatal care during the COVID-19 pandemic at the ambulatory level were identified. Insufficient vaccination coverage of pregnant women (65.5% of respondents were vaccinated during pregnancy). 87.3% of patients considered insufficient information about vaccination of pregnant women. A negative attitude towards vaccination during pregnancy was expressed by 30.0% of respondents. 65.4% of respondents considered insufficient availability of perinatal care in the conditions of the COVID-19 pandemic. Remote counseling was received by less than half of patients (41.8%), and mainly those who were sick with COVID-19 (62.2%). A negative attitude towards remote counseling was expressed by 49.1% of women. More than half (56.4%) of the respondents considered the provided information about COVID-19, treatment and prevention to be insufficient. Only 9.1% of patients received full psychological support. Half of the patients were not satisfied with the qualifications of the medical staff, and 59.1% were not satisfied with the staff’s attitude. More than half (55.4%) of patients were not satisfied with the care provided at the outpatient stage in general, especially those who did not suffer from COVID-19, which may be due to a shift in the focus of attention on infected pregnant women.Conclusions. The following positions can be recommended to improve perinatal care: expansion of information provision of the population, in particular with the involvement of mass media; conducting explanatory work with patients on prevention, vaccination, treatment, possible complications during pregnancy; provision of remote counseling in possible cases; psychological support of the pregnant woman and her family at all stages of perinatal care.

Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD

ABSTRACT Introduction Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help. Objective The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed. Methods A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives. Results Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems. Conclusion Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father’s perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.

MP55-17 THE RELATIONSHIP BETWEEN PROSTATE CANCER AND COLORECTAL CANCER SCREENING: HOW IMPORTANT IS SHARED DECISION-MAKING?

You have accessJournal of UrologyCME1 Apr 2023MP55-17 THE RELATIONSHIP BETWEEN PROSTATE CANCER AND COLORECTAL CANCER SCREENING: HOW IMPORTANT IS SHARED DECISION-MAKING? Borivoj Golijanin, Vikas Bhatt, Alexander Homer, and Elias Hyams Borivoj GolijaninBorivoj Golijanin More articles by this author , Vikas BhattVikas Bhatt More articles by this author , Alexander HomerAlexander Homer More articles by this author , and Elias HyamsElias Hyams More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While guidelines require shared decision-making (SDM) prior to PSA screening, there are more categorical recommendations for colorectal cancer (CRC) screening in persons aged 50-75.Historically, though, patients have been more likely to pursue PSA vs CRC, despite more equivocal recommendations for the former and stronger evidence for the latter.Recently, COVID-19 altered access to and patients’ perceptions of healthcare services. This study investigates the relationship between PSA screening, CRC screening, and SDM, with the hypothesis that SDM is associated with higher rates of both screening practices. METHODS: The 2020 Behavioral Risk Factor Surveillance System (BRFSS) annual survey report was assessed for male patients between the ages of 50 and 75. The identified patients were further eliminated based on response availability: history of PSA and CRC screening must have been provided. Univariate logistic regression was used for predictor selection and multivariate logistic regression models were generated to assess associations between socioeconomic factors that influenced SDM for PSA screening as well as screening practices themselves. RESULTS: 38,617 men between the ages of 50 and 75 met the inclusion criteria. 44% of respondents had PSA screening, 72.2% CRC screening, 38.83% had both, and 22.67% had neither. 45.2% had discussions about PSA advantages and 22.1% had discussions about PSA disadvantages. Odds of CRC screening increased if the patients had PSA screening (OR 2.52, CI 2.43 – 2.6), and if they had discussion on the advantages (OR 1.23, CI 1.09 – 1.38) and the disadvantages (OR 1.23, CI 1.13 – 1.34). Odds of PSA screening increased if the patient had CRC screening (OR 1.48, CI 1.37 – 1.58), had a discussion of the advantages of PSA testing (OR 2.06, CI 1.91 – 2.21), and when the PSA test was recommended (OR 3.95, CI 3.84 – 4.06). Odds of PSA screening decreased when the disadvantages of PSA were discussed (OR 0.84, CI 0.74-0.95). The Northeast had higher odds of PSA screening (OR 1.29, 1.16-1.41) but lower odds of CRC screening (0.68, CI 0.58-0.77) compared to the West. There were no significant associations with being from the Midwest or South and history of PSA or CRC screening. CONCLUSIONS: There are higher rates of CRC vs PSA screening in a contemporary cohort of patients in men aged 50-75. PSA screening has decreased amid fluctuating guidelines in an era of SDM, and in the post-COVID environment. SDM is associated with both screening practices, and may serve as a metric for quality of care across cancer types. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e770 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Borivoj Golijanin More articles by this author Vikas Bhatt More articles by this author Alexander Homer More articles by this author Elias Hyams More articles by this author Expand All Advertisement PDF downloadLoading ...

Immigrant women cancer survivors’ perceptions of healthcare services in Canada: A phenomenological study

Middle Eastern immigrant women (MEIW) living in Canada have significantly increased. However, this group of women is under-represented in health research, and there is a gap in knowledge about their experiences when they access healthcare services for cancer care in Canada. This qualitative approach was conducted to uncover the meaning of the lived experiences of MEIW with healthcare services in Canada during their cancer survivorship (CS). Data were collected through unstructured interviews and one written description from three MEIW. Data were analyzed using a descriptive phenomenological approach developed by Giorgi. Four themes emerged to represent the essence (or meaning) of the participants’ lived experiences. Their healthcare was accompanied with delays and unmet needs. Yet, they found it helpful when they were provided with knowledge and information. The ability to communicate in English was equal to empowerment for each of them, while they faced cultural stigmatization of mental health issues. Thus, healthcare professionals need to identify immigrant women’s unmet support needs and psychosocial responses during their cancer survivorship. Language-specific and culturally competent cancer-care intervention programs must be developed within the Canadian healthcare system.

The role of cultural safety and ethical space within postcolonial healthcare for Maasai in Tanzania

The history of the Maasai tribe in northern Tanzania is characterised by marginalisation, discrimination and political subjugation. Inequities, enacted through power relations, influence healthcare access, practices and outcomes among the...

Population perceptions of health care services provided virtually (telehealth): a cross-sectional study.

BackgroundIn the era of the Coronavirus Disease 2019 (COVID-19) pandemic, health care systems wish to harness the advantage of distant care provision to transcend barriers to access health care facilities. This study aims to investigate general population perceptions (acceptance, comfort, perceived ease of use and perceived quality of care) toward telehealth.MethodsA cross-sectional survey was conducted using a validated online questionnaire. The questionnaire investigated the general population’s familiarity and experience with virtual provision of health care (telehealth) in Kuwait. Descriptive statistics and multivariate analysis were performed.ResultsA total of 484 responses were received. Of those, 65% (N = 315) showed high acceptance of telehealth of which 73.5% (N = 119) were comfortable using it and 48.2% (N = 78) perceived themselves capable of utilizing its systems. Multivariate analysis showed that participants with moderate or high comfort score and those who perceived equal quality of care received from Virtual Visits (VV) are more likely to accept a virtual call from their health care provider compared to those with low comfort score (odds ratio (OR): 4.148, 95% confidence interval (CI): 1.444–11.91, P = 0.008, OR: 20.27, 95% CI: 6.415–64.05, P < 0.0001, OR: 2.585, 95% CI: 1.364–4.896, P < 0.004, respectively).ConclusionsPerceptions of telehealth were overall positive, indicating a tendency to accept the implementation of such technology.

Perceptions of neighborhood environment and loneliness among older Chinese adults: the mediator role of cognitive and structural social capital

Objective This study aimed to examine the mediating role of social capital in the association between perceived physical neighborhood environment and loneliness among older adults in urban China. Method Data were derived from face-to-face interviews with people (n = 472) aged 60 or older in urban communities of Shanghai, China, in 2020. Loneliness was measured by the 6-item De Jong Gierveld Scale. A multiple mediator model was adopted to examine the research hypotheses. Results Cognitive social capital played a full mediation role in the association between perceived community health care (β = −.061, p < .05), safety (β = −.168, p < .001), recreational services (β = −.058, p < .05), and loneliness. Structural social capital was associated with loneliness (β = −.102, p < .05), whereas its mediator effect was not significant. Perceived transportation convenience had neither a direct nor an indirect effect on loneliness among older adults. Conclusion Findings indicate that older adults’ perceptions of healthcare services, safety, and recreational resources could help alleviate their loneliness via fostering cognitive social capital. Interventions improving older adults’ perceptions of community health care, safety, and recreation, and their social capital level could help reduce the prevalence of loneliness.

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania

BackgroundHealth insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.MethodAn explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems’ responsiveness. Qualitative content analysis was used to analyse the data.ResultsElderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare.ConclusionsThe national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended.

Adverse childhood experiences and health among indigenous persons experiencing homelessness

BackgroundCurrent literature has established that adverse childhood experiences (ACEs) are associated with the onset of a variety of physical, mental, and behavioural illnesses. However, there are few studies that have thoroughly examined this association in low-income or marginalized groups.MethodsTo address this knowledge gap, this study used self-reported data on childhood experiences and adult health outcomes in a sample of 91 Indigenous persons experiencing homelessness. While the primary focus of the study was to assess the relationship between ACEs and health status, we also assessed reports on use and perceptions of health care services to test for potential illness-mitigating factors.ResultsResults indicated that reported number of ACEs was significantly associated with reported levels of mental illness (p < .001, d = 1.12). Significant associations were not observed for physical illness or patterns of substance use. We also found that the number of reported ACEs was significantly correlated with the number of formal health care services that an individual used (r = 0.32).ConclusionsOur results reveal that the relationship between ACEs and adult illness is not as deterministic as the current literature suggests. Access to formal health care services may allow individuals to mitigate their adverse health, thereby eliminating some of the effects of ACEs. Conversely, current tools used to measure ACEs may not translate to an Indigenous population, which speaks to a need to revise ACE related surveys to include additional adversity categories.

Jakartans' Perceptions of Health Care Services.

Health Care Services (HCSs) should implement ongoing innovation and continuously improve their quality. However, in evaluating the quality of HCSs, too little attention has been given to the experience of the users concerning the acquired services. This study focused on how the community values the current services in order to improve HCSs in Indonesia, especially in Jakarta. Four focus group discussions were conducted among 45 community members in the Grogol Petamburan sub-district, in Jakarta. Participants were recruited using a convenience sampling and the data were analyzed using a combination of human coding and NVivo-12. Overall, we found that participants had a negative view of the government-mandated Community Health Centers (CHCs) and they preferred to visit private clinics and hospitals over the CHCs. Participants associated CHCs with unfriendly staffs, longer waiting times, shorter opening hours, and crowded visitors. At the same time, participants had a positive view on the affordability of the CHCs. Additionally, we found the reasoning of Jakartans' (i.e., the citizens of Jakarta city) on using self- and traditional treatments before visiting HCSs and they also expressed the need for psychological services at CHCs. The discussion focuses on the results as feedback on how the government and health care providers may facilitate the community's needs in providing HCSs in Indonesia, especially Jakarta. In brief, we recommend the policy-makers to improve the hospitality of the staff members and the quality of the medical equipment; also, to provide psychological services at CHCs. These efforts need to be done while paying more attention to the cultural aspects of medicinal uses.

Perceptions of healthcare services and preference of factors related to care planning among active older persons

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)

Later Life Care Planning and Concerns of Transgender Older Adults in Canada.

While the particular health-care concerns of transgender people have been documented and transgender aging is an emerging area of scholarship, little is known about planning for later and end-of-life care among transgender older adults. As part of a larger project, focus groups and interviews were conducted with 24 transgender older adults (average age 70 years) living in five cities in Canada exploring their concerns and explicit plans for later life care. Three primary themes emerged: (a) “dealing with the day-to-day” reflecting economic precarity and transitioning in later life, (b) fractures and support within family and community, and (c) “there’s a huge gap between principle and practice” reflecting mixed experiences and perceptions of health-care services. These themes suggest that effective promotion of care planning among older transgender persons requires an appreciation of the daily exigencies of their lives and the extent and nature of social support available to them.

Paternal Perinatal Mental Health: At-Risk Fathers’ Perceptions of Help-Seeking and Screening

Given the prevalence of paternal perinatal mental health concerns, researchers have suggested introducing routine screening. However, little is known about the acceptability of perinatal screening measures in male populations. Furthermore, the need for screening is influenced by men’s perinatal help-seeking behaviors. A thematic analysis of interview data from nine men at risk of paternal perinatal depression and/or anxiety investigated both acceptability of screening and help-seeking behaviors. Themes indicate that routine screening is desired, but acceptability is influenced by perceptions of its intention and possible outcomes. Findings also suggest that barriers to men’s perinatal help-seeking are likely to be minimized by increased awareness and normalization. Future research and clinical practice should account for complexities raised by men’s perceptions of health care services.

LGBT+ Individuals' Perceptions of Healthcare Services in Turkey: A Cross-sectional Qualitative Study.

When accessing healthcare services, LGBT+ individuals are often exposed to segregating and marginalizing discourses. Knowledge about how such experiences are reflected in the moral world of LGBT+ individuals living in Turkey is limited. This study examined LGBT+ individuals' lived experiences when utilizing healthcare services. The findings are discussed in terms of moral discourses related to LGBT+ individuals' gender identity and sexual orientation. A qualitative field study was conducted using semi-structured interviews with fifty-five LGBT+ individuals from Turkish cities who were in contact with various non-governmental organizations that conduct studies on gender identity and sexual orientation. A questionnaire was administered with items on participants' demographic information, experiences, behavioural patterns, and knowledge regarding healthcare services. The data were analysed thematically. The findings were evaluated within the framework of "access to healthcare service" theme related to "healthcare service demand" context. Additionally, the "interaction with physicians" theme was addressed in the context of "physician-patient/counselee relationship." LGBT+ individuals state that they are exposed to stigmatizing and segregating discourses by healthcare professionals, which might pose an obstacle for adaptive health-seeking behaviours. These results suggest that physicians' professional approach has a considerable influence on LGBT+ individuals' capacity for utilizing healthcare services.

Assessment of community pharmacists’ perceptions of healthcare services in Saudi Arabia

Objectives The pharmacist faces need to provide clinical services to the patients and then the actual proficiency of the pharmacist can be judged. The aim of the study was to evaluate the elements of clinical knowledge, needs for clinical services, value of practice and confidence to practice among expatriate pharmacists (EPs) working in community pharmacies. Also determine the correlation pattern between the rudiments. Methods A survey-based investigation conducted between December 2015 and May 2016 among EPs working in community pharmacies of Saudi Arabia. A total of 1007 community pharmacies (with 1897 EPs) were approached from four major cities of Saudi Arabia, that is, Riyadh, Jeddah, Madinah and Makkah. Cluster random sampling applied for distribution/selection of community pharmacies based on homogeneity and population density. Self-developed bilingual questionnaire (face-content validation performed with average reliability of 0.784 Cronbach's alpha) used to collect data, however only 1258 EPs responded with 66.31% response rate rest 639 EPs either denied to participate or incomplete responses. Ethics applied and approved from Taibah University research ethics committee. Key findings A total of 1258 EPs participated in the survey with mean ± SD age of 33.17 ± 4.759 years. Participants’ distribution pattern showed highest to lowest as Riyadh-377 (30%), Jeddah-315 (25%), Makkah-302 (24%) and Madinah-264 (21%) approximately. Findings showed different association patterns with; drug-dose adjustment practices, defining critical symptoms with drug use for referral, developing pharmacoinformatic database and others. Total Mean ± SD for knowledge: 3.87 ± 1.172, Value: 4.12 ± 2.11, Need: 4.72 ± 1.788 and Confidence: 3.25 ± 1.021 (shows significantly High Need for practice: P < 0.001, ONE-way ANOVA). Conclusions Conclusion of the study reflective to effective clinical services inbound with knowledge, need, value and confidence of a pharmacist. Expatriate pharmacists have a potential to work efficiently but they should equip themselves with appropriate competencies in order to transform clinical services at community level.

Uninsured free clinic patients’ experiences and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act

Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. There has been a paucity of free clinic research with the few studies employing a quantitative design. The purpose of this study is to conduct an in-depth qualitative exploration of free clinic patients’ experience and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act (ACA). Free clinic adult patients (n=35) participated in four focus groups between June and July 2014 (one Spanish group in June, and two English groups and one Spanish group in July) in a classroom of a free clinic. More than 80% of the participants were non-US born from Mexico, Central/South America, South or East Asia, Pacific Islands, or Western Europe. While participants reported being satisfied overall with free clinic services, they indicated that they desire more specialty services and health education programs. Furthermore, they reported being frustrated by long waiting times- both in the waiting room and when making an appointment, phone communication, and interpreter services. It is necessary to find effective ways to provide information about health education opportunities and the ACA to free clinic patients because participants appeared not to have received sufficient information about available resources. Health education programs for free clinic patients should not only focus on increasing knowledge but also changing behaviors.

Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures.

BackgroundThis paper identifies patterns of health inequalities (consistency and magnitude) of socioeconomic disparities for multiple maternal and child health (MCH) outcomes that represent different health care needs of mothers and infants.MethodsUsing cross-sectional national data (unweighted sample = 6,421, weighted =76,508) from the Canadian Maternity Experiences Survey linked with 2006 Canadian census data, we categorized 25 health indicators of mothers of singletons into five groups of MCH outcomes (A. maternal and infant health status indicators; B. prenatal care; C. maternal experience of labor and delivery; D. neonatal medical care; and E. postpartum infant care and maternal perceptions of health care services). We then examined the association of these health indicators with individual socioeconomic position (SEP) (education and income), neighborhood SEP and combined SEP (a four-level measure of low and high individual and neighborhood SEP), and compared the magnitude (odds ratios and 95% confidence intervals) and direction of the associations within and between MCH outcome groups.ResultsWe observed consistent positive gradients of socioeconomic inequalities within most groups and for 23/25 MCH outcomes. However, more significant associations and stronger gradients were observed for the MCH outcomes in the maternal and infant health status group as opposed to other groups. The neonatal medical care outcomes were weakly associated with SEP. The direction of associations was negative between some SEP measures and HIV testing, timing of the first ultrasound, caesarean section, epidural for vaginal births, infant needing non-routine neonatal care after discharge and any breastfeeding at 3 or 6 months.Gradients were steep for individual SEP but moderate for neighborhood SEP. Combined SEP had no consistent gradients but the subcategory of low individual-high neighborhood SEP often showed the poorest health outcomes compared to the categories within this SEP grouping.ConclusionBy examining SEP gradients in multiple MCH outcomes categorized into groups of health care needs, we identified large and consistent inequalities both within and between these groups. Our results suggest differences in pathways and mechanisms contributing to SEP inequalities across groups of MCH outcomes that can be examined in future research and inform prioritization of policies for reducing these inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0393-z) contains supplementary material, which is available to authorized users.

Perceptions of health care services and HIV-related health-seeking behavior among Uganda adolescents

Youth represent almost half of all new HIV infections globally. Although condom use is an effective method of HIV prevention among sexually active youth in sub-Saharan Africa (SSA), they face substantial barriers in obtaining condoms in environments where adults hold attitudes condemning premarital sex. More research is needed to better understand the multitude of factors that affect SSA youths' behaviors regarding safe sex practices, including factors that may influence their ability to obtain condoms, and decisions to be tested for HIV. In this study of Uganda youth (n = 1503) from five secondary schools, logistic regression models highlight factors that influence perceptions regarding respect and confidentiality at health centers, condom acquisition, and HIV testing. Family support appears to be an especially important factor that affects youth perceptions about how they will be treated when seeking condoms and HIV testing. Condom acquisition and HIV-testing behaviors are also associated with peer influence, self-esteem, and demographic characteristics, such as age.

Acceptance and Decision Making in Amyotrophic Lateral Sclerosis From a Life-Course Perspective

Researchers have explored perceptions of health care services among people with amyotrophic lateral sclerosis (ALS), but little is known about how and why people with ALS engage with services. We undertook a grounded theory study to identify key psychosocial processes that underpin how and why people with ALS engage with health care services. We conducted in-depth interviews with 34 participants sampled from the Irish ALS population-based register. We found that age and life stage shaped participants' decision making about care. Participants in later life were more accepting of ALS and of death than young and middle-aged participants. Family was the primary context to how participants engaged with services, and their decisions about care were shaped by parenthood at different life stages. Health care professionals need to be attuned to the impact of life-course trajectories and family relations on the decisions people with ALS make about their care.

Utilization and Perceptions of Primary Health Care Services in Australian Adults with Mental Illness

Persons accessing inpatient mental health services generally experience reduced access to and quality of primary health care. The objective of this study was to compare health service utilization and perceptions, and receipt of specified health services, in Australian adults with and without a previous mental illness diagnosis. A cross-sectional survey was administered by computer-assisted telephone interviewing in 2011; the main outcome measures were receipt of services in the previous 12 months, satisfaction with health care services, and concerns regarding health care affordability. Participants included 1275 adults residing in Queensland, Australia; 292 (23%) participants reported a diagnosis of mental illness, largely depression and/or anxiety (87%). The mental illness group had higher scores for concerns regarding health care affordability (mean ranks 778 vs. 706, respectively; z=-2.90, P=0.004) and lower scores for perceptions of health care service quality and accessibility (mean ranks 631 vs. 701, respectively; z=-2.90, P=0.004). After adjustment for increased utilization of services, the mental illness group had an increased likelihood of having received only 5 of 19 services in the past 12 months (odds ratios: 1.54-1.71). Compared to those with no mental illness, Australians with a mental illness report increased dissatisfaction with health care affordability, accessibility, and quality, and generally have similar odds of primary care services per health care utilization despite being at significantly greater risk of chronic disease.