Subsequent Health Service Research Articles

Examining the Association Between Preventive Screenings and Subsequent Health Services Utilization by Patients with Type 2 Diabetes Mellitus

Introduction In recent years, health plans have turned to disease management programs as a means of reducing inpatient utilization while promoting preventive outpatient services provided for patients with type 2 diabetes mellitus.

Can mortality studies change clinical care and health policy?: Commentary on “Psychological distress, physical illness, and mortality risk,” by Farhat Rasul, MSc, Stephen Stansfield, PhD, Carole Hart, PhD, Charles Gillis, MD

Purpose: To test the extent to which adolescent victimization predicts subsequent use of mental health services in a prospectively assessed nationwide sample of high school students.Methods: Data were analyzed from 4590 adolescents participating in Waves I and II of the National Longitudinal Survey of Adolescent Health. In-home self-report data were collected on four types of personal victimization, mental health service use, demographics, psychological symptoms/needs, and family connectedness. Using logistic regression analysis, adolescents’ victimization and background variables at Wave I were entered as predictors of subsequent mental health service use, measured at Wave II.Results: In this national sample, 19.6% of the respondents stated that they had experienced at least one of four forms of personal victimization in the prior year. Of those reporting personal victimization, 11.0% stated they had used mental health services at 1-year follow-up, as compared to 9.2% of those who did not report any personal victimization. After controlling for background variables in logistic regression analyses, however, adolescents’ victimization reported at Wave I was associated with significantly lower odds of subsequent mental health service use at Wave II.Conclusions: Evidence does not indicate that adolescents’ victimization prompts mental health service use, and rather indicates that in some instances victimization is associated with lower odds of subsequent mental health service use. These findings raise questions about the degree to which adolescents receive needed professional mental health supports in the wake of serious violence exposure.

Morbidity and mortality after RSV-associated hospitalizations among premature Canadian infants

Objective To evaluate the impact of respiratory syncytial virus (RSV) infections on subsequent health care resource utilization in preterm infants. Study design Analysis of data from 2415 preterm infants (32 to 35 weeks gestational age [GA]) hospitalized for proven or probable RSV and matched to 20,254 control infants. Results Mean (SD) age at the index admission was 7.7 (5.5) months; 46% of the infants were male. Mean (SD) subsequent health services, excluding the index event, for the RSV cohort and control infants, respectively, were hospitalization, 2.96 (2.81) versus 1.28 (1.42); special care unit visits, 0.67 (1.70) versus 0.40 (0.33); respiratory therapy visits, 0:31 (0.70) versus 0.13 (0.37); physician consults, 3.61 (4.54) versus 0.89 (1.12); in-hospital procedures, 1.05 (4.02) versus 0.81 (1.51); outpatient visits, 18.4 (10.58) versus 7.54 (4.31); and mean (SD) inpatient days, 14.71 (18.69) versus 5.04 (7.09). All differences were statistically significant ( P<.001). Diagnoses for the RSV and control cohorts were respiratory conditions (64% versus 13%), fever (2.7% versus 0.7%), anorexia (2.2% versus 0.6%), lack of normal physiological development (2.8% versus 1.1%; P<.05), overall deaths (8.1% versus 1.6%; P<.001), and sudden death (6.1% versus 0.3%; P<.001). Conclusions RSV hospitalization in healthy premature infants is associated with a significant increase in subsequent health care resource utilization and mortality. Results support prophylaxis of premature infants against RSV hospitalization.

Adolescent victimization and subsequent use of mental health counseling services.

To test the extent to which adolescent victimization predicts subsequent use of mental health services in a prospectively assessed nationwide sample of high school students. Data were analyzed from 4590 adolescents participating in Waves I and II of the National Longitudinal Survey of Adolescent Health. In-home self-report data were collected on four types of personal victimization, mental health service use, demographics, psychological symptoms/needs, and family connectedness. Using logistic regression analysis, adolescents' victimization and background variables at Wave I were entered as predictors of subsequent mental health service use, measured at Wave II. In this national sample, 19.6% of the respondents stated that they had experienced at least one of four forms of personal victimization in the prior year. Of those reporting personal victimization, 11.0% stated they had used mental health services at 1-year follow-up, as compared to 9.2% of those who did not report any personal victimization. After controlling for background variables in logistic regression analyses, however, adolescents' victimization reported at Wave I was associated with significantly lower odds of subsequent mental health service use at Wave II. Evidence does not indicate that adolescents' victimization prompts mental health service use, and rather indicates that in some instances victimization is associated with lower odds of subsequent mental health service use. These findings raise questions about the degree to which adolescents receive needed professional mental health supports in the wake of serious violence exposure.

Concurrent versus simultaneous polydrug use: Prevalence, correlates, discriminant validity, and prospective effects on health outcomes.

Few studies have addressed the distinction between concurrent polydrug use (various drugs used on separate occasions) and simultaneous polydrug use (the use of more than 1 drug at the same time). The authors assessed simultaneous polydrug use in a community sample to examine the prevalence of drug combinations, whether simultaneous can be distinguished from concurrent, and the prospective effects of these styles of drug use on subsequent health service utilization, physical symptoms, and psychological distress 4 years later. Marijuana and alcohol were the most common drugs used simultaneously, followed by alcohol and cigarettes. Simultaneous and Concurrent Polydrug Use formed 2 correlated but discriminable constructs. Neither Simultaneous nor Concurrent Polydrug use predicted subsequent Health Service Utilization, Physical Symptoms, or Psychological Distress. Data did reveal unique effects of specific drugs used simultaneously on these outcomes that were larger and more numerous than specific effects of concurrent drug use.

The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study.

The purpose of this study was to prospectively assess the independent effect of hip fracture on mortalìty, hospitalization, and functional status. Among 7527 members of the Longitudinal Study of Aging who were over age 70 at baseline, 368 persons with hip fracture occurring between 1984 and 1991 were identified. Median length of follow-up was 831 days. Hip fracture was significantly related to mortality (adjusted hazards ratio [AHR] = 1.83; 95% confidence interval [CI] = 1.55, 2.16) when treated as a time-dependent covariate. This effect was concentrated in the first 6 months postfracture (AHR = 38.93, 95% CI = 29.58, 51.23, vs AHR = 1.17; 95% CI = 0.95, 1.44). Hip fracture significantly increased the likelihood of subsequent hospitalization (adjusted odds ratio = 3.31, 95% CI = 2.64, 4.15) and increased the number of subsequent episodes by 9.4%, the number of hospital days by 21.3%, and total charges by 16.3%. Hip fracture also increased the number of functional status dependencies. The health of older adults deteriorates after hip fracture, and efforts to reduce the incidence of hip fracture could lower subsequent mortality, morbidity, and health services use.

Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial. II: the outcome of care

Objective: To compare the outcome of out of hours care given by general practitioners from patients' own practices and by commercial deputising services.Design: Randomised controlled trial.Setting: Four urban areas in...

Contemporary Health Practices in the Burren

This is a cross sectional survey of health practices in the Burren, Co. Clare. The primary aim of this research is to examine people’s knowledge of and attitudes toward, folk medicine, alternative medicine and conventional medicine. The design is based on a 1930s folklore scheme, conducted by the Folklore Commission of Ireland. Employing the unique method of the folklore scheme, senior pupils from 11 national schools in the Burren, Co.Clare, were asked to write an essay on ‘Health Practices’, based on a research questionnaire developed for this purpose. With a 76% response rate, 133 essays were collected for analysis. High rates of knowledge were recorded for folk and alternative medicine (95% and 41% respectively). Usage rates for both non-conventional medical systems were considerably lower (23% and 16% respectively). Quantitative analysis of the data revealed that participants cannot be divided into exclusive groups of conventional and non-conventional users of health services. Also, symptom severity appears to be predictive of subsequent health service utilisation. 25% of conditions associated with folk medicine were minor dermatological complaints and 23% were ear, nose and throat complaints. Participants’ attitudes to hospitals do not seem to be indicative of their health practices, thus highlighting the complexity and contradictory nature of health-related attitudes and behaviour. Finally, social class differences were apparent in this sample - knowledge and use of folk medicine was higher amongst manual classes while alternative medicine appears to be a more middle class phenomenon. These differences were not statistically significant.

A Panel Study of Life Stress, Social Support, and the Health Services Utilization of Older Persons

Interest in the health care needs and medical care utilization patterns of older persons has steadily increased in recent years. The major goal of this study was to examine the extent to which specific factors moderate the relationship between life stress exposure and subsequent health services utilization. Two groups of older persons (health maintenance organization members and fee-for-service clients) participating in a multiyear panel study comprised the study sample. Time-ordered, multivariate analyses of links among life stress exposure, moderating variables, and subsequent health services utilization indicate that the process may not be direct or simple to explain. There was no indication in this study that social support had any direct moderating effects on the time-ordered relationship between life stress exposure and the utilization of medical care services. However, the interaction of high life stress exposure and low social support was consistently linked to increased rates of health services utilization.

Health status and the use of outpatient mental health services.

Using data from the RAND Corporation's Health Insurance Study, the authors have linked mental health status (self-reported psychological distress and psychological well-being) to the subsequent use outpatient mental health services delivered by formally trained mental health specialists and general medical providers.

Health status and the use of outpatient mental health services.

Using data from the RAND Corporation's Health Insurance Study, the authors have linked mental health status (self-reported psychological distress and psychological well-being) to the subsequent use outpatient mental health services delivered by formally trained mental health specialists and general medical providers.

Effects of inappropriate laws in developing countries—An illustrative case

Laws in developing countries are frequently archaic and unrevised. This is particularly true of those laws governing abortion, sterilization, and suicides. Even those laws controlling new and/or harmful drugs are lacking, inappropriate, or irrelevant to patterns of living, socioeconomic, political and environmental constraints, and the realities of communities which they purport to serve. The traditional practices of the indigenous peoples are frequently out of step with the changes taking place in society as a result of industrialization and urbanization. The poor suffer most during the transitional stages. The wealthy can evade legal obstacles, going abroad if necessary to obtain a service, or buying the services locally if they require. In most developing countries, one has to have money to get a safe abortion by a qualified practitioner (expecially in countries where the laws are not liberalized). In the city of Nairobi with a population of 700,000 and a growth rate of about 6.5%/year, there is not 1 program for the pregnant teenager. As in many other developing countries, their situation is still determined by the traditional cultural framework. This paper describes the case of a pregnant 17-19 year old unmarried girl from Kenya who has a primary level education, no definite religion, is unemployed and living with her father, a watchman. Private practitioners can charge between US$75 to US$175 depending upon the particular doctor's sense of risk-taking. Unable to pay for a safe abortion and realizing the risks of self-induced abortion, or treatment from a local "quack," she carries the pregnancy to term, giving birth to triplets. Subsequent health services visits reveal the lack of effective and suitable family planning advice by the health visitor and social worker. High parity in a young mother produces high risk. The factors involved are nutritional deficits, poverty, inadequate health care, the short length of time between the 1st delivery of (triplets) and subsequent conception, and insufficient prenatal visits during the 2nd pregnancy. This case study emphasizes the need for: 1) liberal abortion law; 2) social workers, and health visitors trained in counseling and contraception; 3) co-ordination of various agencies; plus 4) more experienced legal personnel.