Rates Of Health Service Utilization Research Articles

Enhancing the Rehabilitation Counseling Process: Understanding the Obstacles to Asian Americans' Utilization of Services

Improving rehabilitation services for Asian Americans with disabilities through the rehabilitation counseling process remains as an ongoing challenge. Despite being the fastest growing ethnic group in the United States, past studies have reported low utilization rates of vocational rehabilitation and mental health services among this population. This article (a) describes Asian American views on disabilities from religious, philosophical, and spiritual perspectives; (b) reviews factors that may contribute to their being underserved in the rehabilitation; (c) discusses the influence of family dynamics on the rehabilitation process; (d) underscores unique employment challenges facing the Asian Immigrant community; and (e) draws out the implications of such an analysis for rehabilitation counseling.

Utilization rates of preventive health services provided for children by the National Health Insurance Program, 1996-2001

Utilization rates of preventive health services provided for children by the National Health Insurance Program, 1996-2001

Socioeconomic Marginality and Health Services Utilization Among Central Harlem Substance Users

The article examines whether decrements in socioeconomic measures in a poor, substance using population predict changes in health services utilization. The sample consisted of 658 “hard drug” (crack, powder cocaine, and heroin) users drawn from Central Harlem in New York City during 1998 and 1999. Chain referral and social networking were used in order to gain access to hidden users. The sample was stratified according to operational measures indicating socioeconomic marginality, one calculated using indices of income, education, and employment and another designed to measure lived homelessness. Rates of self-reported utilization of 10 health services were compared across strata. In this sample socioeconomic marginality reflected by low levels of income, education, and employment sometimes predicts greater rates of health services utilization and, in other cases, it predicts lower rates. When the sample is stratified according to an operational measure of homelessness, the gradient of greater utilization and self-reported morbidity for the homeless is more marked and consistent. Results are supportive of a public health model of drug user treatment that recommends that it occur as part of an integrated strategy addressing poverty, homelessness, violence, and related social problems.

Hierarchical Bayesian modeling of spatially correlated health service outcome and utilization rates.

We present Bayesian hierarchical spatial models for spatially correlated small-area health service outcome and utilization rates, with a particular emphasis on the estimation of both measured and unmeasured or unknown covariate effects. This Bayesian hierarchical model framework enables simultaneous modeling of fixed covariate effects and random residual effects. The random effects are modeled via Bayesian prior specifications reflecting spatial heterogeneity globally and relative homogeneity among neighboring areas. The model inference is implemented using Markov chain Monte Carlo methods. Specifically, a hybrid Markov chain Monte Carlo algorithm (Neal, 1995, Bayesian Learning for Neural Networks; Gustafson, MacNab, and Wen, 2003, Statistics and Computing, to appear) is used for posterior sampling of the random effects. To illustrate relevant problems, methods, and techniques, we present an analysis of regional variation in intraventricular hemorrhage incidence rates among neonatal intensive care unit patients across Canada.

Dementia in Ontario: Prevalence and Health Services Utilization

ABSTRACTTo understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using linked administrative databases to determine the incremental use of health services by elderly Ontarians with dementia. Overall, study results demonstrated that individuals with dementia used services in a pattern similar to non-demented persons, albeit at a higher level. Exceptions were women's use of hospital and home care services, where the most elderly women received significantly fewer services. Thus, the study provided important insight regarding the relative levels of health services used by demented Ontarians. Research in this area will become increasingly important as the population ages and the settings integral to dementia care and management shift and evolve.

Major Mental Illness in a Sexual Minority Psychiatric Sample

Objectives: In this study, the authors compare a lesbian, gay, bisexual, and transgender (LGBT) sample in treatment for major psychiatric disorders with a general psychiatric population sample. Methods: Participants were interviewed utilizing a multi-item, multiple-choice questionnaire with some open-ended questions. Study participants were categorized by biological sex at birth and sexual identity. Parameters assessed included age of symptom onset, number of inpatient admissions, and primary psychiatric diagnosis. Results: No difference was found for mean age of first symptom onset between LGBT and control males or for LGBT and control females. There was no difference in rates of psychiatric hospitalization between LGBT and control participants. LGBT males had lower rates of psychotic disorders, except for schizoaffective disorder, and higher rates of mood disorders than control males. There was no significant difference in rates of psychiatric disorders between LGBT and control females. Conclusions: For those in treatment for major mental illness, sexual identity may be an important variable associated with differential rates of serious psychiatric disorders and/or mental health service utilization. No significant difference in age of onset or number of hospital admissions was observed. Limitations in sample size and the study design warrant further research to confirm these findings.

The relationship of post-acute home care use to Medicaid utilization and expenditures.

To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. 5,299 Medicaid patients aged 18-64 discharged in 1992-1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Linked Ohio Medicaid claims and CHQC medical record abstract data. One stay per patient was randomly selected. Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p < .05) and surgical patients after 90 and 180 days (p < .001). There were no significant differences for any other outcome. Sensitivity analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted.

Prevalence, incidence and stability of premenstrual dysphoric disorder in the community.

Despite an abundance of clinical research on premenstrual and menstrual symptoms, few epidemiological data provide estimates of the prevalence, incidence, co-morbidity, stability and correlates of premenstrual dysphoric disorder (PMDD) in the community. To describe the prevalence, incidence, 12 co-morbidity factors and correlates of threshold and subthreshold PMDD in a community sample of young women. Findings are based on prospective-longitudinal community survey of 1488 women aged 14-24, who were followed-up over a period of 48 months (follow-up, N = 1,251) as part of the EDSP sample. Diagnostic assessments were based on the Composite International Diagnostic Interview (CIDI) and its 12-month PMDD diagnostic module administered by clinical interviewers. Diagnoses were calculated using DSM-IV algorithms, but daily ratings of symptoms, as required, were not available. The baseline 12-month prevalence of DSM-IV PMDD was 5.8%. Application of the diagnostic exclusion rules with regard to concurrent major depression and dysthymia decreased the rate only slightly (5.3%). An additional 18.6 % were 'near-threshold' cases, mostly because they failed to meet the mandatory impairment criterion. Over the follow-up period only few new PMDD cases were observed: cumulative lifetime incidence was 7.4%. PMDD syndrome was stable across 48 months with < 10% complete remissions among baseline PMDD cases. The 12-month and lifetime co-morbidity rates were high (anxiety disorders 47.4%, mood disorders 22.9%; somatoform 28.4%), only 26.5 % had no other mental disorder. Particularly high odds ratios were found with nicotine dependence and PTSD. In terms of correlates increased rates of 4-weeks impairment days, high use of general health and mental health services, and increased rates of suicide attempts were found. In this sample of adolescents and young adults, premenstrual symptoms were widespread. However, DSM-IV PMDD was considerably less prevalent. PMDD is a relatively stable and impairing condition, with high rates of health service utilization, increased suicidality and substantial co-morbidity.

The Distal Impact of Two First-Grade Preventive Interventions on Conduct Problems and Disorder in Early Adolescence

In this article, we examine the impact of two universal, first-grade preventive interventions on the prevalence of conduct problems and disorder and mental health service need and use in early adolescence. The classroom-centered (CC) intervention was designed to reduce the risk for later conduct problems and disorder by enhancing teachers' behavior management in first grade, whereas the Family-School Partnership (FSP) intervention targeted improvement in parent-teacher communication and parents' child behavior management strategies. At Grade 6, or age 12, CC and FSP intervention children received significantly lower ratings from their teachers for conduct problems than control children. CC and FSP children were also significantly less likely than control children to meet diagnostic criteria for Conduct Disorder and to have been suspended from school in the last year. In addition, the CC intervention was associated with significantly lower rates of child mental health service need and utilization. Overall, the CC intervention appeared to be the more effective of the two in reducing the prevalence of conduct problems and disorder at age 12 and in reducing mental health service need and utilization. Nevertheless, future studies may show that the combination of CC and FSP interventions produces additive or even synergistic effects.

Racial and Ethnic Variations in Mental Health Care Utilization Among Children in Foster Care

Although children placed in foster care have an elevated need for mental health services, little is known about the extent to which their needs are met and the factors associated with their utilization of such services. In this study we examined racial and ethnic differences in caregiver-reported mental health service utilization rates among a sample of 659 youth ages 2-17 years in foster care. Results indicate that White American youth were significantly more likely to receive services compared to African American and Latino youth, even when the effects of possible confounding variables were controlled. Possible explanations and implications for racial and ethnic disparities in service utilization are discussed.

Health Status and Health Services Utilization of Canada's Immigrant and Non-Immigrant Populations

This paper compares the health status of immigrants and their utilization rates of health services to those of the Canadian-born population using data contained within two cycles (1985 and 1991) of the General Social Survey (GSS). Our main results show that neither the health status of immigrants nor their utilization rates of health services differ significantly from those of the Canadian-born population. When both data sets are pooled, the estimated results show that immigrants’ health status and their use of health services have remained

Improving service quality: experience from the Tanzania Family Health Project.

To improve the quality and uptake of reproductive health service in rural communities in Tanzania. Descriptive study of operational research. One and a half million people living in urban and rural communities in the Mbeya Region of Tanzania. Design and implementation of a range of service quality improvement measures. Management systems strengthening; clinical skills training; orientation of health staff to service quality; introduction of quality assurance systems; improvement to supervision systems; community involvement in monitoring health service delivery. Health service utilization rates; client perceptions of health service quality; situation analysis of health service provision. Uptake of reproductive health services increased; improved client perceptions of service quality; improved health infrastructure; increased community participation in health service management. Health service quality in sub-Saharan Africa can be improved substantially through a process of identifying and addressing the constraints which militate against effective service provision. The cost of such improvement is modest compared with current health expenditure. Health planners and managers involved in sectoral reform programmes should give due attention to quality assurance mechanisms in addition to structural elements of the reform process.

Anxiety disorders among African-American and white primary medical care patients.

The prevalence of current anxiety disorders and associated clinical patterns was examined in a sample of 125 African American and 120 white primary medical care patients between ages 18 and 64. Patients who indicated they had at least one mood or anxiety symptom in response to a screening questionnaire were interviewed to determine the presence of a DSM-IV anxiety, mood, or possible alcohol abuse disorder. Demographic data and data on mental- and physical-health-related functioning and health service utilization were also collected. The authors found no racial differences in the proportions of patients who met DSM-IV criteria for the disorders, nor in their symptom patterns, level of functional disability, or rates of health and mental health service utilization.

Rates of health services utilization and survival in patients with heart failure in the Department of Veterans Affairs medical care system.

The objective of this study was to describe patterns of hospital and clinic use and survival for a large nationwide cohort of patients with heart failure. A retrospective cohort study of patients treated in the Veterans Affairs medical care system was conducted using linked administrative databases as data sources. In 1996, the average heart failure cohort member had 1-2 hospitalizations, 14 inpatient days, 6-7 visits with the primary physician, 15 other visits for consultations or tests, and 1-2 urgent care visits per 12 months. The overall risk-adjusted 5-year survival rate was 36%. Hospital use rates in the cohort fell dramatically between 1992 and 1996. One-year survival rates increased slightly over the period. Patients with heart failure are heavy users of services and have a very poor prognosis. Utilization and outcome data indicate the need for major efforts to assure quality of care and to devise innovative ways of delivering comprehensive services.

Medical Consequences of Child Sexual Abuse

Limited attention has been paid to the long-term physical health consequences experienced by CSA survivors. Research has found that CSA is often associated with increased health burden in adulthood. However, research in this area is plagued by a range of methodological difficulties, rendering it difficult to draw conclusions regarding the health status of CSA survivors.This research sought to investigate associations between child sexual abuse (CSA) victimisation and rates of subsequent healthcare utilisation.The forensic medical records of 2759 cases of CSA between 1964 and 1995 were linked to commonwealth Australian medical data recorded between 2010 and 2015. Differences in rates of health service utilisation during this five-year period were compared between CSA victims and a age and gender matched comparison cohort without known abuse history.CSA was associated with increased levels of attendance at health professionals (OR = 1.51, p < .001) for medical care and for consultations related to dental (OR = 1.28, p < .001) and chronic disease (OR = 1.23, p <.001). CSA was associated with lower mean rates of attendance at gynaecologists. Gender and age at abuse significantly influenced the relationship between CSA and frequency of health service utilisation.Experiencing CSA was associated with increases in rates of contact with health professionals. Abused females and victims abused after 12 years of age demonstrated the greatest elevations in rates of service utilisation. These findings have significance for both researchers in this field, and medical practitioners providing primary care.

Overcoming Barriers Faced by African-American Families with a Family Member with Mental Illness

A qualitative research design combined with a quantitative analytic technique, concept mapping, was used to examine and address barriers to African-American families' involvement in the treatment of their family members with mental illness. Focus groups were formed with lay and professional informants. The focus groups recommended a variety of strategies for improving caregiver supports and increasing the involvement of caregivers in the treatment process. The implications of these findings for mental health professionals are discussed. Overcoming Barriers Faced by African-American Families with a Family Member with Mental Illness* David E. Biegel**, Jeffrey A. Johnsen, and Robert Shafran Family members of persons with severe mental disability can play critical roles in enhancing the treatment and care of their ill family members. However, the ability of families to fulfill their caregiving role is negatively affected by a number of barriers, including significant levels of perceived burden experienced by many caregivers and a lack of perceived support from mental health professionals and from caregivers' own informal social networks (Biegel, Milligan, Putnam, & Song, 1994). A major gap in the literature is a lack of full understanding of the role of race and ethnicity in family caregiving for persons with mental illness. There is a large body of research evidence documenting the fact that different groups of individuals meet needs and solve problems in differing ways and that there are often obstacles-systemic and personal-that differentially affect the ability, opportunity, and willingness of specific population groups to participate in organized help-seeking and receiving activities (Giordano, 1973; Naparstek, Biegel, & Spiro, 1982; Neighbors & Jackson, 1996; Padgett, 1995). Nevertheless, the role of race and ethnicity has received relatively little attention in the mental health family caregiving literature (Davis, 1982; Davis & Proctor, 1989). Thus, a fuller understanding of obstacles and barriers faced by minority populations in family caregiving for persons with mental illness is needed. Understanding the barriers facing African-American family caregivers is of particular concern to mental health professionals for several reasons. First, African-American consumers with severe mental disability would appear to have even greater needs for family support than do Caucasian consumers, given the fact that they have higher rates of use of in-patient mental health services. In addition, African-American consumers have lower utilization and higher drop-out rates for out-patient mental health services than do Caucasian consumers (Snowden & Cheung, 1990). Second, the samples of only a few research studies have included a sufficient number of African-American family caregivers to allow a specific examination of their problems and needs (Biegel, Milligan, Putnam, & Song, 1994; Pickett, Vraniak, Cook, & Cohler, 1993; Struening, Stueve, Vine, Kreisman, Link, & Herman, 1995). Conceptual Framework and Research Questions This study specifically focused on ways to enhance the involvement of African-American families in the treatment and care of their family member with mental illness. A systems theoretical orientation underlies the design of this study. General systems theory (Bertalanffy, 1969) broadly defines a system as a complex of interacting elements which function together to manage the environment. Individual system elements or components are embedded within a web of interlocking relationships such that change in any one element ultimately affects the entire system. In order to truly understand the functioning of any one system element, it must be examined from within the context of the system of which it is a part. The key informants targeted in this study-family caregivers, mental health consumers, agency case managers, and staff of the county mental health board authority-each represent major components of the local mental health system which have the greatest direct impact on the day-to-day conduct of family caregiving to persons with severe mental disability. …

Bipolar Disorders in a Community Sample of Older Adolescents: Prevalence, Phenomenology, Comorbidity, and Course

The purpose of this study was to examine the prevalence, clinical characteristics, and mental health treatment services utilization of adolescents with bipolar disorders and manic symptoms. Structured diagnostic interviews were administered to a representative community sample of 1,709 older adolescents (aged 14 through 18 years). The lifetime prevalence of bipolar disorders (primarily bipolar II disorder and cyclothymia) was approximately 1%. An additional 5.7% of the sample reported having experienced a distinct period of abnormally and persistently elevated, expansive, or irritable mood even though they never met criteria for bipolar disorder ("core positive" subjects). The rate of manic symptoms in these subjects was similar to that reported in clinical samples, and the course of bipolar disorder was relatively chronic. Compared with adolescents with a history of major depression (n = 316) and a "never mentally ill" group (n = 845), the bipolar and core positive subjects both exhibited significant functional impairment and high rates of comorbidity (particularly with anxiety and disruptive behavior disorders), suicide attempts, and mental health services utilization. These data highlight the clinical and public health significance of even the milder and subthreshold cases of bipolar disorder in adolescence.

Asian Americans' differential patterns of utilization of inpatient and outpatient public mental health services in Hawaii

The major purpose of the present study was to examine Asian Americans' differential patterns of utilization of mental health services in Hawaii. It was proposed that an analysis of Asian Americans' differential patterns of utilization of inpatient and outpatient mental health services may provide some clues to the reasons behind their overall pattern of underutilization. More specifically, whereas it has been established in many studies that Asian Americans tend to underutilize mental health services, the present research questions are directed at determining if Asian Americans tend to (a) underutilize inpatient mental health services, (b) overutilize or use at their representative level outpatient mental health services, and (c) exhibit different patterns in the sources of referral into the mental health system. Using a dataset from the state of Hawaii's Department of Health, mental health service utilization rates for three Asian-American groups (Chinese, Japanese, and Filipino) were compared to each other and to those of White Americans. It was found that there were ethnic subgroups (e.g., Chinese versus Filipino) and intergroup differences (i.e., Asian versus White) in the utilization of inpatient and outpatient mental health services as well as in sources of referral into the mental health system. The clinical and research implications of the findings are discussed.

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.

Clinical assessment of post‐traumatic stress disorder (PTSD) among American minorities who served in Vietnam

AbstractThis paper will review issues in clinical assessment of minority combat veterans who served in Vietnam. We will specify differences and similarities for assessing minorities within the context of evaluating the larger combat veteran population. As a way of introducing a need for specialized diagnosis and treatment, we will present data demonstrating that minorities may be characterized as a distinct group among Vietnam combat veterans; data demonstrating differential rates of PTSD and other psychological disorders; as well as differences in vocational, social, educational, physical and health adjustment along with differential rates of health services utilization. Throughout this paper, we will attempt to give a historical perspective to the role of the minority soldier before, during, and after military service in Vietnam, as well as inter‐related civilian events that impacted minority veterans. We will review pertinent theories that explain higher PTSD rates among minority veterans‐considering the special nature of the Vietnam War and its impact on young minority soldiers. We will frankly discuss problems we have observed about clinician prejudice that adversely affect clinical assessment and treatment. We emphasize that every combat veteran, regardless of racial background, is a unique individual with his or her own unique story to tell. We are aware, though, that cross‐cultural interactions, because of factors internal to both client and clinician, can impede, if not preclude, effective therapeutic encounter. We recognize that providing information about minorities may do relatively little to alter deeply rooted prejudice of an unconscious nature. We hope to address the issues of ethnicity in ways that do not stir clinical resistance but rather that enhance clinician sensitivity, curiosity, and confidence.