Assessing service usage and protective factors in a pediatric psychiatry clinic during the COVID-19 pandemic.

Youth with developmental and pre-existing mental health conditions have been particularly vulnerable to declines in psychological functioning during the COVID-19 pandemic. This study aimed to first, analyze service usage within an outpatient child and adolescent psychiatry clinic in the months preceding and during the COVID-19 pandemic, and second, to examine associations with potential protective factors against mental health concerns in a treatment-engaged sample. Service usage was examined using clinic billing data, and reports on protective factors were gathered via parent survey of 81 children ages 6-17 years who received mental health treatment in an outpatient psychiatry clinic during the pandemic. Protective factors were assessed at the individual, family, and community levels, and included children's use of coping strategies, parental resilience, and parents' perceived social supports. Study outcomes, including mental health concerns, mental health emergencies, pandemic-related distress, and social impact of the pandemic, were analyzed via Pearson correlations and simultaneous multiple linear regressions. Findings suggest increased service usage and child coping, parental resilience, and social connectedness as factors associated with fewer mental health concerns in youth with psychiatric concerns during the pandemic. This study lends support for expanding psychiatric services with continued use of telemedicine platforms. Further, findings suggest a mental health benefit to optimizing individual, parental, and community-based resources to enhance children's psychological functioning, particularly for youth with pre-existing mental health conditions.

How an increase in income affects the use of dental care services among a low-income population: evidence from the Finnish basic income experiment.

BACKGROUND: Previous research has shown that the use of dental care services has a significant socioeconomic gradient. Lower income groups tend to use dental care services less, and they often have poorer dental health than higher income groups. The purpose of this study is to evaluate how an increase in income affects the use of dental care services among a low-income population. METHODS: The study examines the causal effect of increasing cash transfers on the use of dental care services by utilizing unique register-based data from a randomized field experiment conducted in Finland in 2017-2018. The Finnish basic income experiment introduced an exogenous increase in the income of persons who previously received basic unemployment benefits. Register-based data on the study population's use of public and private dental care services were collected both for the treatment group (N = 2,000) and the control group (N = 173,222) of the experiment over a five-year period 2015-2019: two years before, two years during, and one year after the experiment. The experiment's average treatment effect on the use of dental care services was estimated with OLS regressions. RESULTS: The Finnish basic income experiment had no detectable effect on the overall use of dental care services. However, it decreased the probability of visiting public dental care (-2.7% points, -4.7%, p =.017) and increased the average amount of out-of-pocket spending on private care (12.1 euros, 29.8%, p =.032). The results suggest that, even in a country with a universal public dental care coverage, changes in cash transfers do affect the dental care patterns of low-income populations.

Emergency department usage by adults with cerebral palsy: A retrospective cohort study.

OBJECTIVE: To retrospectively profile the ED usage for a cohort of adults with cerebral palsy (CP). METHODS: Five years of ED data from a Victorian hospital network was analysed to identify participants with CP using the Victorian Emergency Minimum Dataset supplemented with scrutiny of inpatient admission data to identify cases because of limited ED coding of CP. Presentation frequency, emergency diagnoses (International Classification of Diseases, 10th Revision codes) and presentation sequelae were calculated and described. An investigation into rates of low urgency presentations was conducted. Differences between adult and paediatric cohorts were described. RESULTS: Participants with CP constituted 1586 ED presentations. Adults represented 43% (n = 689) of these. Thirty percent of adults presented more than five times over the study period, with respiratory (25%), gastrointestinal (17%) and epilepsy/convulsion diagnoses (11%) being the most common presentations. Rates of inpatient hospital admissions from the ED increased with age in adults (P < 0.001). Low urgency presentations made up 8.9% of total adult presentations. CONCLUSIONS: The high rates of respiratory diagnoses and epilepsy/convulsions, both ambulatory care-sensitive conditions, may be indicative of transitional challenges between paediatric and adult healthcare, potentially highlighting difficulties in accessing primary care services. Relatively low rates of 'low urgency' presentations may suggest perceived medical fragility in this vulnerable population. People with CP who present to ED and were not admitted may be underrepresented in this data. National expansion of this research will aid the development of an evidence-based model of care for CP in Australia.

Correlation Between Ophthalmology Market Saturation and Medicare Utilization Rates.

PURPOSE: To characterize usage of ophthalmologic services by Medicare Fee-For-Service (FFS) beneficiaries relative to geography-specific market saturation, demographics, and contextual factors DESIGN: Cross-sectional study METHODS: Data sets from Centers for Medicare & Medicaid Services, US Census Bureau, US Department of Agriculture, and Housing and Urban Development, were used to calculate county- and state-level ophthalmologic service usage, market saturation, and demographic characteristics. Negative binomial regression models were used to evaluate the association between results and demographic or population-specific variables. RESULTS: Ophthalmologic service usage ranged from 58.2% to 15.2%, whereas saturation ranged from 21,763 to 91.4 FFS beneficiaries per registered ophthalmologist. Usage was significantly associated with demographic characteristics in each geography: lower proportion of African American (P = .009), Hispanic (P < .001), and other race beneficiaries (P < .001), relative to white beneficiaries; a higher proportion of female (P < .001) relative to male; a higher proportion of adults having completed an associate degree or some college (P = .001), or holding a bachelor's degree or higher (P < .001), relative to a high school diploma; a lower proportion of adults in each geography experiencing poverty (P = .009), geographies with lower Multidimensional Deprivation Index (P < .001); a higher urban-influence code (P < .001). There was no significant correlation between the usage of ophthalmologic services and the geographic market saturation of ophthalmologists (Spearman rho, -0.030, P = .227). CONCLUSIONS AND RELEVANCE: Ophthalmologic service usage is significantly influenced by population demographics; however, increased provider density alone appears insufficient to promote the usage of eye care services.

Healthcare Service Usage and Costs for Elderly Patients with Obstructive Lung Disease.

Background: The worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with OLD have two or more comorbid conditions. This study describes the impact of such comorbidities on the healthcare service usage and related costs in a country with universal health coverage, basing on a large cohort of elderly patients with OLD and employing real-world data. Methods: We carried out a retrospective cohort study on a large population of elderly (age >64 years) patients with OLD served by a Local Health Unit in northern Italy. Their comorbidities were assessed using the clinical diagnoses assigned by the Adjusted Clinical Group (ACG) system to individual patients by combining different information flows. Correlations between number of comorbidities and total annual healthcare service usage and costs were examined with Spearman's test. Regression models were applied to analyze the associations between the above-mentioned variables, adjusting for age and sex. Results: All types of healthcare service usage (access to emergency care; number of outpatient visits; number of hospital admissions) and pharmacy costs increased significantly with the number of comorbidities. Average total annual costs increased steadily with the number of comorbidities, ranging from € 1158.84 with no comorbidities up to € 9666.60 with 6 comorbidities or more. Poisson regression analyses showed an independent association between the number of comorbidities and the use of every type of healthcare service. Conclusion: These results based on real-world data provide evidence that the burden of care for OLD patients related to their comorbidities is independent of and in addition to the burden related to OLD alone and is strongly dependent on the number of comorbidities, suggesting a holistic approach to multimorbid patients with OLD is the most sound public health strategy.

Predictors of Service Dosage, Recommendation, and Usage in an Early Childhood System of Care.

OBJECTIVES: Children and families enrolled in early childhood systems of care (SOC) present with various psychological and behavioral risk factors that may inhibit healthy development. Within a SOC, wraparound services are designed to increase families' access to numerous child-serving sectors in order to target those risk factors. This study examined whether child and family risk factors at enrollment in an early childhood SOC predicted dosage, service recommendation, and usage of recommended services. METHODS: Participants were 144 children ranging in age from 1.38 to 5.89 years and their caregivers. Families completed measures of child and caregiver functioning prior to participation in the SOC. Service recommendation and usage were measured at intake and three months, respectively. We used multiple regression analysis to examine the relationship between risk factors and dosage of services received. Logistic regression analyses identified the relationships between risk factors and service recommendation and usage according to specific service types within the SOC. RESULTS: Children with greater behavior problems received more services overall (R2 = .103, ß = .243, p = .033). Child risk factors predicted recommendation for child welfare (trauma exposure: O R ^ = 1.352 , p = .052) and mental health services (behavior problems: O R ^ = 1.061 , p = .034; trauma exposure: O R ^ = 1.316 , p = .046), whereas families with substance use issues were less likely to be recommended for mental health services ( O R ^ = .229 , p = .017). CONCLUSIONS: Findings highlight opportunities for improved service provision and service-level decision making in early childhood SOCs.

Service usage by a New Zealand Housing First cohort prior to being housed.

BACKGROUND: The Ending Homelessness in New Zealand: Housing First research programme is evaluating outcomes for people housed in a Housing First programme run by The People's Project in Hamilton, New Zealand. This baseline results paper uses administrative data to look at the scope and duration of their interactions with government services. METHODS: We linked our de-identified cohort to the Integrated Data Infrastructure (IDI). This database contains administrative data on most services provided by the New Zealand Government to citizens. Linkage rates in all datasets were above 90%. This paper reports on the use of government services by the cohort before being housed. We focus on the domains of health, justice and income support. RESULTS: The cohort of 390 people had over 200,000 recorded interactions across a range of services in their lifetime. The most common services were health, justice and welfare. The homeless cohort had used the services at rates far in excess of the general population. Unfortunately these did not prevent them from becoming homeless. CONCLUSION: These preliminary findings show the homeless population have important service delivery needs and a very high level of interaction with government services. This highlights the importance of analysing the contributing factors towards homelessness; for evaluation of interventions such as Housing First, and for understanding the need for integrated systems of government policy and practice to prevent homelessness. This paper also provides the baseline for post-Housing First evaluations.

Understanding Service Usage and Needs for Adults with ASD: The Importance of Living Situation.

With the increasing prevalence of adults with autism spectrum disorder (ASD), research examining the service experiences of this population is greatly needed. The current study investigated service use, unmet needs, and obstacles to service access for a large sample of adults with ASD. After accounting for various demographic factors known to impact service usage and needs, living situation was a significant predictor of service use, needs, and obstacles to services. Adults with ASD living with family reported less service use, higher unmet need, and more obstacles to accessing services. With more than half of this adult sample living with family, results have clear public policy implications to support the increasing population of adults with ASD living with aging caregivers.

Data analytics of call log data to identify caller behaviour patterns from a mental health and well-being helpline.

This work presents an analysis of 3.5 million calls made to a mental health and well-being helpline, seeking to answer the question, what different groups of callers can be characterised by specific usage patterns? Calls were extracted from a telephony informatics system. Each call was logged with a date, time, duration and a unique identifier allowing for repeat caller analysis. We utilized data mining techniques to reveal new insights into help-seeking behaviours. Analysis was carried out using unsupervised machine learning (K-means clustering) to discover the types of callers, and Fourier transform was used to ascertain periodicity in calls. Callers can be clustered into five or six caller groups that offer a meaningful interpretation. Cluster groups are stable and re-emerge regardless of which year is considered. The volume of calls exhibits strong repetitive intra-day and intra-week patterns. Intra-month repetitions are absent. This work provides new data-driven findings to model the type and behaviour of callers seeking mental health support. It offers insights for computer-mediated and telephony-based helpline management.

Acceptability of internet-based interventions for depression in Indonesia.

BACKGROUND: In Indonesia, internet-based interventions may represent a promising strategy to reduce the mental health gap given that the level of internet usage in the country continues to increase. To check the acceptability of internet-based interventions, this study investigates factors that contribute to the use of internet-based interventions for depression in Indonesia. METHOD: The survey was conducted online and had 904 participants recruited from specific social networks on mental health and general social media (Mean age = 27.07, 50.22% females). The three dependent variables were (1) behavioral intention to start using internet-based interventions for depression, (2) preference to use it as a substitute for regular treatments and (3) preference to use it to complement regular treatments. The predictor variables included sociodemographic characteristics, perceived mental health conditions, personal situational characteristics, personal innovativeness toward online services, and depression level. RESULTS: A large majority reported to be open to using internet-based interventions for depression (73.7%), as well as to use it as a substitution (73.3%) or as a complementary (73%) to regular treatments. Personal innovativeness toward online services was the strongest significant predictor for all types of use, even when corrected for current depression level. When added to the analyses separately, depression level was the second strongest predictive factor for all dependent variables. CONCLUSION: The majority of Indonesians showed openness to use internet-based interventions for depression. To increase the adoption of internet-based interventions for depression, it is important to first promote internet usage to more people across the country, especially for those who are currently depressed.

Unmet service needs evaluated by case managers among disabled patients on hemodialysis in Japan.

BACKGROUND: This study aimed to investigate the levels of unmet needs for home and community-based services (HCBS) evaluated by case managers (CMs) among disabled patients on hemodialysis (DPHD) and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors. METHODS: Self-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay. RESULTS: The prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay. CONCLUSION: CMs need to monitor unmet needs after coordinating HCBS for DPHD and need to encourage HBCS use among patients with impaired cognitive function and caregivers with heavier caregiving burdens.

Comparison of incidence, rate and length of all-cause hospital admissions between adults with normoglycaemia, impaired fasting glucose and diabetes: a retrospective cohort study in Geelong, Australia.

OBJECTIVE: To determine whether adults with normoglycaemia, impaired fasting glucose (IFG) and diabetes differed according to the incidence, rate, length and primary reasons for hospital admission. DESIGN: Retrospective cohort study. SETTING: Barwon Statistical Division, Geelong, Australia. PARTICIPANTS: Cohort included 971 men and 924 women, aged 20+ years, participating in the Geelong Osteoporosis Study. Glycaemic status was assessed at cohort entry using fasting plasma glucose, use of antihyperglycaemic medication and/or self-report. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was any admission to the major tertiary public hospital in the study region over the follow-up period. Secondary outcome measures were admission rate and length (days). RESULTS: Over a median follow-up of 7.4 years (IQR 5.3-9.6), participants with diabetes, compared with those with normoglycaemia, were two times as likely to be hospitalised (OR 2.07, 95% CI 1.42 to 3.02), had a higher admission rate (incidence rate ratio 1.61, 95% CI 1.17 to 2.23) and longer hospital stay (third quartile difference 7.7, 95% CI 1.3 to 14.1 and ninth decile difference 16.2, 95% CI 4.2 to 28.3). IFG group was similar to normoglycaemia for the incidence, rate and length of admission. Cardiovascular disease-related diagnoses were the most common primary reasons for hospitalisation across all glycaemic categories. CONCLUSIONS: Our results show increased incidence, rate and length of all-cause hospital admission in adults with diabetes as compared with normoglycaemia; however, we did not detect any associations for IFG. Interventions should focus on preventing IFG-to-diabetes progression and reducing cardiovascular risk in IFG and diabetes.

Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East.

BACKGROUND: Fragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings. METHODS: This systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants. RESULTS: Of 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally. CONCLUSIONS: Findings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the 'targeted policy approach for vulnerable groups' as a means of addressing MNH service usage inequities.

The health and service needs of older veterans: a qualitative analysis.

BACKGROUND: With substantial numbers of older people within the Australian veteran population continuing to age well within the community, appropriate planning of community support and health services is important for this ageing population. OBJECTIVE: The purpose of this research study was to investigate the health and service usage of a group of older Australian war veterans who receive Australian Government support for their health-care needs and conditions. DESIGN: This paper reports on qualitative data gathered from the longitudinal MELSHA study. Utilizing thematic analysis and the theoretical framework of locus of control, this article reports on 25 qualitative interviews of veterans and their widows about their DVA-related health and service usage. RESULTS: Participants within this study were determined to maintain a sense of control and independence in relation to their living circumstances and service usage. In doing so, they attempted to maintain their current community living circumstances and independence while minimizing their utilization of services and perceived 'burden' on family members and friends. Participants accepted that a decline in health status was inevitable, but engaged in a number of different strategies to maintain their current way of life for as long as possible. DISCUSSION & CONCLUSION: Participants, while valuing an internal locus of control, generally engaged in an integrative locus of control to maintain a sense of control and independence in their daily lives. In addition, participants were very grateful of the services provided by the DVA and acknowledged their role in maintaining their independence within the community.

Neonatal intensive care and late preterm infants: health and family functioning at three years.

BACKGROUND: Late preterm infants (LPIs), born at 34+0 to 36+6 weeks of gestation contribute a significant proportion of all neonatal intensive care (NIC) admissions and are regarded as being at risk of adverse outcomes compared to term-born infants. AIM: To explore the health outcomes and family functioning of LPIs who required neonatal intensive care, at three years of age. STUDY DESIGN AND SUBJECTS: This cohort study included 225 children born late preterm, between 1 January and 31 December 2006 in Northern Ireland. Children admitted for NIC (study group, n=103) were compared with children who did not require NIC or who required special care only for up to three days (comparison group, n=122). OUTCOME MEASURES: Health outcomes were measured using the Health Status Questionnaire, health service usage by parent report and family functioning using the PedsQL™ Family Impact Module. RESULTS: LPIs who required NIC revealed similar health outcomes at three years in comparison to those who did not. Despite this, more parents of LPIs who required NIC reported visiting their GP and medical specialists during their child's third year of life. Differences in family functioning were also observed with mothers of LPIs who required NIC reporting, significantly lower levels of social and physical functioning, increased difficulties with communication and increased levels of worry. CONCLUSIONS: LPIs were observed to have similar health outcomes at three years of age regardless of NIC requirement. The increase in GP and medical specialist visits and family functioning difficulties observed among those infants who required NIC merits further investigation.