Understanding preventive health screening services use in persons with serious mental illness: how does integrated behavioral health primary care compare?

OBJECTIVE: People with serious mental illness have reduced life expectancy, in large part due to reduced access to medical services and underutilization of preventive health services. This is a cross-sectional study that compared preventive services use in an integrated behavioral health primary care clinic (IBHPC) with two existing community mental health programs. METHODS: Participants completed questionnaires about preventive health services use that contained 33 questions about demographic clinical information, and use of preventive health services, from October 2010 to December 2012. Services examined included mammogram, Papanicolaou Test, prostate specific antigen, digital rectal exam, fecal occult blood test, and flexible sigmoidoscopy or colonoscopy; blood pressure, height and weight, cholesterol, and blood sugar for diabetes; and influenza immunization, Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) antibodies. A health service utilization score was developed and used as primary outcome for data analyses. RESULTS: In the multivariate analyses female gender (p < 0.05), race/ethnicity (p = 0.01 for Asian, p = 0.04 for Hispanic/Latino, both compared to White), program type (p < 0.001), and having a primary care provider (p < 0.001) were significant predictors of higher services use. IBHPC was associated with higher overall service utilization compared to one community mental health program (p < 0.001) but was similar when compared another (p = 0.34). There was high variability in use of individual services among the clinical programs. CONCLUSION: More studies are needed to examine the effectiveness of integrated care in improving use of health screening services. Characteristics of the clinic in relation to use of preventive services deserve further study.

[Health situation of and health service provided for adult migrants--a survey conducted during school admittance examinations]. / Gesundheitliche Lage und Gesundheitsversorgung von erwachsenen Migranten--ein Survey bei der Schuleingangsuntersuchung.

BACKGROUND: In spite of the increasing numbers of migrants in Germany, only few epidemiological studies have been carried out to investigate the health status of ethnic minorities in Germany. Results from national and international studies on the health of immigrants are inconsistent showing either increased or decreased morbidity in relation to native inhabitants. A survey was undertaken to study the self-reported health status, help-seeking behaviour, and health care utilization among immigrants and Germans. METHODS: 565 adults (276 immigrants and 289 Germans, 97% parents) in Bielefeld, Germany, were interviewed while they accompanied children who attended the pre-school medical examinations. In the analysis descriptive statistics and logistic regression models were used. RESULTS: The self-reported general health status of the study population was good for Germans and immigrants. Germans utilized health care facilities and preventive programmes (e. g. screening programmes) more frequently than immigrants. Furthermore, Germans reported higher levels of satisfaction with health care and a higher level of knowledge about several diseases as compared to immigrants. Logistic regression models indicate that neither migration itself (OR = 0.7, 95% CI = 0.4 - 1.1) nor socio-economic factors (OR for low vs. high social level = 1.2, 95% CI = 0.6 - 2.4) were significantly associated with physical diseases among the study population. CONCLUSIONS: We found no indications that immigrants are less healthy compared to Germans. Further investigations are needed to clarify the differences in patterns of health care utilisation and participation in preventive programmes among Germans and ethnic minorities.

[Retrospective analysis of chief complaints of patients with urogenital malignancies over the past decade at the Jikei University Hospital].

We analyzed the chief complaints of patients with four major urogenital malignancies (renal cancer, renal pelvis and ureter cancer, bladder cancer and prostatic cancer) over the past decade (1990-1999) at the Jikei University Hospital. Over the last 10 years, a high percentage of renal cancers were detected incidentally. By contrast, prostatic cancers were more likely (10.5%) than other cancers to be detected on the basis of symptoms of metastasis. However, since 1995 more prostatic cancers are being detected with prostatic-specific antigen screening at the health checkups. Gross hematuria is the chief complaint of most patients with uroepithelial cancers (cancers of the renal pelvis, ureter and bladder cancer). Additionally, renal pelvis and ureter cancers were diagnosed with screening in a few patients in the past five years.

Feasibility of mobile cancer screening and prevention.

Many areas have high cancer mortality rates and medically underserved populations. This study describes the feasibility (acceptability and costs) of an urban multiphasic (multiple cancers) screening van. Feasibility was evaluated by literature review and informant interviews. Costs were estimated by resource use from urban mobile screening units; decision analysis estimated the costs per cancer detected for breast, cervix, colorectal, and prostate cancer screening. Acceptability of a multiphasic van varied by the informant's perspective. Feasibility and costs were most sensitive to four parameters: age, prior screening history, risk factors, and volume of simultaneous examinations. Subsidized mobile screening facilities may have the potential to reduce cancer morbidity and mortality if they target hard-to-reach underscreened groups, maintain high volume, coordinate with primary care providers, and build on an infrastructure that provides diagnostic and treatment services regardless of ability to pay. It is unclear whether the investment required will translate into a reasonable cost per year of life saved.

[A questionnaire study on health administration in small enterprises in a rural region].

A questionnaire study on the health administration of industrial workers was performed on 230 enterprises in city A in a rural region. Responding subjects numbered 140 and the response rate was 60.9%. Subjects by scale were: 16% with more than 50 workers, 48% with from 10 to 49 workers and 36% with less than 10 workers, and the proportions by industry were: 32% manufacturing, 22% wholesale-retail trade and 14% construction. The subject proportions classified according to the health insurance scheme were: 59% government-managed health insurance, 15% national health insurance and 11% society-managed health insurance. The rate of periodic health examination was 100% in enterprises with more than 50 workers, 67.2% in those with from 10 to 49 workers and 51.0% in those with less than 10 workers. The main reasons why then did not receive health examinations were: 40% had no time available to conduct examinations, 21% believed such examinations were not necessary, and 19% did not know of such an examination system. They encountered some difficulties in promoting health; for example, the advanced age of workers, and no time or money to spare for health administration. They desired provision of facilities close at hand for health examination, health consultation and health information. The results of this study show the difficulty of promoting health administration in small scale enterprises and also that it is difficult to obtain accurate information on actUal conditions including health administration in small enterprises.

National statistics on multiphasic health testing (Human Dock, AMHTS)--with special reference to annual changes in the last eight years.

The present paper discusses the results of an 8-year nationwide survey of multiphasic health testing (MHT) since 1984, referring to the changes with time in the rates of detection of cancers and abnormalities as risk factors for adult diseases. 1) The numbers of hospitals with human dock and institutions with AMHTS answering the questionnaire increased from year to year, with a growth to match in the number of subjects receiving MHT. In 1991, the number of such subjects reached 1,730,000. 2) The relative frequencies of cancers by organs were the stomach greater than the colon greater than the lungs in each of the 8 survey years. The frequency of gastric cancer decreased by 16.7% in the 8 years, while the frequency of colonic cancer increased by 16.3% in the same period. The frequency ratio of gastric to colonic cancer in 1991 was, therefore, 10:6. The proportion of early cancers to cancers detected by MHT was nearly 80% in both gastric and colonic cancers. The high rates of detection of early cancers indicate the utility of MHT. 3) The frequencies of six abnormalities (obesity, impaired glucose tolerance, hepatic dysfunction, hypertension, hypertriglyceridemia, and hypercholesterolemia) as risk factors for adult diseases tended to decrease from year to year. However, when the country was divided into 7 districts to determine regional differences in the frequencies of six abnormalities, it was found the the frequencies of hepatic insufficiency and hypercholesterolemia, in particular, had been increasing form year to year in the northern parts (Hokkaido and Tohoku districts) of Japan and in the southern parts (Kyushu and Shikoku-Chugoku districts). 4) The results of the nationwide survey suggests that regional differences in the health conditions of the nation should be taken into consideration in implementing measures against colonic cancer and life guidance in future MHT.

National statistics on multiphasic health testing (human dock and AMHTS)--especially for the annual-course change during the last five years.

We have gathered national statistics on multiphasic health testing since 1984, and especially analyzed annual-course changes of the past five years. 1) Subjects for questionnaire survey: Despite an increasing number of hospitals with human dock and institutions with automated multiphasic health testing and services (AMHTS), the reply rate to the questionnaire survey has also increased with the number of subjects for the survey being 900,000 in 1988. 2) In the survey of national statistics under the internal organ distinction, the detection rate of cancer of the stomach was the highest, followed by the rates of cancers of the large intestine and lung, in that order. The rate of cancer of the stomach to all the detected cancers decreased by 11.1% during these five years, whereas that of cancer of the large intestine increased to represent 40% of the rate of the stomach. The rate of early stage cancer for all cancers was high, for example, approximately 70% for the stomach and 75% for the large intestine, proving that multiphasic health testing provides excellent accuracy. 3) In the total results collected under item distinction, we examined six items (obesity, glucose tolerance failure, hepatic defficiency, hypertension, hypertriglyceridemia and hypercholesterolemia) which appear frequently and become sources of adult disease. We concluded that especially, hepatic deficiency and hyperlipidemia had increased each year, indicating a deterioration of health and also that regional differences showed a decreasing tendency. 4) The present analysis of the national statistics has apparently provided effective information as data of a preventive counterplan against adult disease.

[A study of factors in medical insurance records associated with participation in health examinations].

Factors in medical insurance records of two groups classified as participants and nonparticipants in a multiphasic health examination (MHE) conducted in a rural town in Kyoto prefecture were compared. The purpose of this study was to clarify how the conditions of medical care influenced the participation in the MHE. The factors were days of consultation, total insurance points and days of consultation classified by specific disease and the area of the medical facility. Participants were examined at least once in 1987-1988 and nonparticipants were never examined in the corresponding period. The data were obtained from the medical insurance records of outpatients for the period from April 1986 thru March 1987. The medical care bills of 170 males and 201 females aged 30-69 were randomly sampled from National Health Insurance records (unit = family), and those of 55 males and 88 females aged 70 and over were from the Medical Service for the Aged (unit = person). These samples were about one forth of target population respectively. Both older participants and older nonparticipants of both sexes had more consultation days and more total insurance points than the corresponding younger subjects. Nonparticipants of both sexes aged 70 and over had more consultation days and more total insurance points than participants; female nonparticipants aged 50-69 had slightly more consultation days and those aged 30-49 also had more insurance points. Nonparticipants tended to have previous medical care for hypertension or ischemic heart disease, which the MHE is responsible for discovering.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk identification and management in clinical practice. Techniques for risk appraisal, screening, and monitoring.

The data on factors that adversely affect health status are mounting, and information on behavioral and environmental means of preventing certain types of disease is becoming more widely available; yet preventive medicine is still seen as a less dynamic form of clinical practice than the crisis-oriented, complaint-responsive form. In this article, first in a series, the author reviews attitudes toward preventive medicine, discusses factors that affect health, explains the notion of how "prospective" medicine can develop through the use of health hazard appraisal, and reviews his and other researchers' ideas about screening tests, periodic physical examinations, health monitoring, and risk-factor identification in physical exams.

Lowering triglyceride values in an occupational setting.

Within a multiphasic screening program it was possible to establish an effective industrial counseling program for individuals identified as potential cardiovascular risks by their serum triglyceride values. A significant reduction of serum triglyceride values was obtained even where minimal supervision was used to modify aspects of an employee's life style. A counseled group of 109 male employees, 40 years and older, with serum triglyceride levels of 200 mg. or higher per 100 ml., was matched by location and age with a control group of 135 noncounseled individuals with similarly elevated triglyceride levels. Individuals in both groups showing significant percentage reduction were those whose serum levels began above 250 mg. per 100 ml. The employees who lowered their triglyceride values most significantly were those that had dieted and were periodically counseled and checked by a physician.

EPSDT impact on health status.

Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a large-scale operational screening program which has generated a tremendous volume of data on the sociodemographic characteristics and health status of Medicaid-eligible children, seems to provide an ideal context within which to evaluate the effectiveness of preventive child health care. Concerns about health care expenditures generally, and the effectiveness of preventive child health services specifically, lead to the question of whether the impact on the health status of the children served can be measured without significantly adding to the cost of these services with primary data collection. We employed a quasi-experimental research design using administratively-generated data from an operational EPSDT program to estimate program impact on the prevalence of serious abnormalities among the children served. We found that, compared either to themselves across time or to a control group, a representative sample of 1831 children had almost 30 percent fewer abnormalities requiring care on rescreening. The ability to demonstrate the impact of EPSDT using these data suggests, among other things relevant to policy, that a national EPSDT monitoring system could be developed that would be cost-effective and could lead to program improvement.