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1.
Crim Behav Ment Health ; 30(1): 38-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32173951

RESUMO

BACKGROUND: In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. AIMS: To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units. METHODS: Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. RESULTS: 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. CONCLUSIONS: The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Tempo de Internação , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Prisões , Instalações Privadas , Setor Privado , Logradouros Públicos , Setor Público , Medidas de Segurança , Fatores Socioeconômicos , Medicina Estatal/organização & administração
2.
Am J Psychiatry ; 177(4): 318-326, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32098486

RESUMO

OBJECTIVE: Psychotic experiences affect more than 10% of children and often co-occur with nonpsychotic mental disorders. However, longitudinal studies of the outcome of psychotic experiences based on unbiased information on mental health service use and psychotropic medications are scarce. The authors investigated whether psychotic experiences at ages 11-12 predicted a psychiatric diagnosis or treatment with psychotropic medications by ages 16-17. METHODS: In a longitudinal register-based follow-up study of the Copenhagen Child Cohort 2000, a total of 1,632 children ages 11-12 were assessed for psychotic experiences in face-to-face interviews. The children were also assessed for mental disorders and IQ. National registries provided information on perinatal and sociodemographic characteristics, on psychiatric disorders diagnosed at child and adolescent mental health services, and on prescribed psychotropic medications through ages 16-17. RESULTS: Among children who had not been previously diagnosed, and after adjustment for sociodemographic and perinatal adversities and IQ, psychotic experiences at ages 11-12 predicted receiving a psychiatric diagnosis in child and adolescent mental health services before ages 16-17 (adjusted hazard ratio=3.13, 95% CI=1.93, 5.07). The risk was increased if the child met criteria for a co-occurring mental disorder (not diagnosed in mental health settings) at baseline compared with no psychotic experiences or diagnosis at baseline (adjusted hazard ratio=7.85, 95% CI=3.94, 15.63), but having psychotic experiences alone still marked a significantly increased risk of later psychiatric diagnoses (adjusted hazard ratio=2.76, 95% CI=1.48, 5.13). Similar patterns were found for treatment with psychotropic medications. CONCLUSIONS: Psychotic experiences in childhood predict mental health service use and use of psychotropic medications during adolescence. The study findings provide strong evidence that psychotic experiences in preadolescence index a transdiagnostic vulnerability for diagnosed psychopathology in adolescence.


Assuntos
Delusões/epidemiologia , Alucinações/epidemiologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adolescente , Criança , Dinamarca/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Modelos de Riscos Proporcionais , Escalas de Wechsler
3.
Med Care ; 58(3): 199-207, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32106164

RESUMO

BACKGROUND: Recent reports of increased national estimates of pediatric psychiatric emergency department (ED) visits and psychiatric hospitalizations emphasize the need to research these utilization patterns. OBJECTIVES: To assess the patient-provider continuity of care (CoC) and compare the risk of psychiatric ED visits or hospitalization according to the CoC level. RESEARCH DESIGN: A cohort design was applied to Medicaid administrative claims data (2007-2014) for 3-16-year olds with a first psychiatric diagnosis between 2009 and 2013 (n=38,825). SUBJECTS: Continuously enrolled youths with (1) ≥1 outpatient psychiatric visits and (2) ≥4 pediatric outpatient visits in the prior 24 months. MEASURES: The authors assessed CoC in the 24 months before the first psychiatric outpatient visit and quantified CoC using the Alpha Index. The authors assessed patient-provider CoC before first psychiatric diagnosis and the odds of psychiatric ED visits or psychiatric hospitalizations in the year after diagnosis. RESULTS: Of the 38,825 youths, 88.9% received a first psychiatric diagnosis by age 14. The odds of ED visits were significantly higher among youths with low CoC [6.63%, adjusted odds ratio (AOR), 1.27; 95% confidence interval (CI), 1.13-1.41] or moderate CoC (5.76%; AOR, 1.14; 95% CI, 1.02-1.27) compared with those with high CoC (4.96%). Greater odds of psychiatric hospitalization related to low (7.53%; AOR, 1.17; 95% CI, 1.06-1.29) or moderate CoC (7.01%; AOR, 1.15; 95% CI, 1.03-1.27) compared with high CoC (6.06%). CONCLUSIONS: The odds of potentially disruptive clinical management and costly psychiatric ED visits or hospitalizations were lower for youths with high CoC. The findings support the need to research the impact of CoC on long-term pediatric mental health service use.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Medicaid , Transtornos Mentais , Serviços de Saúde Mental/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde , Adolescente , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Estados Unidos
4.
Med Care ; 58(5): 433-444, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32028525

RESUMO

BACKGROUND: Opioids are prescribed more frequently than nonpharmacologic treatments for persistent musculoskeletal pain (MSP). We estimate the association between the supply of physical therapy (PT) and mental health (MH) providers and early nonpharmacologic service use with high-risk opioid prescriptions among Medicare beneficiaries with persistent MSP. RESEARCH DESIGN: We retrospectively studied Medicare beneficiaries (>65 y) enrolled in Fee-for-Service and Part D (2007-2014) with a new persistent MSP episode and no opioid prescription during the prior 6 months. Independent variables were nonpharmacologic provider supply per capita and early nonpharmacologic service use (any use during first 3 mo). One year outcomes were long-term opioid use (LTOU) (≥90 days' supply) and high daily dose (HDD) (≥50 mg morphine equivalent). We used multinomial regression and generalized estimating equations and present adjusted odds ratios (aORs). RESULTS: About 2.4% of beneficiaries had LTOU; 11.9% had HDD. The supply of MH providers was not associated with LTOU and HDD. Each additional PT/10,000 people/county was associated with greater odds of LTOU [aOR: 1.06; 95% confidence interval (CI), 1.01-1.11). Early MH use was associated with lower odds of a low-risk opioid use (aOR: 0.81; 95% CI, 0.68-0.96), but greater odds of LTOU (aOR: 1.93; 95% CI, 1.28-2.90). Among beneficiaries with an opioid prescription, early PT was associated with lower odds of LTOU (aOR: 0.75; 95% CI, 0.64-0.89), but greater odds of HDD (aOR: 1.25; 95% CI, 1.15-1.36). CONCLUSIONS: The benefits of nonpharmacologic services on opioid use may be limited. Research on effective delivery of nonpharmacologic services to reduce high-risk opioid use for older adults with MSP is needed.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/terapia , Prescrições de Medicamentos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Dor Musculoesquelética/terapia , Modalidades de Fisioterapia/estatística & dados numéricos , Idoso , Dor Crônica/epidemiologia , Feminino , Humanos , Masculino , Medicare , Dor Musculoesquelética/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
5.
Epidemiol Psychiatr Sci ; 29: e92, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31928567

RESUMO

AIMS: Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. METHODS: We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. RESULTS: We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. CONCLUSIONS: Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.


Assuntos
Depressão/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Comportamento de Busca de Ajuda , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , População Rural/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Feminino , Sistemas de Informação Geográfica , Pesquisas sobre Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Índia , Masculino , Vigilância da População , Fatores de Tempo
6.
J Ment Health Policy Econ ; 22(3): 85-94, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811752

RESUMO

BACKGROUND: Since the introduction and soaring popularity of the managed behavioral healthcare (BH) "carve-out" model in the 1980s, policymakers have been concerned with their impact on access. In carve-outs, BH and medical benefits are administered separately. Earlier literature found they reduced intensity of service use while maintaining penetration rates. Recently it has become more common for employers to drop existing carve-out contracts, partly due to the Mental Health Parity and Addiction Equity Act (MHPAEA), which placed a greater administrative burden on carve-outs for parity compliance. Although prior studies focused exclusively on the impact of moving from carve-in to carve-out models, it is now more policy-relevant to understand the effects of the move from carve-out to carve-in, which may not be symmetric. Moreover, the natural experiment resulting from MHPAEA implementation may attenuate concerns about selection bias. STUDY AIMS: This study examines how specialty BH care patterns change when employees and dependents are moved from a "carve-out" plan to a "carve-in" plan. METHODS: Linked insurance claims, eligibility, plan and employer data from 2008-14 were obtained for three Optum( employers who dropped their carve-out contracts but retained their carve-in plans. A longitudinal "difference-in-differences" study design was used to compare changes in BH services use over time among individuals who were: (i) moved to carve-in plans when the employer dropped its carve-out contract (N=177,653); and (ii) enrolled in carve-in plans before and after the transition (N=58,658). Outcomes included total and inpatient expenditures, broken down by plan, patient, and total; outpatient visits for assessment, individual psychotherapy, family psychotherapy, and medication management; and days of structured outpatient care, day treatment, residential care, and acute inpatient care. We pooled person-year observations and estimated regressions including individual fixed effects, year dummies and interactions between indicators for post-transition period and whether transitioned from carve-out to carve-in. RESULTS: Relative to individuals continuously in carve-in plans, those who were transitioned experienced significant increases in inpatient utilization (beta =.02; p=.05) and patient inpatient costs (beta =2.35; p=.01) and decreases in day treatment (beta =-0.01; p=.02). Our conclusions proved robust against potential biases due to differing secular time trends and differential changes in benefits resulting from MHPAEA. DISCUSSION: The increased inpatient utilization associated with switching from carve-out to carve-in plans is consistent with previous literature. Carve-outs may use day treatment to reduce inpatient care so that increased inpatient utilization post-transition reduced demand for day treatment. Limitations include possible selection bias at the employer level; lack of data on medication and generalist use, quality, clinical endpoints and quality of life; and potential lack of generalizability. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The reduction in the use of carve-out contracts by private employers associated with MHPAEA implementation likely did not have a net negative impact and may have actually increased access to care among former carve-out enrollees in need of inpatient services. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should consider and evaluate possible unintended consequences of legislation designed to improve access to care. IMPLICATIONS FOR FURTHER RESEARCH: Future work should replicate these analyses with a more representative sample.


Assuntos
Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Humanos , Saúde Mental , Psiquiatria , Qualidade de Vida , Estados Unidos
7.
Rev Lat Am Enfermagem ; 27: e3223, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31826164

RESUMO

OBJECTIVE: evaluate the satisfaction of users with the care provided at the Psychosocial Care Centers and its association with clinical and sociodemographic factors. METHOD: this cross-sectional study was conducted with 55 users from 5 Psychosocial Care Centers. The sociodemographic and clinical characteristics were obtained through an individual structured interview. The abbreviated version of the Mental Health Services Satisfaction Scale (SATIS-BR) was used for data collection. RESULTS: were descriptively analyzed and simple and multiple logistic regression models were adjusted for analysis of associations, estimating the gross and adjusted odds ratio, with the respective confidence intervals of 95%. Results: the age average of the sample was 40.1 (±12.4) years and the degree of satisfaction average was 4.56 (±0.45). Users with less education (primary school) had 5 times more chance of having less satisfaction (p<0.05). Users with frequency of intensive monitoring were 5 times more likely to have less satisfaction than users who receive monthly monitoring (p<0.05). CONCLUSION: the majority of users are satisfied with the service and factors such as low education and higher frequency of monitoring influenced the satisfaction.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Satisfação do Paciente , Adulto , Brasil , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Transtornos Mentais/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários
8.
Harm Reduct J ; 16(1): 74, 2019 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878934

RESUMO

BACKGROUND: The HIV epidemic in Vietnam has been primarily driven by injection drug use. HIV-infected people who inject drugs (PWID) in Vietnam have very high rates of mental health problems, which can accelerate progression to AIDS and increase mortality rates. No research has explored the barriers and facilitators of mental health care for HIV-infected PWID in Vietnam. METHODS: We conducted 28 in-depth interviews among HIV-infected PWID (n = 16), HIV and MMT (methadone maintenance treatment) providers (n = 8), and health officials (n = 4) in Hanoi. We explored participants' perceptions of mental health disorders, and barriers and facilitators to seeking and receiving mental health care. RESULTS: HIV-infected PWID were perceived by both PWID, HIV/MMT providers, and health officials to be vulnerable to mental health problems and to have great need for mental health care. Perceived social, physical, and economical barriers included stigma towards HIV, injection drug use, and mental illnesses; lack of awareness around mental health issues; lack of human resources, facilities and information on mental health services; and limited affordability of mental health services. Social support from family and healthcare providers was a perceived facilitator of mental health care. CONCLUSIONS: Interventions should raise self-awareness of HIV-infected PWID about common mental health problems; address social, physical, economic barriers to seeking mental health services; and increase social support for patients.


Assuntos
Infecções por HIV/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/reabilitação , Adulto , Atitude Frente a Saúde , Negação em Psicologia , Transtorno Depressivo/economia , Transtorno Depressivo/psicologia , Transtorno Depressivo/reabilitação , Utilização de Instalações e Serviços , Feminino , Infecções por HIV/economia , Infecções por HIV/psicologia , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Educação de Pacientes como Assunto , Percepção , Pesquisa Qualitativa , Apoio Social , Abuso de Substâncias por Via Intravenosa/economia , Abuso de Substâncias por Via Intravenosa/psicologia , Vietnã , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 993, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870372

RESUMO

BACKGROUND: Some children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns. METHODS: Latent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit. RESULTS: Five patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children's pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits. CONCLUSIONS: Optimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino
10.
Nervenarzt ; 90(11): 1187-1200, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31667532

RESUMO

Social inequality refers to the inequitable distribution of social prosperity including the resource of health. The relationship between social inequality and mental health can be established by means of indicators of social inequality throughout all age groups in Germany. There are social gradients of mental health on the population level, i.e. the linear relationship between social classes or status and state of health. Fundamental determinants of health disparity are cultural, social, political, and geographical conditions, which interact with the genetic make-up and epigenetic processes. These determinants also influence the management of developmental tasks during the life course and are of utmost importance for the development of mental disorders. The maladaptation to chronic stress is at the core of health disparity. Interventions at the individual behavioral level should comprise the development of stress management and coping strategies.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Transtornos Mentais , Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental , Alemanha , Humanos , Transtornos Mentais/etnologia , Classe Social , Fatores Socioeconômicos
11.
Health Serv Res ; 54(6): 1203-1213, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31742687

RESUMO

OBJECTIVE: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. DATA SOURCES: 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. STUDY DESIGN: We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. PRINCIPAL FINDINGS: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. CONCLUSIONS: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais Pediátricos/economia , Medicaid/economia , Medicaid/estatística & dados numéricos , Serviços de Saúde Mental/economia , Atenção Primária à Saúde/economia , Adolescente , Boston , Criança , Pré-Escolar , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
12.
Med Care ; 57(12): 996-1001, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31730569

RESUMO

BACKGROUND: Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration-funded health centers (HRSA HCs). OBJECTIVE: We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians. RESEARCH DESIGN: We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians. SAMPLE: We used a nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care. We used the National Health Interview Survey to independently identify low-income individuals whose usual source of care was clinics (National Health Interview Survey clinics) or physicians (National Health Interview Survey physicians) in the general population. MEASURES: Dependent variables were unmet need and delay in medical care, and unmet need for prescription medications, mental health, and dental care. The primary independent variable of interest was the usual source of care. We controlled for potential confounders. RESULTS: We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs. CONCLUSIONS: HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , United States Health Resources and Services Administration/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Assistência Odontológica/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Medicaid/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Sexuais , Fatores Socioeconômicos , Tempo para o Tratamento , Estados Unidos , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 691, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610790

RESUMO

BACKGROUND: The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub. METHODS: We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale - Domains and Stages (RAS-DS) scores at intake and review (n = 108); (2) RAS-DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation. RESULTS: Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS-DS measurements, averaging 5 months apart. RAS-DS 'total recovery' scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS-DS domains ('Looking forward', p < 0.001; 'Mastering my illness', p < 0.001; and 'Connecting and belonging', p = 0.001). Corresponding improvements, except in 'Connecting and belonging', were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant. CONCLUSIONS: Despite the lack of a control group and small follow-up sample size, Floresco's integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Seguimentos , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Organizações , Avaliação de Programas e Projetos de Saúde , Queensland
14.
BMC Health Serv Res ; 19(1): 687, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601199

RESUMO

BACKGROUND: Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities. METHODS: EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis. DISCUSSION: This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs. TRIAL REGISTRATION: Clinical Trials.gov # NCT03369678 (registration date November 18, 2017).


Assuntos
Assistência à Saúde/normas , Serviço Hospitalar de Emergência/normas , Equidade em Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Colúmbia Britânica , Protocolos Clínicos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Análise de Séries Temporais Interrompida , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Racismo/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Violência/estatística & dados numéricos
15.
Med Care ; 57(12): 1002-1007, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31568162

RESUMO

OBJECTIVE: The National Health Service Corps (NHSC) is a federal program to increase the supply of health professionals in underserved communities, but its role in enhancing the capacity of community health centers (CHCs) has not been investigated. This study examined the role of NHSC clinicians in improving staffing and patient care capacity in primary, dental, and mental health care in CHCs. METHODS: Using 2013-2016 administrative data from CHCs and the NHSC, we used a generalized estimating equation approach to examine whether NHSC clinicians [staff full-time equivalents (FTEs)] complement non-NHSC clinicians in CHCs and whether their productivity (patient visits per staff FTE) was greater than that of non-NHSC clinicians in primary, dental, and mental health care. RESULTS: Each additional NHSC clinician FTE was associated with a significant gain of 0.72 non-NHSC clinician FTEs in mental health care in CHCs and an increase of 0.04 non-NHSC FTEs in primary care in CHCs with more severe staffing shortages. On average, every additional NHSC clinician was associated with an increase of 2216 primary care visits, 2802 dental care visits, and 1296 mental health care visits per center-year. The adjusted visits per additional staff for NHSC clinicians were significantly greater in dental (difference=992) and mental health (difference=423) care, compared with non-NHSC clinicians. CONCLUSIONS: The NHSC clinicians complement non-NHSC clinicians in primary care and mental health care. They help enhance the provision of patient care in CHCs, particularly in dental and mental health services, the 2 major areas of service gaps.


Assuntos
Centros Comunitários de Saúde/organização & administração , Centros Comunitários de Saúde/estatística & dados numéricos , Área Carente de Assistência Médica , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Assistência Odontológica/organização & administração , Assistência Odontológica/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Humanos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração
16.
BMC Health Serv Res ; 19(1): 749, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651302

RESUMO

BACKGROUND: An estimated 8.2 million adults in the United States live with co-occurring mental health and substance use disorders. Although the benefits of integrated treatment services for persons with co-occurring disorders has been well-established, gaps in access to integrated care persist. Implementation research can address this gap. We evaluated if the Network for the Improvement of Addiction Treatment (NIATx) implementation strategy was effective in increasing integrated services capacity among organizations treating persons with co-occurring disorders. METHODS: This study employed a cluster randomized waitlist control group design. Forty-nine addiction treatment organizations from the State of Washington were randomized into one of two study arms: (1) NIATx strategy (active implementation strategy), or (2) waitlist (control). The primary outcome was a standardized organizational measure of integrated service capability: the Dual Diagnosis in Addiction Treatment (DDCAT) Index. Intent-to-treat analyses and per-protocol analyses were conducted to address the following questions: (1) Is NIATx effective in increasing integrated service capacity? and (2) Are there differences in organizations that actually use NIATx per-protocol versus those that do not? RESULTS: From baseline to one-year post active implementation, both the NIATx strategy and waitlist arms demonstrated improvements over time in DDCAT Index total and DDCAT dimension scores. In intent-to-treat analyses, a moderate but statistically significant difference in improvement between study arms was seen only in the Program Milieu dimension (p = 0.020, Cohen's d = 0.54). In per-protocol analyses, moderate-to-large effects in Program Milieu (p = 0.002, Cohen's d = 0.91) and Continuity of Care (p = 0.026, Cohen's d = 0.63) dimensions, and in total DDCAT Index (p = 0.046, Cohen's d = 0.51) were found. CONCLUSIONS: Overall, organizations in both study arms improved DDCAT Index scores over time. Organizations in the NIATx strategy arm with full adherence to the NIATx protocol had significantly greater improvements in the primary outcome measure of integrated service capacity for persons with co-occurring disorders. TRAIL REGISTRATION: ClinicalTrials.gov, NCT03007940 . Retrospectively registered January 2017.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Comportamento Aditivo , Análise por Conglomerados , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/complicações , Washington
17.
Ir J Psychol Med ; 36(3): 195-199, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31524128

RESUMO

OBJECTIVES: To examine similarities and differences in the demographic and clinical profiles of young people (15-25 years of age) referred between the mental health services (MHS) and Jigsaw Galway. METHODS: A retrospective chart review was conducted of clinical files of individuals attending secondary MHS who had been referred to or from Jigsaw Galway over a 5-year period. Differences in demographic and clinical data between individuals referred to or from Jigsaw Galway were compared. RESULTS: A recent act of self-harm was more prevalent in individuals referred from Jigsaw to the adult MHS (p=0.02). No other demographic or clinical differences were detected between individuals attending Jigsaw Galway and the MHS. CONCLUSIONS: Education sessions for clinical staff working in primary care, Jigsaw Galway and the MHS are suggested to support clinicians in choosing the best referral pathway, which may more optimally address young people's mental health difficulties.


Assuntos
Serviços de Saúde do Adolescente/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Encaminhamento e Consulta , Adolescente , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Atenção Primária à Saúde , Estudos Retrospectivos , Comportamento Autodestrutivo , Inquéritos e Questionários , Adulto Jovem
18.
Adv Gerontol ; 32(3): 456-461, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31512435

RESUMO

With the aim to study trends in the provision of psychiatric care to pensioners, the Ministry of internal Affairs (MIA) of Russia in the framework of the implementation of the concept of departmental mental health services conducted a solid analysis of the state of mental health 111 pensioners of MIA, who seek medical assistance in the Center of Mental Health (CMH) across the Kirov region in the period from February to November 2018. All respondents were divided into two groups: the 1st - 56 persons with mental disorders (average age of 59,3+1,3 years), the 2nd - 55 people with before painful mental health disorders (average age from 59,9+1,1 years). Clinical examination and analysis of medical records were carried out. It is shown that the mental health of pensioners of MIA, who applied for help in CMH is characterized by polymorphism of psychopathological symptoms from severe mental disorders (schizophrenia, organic personality disorders) to short-term symptomatic psychopathological disorders and before painful neurotic conditions. It is proposed to provide comprehensive assistance to veterans of MIA with mental disorders within the framework of the concept of development of the psychiatric service of MIA and to involve in the diagnosis and therapy, along with psychiatrists, regular medical psychologists. This will not only improve the quality of diagnosis of mental disorders, but also improve the therapy of psychopathological disorders, reduce the stigmatization of mental health care and systematize areas of work with this contingent at the stages of secondary prevention of changes in mental functions.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Humanos , Transtornos Mentais/terapia , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Federação Russa , Esquizofrenia/terapia , Veteranos
19.
Int J Equity Health ; 18(1): 122, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382979

RESUMO

BACKGROUND: Unmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need. METHODS: We draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States (n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers. RESULTS: Major characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26-35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need. CONCLUSIONS: The correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/psicologia , Saúde Mental , Pessoa de Meia-Idade , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos , Adulto Jovem
20.
Int J Med Inform ; 130: 103939, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31434043

RESUMO

BACKGROUND: Normal users' voluntary behaviors (e.g., knowledge sharing) in virtual communities (VCs) has been well investigated; however, research on health professionals' voluntary behaviors in online health communities (OHCs) is limited. OBJECTIVE: This paper focuses on OHCs for mental health and aims to explore how intrinsic and extrinsic motivations influence mental health service providers' voluntary behaviors. METHODS: Based on motivation theory and prior studies, we incorporated technical competence as intrinsic motivation and online reputation and economic rewards as extrinsic motivations, and proposed five hypotheses. We crawled objective data from YiXinLi, a Chinese OHC for mental health, and tested the hypotheses based on the Poisson regression model. All hypotheses are supported. RESULTS: 1) Technical competence, online reputation, and economic rewards positively influence mental health service providers' voluntary behaviors; 2) the interaction effect between technical competence and online reputation negatively influences mental health service providers' voluntary behaviors; 3) the interaction effect between technical competence and economic rewards negatively influences mental health service providers' voluntary behaviors. CONCLUSIONS: Both intrinsic motivations and extrinsic motivations positively influence mental health service providers' voluntary behaviors, and their interaction effects negatively influence mental health service providers' voluntary behaviors. This study first contributes to the literature on health professionals' voluntary behaviors in OHCs by verifying the positive effect of economic rewards. It then contributes to motivation theory by incorporating a situation where intrinsic motivations and extrinsic motivations could negatively interact.


Assuntos
Comunicação em Saúde/tendências , Pessoal de Saúde/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde Mental/normas , Saúde Mental/normas , Sistemas On-Line/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , China , Feminino , Humanos , Masculino , Motivação , Papel Profissional , Saúde Pública
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