Screening tests in prenatal care: a national study in Israel.

BACKGROUND: Prenatal care in Israel is established as a universal service, but the degree of compliance with care recommendations may vary with the healthcare provider or the characteristics of the population. OBJECTIVES: To study referral to and compliance with the performance of ultrasound, alpha-fetoprotein and amniocentesis and the factors associated with them in a national sample. METHODS: The sampling frame consisted of women who gave birth during March 2000. The sample included 1,100 Israeli Jewish and Arab women who resided in localities with over 50,000 and 20,000 inhabitants respectively. They were interviewed by phone 3 months after delivery. RESULTS: In both population groups 30% reported having seven or more ultrasounds during pregnancy. The performance of fetal body scans was relatively low. Factors associated with non-performance among Jewish women were: lower education, religiousness, and attending Mother and Child Health services as compared to all other services. Seventy-seven percent of Jewish women and 84% of Arab women reported that they had been referred for alpha-protein tests. For women aged 35 and over, 55% of Jewish women were referred for amniocentesis and 63% complied, whereas 39% of Arab women were referred but none complied. CONCLUSIONS: Ultrasound is almost universally performed among Jewish and Arab women, however fetal body scans, alpha-fetoprotein and amniocentesis (for women over the age of 35) are not. The reasons for the lower coverage may be due to under-referral and/or lack of compliance of the women, perhaps due to sociocultural barriers. In both population groups considerable out-of-pocket money is paid for the tests.

Utilization of prenatal care services in larger townships in Israel: should the service be reorganized?

BACKGROUND: In Israel, preventive services for mothers and children are provided mainly by the Ministry of Health through a network of Maternal and Child Health clinics, and partly by municipalities and health maintenance organizations. Utilization of the MCH clinics for prenatal care has declined during the last decades. OBJECTIVE: To study the utilization and satisfaction with prenatal care services following the introduction of the National Health Insurance Law. METHODS: The study population comprised a national sample of Jewish and Arab women who were interviewed by telephone regarding the following: main service utilized for prenatal care, physician and nursing visits, satisfaction with care, and demographic and other characteristics. The response rate was 92% among Jewish women and 88% among Arab women. RESULTS: Twenty percent of the Jewish and 52% of the Arab women selected MCH clinics as the main service for prenatal care. The great majority of the study population attended the HMO services (clinics, independent physicians, women's health centers), while 7% of the Jewish and 4% of the Arab women visited a private clinic. The predisposing factors affecting the women's choice were educational level, ethnic group, religiosity, district of residence, and type of HMO. The mean number of physician visits was more than the eight visits recommended. Forty percent of the sample visited with three or more physicians at different services. More than 40% of the women had no appointment with a nurse, mainly those who chose the services of an HMO clinic, independent physician, or private physician. Satisfaction with the physician, nurse, and physical structure of the main service chosen for prenatal care was high. CONCLUSIONS: Since the majority of women preferred the HMO services, the merging of prenatal care with curative care provided by the HMOs has to be considered. Public health nurses should be integrated in the service, and their specific role needs to be defined.

[Evaluation of utilization of preventive services for infants in Israel--personal and organizational determinants].

UNLABELLED: Preventive services for prenatal and child health care were established 85 years ago by Henrietta Szold, president of the Women's Zionist Organization of America. A network of 1200 Mother and Child-Care clinics (known as "Tipat Halav") has developed as a result of this initiative. Preventive services are provided by the Ministry of Health, municipalities and recently, by all four Health Maintenance Organizations (HMO's) in Israel. OBJECTIVES: To assess the utilization and satisfaction of preventive health services during infancy. METHODS: The sample consisted of Jewish and Arab women who gave birth during March 2000. A total of 667 Jewish and 211 Arab mothers were interviewed after their infants reached the age of 15-19 months. The response rate was 92% and 88% respectively. RESULTS: It was found that 96% of the Jewish women and 100% of the Arab women utilized "Tipat Halav" services. Preventive services were provided mainly by the Ministry of Health and municipalities, while HMO's provided service to 15% of the Jewish infants and 19% of the Arab infants. Nine percent of the infants were not, examined by a physician within the framework of the preventive service, but all infants had health supervision by a nurse. Overall, 25% of the Jewish infants and 32% of the Arab infants had 11 or more visits with the nurse. It was observed that mothers with a higher educational level and those with many children began the process of health supervision at a later stage and visited the clinic less frequently. The number of visits to all health services combined, from birth to 15-19 months, was 26 for Jewish and 28 for Arab infants, indicating over-utilization and dependence. However, the performance of hearing and vision tests was inadequate. Referral to orthopedics was 41% for Jewish and 11% for Arab infants. The level of satisfaction with the service was high, with scores mostly above 3.0 out of a maximum of a total of 4.0 points. CONCLUSIONS: The preventive services provided by the different agencies do not differ significantly except in the case of private physicians and voluntary organizations in East Jerusalem, which do not comply with the recommended routines. RECOMMENDATIONS: Our recommendations include raising the compliance and performance of screening tests and defining the policy of referral to orthopedic services. Furthermore, the clinics should provide more outreach to high-risk families in order to optimize their utilization of services and compliance.

[Performance of screening tests in the preventive services for infants].

UNLABELLED: Early detection is one of the aims of the surveillance by the preventive services in infancy. OBJECTIVES: This article presents the performance of screening for anemia in infancy, compliance with iron supplementation and treatment, screening for hearing, and abnormalities of the hip joint, and referral to ear, nose and throat (E.N.T.) and orthopedic specialists according to the screening results. METHODS: The sample consisted of Jewish and Arab women who gave birth during March 2000. Mothers were interviewed after the infants reached the age of 15-19 months (667 Jewish and 211 Arab). All the women utilized the preventive services of the Ministry of Health, municipalities or H.M.O's. Arab women from East Jerusalem utilized the services of non-governmental organizations (NGO's). RESULTS: A total of 61% of the Jewish and 86% of the Arab infants had a hemoglobin examination. Eighty-five percent of the Jewish and 75% of the Arab infants received iron as a supplement or treatment for anemia. The performance of hearing tests was 88% and 77%, respectively. Among the infants referred to E.N.T. no hearing loss was detected. Fourteen percent were not screened nor referred by the family physician/pediatrician. Among the self referrals, one child was detected with a hearing loss. Percent referrals to the orthopedic surgeon was higher among Jewish than Arab infants. Among those not examined through the preventive services, the rate of pathology detected by the orthopedic surgeon was higher than those referred. RECOMMENDATIONS: Findings highlight the need to improve the quality of screening and increase the percent of infants screened in the Arab and Jewish population, particularly those of the N.G.O.'s, with emphasis on high risk groups. Furthermore, efforts should be directed to define and recommend routines for detection of abnormalities of the hip joint, and integrate the procedures within the health services.

Missed chances: primary care practitioners' opportunity to identify, treat and refer adolescents with mental disorders.

BACKGROUND: Few adolescents with mental disorders consult mental health professionals or informal care providers, but many visit primary health care services. Primary care practitioners (PCP) have then the opportunity to identify and refer these adolescents to specialist services. METHODS: The Israel Survey of Mental Health among Adolescents conducted in 2004-2005 interviewed 957 adolescents and their mothers using the Development and Well-Being Assessment (DAWBA) diagnostic inventory and questions related to mental health and primary health care service use. Response rate in the located sample was 80%. RESULTS: Nearly 70% of adolescents had visited a PCP, more among adolescents with mental disorders and among those belonging to the Jewish majority group. Among adolescents with mental disorders whose mothers did not consult any mental health specialist, 76.5% visited a PCP. CONCLUSIONS: Over 75% of adolescents with a mental disorder, who did not seek help from any mental health service provider in the past 12 months, visited a PCP in that period. The PCP's potential to identify, treat or refer untreated adolescents in need of mental care to specialized services is discussed.

The Israel Survey of Mental Health Among Adolescents: aims and methods?

OBJECTIVE: The Israel Survey of Mental Health among Adolescents (ISMEHA) aimed to ascertain the prevalence of selected mental disorders and patterns of comorbidity, service utilization and unmet needs, health and sociodemographic covariates, and risk and protective factors. This paper reviews the methods used and discusses the strengths and limitations of the survey. METHOD: The ISMEHA was a cross-sectional survey that included 957 Israeli adolescents, representative of the adolescent population aged 14-17 years. The Strengths and Difficulties Questionnaire, Hebrew version (SDQ-H), the Development and Well-Being Assessment (DAWBA) inventory, services utilization, health status and sociodemographic questions were administered to adolescents and their mothers at the respondents homes between January 2004 and March 2005. RESULTS: The overall response rate was 68.2%, and it varied by gender and type of locality. Among boys, 71.3% responded, as compared to 65.2% among girls. The response rate among adolescents living in a Jewish or mixed city was 62.5% as compared to 89.6% among adolescents living in an exclusively Arab-populated city. CONCLUSIONS: The ISMEHA allows the creation of a unique and comprehensive database informing on the prevalence, burden, services utilization and unmet needs of adolescents with psychiatric disorders. These data will enable policymakers to more rationally plan services and prevention programs for the target population.

Service use for mental disorders and unmet need: results from the Israel Survey on Mental Health Among Adolescents.

OBJECTIVE: The first nationwide Israel Survey of Mental Health Among Adolescents was conducted in 2004-2005 with a representative sample of 957 adolescents aged 14-17 and their mothers to assess 12-month mental health service use, unmet needs, and associated factors. METHODS: Need for services was assessed by presence of a psychiatric disorder diagnosed with the Development and Well-Being Assessment inventory, plus clinicians' verification and additional questions on service use. RESULTS: In the past year, 22% of adolescents and 11% of their mothers consulted a service provider. Adolescents' help seeking in school was associated with residing in an Arab locality (odds ratio [OR]=1.6, 95% confidence interval [CI]=1.1-2.4) and with having single, divorced, or widowed parents (OR=2.9, CI=1.8-4.8); an employed father (OR=1.7, CI=1.0-2.8); and an internalizing disorder (OR=2.2, CI=1.2-3.9). Mothers' consultation was associated with residing in a Jewish or mixed locality (OR=18.1, CI=3.4-96.1); being single, divorced, or widowed (OR=3.1, CI=1.6-6.0); and having a child with an internalizing disorder (OR=6.4, CI=3.2-13.0), an externalizing disorder (OR=8.2, CI=2.9-23.0), or a learning disability (OR=4.5, CI=2.4-8.4). Overall, unmet needs were 66% and 60%, according to adolescents' and mothers' reports, respectively. According to mothers' reports, unmet needs were higher in Arab (91%) than in Jewish or mixed localities (54%). CONCLUSIONS: Adolescents and their mothers reported distinct service use patterns with particular implications for policy makers and health service providers. High rates of unmet needs, particularly among Arab-Israeli adolescents, need to be addressed.