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Biomedical subjects

M L Durham

Publications and source records attributed to M L Durham.

17 recordsLinked to original sources
PubMed1996

Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization.

OBJECTIVE: The authors examined the impact of increasing cost sharing on use of outpatient mental health services. METHOD: A quasi-experimental design was used to study outpatient utilization by members of a health maintenance organization (HMO) who were subject to increasing copayments for mental health visits (state government employees and dependents). Their outpatient mental health utilization was compared with that of similar HMO members who were not subject to cost sharing (federal government employees and dependents). Analyses compared both likelihood of any service use and number of visits per year among service users. RESULTS: Institution of $20/visit copayments was associated with a 16% decrease in likelihood of service use but no change in visit rate among service users. A subsequent copayment increase to $30/visit resulted in no significant change in likelihood of use but was associated with a 9% decrease in visits per year among those using services. The impact of the first copayment change on likelihood of using services did not vary according to level of clinical need (as measured by prior service use and psychotropic drug use). CONCLUSIONS: In this staff-model HMO, modest visit copayments significantly reduced initial access to mental health treatment and had a smaller effect on treatment intensity. Copayments restricted access regardless of clinical need. Designers of mental health benefits must consider the impact of copayments on those with the greatest need for treatment.

Ambulatory Care↗
PubMed1995

Socioeconomic status and exercise self-efficacy in late life.

Self-efficacy, or assessments about one's ability to carry out particular tasks, has been shown to play a central role in the adoption and maintenance of exercise. The relationship between exercise self-efficacy and socioeconomic status (SES), however, has not been formally developed or tested, and the implications of SES for exercise interventions are not known. We hypothesize pathways through which income, education, and occupation affect self-efficacy and capitalize on the availability of responses from 1944 older HMO enrollees to investigate the direct and indirect associations of SES indicators with exercise self-efficacy. Direct associations of age and education are found. Indirect associations of age, income, education, and occupation operate primarily through previous exercise experience, satisfaction with amount of walking, depression, and outcome expectations. The potentially modifiable nature of exercise outcome expectations (i.e., belief in the benefits of exercise) in combination with its strong association with exercise self-efficacy argue in support of greater consideration of its role in attempts to improve exercise self-efficacy.

Aged↗
PubMed1994

Prospects and problems in using data from HMOs for the study of aging populations and their health care needs.

Health maintenance organizations (HMOs) are providing a larger volume of health care services to older Americans than ever before. HMOs must reexamine the general practice of equating utilization of services with the health care need and collect better population-based information, including measures of health status. This article discusses the data elements that are widely available in HMO data bases as well as those that are predictably missing.

Aged↗
PubMed1994

Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization.

OBJECTIVE: The authors examined the volume and predictors of outpatient mental health utilization among primary care patients in a large staff-model health maintenance organization (HMO). METHOD: Consecutive primary care patients (N = 1,810) were screened by using the 12-item General Health Questionnaire, and a stratified random sample (N = 373) completed the 28-item General Health Questionnaire and Composite International Diagnostic Interview. Telephone interviews and computerized records were used to examine use of mental health services inside and outside the HMO over the following 3 months. RESULTS: Over 3 months, 6.7% of the screened patients used mental health services within the HMO. Utilization increased with higher General Health Questionnaire score (2.9% among those scoring 0, 22.3% among those scoring 8 or more) and decreased with higher out-of-pocket cost for mental health visits (7.5% for those with no change, 3.3% for those paying $30/visit). Among the interviewed subjects, 5.1% used mental health services within the HMO (mean = 2.92 visits) and 8.9% used outside mental health services (mean = 8.86 visits). Use of outside services was more strongly related to sociodemographic factors, and use of inside services was more related to severity of psychological disorder. CONCLUSIONS: Among these subjects, use of mental health care was high and services purchased outside the HMO exceeded those inside the HMO. Increasing copayment levels progressively reduced demand without respect to severity of illness. Attempts to control outpatient mental health costs must address equity and clinical need.

Adolescent↗
PubMed1991

Participation of higher users in a randomized trial of Medicare reimbursement for preventive services.

In a study of older enrollees in an HMO, we found that seniors who are higher users of health care services are willing to participate in health promotion programs. Although people aged 85 or older and those with chronic diseases are slightly more reluctant to participate, they are willing to make additional visits for health promotion purposes. Close proximity to the clinic and support from their family physician are important correlates of participation.

Age Factors↗
PubMed1986

The impact of public policy and publicity on admissions to state mental health hospitals.

This paper examines the impact of broadened Washington state civil commitment standards on utilization of the state's mental hospitals. Included in the analysis is an assessment of the impact of a public event (a well-publicized murder case) which was in all likelihood a precursor to the law's revision. We also examine the different ways Washington's two state hospitals managed the dramatic increase in civilly committed patients that occurred after the revision took effect. The findings indicate that the murder case, in which the defendant had been denied voluntary admission to a state hospital prior to the killing, resulted in an increase in involuntary admissions in the county where it occurred a full year before the standards were revised. The law itself had the effect of increasing commitments throughout the state, reducing the levels of voluntary admissions, and increasing the likelihood of involuntary admission for individuals previously admitted voluntarily, thus transforming a principally voluntary system into one which was primarily involuntary. Finally, it was found that the increased demand for services mandated by the broadened commitment standards was managed differently in the two state hospitals: one imposed a cap on admissions; the other phased out voluntary admissions at a rate roughly equal to the increase in commitments. These findings illustrate both the substantive impact of broadened civil commitment law and the importance, when assessing the impact of laws, of examining public events and administrative interventions which may have significant causal links with legal interventions.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

The Veterans Administration Northwest Regional Health Services Research and Development Field Program: organization, activities, and early outcomes.

In 1982, the Veterans Administration established Health Services Research field programs in each of the six VA regions. Herein, we describe the historical origins, organization, responsibilities, activities, and early accomplishments of one of these programs--the Northwest Regional HSR&D field program. Special reference is made to this program's commitment to health services research relevant to geriatrics and gerontology, including the development of a system-wide agenda for research, information syntheses in geriatrics-relevant health services research topics, and the conduct of funded projects pertinent to care of the elderly. The importance of a medical center location for the field programs is discussed, and early indications of institutional impact are described.

Aged↗
PubMed1985

The impact of broadened civil commitment standards on admissions to state mental hospitals.

In 1979, the state of Washington broadened its criteria governing the involuntary commitment of the mentally ill. This study examined the impact of the revised law on involuntary and voluntary admissions and on the type of patient admitted to state hospitals in Washington. The short-term effect of the law was an abrupt increase in involuntary commitments, with a concomitant but not offsetting decline in voluntary admissions. Although the law resulted in a substantial change in admissions policy, it does not appear to have altered the type of patient admitted to state mental hospitals in Washington.

Commitment of Persons with Psychiatric Disorders↗
PubMed1985

Implications of need-for-treatment laws: a study of Washington State's Involuntary Treatment Act.

In 1979 the State of Washington revised its civil commitment law to make it easier to hospitalize patients in need of care but not imminently dangerous to themselves or others. To assess the impact of the law, the author studied commitment patterns in Washington for two-year periods before and after the revised law went into effect. Results indicate that the number of involuntary commitments increased substantially after the law was revised, and the commitments were more likely to be based on grave disability rather than on dangerousness even if patients had engaged in violent behavior. However, the mental health system did not expand sufficiently to meet the needs of the increased patient population. Implications of Washington's experience for states considering passage of need-for-treatment legislation are discussed.

Commitment of Persons with Psychiatric Disorders↗
PubMed1984

Police involvement and influence in involuntary civil commitment.

Although observers agree that the police play an important role in involuntary civil commitment of mentally ill individuals, there are scant empirical data to document the importance of the police in swaying the commitment decision. The authors studied 3,570 randomly selected case records of individuals referred to two county offices of civil commitment in Washington State to determine the types of referrals police become involved in , the extent to which referral sources request police assistance, and the percentage of referrals resulting in commitment with and without police involvement. The authors conclude that police most often are asked to assist in cases involving violent behavior, but that under almost all circumstances police involvement is the primary factor in determining whether referral will result in commitment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1982

Beyond deinstitutionalization: a commitment law in evolution.

In 1973 Washington State changed its civil commitment law to more rigorously control the number of involuntary commitments in a move consistent with the national trend toward deinstitutionalization of the mentally ill and the development of community treatment alternatives. In 1979, after six years of working within narrowly drawn criteria for commitment, the state strengthened its civil commitment authority through revisions that included expanding the definition of "gravely disabled", adding destruction of property to the "likelihood of serious harm" clause, making the provisions for revoking conditional releases more stringent, and allowing spouses of mentally ill individuals to testify against them during commitment proceedings. Early figures show that involuntary commitments, while trying to cope with federal cutbacks and diminishing resources.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

Structural conflicts in the neighborhood health center program: the national and local perspectives.

The paper reports the findings of a study of the neighborhood health center (NHC) program which was initiated by the Office of Economic Opportunity (OEO) in 1965. The study focuses on the structure of the NHC system (funding agency, operating agency, and community board), analyzes the goals of the different sets of actors, and argues that the conflicts which evolved within the system were the natural outcome of the divergence in the goals of the different actors. Based on a series of 88 in-depth interviews with key health officials in OEO as well as project officers in NHCs throughout the country, the study suggests a framework for a more comprehensive analysis of the outcome of the NHC program and notes the implications of these findings for some current health legislation.

Community Health Centers↗
PubMedDate not supplied

Effect of tachypnea on oral temperature estimation: a replication.

The effect of tachypnea on oral temperature measurement was examined in 53 patients in a medical intensive care unit. This study was a replication of Tandberg and Sklar's (1983) study. The effect on rectal/oral temperature difference exerted by normal respiratory rate (20 or less respirations per minute) versus tachypnea (greater than 20 respirations per minute) was studied. A t test demonstrated that mean rectal/oral temperature difference between the groups was significantly different, t = -3.26, df = 49.45, p less than .01, supporting Tandberg and Sklar's findings. The present study found a positive relationship between the variables, r = .33, p less than .05, as did the previous study, r = .49, p less than .001.

Adolescent↗