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PubMed2006

Public trust in health care: a performance indicator?

PURPOSE: If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period, from 1997 to 2004. The study expected to find a decrease in public trust, with a low point in 2002. DESIGN/METHODOLOGY/APPROACH: Since 1997, public trust in health care was measured through postal questionnaires to the "health care consumer panel". This panel consists of approximately 1500 households and forms a representative sample of the Dutch population. FINDINGS: Trust in health care and trust in hospitals did not show any significant trend. Trust in medical specialists displayed an upward trend. Trust in future health care, trust in five out of six dimensions of health care and trust in general practitioners actually did show a decrease. However, only for trust in macro level policies and trust in professional expertise this trend continued. For the remaining trust objects, after 1999 or 2000, an upward trend set in. RESEARCH IMPLICATIONS/LIMITATIONS: No support was found for our overall assumption. Explanations for the fact that trust did increase after 1999 or 2000 are difficult to find. On the basis of these findings the study questions whether the measure of public trust is sensitive enough to provide information on the performance of the health care system. ORIGINALITY/VALUE: The aim of this research is to study public trust in health care on its abilities to be used as a performance indicator for health care systems.

Delivery of Health Care↗

PubMed1994

Primary care, financing and gatekeeping in western Europe.

Primary care in western Europe is delivered by general practitioners (GPs) but their role within the overall health system is poorly understood. The aim of this article is to present an overview of the characteristics of general practice in the context of health systems and to describe their variability and interrelationships. Data were obtained from two main sources: publications of official organizations and EC research projects. The characteristics of general practice are described and analysed with regard to three features: mode of payment, gatekeeper function and practice organization and workload. Despite their focus on general practice as the cornerstone of the health system, western European countries differ considerably in the major characteristics of primary care. There is variability in the ratio of GPs to population and in the extent to which patients relate to individual physicians. Although all countries have universal health insurance, the mode of payment of GPs differs. In some countries, the gatekeeper function of general practice is more highly developed and the use of specialist services varies accordingly. Practice characteristics such as workload, length of consultation, ordering of tests and reappointments also vary with differences in payment and gatekeeping arrangements. In particular, fee-for-service was associated with weaker physician-patient relationships, reduced attractiveness of general practice, more home visiting and longer consultations. Strong gatekeeping arrangements are not incompatible with high public satisfaction and are associated with lower visit rates. However, strong gatekeeping is not characteristic of fee-for-service arrangements. These findings suggest a need for more concerted research that could inform policy decisions concerning primary care in the USA as well as in Europe.

Adolescent↗

PubMed1985

An epidemiological assessment of immunization programme participation in the Philippines.

Because a large proportion of preschool children failed to present for free diphtheria-pertussis-tetanus (DPT) immunizations in a poor, rural area of the Philippines, we undertook an epidemiological analysis of their characteristics. The parents of 159 children were interviewed to determine the demographic, attitudinal, knowledge, and administrative correlates of immunization status. Logistic regression was used to model immunization status. Children were less likely to be immunized if they had a high score on an Adversity Index (composed of measures of the weather, the number of visits the team made, the distance, the appropriateness of the time of day, and miscellaneous problems), if they received health care from a native mother and child health specialist, if a parent was not on the town council, and if pain was an important deterrent. By contrast, many demographic and attitudinal measures that have traditionally been thought to predict health behaviour were not useful discriminators. Recommendations are made for immunization programme management. The general use of this method for programme planning is elaborated.

Adult↗

PubMed2000

The workforce in otolaryngology-head and neck surgery: moving into the next millennium.

OBJECTIVE: The goal was to examine the current scope of otolaryngologists' practices, their geographic distribution, and the roles otolaryngologists and other specialists play in caring for patients with otolaryngic and related conditions of the head and neck. STUDY DESIGN: A large national survey and administrative claims databases were examined to develop practice profiles and compile a physician supply for otolaryngology. A focus group of otolaryngologists provided information to model future scenarios. RESULTS: The current and predicted workforce supply and demographics are at a satisfactory level and are decreasing as a proportion of the increasing population. Empiric data analysis supports the diverse nature of an otolaryngologist's practice and the unique role for otolaryngologists that is not shared by many other providers. Together with the focus group results, the study points to areas for which more background and training are warranted. CONCLUSIONS: This study represents a first step in a process to form coherent workforce recommendations for the field of otolaryngology.

Adult↗

PubMed1995

Country watch: Bulgaria.

Eros and Psyche is a club for adolescents based in a youth center in Sofia, Bulgaria. Eros, the ancient Greek god of love, and Psyche, representing the human soul, symbolize the club's activities relating to the psychological and aesthetic aspects of sexuality. The club was started in December 1988 to provide sex education to out-of-school youth, the first attempt to move away from restrictive, medical approaches. Members include pupils, students, workers and even parents. The club meets twice a week for two hours, with specialists from different fields addressing the group, videos, readings and other activities that stimulate discussion. Anyone is free to come and go. Twice a year the club holds training sessions in psychosocial skills that aim to promote self-reflection and help people interact more openly with one another. Each individual is helped to find a personal route to understanding his or her own sexuality. Other clubs have been formed on the Sofia model. To help them organize, the Sofia club has prepared a leaders' manual and is developing a one-week course for club leaders.

Adolescent↗

PubMed2004

A multidisciplinary approach to the adolescent bariatric surgical patient.

PURPOSE: Pediatric obesity is an epidemic in the United States. As of yet, no surgical programs specifically dedicated to the management of clinically severely obese adolescents exist. The purpose of this report was to describe the establishment and early experience of a multidisciplinary Comprehensive Weight Management Center (CWMC) in a free-standing children's hospital. METHODS: With input from an ethicist, gastroenterologist, pulmonologist, endocrinologist, and adolescent medicine physician, guidelines for patient selection, evaluation, and bariatric surgical management were developed and implemented. Roux-en-Y gastric bypass (RYGBP) surgery has been performed using open and laparoscopic techniques. RESULTS: The average age and body mas index (BMI) for 79 patients referred to the CWMC has been 16 years and 54 kg/m2, for boys and 17 years and 51 kg/m2 for girls. Twenty-five percent have been considered appropriate for RYGBP, 25% have not met criteria for surgery, and 50% are being evaluated. Ten patients who have undergone RYGBP had comorbidities of their obesity, including type 2 diabetes mellitus (DM), obstructive sleep apnea syndrome (OSAS), pulmonary embolism, hypertension, dyslipidemias, and depression. Clinically significant weight loss with resolution of comorbidities has occurred in all patients. Significant complications have included leak from the gastric remnant, DVT, partial roux limb obstruction, and micronutrient deficiency. CONCLUSIONS: RYGBP is an effective means to treat obesity-related morbidity in the adolescent. A multidisciplinary team of pediatric specialists is needed for optimal preoperative decision making and postoperative management. Results have been satisfactory and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Adolescent↗

PubMedDate not supplied

Longitudinal assessment of a diabetes care management system in an integrated health network.

OBJECTIVE: To describe the results of longitudinal assessment of the results of a disease management process developed in a large integrated health care system that successfully improved care for patients with diabetes. Outcome measures included rates of testing of hemoglobin A1c (HbA1c) and low-density lipoprotein (LDL), rate of annual eye exams, and LDL and HbA1c values. METHODS: Intermountain Health Care (IHC) initiated the development of a Diabetes Care Management System (DCMS) in early 1998. The DCMS was developed as a comprehensive population-based disease management system. It includes provider education programs; performance feedback to physicians; clinical quality performance incentives for physicians; patient education programs; patient incentive, reminder systems to encourage compliance with best care process models; and tracking of physician behavior change and patient compliance with diabetes therapy. A multifaceted intervention and education approach was chosen because of the complexity of the diabetes treatment process. RESULTS: The percentage of patients with at least one annual HbA1c test increased from 78.5% in 1998 to 90.5% in 2002. During the same time period, the percentage of patients whose most recent HbA1c was less than 7.0 increased from 33.5% to 52.8%, average HbA1c decreased from 8.1 to 7.3, and the percentage of patients whose most recent HbA1c was greater than 9.5 decreased from 34.6% to 21.4%. The percentage of patients who had an LDL cholesterol screening test within the prior 2 years increased from 65.9% in 1998 to 91.7% in 2002. During the same time period, the percentage of patients whose most recent LDL cholesterol was less than 130 mg/dL increased from 39.9% to 69.8%. The percentage of diabetes patients who had an annual eye exam increased from 52% in 1998 to 62% in 2002. CONCLUSION: A multifaceted approach to improving diabetes management has led to improved performance in clinical measures related to diabetes care that have been shown to reduce the risk of patients with diabetes developing diabetes- related complications. All components of the diabetes management continuum of care, including primary care physicians, specialists, office staff, patients, diabetes educators, and others, were involved in the care improvement activities.

Delivery of Health Care, Integrated↗

PubMed2001

Diagnosis and initial management of stroke and transient ischemic attack across UK health regions from 1992 to 1996: experience of a national primary care database.

BACKGROUND AND PURPOSE: The aim of this study was to establish the difference in burden of cerebrovascular disease across the different health regions of the United Kingdom and to determine whether the initial management of new cases of stroke and transient ischemic attack (TIA) was uniform across the United Kingdom: METHODS: The General Practice Research Database (GPRD) is a national database used for epidemiological studies. This was a cohort study identifying incident cases of stroke and TIA over a 5-year study period between 1992 and 1996. The population studied was patients registered with general practitioners contributing to the GPRD across the different health regions of the United Kingdom: Outcome measures were new diagnoses of stroke and TIA, new prescriptions for antiplatelet and anticoagulant agents, and referrals made for specialist opinion. RESULTS: The age-adjusted annual incidence rate across all regions was 151 per 100 000 for stroke and 190 per 100 000 for TIA. There was almost a 2-fold difference in the incidence of cerebrovascular disease between the regions. The management of stroke and TIA in terms of antiplatelet prescription and of referral onward for further opinion to hospital specialists varied significantly between regions. CONCLUSIONS: Reported stroke and TIA incidence on the GPRD was comparable to that of other European studies. There were striking regional differences in the incidence of disease. The primary care management, both in prescription and referral rates, varied significantly between the different regions. There was a marked underuse of antiplatelet and anticoagulant agents, and referral rates for specialists' opinions were low.

Anticoagulants↗

PubMed1997

[Fatal asthma. Description and study of risk factors, in the heart of an asthmatic population followed by the College of Pneumonology of the Southwest].

OBJECTIVES: To describe asthma deaths and to identify the principal short term risk factors in a population followed by twelve thoracic physicians in the South West of France between 1989 and 1995. METHODS: A multicentre clinical study in 312 pure asthmatics recruited freely and reviewed on average 37.4 months later by the same specialist. The attribution of deaths due to asthma was discussed case by case. Predicted risk factors for survival have been researched from variables on the identify card (T0) and analyses using Cox's model. RESULTS: Twenty one subjects died, 16 were due to asthma. This was an annual mortality due to asthma of 1.6%. Seven deaths occurred at home (an acute crisis was the most common) and nine in hospital (respiratory prolonged distress). The principal variables linked to poor survival were: advanced years, asthma with continuous dyspnoea, previous stay in intensive care unit, taking inhaled beta 2 mimetics continuously after inclusion, decreasing FEV1 (P < 0.001). Other variables had a weaker link: duration of asthma, exacerbation of asthma at T0 (P = 0.01), social and psychological problems (P = 0.05), severity of disease at T0 (1992 consensus) were linked to asthma mortality: 75% of the deaths concerned severe asthmatics but 25% occurred in an unforeseen fashion in moderate asthmatics. The presence of personal allergy and of rhinitis was linked to better survival independent of age and severity of asthma. CONCLUSION: This study has shown that it was possible to determine predicted risk factors for asthma deaths in the short term at the time of consultation with an asthmatic and so, to identify the most threatened subjects. The institution of assistance programs could be beneficial as a result of the knowledge of these risk factors.

Adolescent↗

PubMed1998

Managed care: future good news or bad news for vascular surgeons.

Recently, William W. McGuire, Chief Executive Officer of United Health-Care, emphasized that the key from the patient's viewpoint is access. He stated, "We use the term gateway rather than gatekeeper." He emphasizes the importance of direct access of the patient to the right physician, whether it be a specialist or a generalist. Although some health care strategists believe that patients should initially see a generalist before receiving specialty care, this approach may not save dollars in the long run. Managed care is likely to have a major impact on vascular surgeons. Currently, business purchasing cooperatives are one model for containing costs of expensive invasive procedures among the working population. Such cooperatives are likely to achieve a stronger penetration in the health care market and to negotiate aggressively for packaged fee contracts for specialized cardiovascular care and procedures. Because the vast majority of vascular patients are more than 65 years of age, the movement of Medicare toward managed care may also affect vascular surgery in a major way. If vascular surgeons are to survive financially in the managed care environment, they must continue to provide evidence-based solutions to clinical problems at a reasonable cost and with good outcomes. They must also understand that involvement in the administrative and political leadership of health care is essential to maintaining some influence on the future reimbursement for our services.

Contract Services↗

PubMed2005

Doctors in vocational training: rural background and rural practice intentions.

OBJECTIVE: To report the findings of a national survey of Australian doctors in vocational training about their rural practice intentions and their plans to work full time or part time. DESIGN: A self-administered mailed survey. SETTING: Vocational training: general practice and other medical college training programs. SUBJECTS: Australian doctors (i.e. Australian citizens and permanent residents) registered with one of Australia's 17 medical college vocational training programs in September 2002. MAIN OUTCOME MEASURES: Intention to practise in a rural area on completion of vocational training; full-time or part-time practice plans; views about rural practice. RESULTS: Of the 7899 doctors who met the criteria for inclusion in the study, 4259 (54%) responded. In total:14% indicated a preference for rural practice on completion of vocational training; 17% were GP trainees of which 31% preferred rural practice; 83% were registered with one of the other 16 specialist training programs (e.g. adult medicine, paediatric medicine and surgery) of which 10% preferred rural practice; 50% of general practice trainees and 23% of trainees in other specialist training programs with a rural background indicated a preference for rural practice in the long term, compared with 25% and 7%, respectively, of doctors with an urban background; 46% of general practice trainees with intentions to practise in a rural area plan to practise part time. A positive association was observed between rural background and preference for rural practice (odds ratio (OR) 2.9) and between preference for rural practice and enrollment in the rural general practice training pathway (OR 3.1) and involvement in rural education and training activities (OR 5.1). CONCLUSIONS: The findings of this study support initiatives to increase the number of rural background students entering medical school and rural education and vocational training initiatives. Australia's rural doctor shortage is not likely to be addressed by this cohort of doctors in vocational training. General practice workforce plans, rural and urban, need to take note of the high proportion of doctors who plan to practise part time.

Adult↗

PubMedDate not supplied

Infantile hypertrophic pyloric stenosis in a regional centre.

BACKGROUND: It has been suggested that only specialist paediatric surgeons should manage infantile hypertrophic pyloric stenosis (IHPS). AIM: The aim of this retrospective study was to ascertain whether the majority of these infants might be managed in a well-equipped regional centre. METHODS: Using the Hospital Inpatient Enquiry database, all cases of IHPS within a single administrative health region were identified over a six-year period. A chart review was performed to obtain demographic and clinical information for each patient. Reports from the Central Statistics Office were used to obtain data on population and live births for the region. RESULTS: Seventy patients with IHPS were identified from this region from 1991 to 1996, 63 (90%) of which were treated in the region. Of the remaining seven, four were referred directly to specialised paediatric surgical hospitals because of prematurity (n = 1), low birth weight (n = 1), capillary haemangioma (n = 1) and severe metabolic derangement (n = 1) while three were assessed and treated in general hospitals outside the region. Of the 63 infants undergoing pyloromyotomy in this region, the duodenal mucosa was breached in four (6%); there were wound complications in three (5%); and one required a re-pyloromyotomy. The mean postoperative stay was eight days (range 2-42 days). CONCLUSION: The majority of infants with IHPS may be safely managed in regional centres with transfer to specialist paediatric centres reserved for 'high risk' cases. The management of IHPS at a regional level has important implications and presents opportunities for surgical training.

Female↗

PubMedDate not supplied

Clinical nurse specialists' knowledge specific to Medicare structures and processes.

PURPOSE: The purpose of this study was to describe clinical nurse specialists' (CNSs) knowledge of Medicare structures and processes using a multiple-choice examination. DESIGN: This descriptive study used the survey method with a convenient sample. SETTING: Potential subjects received the research study packet at the address designated by them for membership mailings sent from the National Association of Clinical Nurse Specialists (NACNS). SAMPLE: The population of interest was practicing CNSs. The accessible population was NACNS members drawn from the 2002 mailing list organized by zip code. Every third mailing label was skipped. The remaining list members (N = 950) received a study packet. There was a 14.42% response rate with 137 respondents. Eighty-two percent held a master's degree in nursing. METHODS: A 46 item multiple-choice examination was developed based upon a content map established after a review of the available Medicare-related literature and consultation with Medicare advanced practice nurse providers. Content validity was established. Survey packets with the instrument, Scantron answer key, informational letter, and demographic profile were sent to potential subjects. Returned responses were keyed for correct answers. Relationships between demographic variables, raw score, and self-reported Medicare expertise were analyzed. Qualitative data elicited on the demographic form were thematically analyzed. FINDINGS: The examination had a.67 coefficient. Correlation of examination raw score to self-reported Medicare content expertise was 0.982 (P =.000). One third of the examination questions were incorrectly answered by 30% or more of respondents. Percentage correct scores ranged from 60.9 to 95.7 (M = 62.7%; SD = 10.46). Respondents offered 40 comments. Eleven comments related to a self-recognized Medicare knowledge deficit. Four responses highlighted that graduate studies had not provided them with the knowledge necessary for understanding reimbursement issues. Ten respondents expressed an interest in locating some type of educational resource addressing the Medicare system, reimbursement processes, and opportunities. CONCLUSIONS: Findings suggest that NACNS members have Medicare program knowledge deficits. Respondents recognize their deficiencies and are interested in obtaining more information about Medicare but are uncertain as to available resources or networking opportunities that might support them in this process. Graduate nursing programs may need to evaluate the amount of information provided within curriculums specific to insurance reimbursement and Medicare structures and processes. Study limitations include the low response rate and indeterminate sample representativeness. IMPLICATIONS FOR PRACTICE: Educators should examine CNS curriculums to ensure the adequacy of Medicare program information. Continuing education programs and conference workshops addressing Medicare information should be offered to CNSs interested in increasing their expertise or exploring provider opportunities. There may be entrepreneurial opportunities available to CNSs interested in developing an expertise in Medicare programs. Future research studies should quantify potential benefits to Medicare beneficiaries when CNSs participate as providers.

Health Knowledge, Attitudes, Practice↗

PubMed2004

[Mental disorders in the community: healthcare utilization and disability days].

Mental disorders are considered to be costly in terms of elevated rates of healthcare utilization and increased disability days. For the general German population there has been a lack of data on healthcare utilization and disability rates. The available administrative data are incomplete and problematic because they are based on routine clinical diagnoses that lack reliability. Using the German Health Interview and Examination Survey 1998/99 and its Mental Health Supplement (GHS-MHS) data, this paper examines healthcare utilization and disability associated with mental disorders in a representative sample of the general adult population (18-65 years, n=4181). After reviewing the size and treatment status of mental disorders in Germany, data about primary care or specialist consultations, inpatient treatment, and disability days in the last year are presented for the following groups: (1) subjects who never met the criteria of the diagnosis of a mental disorder, (2) subjects who had one or more mental disorders in the past but none in the past year ("remitted") and (3) subjects who currently (within the last year) met the criteria of one or more mental disorders. We found increased healthcare utilization as well as more disability days in those individuals with a current diagnosis. Remitted persons, however, showed results similar to those who never had a diagnosis of a mental disorder during their lifetimes. The results are consistent with the episodic course of many mental disorders and furthermore might indicate that treatment of mental disorders might contribute to a substantial reduction of direct and indirect illness costs.

Absenteeism↗

PubMed1998

Attitudes toward cost-containment features of managed care: differences among patient subgroups.

OBJECTIVE: To analyze the extent to which personal characteristics and circumstances affect attitudes toward cost-containment aspects of managed care. STUDY DESIGN: A national probability sample component of the 1994 Robert Wood Johnson Foundation National Access to Care Survey. METHODS: Telephone and in-person survey follow-up of 3480 persons who completed the 1993 National Health Interview Survey. Findings on respondents' attitudes toward three principal cost-saving features of managed care are reported. These features are choosing physicians from insurance company lists (LIST), accessing specialists through referrals only (SPECIALIST), and seeing a nurse sometimes instead of a physician (NURSE). Data were categorized and analyzed by different population subgroups. RESULTS: Respondents were divided almost equally in terms of how much they minded healthcare features of managed care, with approximately one third minding a lot, one third minding a little, and one third minding not at all. However, slightly more people minded LIST (42%) and NURSE (39%) features a lot. The respondent subgroups with the lowest proportion "minding a lot" were the uninsured poor and those already in managed care. Those groups minding the most were the elderly, those in fee-for-service plans, persons in poor health, and those with ischemic heart disease. CONCLUSIONS: Acceptance of managed care cost-containment features varies by consumer characteristics. Those who have the most to gain financially by cost-containment features and the least to lose in terms of their access to care mind the managed care features the least. Persons who object most strongly are those who are not financially constrained and who are in poor health.

Attitude to Health↗

PubMedDate not supplied

Congestive heart failure education study.

Nursing staff providing care to patients on a medical/surgical unit must be generalists rather than specialists in disease management. The diversity of illnesses seen among this population requires the nurse to be expert in many disease processes. The complexity of patients who are admitted to a medical/surgical unit continues to increase and is therefore challenging to nurses. Complex patient populations can be attributed to individuals living longer and the advancement of technology and information in treating serious medical conditions. Nursing expertise for different disease processes can vary according to experience, educational level, and knowledge regarding evidence-based practice. Lack of knowledge regarding current practice guidelines and care may result in poor patient outcomes and high cost. Confidence in performing safe and quality nursing care can also be affected by lack of knowledge. Continuing education for nursing must be made a priority for nurses to provide safe and high quality care. Education provided must be current and based on positive outcomes through research-based nursing practice.

Attitude of Health Personnel↗

PubMed2005

Family physicians' involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey.

BACKGROUND: Little is known about general and family practitioners' (GP/FPs') involvement and confidence in dealing with children with common psychosocial problems and mental health conditions. The aims of this study were to ascertain GP/FPs' preferred level of involvement with, and perceived comfort and skill in dealing with children with behavioral problems, social-emotional difficulties, attention-deficit/hyperactivity disorder (ADHD), and mood disorders; and to identify factors associated with GP/FPs' involvement, comfort and skill. METHODS: Postal survey of a representative sample of 801 GP/FPs in British Columbia, Canada, which enquired about level of involvement (from primarily refer out to deal with case oneself); ratings of comfort/skill with assessment/diagnosis and management; beliefs regarding psychosocial problems in children; basic demographics; and practice information. RESULTS: Surveys were completed by 405 of 629 eligible GP/FPs (64.4%). Over 80% of respondents reported collaborative arrangements with specialists across problem and condition types, although for children with behavior problems or ADHD, more physicians primarily refer (chi2 (1) = 9.0; P < 0.005; and chi2 (1) = 103.9; P < 0.001, respectively). Comfort/skill levels (mean +/- s.d) were higher for mood disorders (4.4 +/- 1.3) than behavior problems (3.6 +/- 1.1; F [3, 1155] = 84.0, P < .0001; effect size = 0.67), but not different from social-emotional difficulties (3.8 +/- 1.1) or ADHD (3.9 +/- 1.3). Taking primary responsibility for a case was consistently related to self-reported comfort/skill with each condition type (34% to 61% of variance across condition types), while comfort/skill ratings for each condition were related to exposure to relevant continuing medical education (all P < or = 0.001), and beliefs that these problems are significant and that GP/FPs have a role to play in dealing with them (P values ranged from 0.01 to < 0.001). CONCLUSION: Supporting GP/FPs in their care for children with common psychosocial and mental health problems should include efforts to bolster their confidence and modify attitudes in relation towards these problems, especially behavior problems and ADHD, possibly within innovative continuing education programs.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Mental health consultations in a prison population: a descriptive study.

BACKGROUND: The psychiatric morbidity among prison inmates is substantially higher than in the general population. We do, however, have insufficient knowledge about the extent of psychiatric treatment provided in our prisons. The aim of the present study was to give a comprehensive description of all non-pharmacological interventions provided by the psychiatric health services to a stratified sample of prison inmates. METHODS: Six medium/large prisons (n = 928) representing 1/3 of the Norwegian prison population and with female and preventive detention inmates over-sampled, were investigated cross-sectionally. All non-pharmacological psychiatric interventions, excluding pure correctional programs, were recorded. Those receiving interventions were investigated further and compared to the remaining prison population. RESULTS: A total of 230 of the 928 inmates (25 %) had some form of psychiatric intervention: 184 (20 %) were in individual psychotherapy, in addition 40 (4 %) received ad hoc interventions during the registration week. Group therapy was infrequent (1 %). The psychotherapies were most often of a supportive (62 %) or behavioural-cognitive (26 %) nature. Dynamic, insight-oriented psychotherapies were infrequent (8 %). Concurrent psychopharmacological treatment was prevalent (52 %). Gender and age did not correlate with psychiatric interventions, whereas prisoner category (remanded, sentenced, or preventive detention) did (p < 0.001). Most inmates had a number of defined problem areas, with substance use, depression, anxiety, and personality disorders most prevalent. Three percent of all inmates were treated for a psychotic disorder. Remand prisoners averaged 14 sessions per week per 100 inmates, while sentenced inmates and those on preventive detention averaged 22 and 25 sessions per week per 100 inmates, respectively. Five out of six psychiatric health services estimated the inmates' psychiatric therapy needs as adequately met, both overall and in the majority of individual cases. CONCLUSION: Our results pertain only to prisons with adequate primary and mental health services and effective diversion from prison of individuals with serious mental disorders. Given these important limitations, we do propose that the service estimates found may serve as a rough guideline to the minimum number of sessions a prison's psychiatric health services should be able to fulfil in order to serve the inmates psychiatric needs. The results rely on the specialist services' own estimates only. Future studies should take other important informants, including the inmates themselves, into consideration.

Adult↗