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PubMed2003

Health service utilization and benzodiazepine use among heroin users: findings from the Australian Treatment Outcome Study (ATOS).

AIMS: To determine levels of health service utilization among heroin users, the types of prescription drugs obtained by heroin users and the contribution of benzodiazepine use in health service utilization and prescribed drug use. DESIGN: Cross-sectional survey. SETTING: Sydney, Australia. PARTICIPANTS: A total of 615 current heroin users recruited for the Australian Treatment Outcome Study (ATOS). FINDINGS: Sixty per cent of subjects had consulted a general practitioner (GP) and 7% a specialist in the preceding month. An ambulance had attended 11% of subjects in the preceding month. Forty-eight per cent of subjects had prescriptions dispensed for medication in the preceding month. Thirty-nine per cent of participants had prescriptions dispensed for psychotropic medications, representing 80% of all prescriptions. Twenty per cent of subjects had prescriptions dispensed for non-psychotropic medications (20% of prescriptions). The most commonly prescribed drugs were benzodiazepines (59% of prescriptions), which had been obtained by 30% of subjects. Benzodiazepine users had more GP and psychiatrist visits, were more likely to have had an ambulance attendance and had significantly more dispensed prescriptions. CONCLUSIONS: There were high levels of health utilization among heroin users. Prescription drug use was common, and dominated by psychotropic drugs. Benzodiazepine use was a dominant factor in the use of services and in prescriptions dispensed. Despite increased awareness of the harms associated with benzodiazepines, they continue to be prescribed widely to heroin users.

Adolescent↗

PubMed2003

Mental health and medical problems and service use among adolescent substance users.

OBJECTIVE: Adolescents entering the substance abuse treatment system frequently exhibit mental health and medical problems. Because little is known about whether these youths receive services to address these problems, this study examined the services received by youths admitted to substance abuse treatment. METHOD: Admission and 3-month follow-up reports of mental health, medical problems, and service use were examined within a large cohort (N = 1,088) of 12-19-year-olds admitted to seven inpatient and outpatient substance abuse treatment programs across the United States between 1998 and 2001. RESULTS: High levels of mental health problems were found at both time points, but few received mental health treatment. In contrast, there were lower rates of medical problems, and more than half received services. Logistic regression predicting mental health treatment receipt found females in residential settings with more current and baseline distress to be more likely to receive services. Ethnicity, baseline behavioral problems, and whether or not currently in substance abuse treatment did not predict service use. A logistic regression predicting medical services showed that females in residential treatment were also more likely to receive medical treatment. CONCLUSION: Although these results require replication and validation, they suggest that more could be done to take advantage of the opportunity to link youths entering substance use treatment with mental health services.

Adolescent↗

PubMed1994

A survey of marginal wheelchair users.

Significant numbers of wheelchair users experience difficulties with propulsion due to impaired upper limb function (termed marginal users for this study). A survey of wheelchair users in Tayside, Scotland, was carried out to identify and describe the marginal user population and their propulsion difficulties. Subjects for the survey were identified from the records of National Health Service wheelchair users at Dundee Limb Fitting Centre. Subjects were interviewed at home about their wheelchair-propelling experiences. Survey results indicated that marginal users represent approximately 15% of the occupant-propelled wheelchair population. The average age of the marginal users surveyed was 48 years and the modal diagnosis was multiple sclerosis. Fifty-nine percent of the marginal users questioned felt that their wheelchairs were not adequate for their requirements.

Adolescent↗

PubMed2004

[Emergency contraception: user's profile in primary care emergency services].

OBJECTIVES: To establish the emergency contraception (EC) users profile and whether she perceives this type of contraception as an emergency. Design. Cross sectorial study (over one year period: March 2002-March 2003). SETTING: Emergency Services in Primary Care. Usera and Carabanchel; 11th Area; Madrid. PARTICIPANTS: Women requesting EC in these centres. MAIN OUTCOME MEASURES: A questionary was filled out for all participants with their age, how many hours had spent since sexual intercourse took place (within 24 h), usual method of contraception used, previous use of EC, level of education, and reason for this request. RESULTS: 89 women. Drops out: 0. Average age: 23.7+/-48 years (range: 16-40 years). 79.8% of them came to medical emergency services in less than 24 h after sexual intercourse. Usual anticonceptive method was the condom (88.8%), 2.2% used hormones, 9% no contraceptive method at all and none of them had used the intrauterine device. 34.8% were previous users of EC. Education levels: 2.2% of women only could read and write, elementary school (37.1%), secondary school (34.8%) and high school (25.8%). Reasons for requesting EC: 91% condom failure, 7.9% not to have used any contraceptive method, and 1.1% wrong use of natural birth control methods. Among the women who had went to the emergency services within the 24 h of the sexual intercourse the 77.4% of all of them had requested EC previously and the 93% of those had requested EC for the first time (P=.032). Likewise all of them with high school level and who could write and read, the 93.9% with elementary school level, and the 71% with secondary studies went to the emergency services within the 24 h of the non protected sexual intercourse (P=.05). CONCLUSIONS: Most of the women were young, they perceived the unprotected sexual intercourses as an emergency, the condom was the most frequently used anticonceptive method, they requested EC due to condom breakage. In 1/3 of the cases the EC had been requested previously and this group and the young women with secondary studies one were who requested it later.

Adolescent↗

PubMed2002

Health services utilization by injection drug users participating in a needle exchange program.

OBJECTIVE: To determine the characteristics associated with health care and drug treatment utilization among a distinctly high-risk sub-population of injectors participating in a needle exchange program (NEP). METHODS: Between June 1998 and May 1999, study staff collected demographic and health services utilization data on participants of the Baltimore NEP. Odds ratios and logistic regression were used to identify the participant characteristics associateds with utilizing primary health care and drug treatment during the prior 3 years. RESULTS: Among 269 participants, 81% were African-American and 66% were male. Over half (56%) had not graduated from high school, 89% were unemployed, 70% did not have health insurance, and the median age was 39 years. Fifty-eight percent of the participants reported utilizing primary care (i.e., visited a physician or other health care provider) and 44% had utilized drug treatment during the prior 3 years. Primary care utilization was associated with age > or = 39 [adjusted odds ratio (AOR) = 1.82], having health insurance (AOR = 2.16), and exchanging a higher volume of syringes per NEP visit (AOR = 2.45). Recent drug treatment utilization was associated with African-American race (AOR = 0.41), unemployment (AOR = 2.72), having health insurance (AOR = 2.05), and exchanging a higher volume of syringes per NEP visit (AOR = 0.60). CONCLUSIONS: Health insurance was significantly associated with the recent utilization of both primary care and drug treatment, yet only one-third of NEP attenders were insured. Facilitating the uptake of health insurance services at NEP sites may improve the access to health care for drug users who are currently not utilizing the health care system.

Adult↗

PubMed1991

Prediction of use of psychiatric services: application of the CART (classification and regression trees) algorithm.

A computerized recursive partitioning program called Classification and Regression Trees (CART) was used to identify potential high users of services among low-income psychiatric outpatients. Sociodemographic variables, clinical variables (e.g., psychiatric diagnosis and type of presenting complaint), source of referral and the most recent psychiatric treatment setting used were studied. Discharge from inpatient psychiatric treatment right before admission to outpatient psychiatric treatment was found to be the most consistent, the most powerful and the only necessary predictor of high use of outpatient psychiatric services.

Adult↗

PubMed1989

MELVYL MEDLINE: reference service implications of an end-user search system.

The implementation of MELVYL MEDLINE, a successful online end-user system in the University of California (UC) health sciences libraries greatly enhanced the capabilities of reference desk service by providing immediate access to current medical literature from the MEDLINE database. With these enhancements, the extent of the impact on the delivery of reference service was not anticipated. Concurrent with providing traditional reference service requests, there was a constant need for individualized end-user instruction by MELVYL MEDLINE users, and continual maintenance of workstation equipment and supplies. This paper describes the experiences at the UC Irvine (UCI) Biomedical Library and compares these experiences with other UC health sciences libraries. The purpose of this paper is to discuss some of the issues which must be considered when planning for the implementation of an end-user system within the reference service function.

California↗

PubMed2002

Frequent users of emergency departments. Do they also use family physicians' services?

OBJECTIVE: To determine whether frequent users of emergency department (ED) services use more or fewer primary care services than other ED patients. DESIGN: Population-based, observational, cross-sectional study. SETTING: Province of Ontario in 1997-1998. PARTICIPANTS: Frequent users of EDs, defined as people with at least 12 ED physician assessments yearly, were compared with those with one to 11 assessments yearly. MAIN OUTCOME MEASURES: Number of general practitioner and family physician (GP/FP) office visits and number of GP/FPs visited; diagnoses made during office visits; referrals by GP/FPs to specialists. RESULTS: Three quarters of frequent users of EDs visited GP/FPs at least six times yearly, and more than half visited at least 12 times yearly. Although frequent users of EDs saw many GP/FPs (4.2 vs 1.6 in the control group, P < .001), they received, on average, 73% of their primary care from the GP/FPs whom they saw most frequently. Frequent users of EDs also had more referrals to specialists (4.0 vs 1.0). Frequent users of EDs were more likely to live in low socioeconomic neighbourhoods and to be diagnosed with psychosocial conditions (24.1% vs 11.1%). CONCLUSION: Most frequent users of EDs have periodic contact with primary care physicians. Communication and coordination of care between EDs and primary care settings could be easier than anticipated, because in most cases, frequent users of EDs seek most of their care from one main ED and one primary care physician.

Adult↗

PubMed2001

Being a psychiatric patient in the community--reclassified as the stigmatized "other".

AIMS: To explore the experiences of psychiatric patients living in six rural communities in Norway from a primary care perspective. METHODS: A "Knowledge workshop" (KW) was designed. It was a special kind of meeting between users of services for people with mental illness and service providers. The process and outcome were documented on flipcharts and audiotape and analysed by a qualitative method. RESULTS: A main statement was constructed in order to capture the essence of meaning in the 10 main themes identified in the analysis. The statement is mainly about the process and state of being reclassified as a stigmatized "other", with serious consequences for both self-esteem and public esteem. The consequences include isolation and loneliness, low self-esteem, no paid work, lack of money, discrimination, and harassment. Other consequences include altered behaviour from others, lack of necessary conditions for empowerment, and the danger of becoming visible as mentally ill. Attitudinal change is called for. CONCLUSIONS: Although the stigma of mental illness is a wellknown and much discussed fact, it has so far not really been included in the professional knowledge base. It is still practically absent from discussions of quality of care. In order for services to be relevant to people who need them, professionals can no longer ignore issues that are of major importance for users. Stigma must thus be included in the conceptual thinking about serving people with mental illness. The inclusion of stigma as an issue for quality of care could be a fruitful way forward.

Attitude of Health Personnel↗

PubMed1997

Why are cancer patients using non-proven complementary therapies? A cross-sectional multicentre study in Norway.

This study addressed the use of alternative medicine, here called non-proven therapies (NPTs), among hospitalized Norwegian cancer patients. A total of 126 (20%) of the assessable 630 patients were users of NPTs. Approximately 43% of all patients and more than 60% of the users of NPTs stated that they would like NPTs to be an option in hospitals belonging to the National Health Service. Most users of NPTs (82%) consulted traditional medicine first, while 15% started treatment with NPTs simultaneously. Users of NPTs reported to have received less hope of a cure (30%) from their physicians than non-users (50%). Users mostly learned about NPTs from friends and relatives. Most users believed that NPTs might give them strength and relieve their symptoms. Very few patients believed in a cure (10%). Nearly 40% were uncertain of any effect of the NPTs or felt there had been no effect. 4 patients reported adverse effects. 15 patients had been treated abroad, most of them in Denmark. Expenses incurred through use of NPTs were mostly moderate, but some patients used large sums of money. Patients' opinions on whether or not the treatment had been expensive were closely linked to their anticipation of the effect of the treatment.

Adolescent↗

PubMed1984

Start-up analysis for marketing strategy.

The complex start-up effect on utilization of health care services is too often overlooked or underestimated by marketing planners, leading to a range of negative consequences for both the users of services and the provider organization. Start-up analysis allows accurate estimation of these utilization effects for coordinated strategic planning among marketing finance, and operations.

Health Maintenance Organizations↗

PubMed1994

Faxon Finder/Faxon Xpress: report from a beta test site.

In this environment of expanding information needs, spiraling journal costs, and curtailed financial resources, medical libraries must take advantage of the rapid evolution in document delivery services. There are exciting developments in transmission technology, from fax machines to scanners to the Internet. There is also a notable shift away from the traditional reliance on library networks toward use of commercial vendors as document providers. These changes require reevaluation of interlibrary loan (ILL) and document delivery systems on many levels, including pricing structures, work flow, and impact on collection development. As commercial vendors develop increasingly effective products, librarians can test, evaluate, and incorporate them into their ILL operations to enhance service to users and relieve the pressure to acquire new resources; in this way, librarians can move from the "just in case" practice of building an on-site collection to the "just in time" model of providing timely delivery of materials to users as needed. This paper describes a beta test of the Faxon Finder/Faxon Xpress table of contents and document delivery services conducted by the Treadwell Library of the Massachusetts General Hospital.

Databases, Bibliographic↗

PubMed1997

Short-term response to counseling and case management intervention in a domestic violence shelter.

81 women who accessed counseling and case management services at a domestic violence shelter after three sessions reported that abuse decreased, life satisfaction increased, perceived coping ability improved, as did their satisfaction with the services. Shelter users, however, also displayed significant skill deficits in the inability to apprise or respond appropriately to abusive situations. Limitations on understanding how shelter services affect longer-term outcomes were ascribed to high drop out rates and the absence of follow-up measures. Researchers need to address the causes of drop-out and what specific interventions can meet the needs of short-term shelter users.

Adolescent↗

PubMed2001

Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa.

User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 years and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001) for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant. The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.

Ambulatory Care Facilities↗

PubMed2004

Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation.

Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the

Employment↗

PubMed2002

Parental perceptions of a school dental service in Australia.

OBJECTIVE: Data on parental perceptions of the School Dental Service in Australia are scarce. The aim of this study was to investigate parental attitudes towards the School Dental Service based in Victoria and to explore differences between parents who had recently used the service (SDS users) and those who had elected not to use it during the previous 12 months (SDS non-users). BASIC RESEARCH DESIGN: 1,060 questionnaires were distributed through primary schools that had recently been offered treatment through the School Dental Service. Questions were asked about quality of care, cost, access to services, and continuity of care. The response rate was 65%. PARTICIPANTS: The study sample consisted of 692 parents of primary school-age children. RESULTS: Statistical tests revealed significant differences between the two groups of parents. Those who chose not to use the service had greater concerns about the quality of care provided (P<0.001) and were more likely to perceive that the cost of $25 for a course of treatment was too high (P<0.05). In both groups combined, 68% of parents believed they did not have enough knowledge about the service, 79% felt that more appointments should be available out of school hours, and 93% felt that treatment should be available on a six-monthly basis. CONCLUSION: The results of this study suggest that parents' choice in utilising the School Dental Service in Victoria is strongly related to their level of perception and satisfaction.

Appointments and Schedules↗

PubMed1982

Who receives the aftercare? Utilization of services by discharged in-patients.

A prospective one-year follow-up of 216 in-patients showed that utilization of aftercare was significantly associated with certain clinical and social factors in the year after discharge from hospital. Rural domicile, a diagnosis of schizophrenia, long dependence on services, and ease of access to care comprised an aftercare dependency syndrome with substantial predictive power. Alcoholic and personality disordered patients were light users of services. Staff-patient relationships and attitudes of staff and patients to the need for aftercare were important. Depot neuroleptics were associated with high levels of aftercare for patients with chronic schizophrenia. The findings reveal the steady silting up of a new area service for the adult mentally ill by patients with a combination of social disadvantage and severe chronic psychosis. Family doctors played very little part in the delivery of aftercare. Some implications of the findings for the future development of community-based psychiatric services are discussed.

Adolescent↗

PubMed2001

ARIANE: a mediation framework with health information sources.

OBJECTIVES: to design and implement mediators dedicated to access heterogeneous information sources in a homogeneous way. METHOD: processes translate a query into the syntax of a target source built thanks to the UMLS knowledge sources and a catalog of information sources. Communication services connect users with information sources at the point they deliver results. RESULTS: examples show the benefits healthcare professionals may found in searching information in this way. DISCUSSION: improvements on the current developments may be done according to the current architecture of ARIANE. Specially, the user interface should be easier to use than the present one.

Information Services↗