Sample records for services utilization study
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2013-01-01
Background Although literature has associated geodemographic factors with healthcare service utilization, little is known about how these factors — such as population size, age profile, service accessibility, and educational profile — interact to influence service utilization. This study fills this gap in the literature by examining both the direct and the moderating effects of geodemographic profiles on the utilization of cardiac surgery services. Methods We aggregated secondary data obtained from Statistics Canada and Cardiac Care Network of Ontario to derive the geodemographic profiles of Ontario and the corresponding cardiac surgery service utilization in the years between 2004 and 2007. We conducted a two-step test using Partial Least Squares-based structural equation modeling to investigate the relationships between geodemographic profiles and healthcare service utilization. Results Population size and age profile have direct positive effects on service utilization (β=0.737, p<0.01; β=0.284, p<0.01, respectively), whereas service accessibility is negatively associated with service utilization (β=−0.210, p<0.01). Service accessibility decreases the effect of population size on service utilization (β=−0.606, p<0.01), and educational profile weakens the effects of population size and age profile on service utilization (β=−0.595, p<0.01; β=−0.286, p<0.01, respectively). Conclusions In this study, we found that (1) service accessibility has a moderating effect on the relationship between population size and service utilization, and (2) educational profile has moderating effects on both the relationship between population size and service utilization, and the relationship between age profile and service utilization. Our findings suggest that reducing regional disparities in healthcare service utilization should take into account the interaction of geodemographic factors such as service accessibility and education. In addition, the allocation of resources for a particular healthcare service in one area should consider the geographic distribution of the same services in neighboring areas, as patients may be willing to utilize these services in areas not far from where they reside. PMID:23816201
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Methods for measuring utilization of mental health services in two epidemiologic studies
NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.
2015-01-01
Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205
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Tian, Wei-Hua
2016-07-01
The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program. © Australian Council for Educational Research 2016.
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Measuring the equity of inpatient utilization in Chinese rural areas
2011-01-01
Background As an important outcome of the health system, equity in health service utilization has attracted an increasing amount of attention in the literature on health reform in China in recent years. The poor, who frequently require more services, are often the least able to pay, while the wealthy utilize disproportionately more services although they have less need. Whereas equity in health service utilization between richer and poorer populations has been studied in urban areas, the equity in health service utilization in rural areas has received little attention. With improving levels of economic development, the introduction of health insurance and increasing costs of health services, health service utilization patterns have changed dramatically in rural areas in recent years. However, previous studies have shown neither the extent of utilization inequity, nor which factors are associated with utilization inequity in rural China. Methods This paper uses previously unavailable country-wide data and focuses on income-related inequity of inpatient utilization and its determinants in Chinese rural areas. The data for this study come from the Chinese National Health Services Surveys (NHSS) conducted in 2003 and 2008. To measure the level of inequity in inpatient utilization over time, the concentration index, decomposition of the concentration index, and decomposition of change in the concentration index are employed. Results This study finds that even with the same need for inpatient services, richer individuals utilize more inpatient services than poorer individuals. Income is the principal determinant of this pro-rich inpatient utilization inequity- wealthier individuals are able to pay for more services and therefore use more services regardless of need. However, rising income and increased health insurance coverage have reduced the inequity in inpatient utilization in spite of increasing inpatient prices. Conclusions There remains a strong pro-rich inequity of inpatient utilization in rural China. However, a narrowing income gap between the rich and poor and greater access to health insurance has effectively reduced income inequality, equalizing access to care. This suggests that the most effective way to reduce the inequity is to narrow the gap of income between the rich and poor while adopting social risk protection. PMID:21854641
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Marital Distress and Mental Health Care Service Utilization
ERIC Educational Resources Information Center
Schonbrun, Yael Chatav; Whisman, Mark A.
2010-01-01
Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…
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Yeom, Hyong Suk
2015-01-01
This study examined gender differences in the utilization of substance abuse treatment including inpatient, outpatient, and self-help services, using existing data sets from a National Institute on Drug Abuse study that enrolled 78 females and 141 males in a mixed-gender aftercare program in Massachusetts for a 2-year follow-up period. This study found that women came to the study in greater need of treatment than men. Women utilized significantly more outpatient treatment services than men. The characteristic of female per se led to more utilization of outpatient services, whereas the baseline characteristics of employed status and alcohol use led to less utilization of outpatient services.
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Rho, Mi Jung; Kim, Hun-Sung; Yoon, Kun-Ho; Choi, In Young
2017-04-01
Knowledge regarding compliance patterns and service utilization in e-health is important for the development of effective services. To develop proper e-health, the characteristics of compliance patterns and utilization of e-health should be studied. We studied these for glucose monitoring of diabetic patients from primary clinics. Data were collected from 160 outpatients who participated in e-health for glucose monitoring funded by the Korean government. Specifically, this study focused on two device types: a standalone Internet gateway and a tablet device. The SPSS 18.0 software was used for statistical analyses of demographic characteristics, survival data, and Cox proportional hazards regression model. Standalone Internet gateway users demonstrated a more stable compliance pattern than did tablet device users. The compliance rate differed according to the device type. Typically, compliance decreases considerably around 8 months. In these results, standalone Internet gateway users utilized the service for longer periods than tablet device users. Gateway type and location also influenced utilization (p < 0.05). The service should be designed according to the device type to develop appropriate service models. Thus, service designers should understand the different characteristics of service devices. This study provides insight into compliance patterns and utilization to develop appropriate service models and service interventions depending on the device.
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Moineddin, Rahim; Nie, Jason X; Wang, Li; Tracy, C Shawn; Upshur, Ross E G
2010-11-09
The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization. We conducted a population-based retrospective cohort study of all Ontario residents aged 65+ eligible for public healthcare coverage from January 1998-December 2006. The main outcome measure was total number of utilization events. The total is computed by summing, on a per annum basis, the number of family physician visits, specialist visits, Emergency Department visits, drug claims, lab claims, X-rays, CT scans, MRI scans, and inpatient admissions. Three categories of utilization were created: low, moderate, and high. There is heterogeneity in health services utilization across the late lifespan. Utilization increased consistently in the 9-year study period. The probability of remaining at the high utilization category when the person was in the high category the previous year was more than 0.70 for both males and females and for all age groups. Overall healthcare utilization increases more rapidly among the high users compared to the low users. There was negligible probability for moving from high to low utilization category. Probability of death increased exponentially as age increased. Older adults in the low utilization category had the lowest probability of death. The number of male nonagenarians increased more rapidly than female nonagenarians. There are measurable and identifiable differences in the patterns of health services utilization among older adults. This data will permit clinicians and policy makers to tailor interventions appropriate to the risk class of patients.
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Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles
2016-07-07
Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Regional State, Ethiopia. A community-based cross-sectional study design was employed among 703 randomly identified mothers of Abuna Gindeberet district in March, 2013. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0. Descriptive, bivariate and multivariate analyses were used to determine prevalence and to identify associated factors with institutional delivery and postnatal care, considering p-value of less than 0.05 as significant. The results were presented in a narrative forms, tables and graphs. One hundred one (14.4 %) of mothers gave birth to their last baby in health institutions. From 556 (79.1 %) of respondents who heard about postnatal care services, only 223 (31.7 %) of them utilized postnatal care services for their recent childbirth. From the total postnatal care users, 204 (91.5 %) of them took the services from health extension workers. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were found to be statistically significant with both institutional delivery and postnatal care services utilizations. But educational status of husbands was statistically significant with only postnatal care services utilizations. Both institutional delivery and postnatal care services utilizations from health institutions were low. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were the common factors that affect institutional delivery and postnatal care services utilizations from health institutions. Therefore, giving attention to the identified factors could improve and sustain institutional delivery and postnatal care services utilizations from health institutions.
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Benenson, Irina; Jadotte, Yuri; Echevarria, Mercedes
2017-03-01
Painful vaso-occlusive crisis is a hallmark of sickle cell disease (SCD) that commonly results in utilization of hospital services. Recurrent use of hospital services by SCD patients is associated with high healthcare costs and adverse clinical outcomes. Understanding the factors influencing the pattern of utilization is a first step in improving medical care of this patient population while reducing healthcare expenditures. The primary objective of this systematic review was to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult SCD patients. Adult SCD patients of both sexes who utilized hospital services for acute or emergency care. Non-modifiable and modifiable factors influencing utilization of hospital services. Prospective and retrospective cohort studies, case-control and analytical cross-sectional studies. The primary outcome of interest was high utilization of hospital services by adult SCD patients based on non-modifiable and modifiable factors measured as an odds ratio (analytical outcome). The secondary outcome was the prevalence of non-modifiable and modifiable factors among SCD patients who utilized hospital services measured as an event rate (descriptive outcome). A comprehensive multi-step search was undertaken to find both published and unpublished studies. Only studies published in the English language were included. The search was not limited by year of publication. Retrieved papers were assessed for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Data were extracted using a researcher-developed tool. Included studies were combined in a statistical meta-analysis. The meta-analysis was based on a random effect model. For studies that did not allow statistical pooling, the findings have been presented in a narrative form. Fourteen studies were included in this review. The analysis demonstrated that male patients accounted for 40.8% (95% confidence interval [CI] 0.370-0.447) of all utilizing patients. Sickle cell disease patients who were publically insured accounted for 76.5% (95% CI 0.632-0.861) of all patients who had hospital encounters. Patients aged 25-35 years had the highest rate of utilization, and the rate of utilization declined in patients older than 50 years. High utilizing patients had more diagnoses of acute chest syndrome and sepsis than patients who were moderate or low utilizers. The majority of SCD patients who utilized hospital services were women, young people and publically insured individuals. Patients with particularly high level of utilization had more frequent diagnoses of acute chest syndrome and sepsis.
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Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey.
Gebrehiwot, Genet; Medhanyie, Araya Abrha; Gidey, Gebreamlak; Abrha, Kidan
2018-05-30
Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.
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Medina-Solis, Carlo Eduardo; Maupomé, Gerardo; del Socorro, Herrera Miriam; Pérez-Núñez, Ricardo; Avila-Burgos, Leticia; Lamadrid-Figueroa, Hector
2008-01-01
To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua. A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression. The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs. Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.
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Predictors of Service Utilization among Youth Diagnosed with Mood Disorders
ERIC Educational Resources Information Center
Mendenhall, Amy N.
2012-01-01
In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the…
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Clewley, Derek; Rhon, Dan; Flynn, Tim; Koppenhaver, Shane; Cook, Chad
2018-02-21
Physical therapists' familiarity, perceptions, and beliefs about health services utilization and health seeking behaviour have not been previously assessed. The purposes of this study were to identify physical therapists' characteristics related to familiarity of health services utilization and health seeking behaviour, and to assess what health seeking behaviour factors providers felt were related to health services utilization. We administered a survey based on the Andersen behavioural model of health services utilization to physical therapists using social media campaigns and email between March and June of 2017. In addition to descriptive statistics, we performed binomial logistic regression analysis. We asked respondents to rate familiarity with health services utilization and health seeking behaviour and collected additional characteristic variables. Physical therapists are more familiar with health services utilization than health seeking behaviour. Those who are familiar with either construct tend to be those who assess for health services utilization, use health services utilization for a prognosis, and believe that health seeking behaviour is measurable. Physical therapists rated need and enabling factors as having more influence on health services utilization than predisposing and health belief factors. Physical therapists are generally familiar with health services utilization and health seeking behaviour; however, there appears to be a disconnect between what is familiar, what is perceived to be important, and what can be assessed for both health services utilization and health seeking behaviour. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. All rights reserved.
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An Examination of the Utilization of Electronic Government Services by Minority Small Businesses
ERIC Educational Resources Information Center
Ford, Wendy G.
2010-01-01
There are a wide variety of e-government information and services that small business owners and managers can utilize. However, in spite of all of the service incentives and initiatives to promote e-government, research studies have shown that this information is not widely accessed. Studies that explore the utilization of e-government information…
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Health Services Utilization between Older and Younger Homeless Adults.(author Abstract)
ERIC Educational Resources Information Center
Nakonezny, Paul A.; Ojeda, Michael
2005-01-01
Purpose: Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being…
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ERIC Educational Resources Information Center
Public Health Service (DHEW), Washington, DC. Div. of Indian Health.
A descriptive study of health services utilization patterns, and possible factors contributing to such patterns, was conducted in April 1970 at the Zuni, New Mexico, Indian Health Service Unit. Health service utilization was explored by selected disease categories, preventative services (maternal and child health), and general population attitudes…
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Girmaye, Melese; Berhan, Yifru
2016-07-01
In response to high maternal and perinatal morbidities and mortalities in Ethiopia, "Women's Health Development Army" was established to enhance utilization of skilled maternity services including antenatal care (ANC). However, its effect on skilled ANC service utilization is not well measured. Our study was aimed to assess skilled antenatal care service utilization and its association with the characteristics of women's health development team (WHDT). A community based cross sectional study was conducted from January to February 2015. A multi-stage cluster sampling technique was applied, and a total of 748 women (15-49 years) who gave birth in one year preceding the study were included in the study. Data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Bivariate and multilevel mixed effects analysis techniques were applied to check for association of selected independent variables with utilization of skilled ANC. About 71% women received skilled ANC service at least once. A significant heterogeneity was observed between WHDTs for skilled ANC utilization. Level-1 predictors of skilled ANC utilization were: preference of skilled personnel (AOR=11.0; 95%, CI, 3.02-40.04), awareness about places where to get skilled providers (AOR=51.6; 95% CI, 13.92-,190.97) and listening to radio (AOR=5.7; 95% CI, 1.46-21.94). Distance of WHDT within 2 km radius from the nearest health facility (HF) was the only level-2 significant predictor of skilled ANC service utilization (AOR=8.28; 95%CI, 1.08-62.20). Skilled ANC service utilization is the joint effect of individual and WHDT characters. Awareness and perception creation towards skilled maternity service utilization need to be enhanced. Facilities and transport services should be more accessible towards WHDTs.
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Distribution and utilization of curative primary healthcare services in Lahej, Yemen.
Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M
2013-09-01
No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Kileo, Neema Minja; Michael, Denna; Neke, Nyasule Majura; Moshiro, Candida
2015-12-15
Worldwide cervical cancer is one of the more common forms of carcinoma among women, causing high morbidity and high mortality. Despite being a major health problem in Tanzania, screening services for cervical cancer are very limited, and uptake of those services is low. We therefore conducted a study to investigate utilization of cancer screening services, and its associated factors among female primary school teachers in Ilala Municipality, Dar es Salaam. We conducted a cross-sectional study between May - August 2011 which involved 110 primary schools in Ilala Municipality in Dar es Salaam. Five hundred and twelve female primary school teachers were sampled using a two-stage cluster sampling procedure. Data on utilization of cervical cancer and risk factors were collected using a self-administered questionnaire. Proportional utilization of cervical cancer screening services was identified through a self report. Risk factors for services utilization were assessed using logistic regression analyses. Out of 512 female primary school teachers, only 108 (21 %) reported to ever been screened for cervical cancer. Utilization of cervical cancer screening services was 28 % among those aged 20-29, 22 % among married and 24 % among those with higher level of education. Women were more likely to utilize the cancer-screening service if they were multiparous (age-adjusted OR = 3.05, 95 % CI 1.15-8.06, P value 0.025), or reported more than one lifetime sexual partner (age-adjusted OR 2.17, 95 % CI 1.04-4.54, P value 0.038), or did not involve their spouse in making health decisions (adjusted OR 3.56, 95 % CI 2.05-6.18, P value <0.001). The study has demonstrated low level of utilization of cervical cancer screening service among female primary school teachers in Ilala munipality. Female primary school teachers with more than one previous pregnancy and those with more than one life-time sex partners were more likely to report utilization of the service. Spouse or partners support was an important factor in the utilization of cervical cancer screening service amongst the study population.
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Determinants of psychology service utilization in a palliative care outpatient population.
Azuero, Casey; Allen, Rebecca Sue; Kvale, Elizabeth; Azuero, Andres; Parmelee, Patricia
2014-06-01
Research has demonstrated that treating cancer patients' psychological and physical health leads to improved overall health. This may be especially true for palliative care patients facing serious illness. This study examines the proportion and determinants of psychology service utilization in an outpatient palliative care population. Data from an existing clinical database in an outpatient palliative clinic utilizing a collaborative care model to deliver psychology services were explored. This study was framed by Andersen's Behavioral Model of Health Service Use, which incorporates three main components: predisposing, enabling, and need factors to model health service utilization. The sample (N = 149) was majority middle aged, female, and White with a primary diagnosis of cancer. Cross-tabulations were conducted to determine how many patients who met screening criteria for depression or anxiety sought psychology services. Logistic regression analyses were conducted to assess for predisposing, enabling, and need factor determinants of psychology service utilization. Among patients who met criteria for moderate depression or anxiety, 50% did not access readily available psychology services. Enabling factors were the strongest determinant of psychology utilization. Factors associated with need for psychology services (i.e., emotional distress and psychological symptom burden) did not reach significance in determining psychology service use. This study extends current knowledge about psychology utilization to palliative care outpatients receiving care within a collaborative care model. Directions for future research include further investigation of care models that optimize enabling strategies to enhance access to these services, and examination of patient-reported barriers to receiving this care. Copyright © 2013 John Wiley & Sons, Ltd.
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Zhang, Hui-Shan; Mai, Yan-Bing; Li, Wei-Da; Xi, Wen-Tao; Wang, Jin-Ming; Lei, Yi-Xiong; Wang, Pei-Xi
The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%. Poorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables. Copyright © 2016. Published by Elsevier B.V.
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Hasegawa, Aya; Yasuoka, Junko; Ly, Po; Nguon, Chea; Jimba, Masamine
2013-08-23
Malaria and other communicable diseases remain major threats in developing countries. In Cambodia, village malaria workers (VMWs) have been providing malaria control services in remote villages to cope with the disease threats. In 2009, the VMW project integrated child health services into the original malaria control services. However, little has been studied about the utilization of VMWs' child health services. This study aimed to identify determinants of caregivers' VMW service utilization for childhood illness and caregivers' knowledge of malaria management. A cross-sectional study was conducted in 36 VMW villages of Kampot and Kampong Thom provinces in July-September 2012. An equal number of VMW villages with malaria control services only (M) and those with malaria control plus child health services (M+C) were selected from each province. Using structured questionnaires, 800 caregivers of children under five and 36 VMWs, one of the two VMWs who was providing VMW services in each study village were interviewed. Among the caregivers, 23% in M villages and 52% in M+C villages utilized VMW services for childhood illnesses. Determinants of caregivers' utilization of VMWs in M villages included their VMWs' length of experience (AOR = 11.80, 95% confidence interval [CI] = 4.46-31.19) and VMWs' service quality (AOR = 2.04, CI = 1.01-4.11). In M+C villages, VMWs' length of experience (AOR = 2.44, CI = 1.52-3.94) and caregivers' wealth index (AOR = 0.35, CI = 0.18-0.68) were associated with VMW service utilization. Meanwhile, better service quality of VMWs (AOR = 3.21, CI = 1.34-7.66) and caregivers' literacy (AOR = 9.91, CI = 4.66-21.05) were positively associated with caregivers' knowledge of malaria management. VMWs' service quality and length of experience are important determinants of caregivers' utilization of VMWs' child health services and their knowledge of malaria management. Caregivers are seeking VMWs' support for childhood illnesses even if they are providing only malaria control services. This underlines the importance of scaling-up VMWs' capacity by adding child health services of good quality, which will result in improving child health status in remote Cambodia.
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Toppelberg, Claudio O; Hollinshead, Marisa O; Collins, Brian A; Nieto-Castañon, Alfonso
2013-06-01
The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants ( n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers ( p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing ( r = .23; p ≤ 0.01) and total problems ( r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.
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Jaidee, Jeeratip; Ratanasiri, Amornrat; Chatrchaiwiwatana, Supaporn; Soonthon, Surasak
2015-07-01
The present study aimed to find out the utilization prevalence of dental care services among factory workers over a period of one year and factors associated with utilization of dental care services. This was a cross-sectional analytic study. The study population was factory workers in Nava Nakorn Industrial Estate randomly sampled using Probability Proportion to Size Cluster Sampling Method. The tool was a questionnaire about utilization of dental care services. Among the sample group of 1,500 workers from 16 factories, almost 2/3 (63.9%) had never used any dental care services in the previous year while only 36.1% did. A multivariable logistic regression analysis showed that workplace, accommodation, tooth decay, toothache history, transportation, experience in using social security fund for dental care services, availability and accessibility of dental care services, brushing teeth regularly after meals, using dental care services regularly in a dental clinic, and agreement with the idea that a tooth extraction and medication by a dentist could reduce the risk of progression of disease, statistical significance (p-value < 0.05), were factors associated with the utilization of dental care services at R2 (The Nagelkerke R Square) 0.38. That the prevalence of the factory workers who did not use dental care services during the last one year was 63.9 percent. This study identified three groups of factors associated with the utilization of dental care services as: 1) Predisposing factors, 2) Enabling factors, and 3) Need factors.
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Understanding Service Utilization Disparities and Depression in Latinos: The Role of Fatalismo.
Anastasia, Elizabeth A; Bridges, Ana J
2015-12-01
Research demonstrates a disparity between need and utilization of mental health services for Latinos. Cultural variations in perceptions of mental illness may be partially responsible for this discrepancy. Past research with Latinos has shown links between fatalismo, a cultural value similar to external locus of control, and both depression and lower service utilization in medical care, while links to psychiatric care have not been investigated. The current study therefore aimed to explore the associations between fatalismo, depression, and past year mental health service utilization by Latinos. A community sample of 83 Latino adults were recruited during local cultural events. Participants completed self-report measures of depression, fatalism, and past year service utilization. Analyses using structural equation modeling showed fatalismo was directly negatively related to past year medical service utilization (β = -.35). In contrast, the link between fatalismo and past year mental health service utilization was mediated by self-reported depressive symptoms (indirect β = .19, p < .001). We conclude that while fatalismo is associated with depression in Latinos, other barriers likely serve as more salient deterrents of service utilization.
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Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa
2016-01-01
Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.
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Nam, Boyoung; Wilcox, Holly C; Hilimire, Matthew; DeVylder, Jordan E
2018-01-31
This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.
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Utilization of Ambulatory Mental Health Services.
ERIC Educational Resources Information Center
Williams, Stephen J.; Richardson, Mary
1980-01-01
Studied the use of mental health services by enrolled populations, in order to establish a model or predictor of utilization. Primary focus of utilization data has been patient characteristics; organizational variables, such as plan design and benefit packages, are also shown to affect utilization. (LAB)
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Determinants of postnatal care non-utilization among women in Nigeria.
Somefun, Oluwaseyi Dolapo; Ibisomi, Latifat
2016-01-11
Although, there are several programs in place in Nigeria to ensure maternal and child health, maternal and neonatal mortality rates remain high with maternal mortality rates being 576/100,000 and neonatal mortality rates at 37/1000 live births (NDHS, 2013). While there are many studies on the utilization of maternal health services such as antenatal care and skilled delivery at birth, studies on postnatal care are limited. Therefore, the aim of this study is to examine the factors associated with the non-utilization of postnatal care among mothers in Nigeria using the Nigeria Demographic and Health Survey (NDHS) 2013. For analysis, the postnatal care uptake for 19,418 children born in the 5 years preceding the survey was considered. The dependent variable was a composite variable derived from a list of questions on postnatal care. A multinomial logistic regression model was applied to examine the adjusted and unadjusted determinants of non-utilization of postnatal care. Results from this study showed that 63% of the mothers of the 19,418 children did not utilize postnatal care services in the period examined. About 42% of the study population between 25 and 34 years did not utilize postnatal care and 61% of the women who did not utilize postnatal care had no education. Results from multinomial logistic regression show that antenatal care use, distance, education, place of delivery, region and wealth status are significantly associated with the non-utilization of postnatal care services. This study revealed the low uptake of postnatal care service in Nigeria. To increase mothers' utilization of postnatal care services and improve maternal and child health in Nigeria, interventions should be targeted at women in remote areas who don't have access to services and developing mobile clinics. In addition, it is crucial that steps should be taken on educating women. This would have a significant influence on their perceptions about the use of postnatal care services in Nigeria.
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Abuka Abebo, Teshome; Jember Tesfaye, Dawit
2018-01-01
Despite postnatal care services significant role in improving maternal and new-born health, services are underutilized in most developing countries including Ethiopia. Hence, it is important to identify factors that facilitate or impede postnatal care services utilization. The aim of this study was to assess postnatal care services utilization and associated factors among reproductive age women who gave live birth in 2015 at Halaba kulito town, Southern Ethiopia. A community-based cross-sectional study was conducted on 401 reproductive age women who gave live birth a year prior to the survey. Data were collected by using structured questionnaire. Bivariate and multivariable logistic regression analysis were carried out to identify factors associated with postnatal care services utilization. A significant association was declared when p -value is less than 0.05. The strength of association was determined by calculating odds ratio at 95% confidence interval. In this study, postnatal care services utilization by reproductive age women was 47.9%. Multivariable analysis revealed that government employed (AOR = 3.01, 95%CI = 1.36, 6.67), have three ANC visits (AOR = 4.29, 95% CI = 1.59, 11.55), have four ANC visits (AOR = 9.55, 95% CI = (3.46, 26.39), gave last birth at Health Centre (AOR = 10.76, 95% CI = 3.26, 35.57), gave last birth at Hospital (AOR = 13.15, 95% CI = (3.64, 47.50), didn't aware of at least one postpartum danger signs (AOR = 0.06, 95% CI = (0.01, 0.37), didn't know child care and had three ANC visits (AOR =0 .14, 95% CI (0.02, 0.8), and didn't know child care and had four or more ANC visits (AOR =0 .13, 95% CI (0.02, 0.79) were significantly associated with postnatal care services utilization. This study assessed PNC services utilization and associated factors among reproductive age women. The study results provided a basic understanding of factors that associated with PNC services utilization by reproductive age women. The findings of this study showed direct association between postnatal care utilization and maternal employment, awareness to postpartum danger signs, frequency of ANC and attending birth at health institution. Therefore, the results suggested context-specific evidence which might be taken into consideration when rethinking policies to increase PNC utilization.
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Miranda, Camila Dal-Bó Coradini; Peres, Marco Aurélio
2013-11-01
This study aimed to estimate the prevalence of dental services utilization by adults and to identify associated socioeconomic, demographic, behavioral, and self-awareness factors. A cross-sectional population-based study was conducted with adults living in the urban area of Florianópolis, Santa Catarina State, Brazil, in 2009. Associations were tested between use of dental services and predisposing, enabling, and needs-based variables. Multivariate analysis was conducted using Poisson regression with estimates of prevalence ratios and was stratified by place of last dental appointment. Prevalence of dental services utilization was 66% (95%CI: 62.9-70.7). Dental visits were 20% more frequent among women and 72% more frequent among individuals with more schooling (the latter in both public and private dental services). Individuals with private dental plans used dental services 13% more than those without. Schooling was the most important variable in predicting utilization. The study's results show the importance of monitoring associated factors in order to promote more equitable use of dental services.
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Cheng, M L; Si, Y
2017-05-09
It has been reported that children's oral health conditions are correlated with their attendance to dental health services. Evaluating the influencing factors of utilization of dental services for children may give ways to improve the services per se, and furtherly the children's oral health. The present review retrieved and summarized domestic and foreign studies on the utilization of oral health services for children based on the Andersen behavior model. It was concluded that the utilization of dental services for children was affected by demographic characteristics, social structure, health belief, family factors, community factors and perceived/evaluated needs. To improve the utilization of dental services for children, effort should be made by means of changing caregivers' health belief, developing oral health insurance system, setting up regular oral health resources and increasing the financial support for oral health services by government.
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Choi, Sam
2015-01-01
Substance abusers often face substantial systematic and personal barriers to receiving required substance abuse treatment services as well as other services; hence, various linkage mechanisms have been proposed for drug abuse treatment programs to overcome such barriers. Although there is a growing interest in the use of case management with a substance abuse background, its effectiveness in child welfare has yet to be explored. In this study the author attempts to investigate the effectiveness of case management in service utilization by systematically evaluating the five-year Alcohol and Other Drug Abuse (AODA) waiver demonstration project with Recovery Coaches in Illinois. A classic experimental design with a control group was used. Random assignment occurs at the agency level. Parents in the experimental group (N = 1562) received recovery coaches in addition to traditional child welfare services while parents in the control group (N = 598) only received traditional child welfare services. Bivariate and multivariate analyses (Ordinary Last Square regressions) were used. Compared to parents in the control group, parents in the experimental group were more likely to utilize substance abuse treatment. The results suggest that gender, education level, employment status, and the number of service needs were significantly associated with service utilization. Controlling other factors, recovery coaches improved overall service utilization. Because the outcome of child welfare often depends on the improvement of risks or resolution, it is important for parents to utilize the needed services. Future studies need to address what aspects of recovery coaches facilitate the services utilization.
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Perlman, Christopher
2018-01-01
Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed. PMID:29587426
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Progressive segmented health insurance: Colombian health reform and access to health services.
Ruiz, Fernando; Amaya, Liliana; Venegas, Stella
2007-01-01
Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright (c) 2006 John Wiley & Sons, Ltd.
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Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya
2017-01-01
A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P <0.01). There was significant difference in the utilization of antenatal checkup ( P <0.01) during pregnancy, whilst there was no significant difference in utilization of healthcare services during the postpartum period. Women who delivered at home were more likely to experience feeling of irritated eyes and headaches, and continuous abdominal pain ( P <0.05). Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.
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Malik, Sadia Mariam; Ashraf, Nabila
2016-07-26
Poor maternal and infant health indicators are mostly concentrated among low income households in Pakistan and health care expenditures - especially on medical emergencies - are the most common income shocks experienced by the poor. Public investments in health are therefore considered as pro-poor interventions by the government of Pakistan. This study employs nationally representative household data for Pakistan for 2007-08 and 2010-11 to investigate whether benefits from publicly financed services on Mother and Newborn Child Health (MNCH) are effectively captured by the poor in terms of service utilization. The study conducts a Utilization Incidence Analysis of the use of public health services for MNCH in Pakistan. For this purpose, the utilization shares of households, ranked by economic status, are computed. The concentration curves are plotted and their dominance is tested against an equal distribution and Lorenz curves to determine whether the distribution is pro-poor and progressive. Although the shares of bottom income groups in the utilization of most services for MNCH have increased between 2007 and 2011, the utilization of some services such as post-natal consultation; institutional maternal delivery; and Tetanus Toxoid injections for pregnant women remains pro-rich in 2011. The utilization of pre-natal consultation, especially through lady health workers and visitors; the use of Family Panning Units; and immunization services is somewhat evenly distributed. The use of Basic Health Units (BHUs) is found to be pro-poor. The provincial analysis reveals that the province of Baluchistan depicts an unusually high level of inequity in the distribution of utilization benefits from almost all public health services. Finally, in terms of progressivity, public spending on all health services analyzed in the study is found to be progressive at the national level implying that investment in MNCH has the potential to redistribute income from rich to the poor. To target the poor effectively, the study recommends expanding the network of BHUs as well as basic reproductive and child health care services. The outreach of health facilities in Baluchistan need to be expanded while targeting the poor effectively by mitigating various access costs that prevent them from using public health services.
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Karim, Rizwanul M; Abdullah, Mamun S; Rahman, Anisur M; Alam, Ashraful M
2016-06-24
Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality.
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Obiechina, G O; Ekenedo, G O
2013-01-01
Most university health services have extensive health infrastructures, for the provision of effective and efficient health services to the students. In this study, we have tried to determine student's perception of factors affecting their utilization. To determine students' perception of health care services provided in a tertiary institution and assess students' attitude towards utilization. Simple random sampling technique was used to select 540 respondents, comprising of 390 males and 150 females. A structured and self-administered questionnaire was the instrument used to collect data for the study, while data collected was analyzed using descriptive statistics of frequency count and percentage. High cost of drugs (72.0%), non availability of essential drugs (54.8%), time spent waiting for treatment (67.2%), inadequate referral services (81.7%), and satisfaction with services (60.6%) were considered by the respondents as factors affecting the utilization of university health services. Students-medical staff relationship and accessibility to health facility (77.6% and 74.3% respectively) were, however, not considered as factors that affect utilization of university health services. It is recommended that to improve utilization and cost of care, government should make necessary efforts to incorporate tertiary institution into National Health Insurance scheme so that students above the age of 18 years can benefit from free treatment.
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Okoronkwo, I L; Ejike-Okoye, P; Chinweuba, A U; Nwaneri, A C
2015-01-01
To determine financial barriers that impede the utilization of screening and treatment services for breast cancer among Nigerian women from different socioeconomic groups. A descriptive study was carried out in 2013 among women attending the oncology clinic of a tertiary institution in Enugu, Southeast Nigeria. Data were collected from 270 women using an interviewer-administered questionnaire. The links between the influence of socioeconomic factors on barriers to the utilization of breast cancer screening and treatment services were examined. A total of 270 women were studied. The mean age was 34.69 (Standard deviation = 5.07) years. Half of the study participants were single 141 (51.3%), while 105 (38.2%) were married. Cost of medical treatment and not having insurance coverage was major financial barriers to utilization of screening and treatment services. The least poor and poor socioeconomic status (SES) groups utilized screening services and treatment more frequently than the very poor and poorest SES groups ( P = 0.034). There was no significant difference in the utilization of the different treatment options among the different socioeconomic groups with the exception of surgery (χ² = 11.397; P = 0.000). Financial barriers limit the ability of women, especially the poorest SES group, to utilize screening and treatment services for early diagnosis and treatment of breast cancer. Interventions that will improve financial risk protection for women with breast cancer or at risk of breast cancer are needed to ensure equitable access to screening and treatment services.
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Emelumadu, OF; Ukegbu, AU; Ezeama, NN; Kanu, OO; Ifeadike, CO; Onyeonoro, UU
2014-01-01
Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2-test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively. Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits. PMID:24971212
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ERIC Educational Resources Information Center
Mendenhall, Amy N.; Fristad, Mary A.; Early, Theresa J.
2009-01-01
This study investigated the impact of psychoeducation on service utilization and mood symptom severity in children with mood disorders. Parents' knowledge of mood disorders, beliefs about treatment, and perceptions of children's need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and…
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ERIC Educational Resources Information Center
Espinosa, Allen A.; Datukan, Janir T.; Butron, Benilda R.; Tameta, Anna Danica C.
2018-01-01
The present study determined the perceptions of pre-service teachers on utilizing productive lesson study as a framework in teaching high school chemistry. Participants of the study were thirty (30) junior pre-service chemistry teachers from a state-funded teacher education institution in Manila, Philippines. Participants were exposed to a…
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Alsubaie, Abdulaziz M.; Almohaimede, Khaled A.; Aljadoa, Abdulrahman F.; Jarallah, Osamah J.; Althnayan, Yasser I.; Alturki, Yousef A.
2016-01-01
Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients' utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333), and bad self-health-perception (P < 0.014, OR: 2.088). Chronic illness was also associated with higher utilization (OR = 2.003). Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services. PMID:26929723
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Predictors of Dental Care Use: Findings from the National Longitudinal Study of Adolescent Health
Okunseri, Christopher; Okunseri, Elaye; Garcia, Raul I.; Visotcky, Alexis (Dye); Szabo, Aniko
2013-01-01
Objective To examine longitudinal trends and associated factors in dental service utilization by adolescents progressing to early adulthood in the United States. Data Source The National Longitudinal Study of Adolescent Health from Waves I (1994-95), II (1996), III (2001-2002) and IV (2007-2008). Study Design This is a retrospective, observational study of adolescents' transition to early adulthood. We obtained descriptive statistics and performed logistic regression analyses to identify the effects of baseline and concurrent covariates on dental service utilization from adolescence to early adulthood over time. Principal Findings Dental service utilization within the prior 12 months peaked at age 16 (72%), gradually decreased until age 21 (57%), and thereafter remained flat. Whites and Asians had a 10-20 percentage points higher proportion of dental service utilization at most ages compared to Blacks and Hispanics. Dental service utilization at later follow-up visits was strongly associated with baseline utilization with OR= 10.7, 2.4 and 1.5 at the 1-year, 7-year and 13-year follow-ups respectively. These effects decreased when adjusted for current income, insurance and education. Compared to Whites, Blacks were consistently less likely to report any dental examination. Conclusion Dental service utilization was highest in adolescents. Gender, education, health insurance and income in young adulthood were significant predictors of reporting a dental examination. Blacks had lower odds of reporting a dental examination either as adolescents or as young adults. PMID:23850156
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Utilization of maternal health-care services by tribal women in Kerala.
Jose, Jinu Annie; Sarkar, Sonali; Kumar, S Ganesh; Kar, Sitanshu Sekhar
2014-01-01
The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services.
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FACTORS ASSOCIATED WITH HEALTHCARE UTILIZATION AMONG ARAB IMMIGRANTS AND REFUGEES
2015-01-01
Background Arab migrants are exposed to pre- and post migration stressors that increase their risk for health problems. However, little is known regarding healthcare utilization rates or factors associated with healthcare utilization among Arab immigrants and refugees. Methods 590 participants were interviewed 1 year post-migration to the United States Factors associated with healthcare utilization including stress coping mechanisms were examined using binary logistic regressions. Results Compared to national healthcare utilization data, immigrants had significantly lower and refugees had significantly higher rates. Being a refugee, married, and having health insurance were significantly associated with medical service utilization. None of the immigrants in this study had utilized psychological services. Among refugees, the use of medications and having strategies for dealing with stress were inversely associated with utilization of psychological services. Discussion (Conclusion) Healthcare utilization was significantly higher among refugees, who also reported a greater need for services than immigrants. PMID:25331684
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A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines
Yamashita, Tadashi; Suplido, Sherri Ann; Ladines-Llave, Cecilia; Tanaka, Yuko; Senba, Naomi; Matsuo, Hiroya
2014-01-01
Background The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care. Methods A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed. Results The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test. Conclusion We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services. PMID:24465626
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Utilization of KSC Present Broadband Communications Data System for Digital Video Services
NASA Technical Reports Server (NTRS)
Andrawis, Alfred S.
2002-01-01
This report covers a visibility study of utilizing present KSC broadband communications data system (BCDS) for digital video services. Digital video services include compressed digital TV delivery and video-on-demand. Furthermore, the study examines the possibility of providing interactive video on demand to desktop personal computers via KSC computer network.
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Utilization of KSC Present Broadband Communications Data System For Digital Video Services
NASA Technical Reports Server (NTRS)
Andrawis, Alfred S.
2001-01-01
This report covers a visibility study of utilizing present KSC broadband communications data system (BCDS) for digital video services. Digital video services include compressed digital TV delivery and video-on-demand. Furthermore, the study examines the possibility of providing interactive video on demand to desktop personal computers via KSC computer network.
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Impact of information and communications technologies on residental customer energy services
DOE Office of Scientific and Technical Information (OSTI.GOV)
Goldman, C.; Kempton, W.; Eide, A.
1996-10-01
This study analyzes the potential impact of information and communications technologies on utility delivery of residential customer energy services. Many utilities are conducting trials which test energy-related and non-energy services using advanced communications systems.
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ERIC Educational Resources Information Center
McIntyre, Laura Lee; Zemantic, Patricia K.
2017-01-01
Autism spectrum disorder (ASD) is the fastest growing group of neurodevelopmental disorders in childhood. Earlier detection means an increased need for early intervention and other educational services. This study examined what services a sample of young children with ASD received, what variables predicted service utilization, and how satisfied…
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Correlates of service utilization among homeless youth.
Tyler, Kimberly A; Akinyemi, Sarah L; Kort-Butler, Lisa A
2012-07-01
Though few studies exist on service utilization among homeless youth in the U.S., services are important because without them, many of these young people may resort to delinquent strategies in order to meet their daily survival needs. The current study examines frequency and correlates of service utilization (i.e., shelters, food programs, street outreach, counseling, STI and HIV testing) among a sample of 249 homeless youth ages 14 to 21. Multivariate analysis revealed significant differences in service usage by sex, age, and sexual orientation. Experiencing family physical and/or sexual abuse, being kicked out of the family home, spending more nights per week sleeping on the street, and having ever stayed in a group home facility were significant correlates of homeless youths' service usage.
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Motuma, Aboma; Syre, Thomas; Egata, Gudina; Kenay, Abera
2016-07-17
Youth friendly services are designed to make health services accommodate the unique needs of youth. Nevertheless, in developing countries like Ethiopia, the level of knowledge about the use of these services is limited. The main aim of this study was to assess the extent of youth friendly service utilization and the associated factors among the youth. A community based- cross sectional quantitative study design supplemented with qualitative inquiry was used from January to February 2011. Data were collected from a random sample of 845 youth using a pretested structured questionnaire. Qualitative data were collected through interview guides. Odds ratios, along with 95 % confidence level, were estimated to measure the strength of association between the study variables using multivariable logistic regression. Level of statistical significance was declared at p-value less than 0.05. Thematic analysis was used to analyze the qualitative data. Nearly 64 % of the youth had already utilized youth friendly services at least once at the time of the survey. In multivariable logistic regression analysis, using friends [AOR = 3.65, 95 % CI (1.81,7.32)], health care providers [AOR = 3.27, 95 % CI (1.18,9.00)], and schools [AOR = 1.79, 95 % CI (1.00,3.19) as source of information, and having knowledge about the youth friendly services [AOR = 2.77,95 % CI (1.93,3.96)] were significantly associated with the utilization of youth friendly services. In contrast, being daily laborer and private worker by occupation [AOR = 0.12, 95 % CI (0.05, 0.92)], having negative perception about counseling [AOR = 0.50, 95 % CI (0.31-0.80)], about reproductive health services [AOR = 0 .13, 95 % CI (0.04-0.46)], and about youth friendly service providers [AOR-0.02, 95 % CI (0.08-0.50)] negatively influenced the outcome variable. The utilization of youth friendly services is moderate in this study. Getting youth related services information from different sources and being knowledgeable about the services have increased the utilization of the services. Efforts should be made by all relevant stakes to create conducive environment for the youth through training of the youth service providers, particularly for those who work in the government institutions, and strengthening of the awareness creation strategies among the youth to increase the utilization of the services.
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Kikui, Miki; Kida, Momoyo; Kosaka, Takayuki; Yamamoto, Masaaki; Yoshimuta, Yoko; Yasui, Sakae; Nokubi, Takashi; Maeda, Yoshinobu; Kokubo, Yoshihiro; Watanabe, Makoto; Miyamoto, Yoshihiro
2015-01-01
Abstract There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t‐test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t‐test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population. PMID:29744141
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Kikui, Miki; Ono, Takahiro; Kida, Momoyo; Kosaka, Takayuki; Yamamoto, Masaaki; Yoshimuta, Yoko; Yasui, Sakae; Nokubi, Takashi; Maeda, Yoshinobu; Kokubo, Yoshihiro; Watanabe, Makoto; Miyamoto, Yoshihiro
2015-12-01
There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t -test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t -test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population.
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Aiken, Alice B; Mahar, Alyson L; Kurdyak, Paul; Whitehead, Marlo; Groome, Patti A
2016-08-04
Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1-83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0-61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2-41.5) went to the emergency department in that same time period and 9.9 % (9.5-10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.
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Health service utilization before and after evidence-based treatment for PTSD.
Tuerk, Peter W; Wangelin, Bethany; Rauch, Sheila A M; Dismuke, Clara E; Yoder, Matthew; Myrick, Hugh; Eftekhari, Afsoon; Acierno, Ron
2013-11-01
Posttraumatic stress disorder (PTSD) is associated with functional impairment, co-occurring diagnoses, and increased health care utilization. Associated high demand for health care services is an important contributor to the large public-health cost of PTSD. Treatments incorporating exposure therapy are efficacious in ameliorating or eliminating PTSD symptoms. Accordingly, the Veterans Health Administration has made significant investments toward nationwide dissemination of a manualized exposure therapy protocol, prolonged exposure (PE). PE is effective with veterans; however, the relationship between PE and mental health service utilization is unknown. The current study investigates PE as it relates to actual tracked mental health service utilization in an urban VA medical center. A sample of 60 veterans with a diagnosis of PTSD was used to examine mental health service utilization in the 12-months prior to and 12-months after being offered PE. Hierarchical Linear Models and traditional repeated-measures ANOVA were used to estimate R²- and d-type effect sizes for service utilization. Associated estimated cost saving are reported. PE was associated with large reductions in symptoms and diagnosis remission. Treatment was also associated with statistically significant, large reductions in mental health service utilization for veterans who completed treatment. Findings suggest that expanding access to PE can increase access to mental health services in general by decreasing ongoing demand for specialty care clinical services.
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Meyers, Laura L; Strom, Thad Q; Leskela, Jennie; Thuras, Paul; Kehle-Forbes, Shannon M; Curry, Kyle T
2013-01-01
This study evaluated the impact of a course of prolonged exposure or cognitive processing therapy on mental health and medical service utilization and health care service costs provided by the Department of Veterans Affairs (VA). Data on VA health service utilization and health care costs were obtained from national VA databases for 70 veterans who completed prolonged exposure or cognitive processing therapy at a Midwestern VA medical center. Utilization of services and cost data were examined for the year before and after treatment. Results demonstrated a significant decrease in the use of individual and group psychotherapy. Direct costs associated with mental health care decreased by 39.4%. Primary care and emergency department services remained unchanged.
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Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin
2015-01-01
Background High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. Methods A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Results Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. Conclusion The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently. PMID:26588244
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Ayehu, Atitegeb; Kassaw, Teketo; Hailu, Getachew
2016-01-01
Currently in Ethiopia, young people's sexual and reproductive health services are limited and there is a growing issue of confidentiality and affordability of these health services. Moreover, the available services provided are not sensitive to the special needs of young people. Therefore, this study was aimed to assess young people's sexual and reproductive health service utilization and its associated factors in Awabel district, Northwest Ethiopia. A community based cross-sectional study was conducted among 781 randomly selected young people using a pre-tested structured questionnaires in Awabel district, Northwest Ethiopia. Data were entered into Epi data version 3.1 and analyzed using SPSS version 16.0 software. The mean age of respondents were 17.80 (+ 2.65) years. About 41% of young people had utilized sexual and reproductive health services. Young people from families of higher family expenditure, lived with mothers, participated in peer education and lived near to a Health Center were more likely to utilize sexual and reproductive health services. Furthermore, those who had a parental discussion on sexual and reproductive health (AOR (95% C.I): 2.23 (1.43, 3.46)) and ever had sexual intercourse (AOR (95% C.I): 1.88 (1.30, 2.71)) were more likely to utilize the service than their counterparts. On the other hand, those young people lived with their father and had a primary level of educational attainment was less likely to utilize the service. Utilization of sexual and reproductive health services is low which needs a great attention where; if not intervened, young people might engage in risky sexual activities. Therefore, it needs a concerted effort from all the concerned bodies to improve their service utilization and thereby reduce the burden of young people's disease and disabilities associated with sexual and reproductive health.
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Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin
2015-01-01
High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.
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Socio-economic inequalities in health services utilization: a cross-sectional study.
Ranjbar Ezzatabadi, Mohammad; Khosravi, Ameneh; Bahrami, Mohammad Amin; Rafiei, Sima
2018-02-12
Purpose Developing country workers mainly face important challenges when examining equality in health services utilization among the population and identifying influential factors. The purpose of this paper us to: understand health service use among households with different socio-economic status in Isfahan province; and to investigate probable inequality determinants in service utilization. Design/methodology/approach Almost 1,040 households living in Isfahan province participated in this cross-sectional study in 2013. Data were collected by a questionnaire with three sections: demographic characteristics; socio-economic status; and health services utilization. The concentration index was applied to measure inequality. Analysts used STATA 11. Findings Economic status, educational level, insurance coverage and household gender were the most influential factors on health services utilization. Those with a high socio-economic level were more likely to demand and use such services; although self-medication patterns showed an opposite trend. Practical implications Female-headed families face with more difficulties in access to basic human needs including health. Supportive policies are needed to meet their demands. Originality/value The authors used principle component analysis to assess households' economic situation, which reduced the variables into a single index.
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Fekadu, Melaku; Regassa, Nigatu
2014-12-01
Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia. The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression). The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women's education, age and birth order were identified as key predictors of service utilization. The findings highlight the need for coordinated effort from government and stakeholders to improve women's education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.
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Influences of Risk History and Adoption Preparation on Post-Adoption Services Use in U.S. Adoptions
ERIC Educational Resources Information Center
Wind, Leslie H.; Brooks, Devon; Barth, Richard P.
2007-01-01
In spite of the need for pre- and post-adoption support, studies indicate low levels of services utilization among adoptive families, particularly those involving children with special needs. This study examines the relationship between utilization of adoptions services and adoptive child and family characteristics, pre-adoptive risk history, and…
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Choulagai, Bishnu; Onta, Sharad; Subedi, Narayan; Mehata, Suresh; Bhandari, Gajananda P; Poudyal, Amod; Shrestha, Binjwala; Mathai, Matthews; Petzold, Max; Krettek, Alexandra
2013-12-23
Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women's background characteristics. Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women's knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal's health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.
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Utilization of maternal health-care services by tribal women in Kerala
Jose, Jinu Annie; Sarkar, Sonali; Kumar, S. Ganesh; Kar, Sitanshu Sekhar
2014-01-01
Background: The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. Aim: This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. Settings and Design: This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Materials and Methods: Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Statistical Analysis Used: Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. Results: The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Conclusions: Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services. PMID:24678214
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Yoshiyuki, Noriko; Kono, Ayumi; Soga, Tomoko; Kanaya, Yukiko; Hotta, Kuniko
2016-01-01
This cross-sectional study clarified the association between service utilization patterns and frailty in the elderly certified at the support level in Japan's long-term care insurance (LTCI) system. We analyzed 710 subjects who completed in-home assessments and interviews from 1,033 elderly aged 65 and over living in Izumiotsu who had been certified at the LTCI support level in August 2014. The long-term service utilization data were collected from the local governmental office. Frailty was examined by the in-home structured assessment conducted by local health and welfare professionals. As frailty indicators, we measured subjects' frailty using the Kaigo-Yobo-Checklist (CL frailty), handgrip strength, body mass index, depression, and cognitive function. Long-term service utilization patterns were classified into five patterns: (1) home helper service only, (2) day care service only, (3) home helper and day care service, (4) one or more other services (using at least one other service regardless of home helper or day care), and (5) no service utilization. Odds ratios (ORs) of each frailty indicator were estimated by service utilization patterns by using logistic regression analyses adjusted for demographic characteristics, with the other services group as the reference category. Out of 710 subjects (100%), the proportions of the service utilization patterns were as follows: home helper service only, 17.9%; day care service only, 15.6%; home helper and day care service, 13.1%; one or more other services, 27.0%; and no service utilization, 26.3%. The logistic regression analyses showed that compared with the one or more other services group, the day care service only group had lower odds of CL frailty (OR=0.57, 95% confidence interval (CI)=0.34 to 0.95) and lower odds of low handgrip strength (OR=0.59, 95% CI=0.35 to 1.00). The no service utilization group had lower odds of CL frailty (OR=0.50, 95% CI=0.32 to 0.79) and lower odds of low handgrip strength (OR=0.58, 95% CI=0.37 to 0.91). The home helper service only group had higher odds of low handgrip strength (OR=1.91, 95% CI=1.11 to 3.29). Long-term service utilization patterns of the elderly certified at the support level in the LTCI system were associated with frailty. Classifying frailty characteristics by long-term service utilization patterns may be considered as a method to provide community-based resources and support for older adults in the community.
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Choi, Kristen R; Briggs, Ernestine C; Seng, Julia S; Graham-Bermann, Sandra A; Munro-Kramer, Michelle L; Ford, Julian D
2017-11-27
The purpose of this study is to describe typologies of service utilization among trauma-exposed, treatment-seeking adolescents and to examine associations between trauma history, trauma-related symptoms, demographics, and service utilization. Latent class analysis was used to derive a service utilization typologies based on 10 service variables using a sample of 3,081 trauma-exposed adolescents ages 12 to 16 from the National Child Traumatic Stress Network Core Dataset. Services used 30 days prior to the initial assessment from 5 sectors were examined (health care, mental health, school, social services, and juvenile justice). A 5-class model was selected based on statistical fit indices and substantive evaluation of classes: (a) High intensity/multisystem, 9.5%; (b) Justice-involved, 7.2%; (c) Low intensity/multisystem, 19.9%; (d) Social service and mental health, 19.9%; and (e) Low service usage/reference, 43.5%. The classes could be differentiated based on cumulative trauma, maltreatment history, PTSD, externalizing and internalizing symptoms, and age, gender, race/ethnicity and place of residence. This study provides new evidence about patterns of service utilization by trauma exposed, treatment seeking adolescents. Most of these adolescents appear to be involved with at least 2 service systems prior to seeking trauma treatment. Higher cumulative exposure to multiple types of trauma was associated with greater service utilization intensity and complexity, but trauma symptomatology was not. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Kawaguchi, Leo; Fouad, Nawal Abdel Moneim; Chiang, Chifa; Elshair, Inass Helmy Hassan; Abdou, Nagah Mahmoud; El Banna, Saneya Rizk; Aoyama, Atsuko
2014-02-01
This study investigated the association between women's empowerment and the utilization of maternal health services by women in Egypt and analyzed the dimensions of women's empowerment that are associated with increased health service utilization. A cross-sectional survey was conducted in a village in Egypt in November 2007. A total of 189 women, who had ever been married and had at least one child, were interviewed to collect data on the utilization of maternal health services, such as the number of antenatal care (ANC) visits during their pregnancies and whether delivery of their child was attended by skilled health personnel. Proxy variables on five different dimensions of women's empowerment were obtained by principal component analysis, and were tested for an association with the utilization of maternal health services, using logistic regression models. The five dimensions extracted from the data were freedom of movement, economic security and stability, support by family and freedom from domination, decision-making in daily life, and relationship with the community/participation in society. Among these dimensions, support by family and freedom from domination was the only factor that was positively associated with maternal health service utilization (regular ANC: OR = 1.38, P = 0.05; deliveries assisted by skilled health personnel: OR = 1.71, P = 0.01). Current age was also associated with the latter, possibly influenced by the recent rapid increase in the provision of health services in the village studied. Furthermore, this study revealed that a relatively high proportion of younger women still only limited access to maternal health services in Egypt.
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Wu, F.; Fu, L.M.; Hser, Y.H.
2015-01-01
Background This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Methods Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Results Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Conclusions Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. PMID:24990956
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Bridges, Ana J.; Andrews, Arthur R.; Deen, Tisha L.
2014-01-01
Purpose This study assessed mental health needs and service utilization patterns in a convenience sample of Hispanic immigrants. Design and Method A total of 84 adult Hispanic participants completed a structured diagnostic interview and a semistructured service utilization interview with trained bilingual research assistants. Results In the sample, 36% met diagnostic criteria for at least one mental disorder. Although 42% of the sample saw a physician in the prior year, mental health services were being rendered primarily by religious leaders. The most common barriers to service utilization were cost (59%), lack of health insurance (35%), and language (31%). Although more women than men met criteria for a disorder, service utilization rates were comparable. Participants with a mental disorder were significantly more likely to have sought medical, but not psychiatric, services in the prior year and faced significantly more cost barriers than participants without a mental disorder. Conclusions Findings suggest that Hispanic immigrants, particularly those with a mental illness, need to access services but face numerous systemic barriers. The authors recommend specific ways to make services more affordable and linguistically accessible. PMID:22802297
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ERIC Educational Resources Information Center
Hsu, Shang-Wei; Lin, Ya-Wen; Chwo, Miao-Ju; Huang, Hui-Chi; Yen, Chia-Feng; Lin, Lan-Ping; Wu, Jia-Ling; Lin, Jin-Ding
2009-01-01
Although many studies have explored emergency services for children, there are few published reports of the utilization of emergency services by children with disabilities. The present study attempts to provide data regarding the utilization of, and factors affecting, emergency department visits by disabled children in Taipei. A general census of…
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2013-01-01
Background Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil. Methods N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011. Results The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important. Conclusions The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also. PMID:24373346
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McKernan, Susan C.; Kuthy, Raymond A.; Momany, Elizabeth T.; McQuistan, Michelle R.; Hanley, Paul F.; Jones, Michael P.; Damiano, Peter C.
2014-01-01
Objectives To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. Methods We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. Results The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. Conclusions Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees. PMID:23289856
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Koka, Krishna Mohan; Pachava, Srinivas; Sanikommu, Suresh; Ravoori, Srinivas; Chandu, Viswa Chaitanya
2016-01-01
Introduction The biological process of ageing is outside human control and has its own dynamics. It is a known fact that elderly people have more treatment needs compared to the younger population and at the same time elderly people are facing a multitude of barriers in utilization of health care as well as oral health care. Aim To identify the utilization patterns of oral health care and barriers for utilization among rural population. Materials and Methods A cross-sectional study was done on 621 rural elderly subjects to identify the utilization of oral health care services and the barriers for utilization. Using stratified cluster sampling study area was stratified into 13 rural clusters, fifty houses were randomly selected from each stratum. All the elderly subjects, as defined by the age criteria were considered for study. The data were analysed using SPSS 20 v and Chi-square tests were used to analyse the data. Results Only 31.9% of participants reported visiting a dentist in the past while 36.7% reported experiencing a dental problem at some point in their life. There were no significant differences in utilization of dental services based on gender, socio-economic status, age groups and religion. However, significant differences were found in utilization of dental services based on the response of participants to past experience of dental problems. Conclusion The present study results conclude that fear was one of the most commonly reported barriers for utilisation of dental services and there is a need for oral health education and promotion among elderly population. PMID:27135000
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Negash, Wassie; Dessalegn, Muluken; Yitayew, Berhanu; Demsie, Mohammed; Wagnew, Maereg; Nyagero, Josephat
2016-01-01
Introduction Many youth are less informed, less experienced and less comfortable in utilizing reproductive health services. In the Sub-Saharan region the adolescents account for a higher proportion of new HIV infections and unmet need for reproductive health (RH) services. This study assessed reproductive health service utilization and associated factors among the youth in Amhara Region, Ethiopia. Methods A community based cross-sectional study was conducted from June 15-July 30, 2014. Three hundred ninety one youth were selected by systematic random sampling technique and interviewed using structured questionnaire. Data were anlyzed using SPSS windows version 20. Multiple logistic regression was done to control potential confounding variables. P-values <0.05 were considered statistically significant. Results Three hundred and nighty one in-school and out-of-school youth were interviewed; 256 (65.5%) participants were in school and 209 (53.5%) were males. Almost all respondents (93.9%) had heard about reproductive health services and a third 129 (33%) had ever practiced sexual intercourse and 54.7% of them had utilized at least one reproductive health services. Never had sexual intercourse (AOR=3.693, 95%CI: 1.266, 10.775), families that asked their children about friends (parental monitoring) (AOR=1.892, 95%CI: 1.026, 3.491), know where service provided (AOR=3.273, 95%CI: 1.158, 9.247), youths who reads newspaper readers (AOR=3.787, 95%CI: 1.849were independent predictors of youth reproductive service utilization at 95 % CI and p-value <0.05%. Conclusion Even though the youth have information about reproductive health services, youth reproductive health services utilization is very low. Therefore, building life skill, facilitating parent to child communication, establishing and strengthening of youth centres and increasing awareness for youth about those services are important steps to improve adolescents' reproductive health (RH) service utilization. PMID:28439328
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Negash, Wassie; Dessalegn, Muluken; Yitayew, Berhanu; Demsie, Mohammed; Wagnew, Maereg; Nyagero, Josephat
2016-01-01
Many youth are less informed, less experienced and less comfortable in utilizing reproductive health services. In the Sub-Saharan region the adolescents account for a higher proportion of new HIV infections and unmet need for reproductive health (RH) services. This study assessed reproductive health service utilization and associated factors among the youth in Amhara Region, Ethiopia. A community based cross-sectional study was conducted from June 15-July 30, 2014. Three hundred ninety one youth were selected by systematic random sampling technique and interviewed using structured questionnaire. Data were anlyzed using SPSS windows version 20. Multiple logistic regression was done to control potential confounding variables. P-values <0.05 were considered statistically significant. Three hundred and nighty one in-school and out-of-school youth were interviewed; 256 (65.5%) participants were in school and 209 (53.5%) were males. Almost all respondents (93.9%) had heard about reproductive health services and a third 129 (33%) had ever practiced sexual intercourse and 54.7% of them had utilized at least one reproductive health services. Never had sexual intercourse (AOR=3.693, 95%CI: 1.266, 10.775), families that asked their children about friends (parental monitoring) (AOR=1.892, 95%CI: 1.026, 3.491), know where service provided (AOR=3.273, 95%CI: 1.158, 9.247), youths who reads newspaper readers (AOR=3.787, 95%CI: 1.849were independent predictors of youth reproductive service utilization at 95 % CI and p-value <0.05%. Even though the youth have information about reproductive health services, youth reproductive health services utilization is very low. Therefore, building life skill, facilitating parent to child communication, establishing and strengthening of youth centres and increasing awareness for youth about those services are important steps to improve adolescents' reproductive health (RH) service utilization.
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Utilization of preventive services by pregnant women in Jerusalem--a cross sectional study.
Ellencweig, A Y; Ritter, M; Peleg-Olavsky, E; Tamir, D
1990-09-01
A study was made of health service utilization patterns during pregnancy of 279 young mothers, a representative sample of the Jewish population in Jerusalem. Only 47% reported that they used the municipal family health centers (FHCs) for prenatal care. Some 82% reported that they had resorted to more than one source of care during pregnancy. Sources other than the FHC were: regular Sick Fund doctor service (33%); private practitioners (25%); hospital-based services (25%). Among the FHC users, there was an unexpectedly high percentage of women of Asian-African origin and of those living in remote neighborhoods. Under-utilization was frequent among wealthy women, those with higher education and members of the Orthodox religious sector. While there was general satisfaction with the service, lower gratification was associated with higher utilization. This phenomenon may intimate that there may be a process of negative selection among women who use the service, when other alternatives are not readily available.
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Young, Amanda; Muhlner, Stasia; Kurowski, Alicia; Cifuentes, Manuel
2015-06-05
Rural residents with work-related fractures utilize healthcare differently and return to work (RTW) sooner than their similarly-injured urban peers. To elucidate the relationship between physical medicine and rehabilitation (PM&R) service usage and work-disability duration following work-related injury. Retrospective cohort study, employing a two-phase sequential analysis. The project involved a longitudinal analysis of PM&R utilization and work-disability duration of 2,216 people across the U.S. who fractured a bone, received PM&R services, and had at least seven days off work. In the first phase of the analysis each individual was assigned a PM&R utilization score based on how similar his or her usage was to that typical of rural residents. The second phase tested the relationship between assigned PM&R utilization scores and work-disability duration. Differences in urban versus rural PM&R utilization included less total PM&R services and fewer passive services in the first 8 weeks for rural claimants. Among those off work for more than a month, rural residents used more active services just prior to RTW, with a gradual decreasing of services leading up to RTW. Controlling for covariates, aggregate PM&R utilization scores were found to relate to time to first RTW (Hazard Ratio=1.66, p<0.005). Findings suggest that using services in a way that is more consistent with rural patterns is associated with decreased work-disability durations. Consistent with previous studies, results suggest that passive services, prolonged episodes of care, and failure to focus on transitioning to self-management are related to longer work-disability durations.
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Homaie Rad, Enayatollah; Kavosi, Zahra; Moghadamnia, Mohammad Taghi; Arefnezhad, Masoud; Arefnezhad, Masoumeh; Felezi Nasiri, Banfashe
2017-01-01
Background: Studies have shown that people using complementary health insurances have more access to health services than others. In the present study, we aimed at finding the differences between out- of- pocket payments and health service utilizations in complementary health insurances (CHIs) users and nonusers. Methods: Propensity score matching was used to compare the 2 groups. First, confounder variables were identified, and then propensity score matching was used to compare out- of- pocket expenditures with dental, general physician, hospital inpatient, emergency services, nursing, midwifery, laboratory services, specialists and rehabilitation services utilization. Results: Our results revealed no significant differences between the 2 groups in out- of- pocket health expenditures. Also, the specialist visits, inpatient services at the hospital, and dental services were higher in people who used CHIs compared to nonusers. Conclusion: People did not change their budget share for health care services after using CHIs. The payments were equal for people who were not CHIs users due to the increase in the quantity of the services.
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Lu, Chu-Hong; Wang, Pei-Xi; Lei, Yi-Xiong; Luo, Zhong-Cheng
2014-08-15
Rural-to-urban migrant workers have been increasing rapidly in China over recent decades. Health related quality of life (HRQOL) may affect health service utilization. There is a lack of data on HRQOL in relation to health service utilization in Chinese rural-to-urban migrant workers. This study was aimed to explore the influence of HRQOL on health service utilization in Chinese rural-to-urban female migrant workers. This was a cross-sectional survey of 1,438 female rural-to-urban migrant workers in Shenzhen-Dongguan economic zone, China in 2013. HRQOL was assessed by the 36-items Health Survey Short Form (SF-36). Health service utilization was measured by any physician visit over the recent two weeks and any hospitalization over the last 1-year (annual hospitalization). Clustered logistic regression was used to analyze the influence of HRQOL on health service utilization. Lower scores in three HRQOL domains (bodily pain, general health, role physical) were associated with more frequent health service utilization in female rural-to-urban migrant workers. Bodily pain and general health were associated with an independent influence of 15.6% on the risk of recent two-week physician visit, while role physical and general health were associated with an independent influence of 21.2% on the risk of annual hospitalization. The independent influence of HRQOL on health service utilization was smaller than that of socio-demographic and health-related variables. HRQOL may have a modest influence on health service utilization in Chinese rural-to-urban female migrant workers - an underprivileged population in urban China.
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NASA Astrophysics Data System (ADS)
Zhang, Cuihua; Xing, Peng
2015-08-01
In recent years, Chinese service industry is developing rapidly. Compared with developed countries, service quality should be the bottleneck for Chinese service industry. On the background of three major telecommunications service providers in China, the functions of customer perceived utilities are established. With the goal of consumer's perceived utility maximization, the classic Nash equilibrium solution and quantum equilibrium solution are obtained. Then a numerical example is studied and the changing trend of service quality and customer perceived utility is further analyzed by the influence of the entanglement operator. Finally, it is proved that quantum game solution is better than Nash equilibrium solution.
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ERIC Educational Resources Information Center
Deen, Tisha L.; Bridges, Ana J.; McGahan, Tara C.; Andrews, Arthur R., III
2012-01-01
Purpose: Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of…
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Evans, Elizabeth; Hser, Yih-Ing; Huang, David
2010-10-01
California drug treatment programs may use funds to address barriers to work faced by Proposition 36 offenders, most of whom are not working at treatment entry, but employment services utilization and related behavioral outcomes have never been studied. This study examined primary data collected on 1,453 offenders by 30 programs during 2004 to explore the characteristics, employment services utilization, and outcomes of those who did and did not receive employment services while in drug treatment. One-year outcomes were mostly similar across groups, however, increases in the proportion of offenders employed, receiving income from employment and family or friends, and being paid for work were significantly greater among the received-employment-services group, and a greater proportion of this group also completed drug treatment. Employment services utilization was less likely for persons recruited from outpatient settings and more likely with greater severity of family/social problems and desire for services. Odds of employment one-year post-treatment entry were higher for those of Hispanic race/ethnicity (vs. White) and for those with treatment completion/longer retention but lower for those who were older, lived in specific counties, had greater employment problem severity at intake, and received other income-related services. Strategies for improving employment services utilization and outcomes among Proposition 36 offenders are discussed.
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Ogwumike, Omoyemi O; Kaka, Bashir; Adeniyi, Ade F
2013-02-01
Physiotherapy is usually indicated for health promotion and the rehabilitation of individuals with paralytic poliomyelitis. The endemic nature of this condition in children in Zamfara State, Nigeria necessitated investigation into the utilization of physiotherapy services by parents or primary caregivers of children affected with polio in this sub-region. Parents and primary caregivers of children with paralytic poliomyelitis were recruited using a purposive multi-stage sampling procedure in a cross-sectional survey. Factors associated with the utilization of physiotherapy services were assessed based on questions extracted from a 4-part, 52-item structured questionnaire originally designed for a study which investigated knowledge, attitude, and beliefs of parents of children with paralytic poliomyelitis. A total of 217 participants were included in this study. The mean age was 32.29 ± 9.89 years and the mean knowledge of polio score was 62.0 ± 17.3%. The mean age of the children with paralytic poliomyelitis was 6.41 ± 2.50 years. Only 27.2% of the parents or primary caregivers had utilized physiotherapy service for their children at some point. No association existed between utilization of physiotherapy service and 'knowledge of paralytic poliomyelitis', 'employment status', and 'family income' of respondents. Explanations for low utilization of physiotherapy services for children with paralytic poliomyelitis by parents or primary caregivers are discussed.
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Kupprat, Sandra A; Dayton, Alex; Guschlbauer, Andrea; Halkitis, Perry N
2009-07-01
A retrospective, longitudinal analysis of case management and medical charts was used to evaluate utilization of support group, mental health, and substance abuse treatment services among HIV-positive women in New York City. Analyses of 4134 case management and supportive service transactions revealed that 70% utilized support groups over the two-year study period. In contrast, only 35% utilized mental health services (therapy) and of those identified as using substances, only 48% utilized substance abuse treatment services. Considering the high prevalence of mental illness (63%, n=29) and substance use (54%, n=25) in the sample, the low utilization rates highlight unmet needs for service. Significant differences were found in utilization of mental health and substance abuse treatment services, with those who received services at a medical model agency (integrated care) being more likely to receive both types of treatment. In contrast, participants attending support groups in non-medical model agencies (77.8%, n=7) were significantly more likely to be retained in group (i.e., attend 11 or more sessions) than those at medical model agencies (39.1%, n=9). Based on the higher utilization rates of support groups among seropositive women, perhaps these groups could be a vehicle for establishing rapport between mental health professionals and group members to bridge the utilization gap and reduce the stigma associated with therapy and substance abuse treatment services. These findings both taut the success and highlight weaknesses regarding accessing mental health and substance abuse care, and support group retention. Sharing of information regarding recruitment and retention efforts between agencies of different modalities would be beneficial and also could identify service niches that capitalize on their subsequent strengths.
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2014-01-01
Background High maternal mortality is a continued challenge for the achievement of the fifth millennium development goal in Sub-Saharan African countries including Ethiopia. Although institutional delivery service utilization ensures safe birth and a key to reduce maternal mortality, interventions at the community and/or institutions were unsatisfactorily reduced maternal mortality. Institutional delivery service utilization is affected by the interaction of personal, socio-cultural, behavioral and institutional factors. Therefore this study was designed to assess factors associated with institutional delivery service use among mothers in Bahir Dar city administration. Methods A community based cross sectional study was conducted in Bahir Dar City administration Northwest of Addis Ababa, Ethiopia. Four hundred eighty four mothers were included in the study. Data were collected by trained female data collectors. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios (OR) with 95% confidence intervals. Result In this study, 78.8% of women gave birth to their current child at health institution. The multivariable logistic regression showed that, attending primary education (AOR = 4.7[95% CI:1.3-16.7], secondary education (AOR = 3.5[95% CI:1.1-10.7]), age at first marriage; first time marriage at 15–19 years (AOR = 5.4[95% CI:2.0-15.0]) and first time marriage at 20–24 years (AOR = 5.0[95% CI:1.5-16.8] and gestational age at first ANC visit (first trimester) (AOR = 5.3[1.3-22.2]) and second trimester (AOR = 2.8[95% CI:0.7-11.]) were independent factors affecting institutional delivery service utilization. Conclusion In this study, institutional delivery service utilization is optimal, urban mothers were more likely to practice institutional delivery. This study indicated that age at first marriage, educational status of the women and gestational age at first ANC visit are independent predictors of delivery service utilization. Hence, intensifying education for women and behavior change communication (BCC) interventions to increase early initiation and up-take of ANC service use in the first trimester and delaying marriage are recommended to promote institutional delivery service utilization. PMID:24629278
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HIV COST AND SERVICES UTILIZATION STUDY (HCSUS)
The HIV Cost and Services Utilization Study (HCSUS) is the first major research effort to collect information on a nationally representative sample of people in care for HIV infection. HCSUS is funded through a cooperative agreement between the Agency for Health Care Policy Resea...
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Dental Workforce Availability and Dental Services Utilization in Appalachia: A Geospatial Analysis
Feng, Xue; Sambamoorthi, Usha; Wiener, R. Constance
2016-01-01
Objectives There is considerable variation in dental services utilization across Appalachian counties, and a plausible explanation is that individuals in some geographical areas do not utilize dental care due to dental workforce shortage. We conducted an ecological study on dental workforce availability and dental services utilization in Appalachia. Methods We derived county-level (n = 364) data on demographic, socio-economic characteristics and dental services utilization in Appalachia from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) using person-level data. We obtained county-level dental workforce availability and physician-to-population ratio estimates from Area Health Resource File, and linked them to the county-level BRFSS data. The dependent variable was the proportion using dental services within the last year in each county (ranging from 16.6% to 91.0%). We described the association between dental workforce availability and dental services utilization using ordinary least squares regression and spatial regression techniques. Spatial analyses consisted of bivariate Local Indicators of Spatial Association (LISA) and geographically weighted regression (GWR). Results Bivariate LISA showed that counties in the central and southern Appalachian regions had significant (p < .05) low-low spatial clusters (low dental workforce availability, low percent dental services utilization). GWR revealed considerable local variations in the association between dental utilization and dental workforce availability. In the multivariate GWR models, 8.5% (t-statistics >1.96) and 13.45% (t-statistics >1.96) of counties showed positive and statistically significant relationships between the dental services utilization and workforce availability of dentists and dental hygienists, respectively. Conclusions Dental workforce availability was associated with dental services utilization in the Appalachian region; however, this association was not statistically significant in all counties. The findings suggest that program and policy efforts to improve dental services utilization need to focus on factors other than increasing the dental workforce availability for many counties in Appalachia. PMID:27957773
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Miao, Yudong; Ye, Ting; Qian, Dongfu; Li, Jinlong; Zhang, Liang
2014-06-01
Primary care physicians' visit services for diabetes management are now widely delivered in China's rural public health care. Current studies mainly focus on supply but risk factors from patients' view have not been previously explored. This study aims to present the utilization of rural primary care physicians' visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients' view. This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, χ2 contingency table analyses and Logistic regression were used. 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration (OR=1.654), use of diabetic drugs (OR=1.869), consulting diabetes care knowledge (OR=1.602), recognition of diabetic complications (OR=1.662), needs of visit services (OR=2.338). The utilization of rural primary care physicians' visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries.
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Assimilation and health service utilization of Korean immigrant women.
Son, Juyeon
2013-11-01
In this case study, I present descriptive findings with regard to immigrant incorporation and health service utilization. Using focus groups and survey of Korean immigrant women in Wisconsin, I examine whether the ways in which they adapt to the U.S. society is relevant to their health services utilization and the alternatives they seek when available health services are less than satisfactory. The findings suggest that adherence to Korean identity appears to be associated with health service utilization. This is evident in the immigrants' evaluation of the U.S. health services as compared to those of Korea, and the consideration given by these immigrants to seeking health services in Korea instead of the United States. Such concerns on the part of these immigrants have important implications for health researchers, as they highlight the significance of immigrants' transnational experiences and their sense of personal agency in the use of health care.
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Mendenhall, Amy N; Fristad, Mary A; Early, Theresa J
2009-06-01
This study investigated the impact of psychoeducation on service utilization and mood symptom severity in children with mood disorders. Parents' knowledge of mood disorders, beliefs about treatment, and perceptions of children's need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and between psychoeducation and mood symptom severity. Linear mixed effects modeling and joint significance test for mediation were used in secondary data analyses of the multifamily psychoeducation group (MFPG) study, a randomized controlled trial of 165 children ages 8 to 12 years with mood disorders. A majority of those sampled were male (73%) and White, non-Hispanic (90%), and the median range of family income was $40,000-$59,000. Participation in MFPG significantly improved quality of services utilized, mediated by parents' beliefs about treatment. Participation in MFPG also significantly improved severity of child's mood symptoms, mediated by quality of services utilized. MFPG appears to be a psychoeducational intervention that helps parents to become better consumers of the mental health system who access higher quality services. Children's symptom severity decreases as a result. Copyright 2009 APA
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Johnson, L.E.
1991-01-01
This research sought to address the relationship between self-concept and customer satisfaction: can customer satisfaction with a major electric utility be explained in terms of the self-reported, self-concept of the utility's managers The population to which the results of this study were generalized consisted of customer service managers in public electric utilities across the United States. In order to represent this population, a sample was selected consisting of customer service managers at a midwestern electric utility based in a large metropolitan area. Participants in this study were managers of four direct customer contact service organizations within six geographic division organizations.more » The methodology included comparisons of these four customer contact service organizations on twelve independent, self-concept variables and six customer satisfaction dependent variables using Analysis of Variance (ANOVA), Scheffe' tests, Chi-Square, and Stepwise multiple regression. The groups were found not to be significantly different and knowledge of the self-concept scores for managers will not increase the ability to predict customer satisfaction over no knowledge of self-concept scores.« less
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Health care service utilization and associated factors among heroin users in northern Taiwan.
Chen, Yi-Chih; Chen, Chih-Ken; Lin, Shih-Ku; Chiang, Shu-Chuan; Su, Lien-Wen; Wang, Liang-Jen
2013-11-01
Due to the needs of medical care, the probability of using health care service from heroin users is high. This cross-sectional study investigated the frequency and correlates of health service utilization among heroin users. From June to September 2006, 124 heroin users (110 males and 14 females, mean age: 34.2 ± 8.3 years) who entered two psychiatric hospitals (N = 83) and a detention center (N = 41) in northern Taiwan received a face-to-face interview. Therefore, socio-demographic characteristics, patterns of drug use, psychiatric comorbidities, blood-borne infectious diseases and health service utilization were recorded. The behaviors of health service utilization were classified into the frequency of out-patient department visit and hospitalization, as well as the purchase of over-the-counter drugs. During 12 months prior to interview, 79.8% of the participants attended health care service at least once. The rate of having any event in out-patients service visit, hospitalization, and over-the-counter drugs were 66.1%, 29.8% and 25.8% respectively. The frequency of health service utilization was associated with numerous factors. Among these factors, patients who were recruited from hospital and having a mood disorder were conjoint predictors of out-patient department visit, hospitalization and purchase of over-the-counter drugs. According to the results of this study, social education and routine screening for mood disorders can help heroin users to obtain adequate health care service. The findings of this study are useful references for targeting the heroin users for whom a successful intervention represents the greatest cost benefit. © 2013 Elsevier Ltd. All rights reserved.
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2012-01-01
Background Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Methods Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. Results The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Conclusions Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service. PMID:22849421
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Teferra, Alemayehu Shimeka; Alemu, Fekadu Mazengia; Woldeyohannes, Solomon Meseret
2012-07-31
Reduction of maternal mortality is a global priority particularly in developing countries including Ethiopia where maternal mortality ratio is one of the highest in the world. The key to reducing maternal mortality ratio and improving maternal health is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Amhara Regional State, Ethiopia. Therefore, this study aimed to assess factors affecting institutional delivery service utilization among mothers who gave birth in the last 12 months in Sekela District, Amhara Region, Ethiopia. Community-based cross-sectional study was conducted among mothers with birth in the last 12 months during August, 2010. Multistage sampling technique was used to select 371 participants. A pre tested and structured questionnaire was used to collect data. Bivariate and multivariate data analysis was performed using SPSS version 16.0 software. The study indicated that 12.1% of the mothers delivered in health facilities. Of 87.9% mothers who gave birth at home, 80.0% of them were assisted by family members and relatives. The common reasons for home delivery were closer attention from family members and relatives (60.9%), home delivery is usual practice (57.7%), unexpected labour (33.4%), not being sick or no problem at the time of delivery (21.6%) and family influence (14.4%). Being urban resident (AOR [95% CI] = 4.6 [1.91, 10.9]), ANC visit during last pregnancy (AOR [95% CI] = 4.26 [1.1, 16.4]), maternal education level (AOR [95%CI] =11.98 [3.36, 41.4]) and knowledge of mothers on pregnancy and delivery services (AOR [95% CI] = 2.97[1.1, 8.6]) had significant associations with institutional delivery service utilization. Very low institutional delivery service utilization was observed in the study area. Majority of the births at home were assisted by family members and relatives. ANC visit and lack of knowledge on pregnancy and delivery services were found to be associated with delivery service utilization. Strategies with focus on increasing ANC uptake and building knowledge of the mothers and their partners would help to increase utilization of the service. Training and assigning skilled attendants at Health Posta level to provide skilled home delivery would improve utilization of the service.
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Reda, Seif Magdy; Krois, Joachim; Reda, Sophie Franziska; Thomson, William Murray; Schwendicke, Falk
2018-04-16
Regular and/or preventive dental services utilization is an indicator of healthcare access and associated with improved health outcomes. We assessed the proportion of individuals regularly/preventively utilizing dental services, and how this was affected by demographic, health-related and social factors. Three electronic databases (Medline, Embase, Central) were searched (2005-2017). We included observational studies investigating the association between preventive/regular dental service utilization and age, oral and general health, edentulism, family structure and health literacy. The proportion of individuals with regular/preventive utilization overall and in different sub-groups were extracted. Random-effects meta-analyses, with subgroup analyses by region, were performed. Meta-regression was used to assess whether and how associations changed with time and countries' human developmental status (HDI). 103 studies on 7,395,697 participants from 28 countries were included. The global mean (95% CI) proportion of individuals regularly/preventively utilizing dental services was 54% (50-59%). In countries with higher HDI, more individuals regularly/preventively utilized services (p < 0.001). Age did not have a significant impact on utilization in adults (OR = 1.00; 0.89-1.12). Utilization was significantly lower in younger than older children (OR = 0.52; 0.46-0.59), individuals with poorer general health (OR = 0.73; 0.65-0.80) and poorer oral health (OR = 0.64; 0.52-0.75), edentulous individuals (OR = 0.32; 0.23-0.41), and individuals with less supportive family structures (OR = 0.81; 0.73-0.89) or poor health literacy (OR = 0.41; 0.01-0.81). The observed differences within populations did not significantly change with time and were universally present. Regular/preventive utilization varied widely between and within countries. Understanding and tackling the reasons underlying this may help to consistently improve utilization. Higher developmental status of countries is reflected in greater regular/preventive utilization of dental services. However, large demographic, health-related and social differences in utilization remain. These may contribute to dental health inequalities. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy
2017-01-01
Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.
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Patron perception and utilization of an embedded librarian program.
Blake, Lindsay; Ballance, Darra; Davies, Kathy; Gaines, Julie K; Mears, Kim; Shipman, Peter; Connolly-Brown, Maryska; Burchfield, Vicki
2016-07-01
The study measured the perceived value of an academic library's embedded librarian service model. The study took place at the health sciences campuses of a research institution. A web-based survey was distributed that asked respondents a series of questions about their utilization of and satisfaction with embedded librarians and services. Over 58% of respondents reported being aware of their embedded librarians, and 95% of these were satisfied with provided services. The overall satisfaction with services was encouraging, but awareness of the embedded program was low, suggesting an overall need for marketing of services.
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ERIC Educational Resources Information Center
Blum, Steven; Tuthill, Robert W.
1977-01-01
Results are presented of an undergraduate and graduate student survey investigating (1) the state of oral pathology of the students, (2) utilization of dental services during the fifteen-months preceeding the study, (3) perceptions and utilization of local dental services, and (4) attitudes toward emergency and routine dental services at the…
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ERIC Educational Resources Information Center
Hamilton, Hayley A.; Paglia-Boak, Angela; Wekerle, Christine; Danielson, Anna Marie; Mann, Robert E.
2011-01-01
The objective of this study was to examine differences in psychological distress, service utilization, and prescriptions for medications between adolescents with histories of family involvement with child protective services (CPS) and adolescents without such involvement. Data on 3,497 students were obtained from the 2009 cycle of the Ontario…
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ERIC Educational Resources Information Center
Ibrahim, Hatim G.
2017-01-01
The current study aims to identify the utilization of innovations and techniques of educational technology in teaching of educational practicum and its impact on increasing academic achievement among pre-service teachers. The study sample consisted of (60) pre-service teachers (student teachers) randomly selected from public middle and secondary…
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Dorin, Lena; Turner, Suzi C; Beckmann, Lea; große Schlarmann, Jörg; Faatz, Andreas; Metzing, Sabine; Büscher, Andreas
2014-05-22
We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.
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2014-01-01
Background We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. Methods 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Results Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. Conclusion The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families. PMID:24884598
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Bui, Ha Thi Thu; Le, Thi Minh; Van Pham, Tac; Doan, Duong Thi Thuy; Nguyen, Duy Anh; Nguyen, Canh Chuong; Duong, Duc Minh
Gender inequalities influence the utilization of maternal health services in Vietnam, but little research has been published. This study, therefore, aimed to explore the association between gender inequalities and women's utilization of maternal health services in Vietnam. The study was conducted in 8 provinces in the South Central Coast region of Vietnam during August 2013 to May 2014. A total of 907 women who delivered a year prior to the date of interview participated in the study. A multiple logistic regression model was used to examine the association between gender inequalities (including sociodemographic determinants of health) and utilization of 4 or more antenatal care (ANC4+) services, institutional delivery, and ever used contraceptive methods. The utilization rate of maternal health services was varied, from 53.9% for ANC4+ to 87.7% for ever used a contraceptive method and 97% for institutional delivery. Ethnicity was identified as the most influential variable out of all sociodemographic determinants of health. Regarding gender inequalities, couple communication was the only variable having significant association with women's utilization of maternal health services. Women's equal role within context of their daily life and relations with their husbands (discussing maternal care with husband and having equal income to husband) supported their use of maternal health services. Therefore, there should be concerted efforts from all relevant stakeholders including the health system to focus on disadvantaged women in planning and delivery of maternal health services, especially to ethnic minority women. Male involvement strategy should be implemented to promote maternal health care, especially during the prenatal and postpartum period. To provide more culturally sensitive and right-based approaches in delivery of maternal health services to disadvantaged women in Vietnam, interventions are recommended that promote male involvement, that is, to engage men in service delivery to adapt and ensure the most appropriate and effective maternal health care.
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Yu, Baorong; Meng, Qingyue; Collins, Charles; Tolhurst, Rachel; Tang, Shenglan; Yan, Fei; Bogg, Lennart; Liu, Xiaoyun
2010-05-10
Many countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China. Using multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey. NCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location.Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital.High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization. Outpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low income group. While providing financial protection against catastrophic medical expenditure is the principal focus of NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development. NCMS policy should also be more equity oriented to achieve its policy goal.
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42 CFR 456.243 - Content of medical care evaluation studies.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...
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Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen
2017-01-01
Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem.
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Fisseha, Girmatsion; Berhane, Yemane; Worku, Alemayehu; Terefe, Wondwossen
2017-01-01
Background Poor maternal health service utilization is one of the contributing factors to a high level of maternal and newborn mortality in Ethiopia. The factors associated with utilization of services are believed to differ from one context to another. We assessed the factors associated with skilled delivery service utilization in rural northern Ethiopia. Subjects and methods A community-based survey was conducted among mothers who gave birth in the 12 months preceding the study period, from January to February 2015, in the Tigray region of Ethiopia. Multistage sampling technique was used to select mothers from the identified clusters. Households within a 10 km radius of the health facility were taken as a cluster for a community survey. Data were collected using face-to-face interview at the household level. We compared the mothers who reported giving birth to the index child in a health facility and those who reported delivering at home, in order to identify the predictors of skilled delivery utilization. Multivariable logistic regression model was used to determine the predictors of skilled delivery service utilization. The results are presented with odds ratio (OR) and 95% confidence interval (CI). Results A total of 1,796 mothers participated in the study, with a 100% response rate. Distance to health facilities (adjusted odds ratio [AOR] =0.53 [95% CI: 0.39, 0.71]), perception of mothers to the availability of adequate equipment in the delivery service in their catchment area (AOR =1.5 [95% CI: 1.11, 2.13]), experiencing any complication during childbirth, using antenatal care, lower birth order and having an educated partner were the significant predictors of skilled delivery service utilization. Conclusion Implementing community-based intervention programs that will address the physical accessibility of delivery services, such as the ambulance service, road issues and waiting rooms, and improving quality maternity service will likely reduce the current problem. PMID:29042819
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Iecovich, Esther; Carmel, Sara
2010-01-01
To examine differences in health and functional status and in utilization of health services between holocaust survivors and their counterparts; and (b) to investigate if holocaust survivor status is a significant predictor of health status, functional status, and utilization of health services. The study included 1255 respondents of whom 272 were holocaust survivors. Interviews were conducted face-to-face at the respondents' homes. Participants were asked about their health (self-rated health and comorbidity) and functional (ADL and IADL) status, utilization of inpatient and outpatient health care services, age, gender, education, marital status, length of residence in Israel, and if they were holocaust survivors. Holocaust survivors, who were frailer and more chronically ill compared to their counterparts, visited their family physician and the nurse at the health care clinic more often than their counterparts did, and received more homecare services. Yet, there were no differences between them in the utilization of other health care services such as visits to specialists, emergency department, and hospitalizations. Holocaust survivors are more homebound due to more morbidity and functional limitations and therefore receive more health home care services that offset the utilization of other health services. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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2013-01-01
Background Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal. Methods This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women’s background characteristics. Results Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs. Conclusions Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women’s knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal’s health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services. PMID:24365039
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Szymkowiak, Dorota; Montgomery, Ann Elizabeth; Johnson, Erin E; Manning, Todd; O'Toole, Thomas P
2017-10-01
Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood. The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services. We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans' diagnoses and acute care utilization. Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity. Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.
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Ellis, B Heidi; Lincoln, Alisa K; Charney, Meredith E; Ford-Paz, Rebecca; Benson, Molly; Strunin, Lee
2010-11-01
This mixed-method study examines the utility of the Gateway Provider Model (GPM) in understanding service utilization and pathways to help for Somali refugee adolescents. Somali adolescents living in the Northeastern United States, and their caregivers, were interviewed. Results revealed low rates of use of mental health services. However other sources of help, such as religious and school personnel, were accessed more frequently. The GPM provides a helpful model for understanding refugee youth access to services, and an elaborated model is presented showing how existing pathways to help could be built upon to improve refugee youth access to services.
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Adhisesha Reddy, Priya; Kishiki, Elizabeth A; Thapa, Hari Bahadur; Demers, Lisa; Geneau, Robert; Bassett, Ken
2018-06-01
Gender and blindness initiatives continue to make eye care personnel aware of the service utilization inequity strongly favouring men, yet interventions to reduce that inequity, particularly for girls, are under developed. This descriptive study gathered quantitative data on the degree of gender equity at five Child Eye Health Tertiary Facilities (CEHTFs) in Asia and Africa and conducted in-depth interviews with eye care personnel to assess their strategies and capacity to reduce gender inequity. Cataract surgery was utilized to assess the degree of inequity and success of interventions to reduce inequity in case finding, service utilization, and follow-up. CEHTF administrative data showed significant gender inequity in cataract surgical services favouring boys in all settings. CEHTFs actively seek children through community and school-based outreach, yet do not have initiatives to reduce gender inequity. Little gender inequity was found among children receiving surgical and follow-up care, although two out of three children were boys. CEHTF staff, despite being aware, offered no effective means to reduce gender inequity involving cataract surgical services. Interventions that successfully increased service utilization by girls came from individual cases, involving extraordinary effort by a single eye care programme person. Community-based case finders such as Anganwadi workers in India, Female Community Health Volunteers (FCHVs) in Nepal, and Key Informants (KIs) in Africa are necessary to identify children in need of cataract services, but insufficient to increase service utilization by girls. Secondary, often extra-ordinary community-based interventions by eye care personnel are needed in all settings.
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Ahmed, A K; Agbana, B E
2015-01-01
Health has been a prime concern of humanity since the dawn of history. People aspire to improve their health and also that of their household and communities. Healthcare utilization by the community is greatly influenced by their awareness and perception. A descriptive study of the Awareness, Perception and Utilization of the Muslim Ummah Hospital, Kisi was carried out using a structured, interviewer administered questionnaire. Three hundred and eighty (380) participated in the study. A systematic sampling technique was utilized in sample selection. The mean age of respondent was 36.9 + 2.95 years. Female respondents constituted 58.92% while the male counterpart were 41.08%. Awareness among the respondents is quite encouraging, as 198 (52%) of women respondents showed knowledge of the presence of the health center. A total of 38.1% (145) believed the service is very good while only 6.5% (25) considered it to be poor. On utilization profile 56.7% (215) had one time or the other attended the Outpatient Department; 43 (11.3%) for General Surgery, 7.4% (28) immunization, 15.4% (59) Delivery service and 9.2% (35) for Antenatal care. Health service utilization of the Muslim Ummah Comprehensive Hospital was shown to be greatly influenced by the community awareness of the service provided and their perception of the quality of service.
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Park, Subin; Lee, Yeeun; Seong, Su Jeong; Chang, Sung Man; Lee, Jun Young; Hahm, Bong Jin; Hong, Jin Pyo
2017-05-05
Personality traits are not only associated with psychiatric symptoms, but also with treatment seeking behavior. Our purpose was to examine the relationship between mental health service utilization and personality characteristics in a nationwide community sample of Korean adults. Of the 6022 subjects aged 18-74 years who participated in the Korean Epidemiologic Catchment Area study, 1544 (25.6%) with a lifetime diagnosis of any DSM-IV psychiatric disorder were analyzed. Diagnostic assessments were based on the Composite International Diagnostic Interview and personality constructs were measured by Big Five Personality Inventory-10. Of the 1544 participants, 275 (17.8%) had used mental health services. Multivariate analyses revealed positive associations between mental health service utilization and both neuroticism and openness, and an inverse association between mental health service utilization and agreeableness. These findings suggest that specific personality traits may have a role in treatment-seeking behaviors for mental health problems independent of the psychiatric disorder.
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Ruy, Hosihn; Young, Wendy B; Kwak, Hoil
2002-01-01
The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.
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Dementia in Ontario: Prevalence and Health Services Utilization
ERIC Educational Resources Information Center
Tranmer, J. E.; Croxford, R.; Coyte, P. C.
2003-01-01
To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using…
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ERIC Educational Resources Information Center
Cronley, Courtney; Madden, Elissa; Davis, Jaya; Preble, Kathleen
2014-01-01
The current study (N = 209) explored service-learning utilization in social work education by examining the influence of personal and institutional characteristics, perceived barriers, and beliefs about service-learning outcomes. Results of an online survey of social work educators showed that neither personal nor institutional characteristics…
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Occupational Therapy in the Context of Head Start: A Preliminary Survey Study
ERIC Educational Resources Information Center
Bowyer, Patricia; Moore, Cary C.; Thom, Carly
2016-01-01
This preliminary, descriptive study yields information on the utilization of occupational therapy services within Head Start programs. Participants completed an Internet-based survey of 25 questions pertaining to the understanding, scope, and utilization of occupational therapy services. Surveys were completed by 35 respondents nationwide. A total…
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Women's autonomy and maternal healthcare service utilization in Ethiopia.
Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih
2017-11-13
Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.
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2014-01-01
Background This study aimed to investigate the utilization of preventive health services in the adults with intellectual disabilities from the nationwide database. Methods The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of preventive health services by intellectual disabled adults. Chi-square test was used to determine the relationship between the utilization of preventive health services and these variables. Multivariate logistic regression analysis was used to explore the factors that affect intellectual disabled adults’ use of preventive health services. Results Our findings indicated 16.65% of people with intellectual disabilities aged over 40 years used the preventive health services. Females were more frequent users than males (18.27% vs. 15.21%, p <0.001). The utilization rate decreased with increasing severity of intellectual disabilities. The utilization was lowest (13.83%) for those with very severe disability, whereas that was the highest (19.38%) for those with mild severity. The factors significantly influencing utilization of the services included gender, age, and marital status, urbanization of resident areas, monthly payroll, low-income household status, catastrophic illnesses status and relevant chronic diseases and severity of disability. Conclusions Although Taiwan’s Health Promotion Administration (HPA) has provided free preventive health services for more than 15 years, people with intellectual disabilities using preventive health care tend to be low. Demographics, economic conditions, health status, relevant chronic diseases, environmental factor, and severity of disability are the main factors influencing the use of preventive healthcare. According to the present findings, it is recommended that the government should increase the reimbursement of the medical staff performing health examinations for the persons with intellectual disabilities. It is also suggested to conduct media publicity and education to the public and the nursing facilities for the utilization of adult preventive health services. PMID:24923548
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Yen, Suh-May; Kung, Pei-Tseng; Chiu, Li-Ting; Tsai, Wen-Chen
2014-06-12
This study aimed to investigate the utilization of preventive health services in the adults with intellectual disabilities from the nationwide database. The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of preventive health services by intellectual disabled adults. Chi-square test was used to determine the relationship between the utilization of preventive health services and these variables. Multivariate logistic regression analysis was used to explore the factors that affect intellectual disabled adults' use of preventive health services. Our findings indicated 16.65% of people with intellectual disabilities aged over 40 years used the preventive health services. Females were more frequent users than males (18.27% vs. 15.21%, p <0.001). The utilization rate decreased with increasing severity of intellectual disabilities. The utilization was lowest (13.83%) for those with very severe disability, whereas that was the highest (19.38%) for those with mild severity. The factors significantly influencing utilization of the services included gender, age, and marital status, urbanization of resident areas, monthly payroll, low-income household status, catastrophic illnesses status and relevant chronic diseases and severity of disability. Although Taiwan's Health Promotion Administration (HPA) has provided free preventive health services for more than 15 years, people with intellectual disabilities using preventive health care tend to be low. Demographics, economic conditions, health status, relevant chronic diseases, environmental factor, and severity of disability are the main factors influencing the use of preventive healthcare. According to the present findings, it is recommended that the government should increase the reimbursement of the medical staff performing health examinations for the persons with intellectual disabilities. It is also suggested to conduct media publicity and education to the public and the nursing facilities for the utilization of adult preventive health services.
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Buor, Daniel
2003-01-01
Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made.
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2013-01-01
Background The utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. It plays a vital role in safeguarding youth in Sub-Saharan African countries including Ethiopia, which accounts for a high proportion of the region’s new HIV infections as well as maternal and infant mortality ratios. Due to this, assessing adolescent reproductive health service utilization and associated factors has its own contribution in achieving the national Millennium Development Goals (MDG), especially goals 4 to 6. Methods A community based cross-sectional study was conducted from April 5–19, 2012, in 4 randomly selected administrative areas of Gondar town. A total of 1290 adolescents aged 15–19 were interviewed using a pre-tested and structured questionnaire. Data were entered in to the EPI INFO version 3.5.3 statistical software and analyzed using an adapted SPSS version 20 software package. Logistic regression was done to identify possible factors associated with family planning (FP), and voluntary counseling and testing (VCT) service utilization. Results Out of the total participants, 79.5% and 72.2% utilized FP and VCT services, respectively. In addition, among sexually experienced adolescents, 68.1% and 88.4% utilized contraceptive methods and VCT service during their first sexual encounter, respectively. Educational status, discussion with family/relatives, peer groups, sexual partners and teachers were significantly associated with FP service utilization. Also, adolescents who had a romantic sexual relationship, and those whose last sexual relationship was long-term, were about 6.5 times (Adjusted Odds Ratio [AOR] = 6.5, 95% CI: 1.23, 34.59), and about 3 times (AOR = 3, 95% CI: 1.02, 8.24) more likely to utilize FP services than adolescents who had no romantic relationship or long-term sexual relationship, respectively. In addition, the variables significantly associated with VCT service utilization were: participants who had secondary education and above, schooling attendance, co- residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV/AIDS. Conclusions The majority of the adolescents were utilizing FP and VCT service in Northwest Ethiopia. But among the sexually experienced adolescents, utilization of FP at first sexual intercourse and VCT service were found to be low. Educational status, schooling attendance, discussion of services, type of sexual relationship and perception of risk were important factors affecting the utilization of FP and VCT services. Building life skill, facilitating parent to child communication, establishing and strengthening of youth centers and school reproductive health clubs are important steps to improve adolescents’ reproductive health (RH) service utilization. PMID:23915299
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Scannapieco, Frank A; Amin, Summar; Salme, Marc; Tezal, Mine
2017-03-01
To describe factors associated with the utilization of dental services in a long-term care facility (LTCF) in Western New York. A descriptive cross-sectional study reviewed the dental and medical records of residents of an LTCF discharged between January 1, 2008 and December 30, 2012. Information on demographic and health variables at admission was extracted from electronic health records. Information on oral health variables was extracted from patient charts. A total of 2,516 residents were discharged between 2008 and 2012. From those, 259 (10.3%) utilized dental services at least once during their stay. Those who utilized dental services were significantly older at admission (78.5 vs. 82.0 years, p < 0.001), stayed longer (1.6 vs. 3.9 years, p < 0.001), more likely to be female (63.6 vs. 75.6%, p = 0.008), and less likely to be married (37.7 vs. 14.0%, p = < 0.001) compared to those who did not. Patients with endocrine, nutritional, metabolic, and immunity disorders, mental disorders, and circulatory system diseases were more likely to receive dental services. Dental services appear to be underutilized by residents of LTCF. Significant differences exist in demographic and health variables between residents who utilize these services compared to those who do not. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.
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Wu, F; Fu, L M; Hser, Y H
2015-09-01
This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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2012-01-01
Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290
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Rajmokan, M; Morton, A; Marquess, J; Playford, E G; Jones, M
2013-10-01
Making valid comparisons of antimicrobial utilization between hospitals requires risk adjustment for each hospital's case mix. Data on individual patients may be unavailable or difficult to process. Therefore, risk adjustment for antimicrobial usage frequently needs to be based on a hospital's services. This study evaluated such a strategy for hospital antimicrobial utilization. Data were obtained on five broad subclasses of antibiotics [carbapenems, β-lactam/β-lactamase inhibitor combinations (BLBLIs), fluoroquinolones, glycopeptides and third-generation cephalosporins] from the Queensland pharmacy database (MedTrx) for 21 acute public hospitals (2006-11). Eleven clinical services and a variable for hospitals from the tropical region were employed for risk adjustment. Multivariable regression models were used to identify risk and protective services for these antibiotics. Funnel plots were used to display hospitals' antimicrobial utilization. Total inpatient antibiotic utilization for these antibiotics increased from 130.6 defined daily doses (DDDs)/1000 patient-days in 2006 to 155.8 DDDs/1000 patient-days in 2011 (P < 0.0001). Except for third-generation cephalosporins, the average utilization rate was higher for intensive care, renal/nephrology, cardiac, burns/plastic surgery, neurosurgery, transplant and acute spinal services than for the respective reference group (no service). In addition, oncology, high-activity infectious disease and coronary care services were associated with higher utilization of carbapenems, BLBLIs and glycopeptides. Our model predicted antimicrobial utilization rates by hospital services. The funnel plots displayed hospital utilization data after adjustment for variation among the hospitals. However, the methodology needs to be validated in other populations, ideally using a larger group of hospitals.
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Angore, Banchalem Nega; Tufa, Efrata Girma; Bisetegen, Fithamlak Solomon
2018-04-19
Reducing maternal mortality and improving maternal health care through increased utilization of postnatal care utilization is a global and local priority. However studies that have been carried out in Ethiopia regarding determinants are limited. So This study aims to assess the magnitude of postnatal care utilization and its determinants in Debre Birhan Town, North Ethiopia. A community-based cross-sectional study was conducted from March 1 to April 25, 2015, in Debre Birhan Town. Data were collected through face-to-face interviews using structured pre-tested questionnaires. The data were entered and cleaned in Epi Info version 3.5 and analyzed using SPSS version 20. Bivariate and multiple logistic regression analyses were used. Variable with p value less than or equal to 0.2 at bivariate analysis were entered into multiple logistic regression. Significance was declared at 0.05 in multiple logistic regressions and considered to be an independent factor. From the total respondents, we found that 327 (83.3%) mothers utilized the postnatal care services. Single mothers were less likely to utilize postnatal care services than those mothers who are married and live together [adjusted odds ratio (AOR) = 0.06, 95% CI (0.01, 0.45)]. This study revealed that respondent's knowledge about postnatal care services is an important predictor of postnatal care utilization [AOR = 0.03, 95% CI (0.00, 0.44)] and mothers who delivered in a health care facility were more likely to receive PNC than mothers who did not deliver in a health care facility [AOR = 0.65, 95% CI (0.58, 0.94)]. The postnatal care utilization rate in Debre Birhan town was 83.3%. Marital status, maternal knowledge, and place of delivery were predictors of postnatal care service utilization. So specific attention should be directed towards the improvement of women's education since the perception of the need for PNC services were positively correlated with the mother's education.
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Scheffler, R; Zhang, A; Snowden, L
2001-11-01
Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.
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Trends in mental health services utilization and stigma in US soldiers from 2002 to 2011.
Quartana, Phillip J; Wilk, Joshua E; Thomas, Jeffrey L; Bray, Robert M; Rae Olmsted, Kristine L; Brown, Janice M; Williams, Jason; Kim, Paul Y; Clarke-Walper, Kristina; Hoge, Charles W
2014-09-01
We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12,835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22,627). HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention.
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Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P; Krettek, Alexandra
2014-01-01
Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.
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Tsukahara, Takahiro; Sugahara, Takuma; Furusawa, Takuro; Hombhanje, Francis Wanak
2018-01-01
In Papua New Guinea (PNG), a malaria treatment policy using rapid diagnostic tests (RDTs) plus artemisinin-based combination therapy (ACT) was widely introduced to rural communities in 2012. The objectives of the study were to evaluate the effect of this RDT/ACT introduction to a rural PNG population on health service utilization and to compare factors associated with health service utilization before and after the RDT/ACT introduction. Household surveys with structured questionnaires were conducted before and after the introduction of RDT/ACT in a catchment area of a health center in East Sepik Province, PNG. We interviewed caregivers with children less than 15 years of age and collected data on fever episodes in the preceding 2 weeks. Using propensity score matching, febrile children before the introduction of RDT/ACT were matched to febrile children after the introduction. Then, the adjusted difference in the proportion of health service utilization [i.e., the average treatment effect (ATE) of the introduction of RDT/ACT on health service utilization] was estimated. We also employed a multilevel Poisson regression model to investigate factors influencing the use of health services. Of 4,690 children, 911 (19%) were reported to have a fever episode. The unadjusted proportion of health service utilization was 51.7 and 57.2% before and after the RDT/ACT introduction, respectively. After matching, no significant difference in the health service utilization was observed before and after the introduction of RDT/ACT (ATE: 0.063, 95% confidence interval -0.024 to 0.150). Multilevel regression analysis showed that the consistent factors associated with a higher utilization of health services were severe illness and being female. The utilization of health services was not significantly different before and after the introduction of RDT/ACT. Villagers may have neither sufficient informations on the new protocol nor high acceptance of RDT/ACT. The observed gender bias in health service utilization could be due to female caregivers' preferences toward girls.
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Age Cohort and Health Service Utilization Among Gay Men.
Green, Daniel C; Goldbach, Jeremy T; Raymond, Henry F
2018-05-01
Gay men report unique health disparities and service utilization trends compared to their heterosexual peers including a lack of health-care participation which may lead to chronic health conditions. Limited research has been conducted analyzing group differences among gay men such as the influence of one's age cohort on disparities. The aim of this study was to examine the association age cohort has on health service utilization among gay men. A sample of 383 self-identified gay men was collected by the San Francisco Department of Public Health. Older men were less likely to have visited a medical provider in the past 12 months compared to middle-aged men (OR = 0.10; 95% CI [2.47, 39.8]) and younger men (OR = 0.35; 95% CI [1.28, 10.42]). However, older men were more likely to have a usual source of medical care compared to younger men (OR = 4.0; 95% CI [.05, .84]). Age cohort differences in health-care service utilization appear to exist among gay men. This study highlights additional areas for exploration including the impact HIV and socioeconomic status have on health-seeking behavior and health service utilization.
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Romano, Donald H
2009-11-01
Health care costs are higher in the United States than in any other country in the world, and imaging services have been growing much more rapidly than other services. Studies have shown a tendency for increased utilization of services, including imaging services, when referring physicians have ownership interest in the services. In recent years, the CMS has taken some action with respect to how it pays for imaging, including reducing physician payments when multiple images are taken on contiguous body parts during the same visit, establishing a cap on payments for certain imaging services, and imposing an antimarkup rule on diagnostic tests. In addition, CMS has made some changes to the Stark rules, which included adding nuclear medicine to the list of designated health services, prohibiting certain per-service or per-click leasing arrangements, and prohibiting physicians from owning entities that sell services to providers that then bill for them under arrangements. Because it is unclear whether these policy changes will have much effect on imaging utilization, CMS will continue to seek new ways to rein in utilization. In the near future, CMS and the US Department of Health and Human Services are likely to attempt to curb utilization not only through postpayment review and education but also through its various initiatives on improving the quality of services furnished to Medicare benificiaries.
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Mental health literacy as a mediator in use of mental health services among older korean adults.
Kim, Young Sun; Rhee, T Greg; Lee, Hee Yun; Park, Byung Hyun; Sharratt, Monica L
2017-02-01
Existing literature suggests that mental health literacy is positively associated with mental health services utilization. Despite an aging population that faces significant mental health concerns in Korea, the role of mental health literacy on mental health services utilization is not known among older adults in Korea. This study aimed to (1) identify whether mental health literacy mediates the association between population characteristics and mental health services utilization and (2) identify an optimal path model for mental health services utilization among Korean older adults. Using a cross-sectional survey with a quota sampling strategy, we collected and analyzed responses from 596 community-dwelling individuals ages 65 years and older. We used structural equation modeling (SEM) to estimate the effect of mental health literacy as a mediator. When controlling for other relevant covariates in the optimal path model, mental health literacy mediated the relationships between three socio-demographic factors (education, general literacy, and health status) and mental health services utilization. The model fit index shows that the SEM fits very well (CFI = 0.92, NFI = 0.90, RMSEA = 0.07). Efforts to improve mental health literacy through community-based education programs may need to particularly target Korean older adults with the relevant socio-demographic characteristics to enhance their utilization of appropriate mental health services.
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Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul
Alemi, Qais; Stempel, Carl; Koga, Patrick Marius; Smith, Valerie; Danis, Didem; Baek, Kelly; Montgomery, Susanne
2017-01-01
There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live. PMID:28218688
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Care and Service at Home for Persons With Dementia in Europe.
Bökberg, Christina; Ahlström, Gerd; Leino-Kilpi, Helena; Soto-Martin, Maria E; Cabrera, Esther; Verbeek, Hilde; Saks, Kai; Stephan, Astrid; Sutcliffe, Caroline; Karlsson, Staffan
2015-09-01
To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of "basic care and services" and "healthcare interventions," they were utilized by few in most countries. Furthermore, "specialized dementia care and services" were sparsely available and even more sparsely utilized in the participating countries. The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. © 2015 Sigma Theta Tau International.
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ERIC Educational Resources Information Center
Schonfeld, Lawrence; Larsen, Rebecca G.; Stiles, Paul G.
2006-01-01
Purpose: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment. Design and Methods: We compared Medicaid and Medicare claims…
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Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan
Steinhardt, Laura C; Aman, Iqbal; Pakzad, Iqbalshah; Kumar, Binay; Singh, Lakhwinder P; Peters, David H
2011-01-01
Background User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees. Methods Data on utilization and observed structural and perceived overall quality of health care were compared from before-and-after facility assessments, patient exit interviews and catchment area household surveys from eight facilities where fees were removed and 14 facilities where fee levels remained constant, as part of a larger health financing pilot study from 2005 to 2007. After a national user fee ban was instituted in 2008, health facility administrative data were analysed to assess subsequent changes in utilization and quality. Results The pilot study analysis indicated that observed and perceived quality increased across facilities but did not differ by fee removal status. Difference-in-difference analysis showed that utilization at facilities previously charging both service and drug fees increased by 400% more after fee removal, prompting additional inputs from service providers, compared with facilities that previously only charged service fees or had no change in fees (P = 0.001). Following the national fee ban, visits for curative care increased significantly (P < 0.001), but institutional deliveries did not. Services typically free before the ban—immunization and antenatal care—had immediate increases in utilization but these were not sustained. Conclusion Both pilot and nationwide data indicated that curative care utilization increased following fee removal, without differential changes in quality. Concerns raised by non-governmental organizations, health workers and community leaders over the effects of lost revenue and increased utilization require continued effort to raise revenues, monitor health worker and patient perceptions, and carefully manage health facility performance. PMID:22027924
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Mental Health Service Utilization among African American and Caucasian Mothers and Fathers
ERIC Educational Resources Information Center
Thurston, Idia B.; Phares, Vicky
2008-01-01
Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors…
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Utilization of Mammography Services among Elderly Rural and Urban African American Women
ERIC Educational Resources Information Center
Agho, Augustine O; Mosley, Barbara W; Rivers, Patrick A; Parker, Shandowyn
2007-01-01
Purpose: This study was a two-year educational intervention and research project aimed at increasing the awareness of breast cancer and the utilization of Clinical Breast Examination (CBE) services and Self-Breast Examination (SBE) among elderly rural and urban African American women who are Medicare beneficiaries. Design: The study was…
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ERIC Educational Resources Information Center
Nguyen, Cathina T.; Krakowiak, Paula; Hansen, Robin; Hertz-Picciotto, Irva; Angkustsiri, Kathleen
2016-01-01
This study investigates whether sociodemographic factors are associated with utilization of intervention services for children with autism spectrum disorder (ASD) enrolled in the Childhood Autism Risks from Genetics and the Environment Study. Maternal ethnicity, insurance status, and education for 696 families of children with ASD were available.…
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Kesuma, Zurnila Marli; Chongsuvivatwong, Virasakdi
2015-04-01
Aceh province of Indonesia created its own health coverage scheme called Jaminan Kesehatan Aceh (JKA) to cover Aceh's populations who were not registered under insurance for the poor (Jamkesmas). This study aims to compare the utilization rate of maternal health care (MHC) services and contraceptive prevalence rate (CPR) before JKA, during the transition period, and after JKA had been established. A cross-sectional household survey was conducted from June 2011 to July 2012. Utilization of MHC services and CPR during the 3 periods was assessed using a questionnaire. The Mantel-Haenszel χ(2) test was used to examine the association between period and coverage. Generalized estimating equations (GEEs) were used to examine utilization and type of service, period of service, and type of scheme. Coverage of utilization of skilled birth attendants significantly improved among the JKA holders (odds ratio = 1.84; 95% confidence interval = 1.18-2.89). JKA, thus, has shown its positive impact. © 2014 APJPH.
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2014-01-01
Maternal complications and poor perinatal outcome are highly associated with nonutilisation of antenatal and delivery care services and poor socioeconomic conditions of the patient. It is essential that all pregnant women have access to high quality obstetric care throughout their pregnancies. Present longitudinal study was carried out to compare utilization of maternal and child health care services by urban and rural primigravida females. A total of 240 study participants were enrolled in this study. More illiteracy and less mean age at the time of marriage were observed in rural population. Poor knowledge about prelacteal feed, colostrums, tetanus injection and iron-follic acid tablet consumption was noted in both urban and rural areas. Very few study participants from both areas were counselled for HIV testing before pregnancy. More numbers of abortions (19.2%) were noted in urban study participants compared to rural area. Thus utilization of maternal and child health care (MCH) services was poor in both urban and rural areas. A sustained and focussed IEC campaign to improve the awareness amongst community on MCH will help in improving community participation. This may improve the quality, accessibility, and utilization of maternal health care services provided by the government agencies in both rural and urban areas. PMID:24977099
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Tsegay, Girmay; Edris, Melkie; Meseret, Solomon
2013-03-19
Voluntary Counseling and Testing (VCT) is the key entry point to prevention, care, treatment and support services, where people learn whether they are infected or not and to understand the implications of their HIV status and make informed choices for the future. A cross sectional study design was done among 753 students drawn from selected departments in Debre Markos University, Ethiopia, using multi-stage sampling technique. Self-administered questionnaire was used to estimate the prevalence of VCT service utilization and to assess associated factors. Data were entered and analyzed using SPSS version 16. 711 students were participated in the study, of whom, 521 were males. Majority (93.8%) were within the age range of 15 to 24 years. The mean age was 21.5 (3.2 ±); most of the respondents (91.6%) were single. Majority (81.4%) heard about the confidential VCT service, and their major sources of information were mass media (73.3%) and health workers (71.1%). The study revealed that 58.5% of the study participants had undergone voluntary counseling and testing. It was shown that VCT service utilization was significantly associated with availability of ART drug in VCT site, heard presence of confidentiality, perceived stigma, risk perception and knowledge about HIV. The major factors identified for increased VCT service utilization were knowledge about availability of ART drug in VCT site, information about confidentiality, absence of perceived stigma, higher risk perception and knowledge about HIV. Therefore, actions targeting on these predictors are necessary to effectively enhance the use of the VCT services utilization.
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Assessing the Local Need for Family and Child Care Services: A Small Area Utilization Analysis.
ERIC Educational Resources Information Center
Percy, Andrew; Carr-Hill, Roy; Dixon, Paul; Jamison, James Q.
2000-01-01
Describes study of administrative data from Northern Ireland on the costs of family and child care services, using small area utilization modeling, to derive a new set of needs indicators that could be used within the family and child care capitation funding formula. Argues that small area utilization modeling produces a fairer and more equitable…
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Effect of diabetic case management intervention on health service utilization in Korea.
Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George
2015-12-01
This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups. © 2014 Wiley Publishing Asia Pty Ltd.
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Marks, David J; Mlodnicka, Agnieszka; Bernstein, Melissa; Chacko, Anil; Rose, Scott; Halperin, Jeffrey M
2009-07-01
To examine whether preschool children with Attention deficit/hyperactivity disorder (ADHD) utilize more speech and language therapy (ST), occupational therapy (OT), and physical therapy (PT) services and are more likely to be placed in special education (SPED) classrooms as compared to their peers. Corresponding financial consequences were also examined. The amount of ST, OT, and PT, as well as SPED placements, was examined in 3- and 4-year-old children with and without ADHD (n = 109 and n = 97, respectively) during the baseline portion of an ongoing, 5-year longitudinal study. Costs for individual services and aggregate cost were determined per child and compared across groups. Preschool children with ADHD were more likely to receive individual and multiple services. Higher rates of service utilization translated into increased costs for each individual service with the exception of PT. A comprehensive understanding of service utilization in the early years of development is important in addressing the increased service use in the preschool years and assist in guiding allocation of resources.
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Seiber, Eric E; Hotchkiss, David R; Rous, Jeffrey J; Berruti, Andrés A
2005-07-01
Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.
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Utilization of Dental Services in Public Health Center: Dental Attendance, Awareness and Felt Needs.
Pewa, Preksha; Garla, Bharath K; Dagli, Rushabh; Bhateja, Geetika Arora; Solanki, Jitendra
2015-10-01
In rural India, dental diseases occur due to many factors, which includes inadequate or improper use of fluoride and a lack of knowledge regarding oral health and oral hygiene, which prevent proper screening and dental care of oral diseases. The objective of the study was to evaluate the dental attendance, awareness and utilization of dental services in public health center. A cross-sectional study was conducted among 251 study subjects who were visiting dental outpatient department (OPD) of public health centre (PHC), Guda Bishnoi, and Jodhpur using a pretested proforma from month of July 2014 to October 2014. A pretested questionnaire was used to collect the data regarding socioeconomic status and demographic factors affecting the utilization of dental services. Pearson's Chi-square test and step-wise logistic regression were applied for the analysis. Statistically significant results were found in relation to age, educational status, socioeconomic status and gender with dental attendance, dental awareness and felt needs. p-value <0.05 was kept as statistically significant. The services provided in public health center should be based on the felt need of the population to increase attendance as well as utilization of dental services, thereby increasing the oral health status of the population.
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Guo, Lijun; Bao, Yong; Ma, Jun; Li, Shujun; Cai, Yuyang; Sun, Wei; Liu, Qiaohong
2018-01-01
Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction.
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Ma, Jun; Li, Shujun; Cai, Yuyang; Sun, Wei; Liu, Qiaohong
2018-01-01
Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban and suburban institutions and to provide the required support to underdeveloped areas to improve resident satisfaction. PMID:29791470
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Nelson, Kristin N; Wallace, Aaron S; Sodha, Samir V; Daniels, Danni; Dietz, Vance
2016-11-04
Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Nelson, Kristin N.; Wallace, Aaron S.; Sodha, Samir V.; Daniels, Danni; Dietz, Vance
2016-01-01
Introduction Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. Methods We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Results Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Conclusion Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap. PMID:27692772
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Merritt, Jantraveus M.; Greenlee, Geoffrey; Bollen, Anne Marie; Scott, JoAnna M.; Chi, Donald L.
2016-01-01
Introduction We assess the relationship between race and orthodontic service utilization for Medicaid-enrolled children. Methods This cross-sectional study focused on 570,364 Washington Medicaid-enrolled children ages 6-19 years. The main predictor variable was self-reported race (White versus non-White). The outcome variable was orthodontic service utilization, defined as children who were pre-authorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that non-Whites would be less likely to utilize orthodontic care than Whites. Results A total of 8,223 children were approved by Medicaid for orthodontic treatment and 7,313 received records and initiated treatment. Non-Whites were significantly more likely to utilize orthodontic care than Whites (Odds Ratio [OR]=1.18; 95% confidence interval [CI]=1.02, 1.36; p=.031). Hispanic non-White children were more likely to utilize orthodontic care than non-Hispanic White children (OR=1.42; 95% CI=1.18, 1.70; p<.001). Conclusion In 2012, non-White children in Washington Medicaid were significantly more likely to utilize orthodontic care than White children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service utilization. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service utilization for minority children in Medicaid. PMID:27021456
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Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China
Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang
2015-01-01
Background This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. Methods We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. Results The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the “best practice frontier”. The other 8 (25.8%) provinces were technically inefficient. Conclusions Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces. PMID:26679187
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Study on Equity and Efficiency of Health Resources and Services Based on Key Indicators in China.
Zhang, Xinyu; Zhao, Lin; Cui, Zhuang; Wang, Yaogang
2015-01-01
This study aims to evaluate the dialectical relationship between equity and efficiency of health resource allocation and health service utilization in China. We analyzed the inequity of health resource allocation and health service utilization based on concentration index (CI) and Gini coefficient. Data envelopment analysis (DEA) was used to evaluate the inefficiency of resource allocation and service utilization. Factor Analysis (FA) was used to determine input/output indicators. The CI of Health Institutions, Beds in Health Institutions, Health Professionals and Outpatient Visits were -0.116, -0.012, 0.038, and 0.111, respectively. Gini coefficient for the 31 provinces varied between 0.05 and 0.43; out of these 23 (742%) were observed to be technically efficient constituting the "best practice frontier". The other 8 (25.8%) provinces were technically inefficient. Health professionals and outpatient services are focused on higher income levels, while the Health Institutions and Beds in Health Institutions were concentrated on lower income levels. In China, a few provinces attained a basic balance in both equity and efficiency in terms of current health resource and service utilization, thus serving as a reference standard for other provinces.
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Hipwell, Alison E.; Stepp, Stephanie D.; Keenan, Kate
2015-01-01
Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787
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Effect of Women's autonomy on maternal health service utilization in Nepal: a cross sectional study.
Adhikari, Ramesh
2016-05-13
Women's role has been a priority area not only for sustainable development, but also in reproductive health since ICPD 1994. However, very little empirical evidence is available about women's role on maternal health service utilization in Nepal. This paper explores dimensions of women's autonomy and their relationship to utilization of maternal health services. The analysis uses data from the Nepal Demographic and Health Survey, 2011. The analysis is confined to women who had given birth in the 5 years preceding the survey (n = 4,148). Women's autonomy related variables are taken from the standard DHS questionnaire and measured based on decision in household about obtaining health care, large household purchases and visit to family or relative. The net effect of women's autonomy on utilization of maternal health services after controlling for the effect of other predictors has been measured through multivariate logistic regression analysis. The findings indicate only about a half of the women who had given birth in the past 5 years preceding the survey had 4 or more ANC check up for their last birth. Similarly, 40 % of the women had delivered their last child in the health facilities. Furthermore, slightly higher than two-fifth women (43 %) had postnatal check up for their last child. Only slightly higher than a fourth woman (27 %) had utilized all the services (adequate ANC visit, delivered at health institution and post natal check up) for their last child. This study found that many socio-demographic variables such as age of women, number of children born, level of education, ethnicity, place of residence and wealth index are predicators of utilizing the maternal health services of recent child. Notably, higher level autonomy was associated with higher use of maternal health services [adjusted odds ratio (aOR) =1.40; CI 1.18-1.65]. Utilization of maternal health services for the recent child among women is very low. The study results suggest that policy actions that increase women's autonomy at home could be effective in helping assure good maternal health.
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ERIC Educational Resources Information Center
Bice-Wigington, Tiffany; Huddleston-Casas, Catherine
2012-01-01
Using structural equation modeling, this study examined the mesosystemic processes among rural low-income women, and how these processes subsequently influenced self-reported health. Acknowledging the behavioral processes inherent in utilization of health care and formal social support services, this study moved beyond a behavioral focus by…
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Demilew, Yeshalem Mulugeta; Gebregergs, Gebremedhin Berhe; Negusie, Azezu Asres
2016-03-01
Childbirth in a health institution has been shown to be associated with lower rates of maternal and neonatal mortality. However, about 85% of mothers in Ethiopia deliver at home. To assess factors associated with institutional delivery service utilization among women who gave birth within one year prior to the study in Dangila district. A cross-sectional study was conducted from February 01-28, 2015. A total of 763 mothers were interviewed using structured questionnaire. SPSS version 20 was used for analysis. Crude and adjusted Odds ratios were computed for selected variables. A P-value less than 0.05 was considered statistical significant. Only 18.3% of mothers gave birth at health facilities. Knowledge on danger signs [AOR=2.0, 95% CI: (1.1, 3.4)], plan to give birth at health institution [AOR=5.4, 95% CI: (3.0, 9.6)], having ANC follow up during pregnancy [AOR=12.9, 95% CI: (5.0, 33.3)] and time taken to get to a nearby health institution [AOR=5.1, 95% CI: (2.9, 9.1)] were associated with institutional delivery service utilization. Institutional delivery was very low. Knowledge about danger signs, having ANC visits, and time were factors associated with institutional delivery service utilization. Thus, the findings recommend repeated re-enforcement of institutional delivery service utilization through professionals. And also, the findings recommend promotion of institutional delivery service utilization through mass media.
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Dong, Xiaoxin; Liu, Ling; Cao, Shiyi; Yang, Huajie; Song, Fujian; Yang, Chen; Gong, Yanhong; Wang, Yunxia; Yin, Xiaoxu; Xu, Xing; Xie, Jun; Sun, Yi; Lu, Zuxun
2014-05-26
Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.
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Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert
2016-01-01
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155
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Factors Associated with Mental Health Service Utilization among Korean American Immigrants
Park, So-Youn; Cho, Sunhee; Park, Yeddi; Bernstein, Kunsook S.; Shin, Jinah K.
2014-01-01
This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services. PMID:23417654
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Guerrero, Erick G.; Marsh, Jeanne C.; Cao, Dingcai; Shin, Hee-Choon; Andrews, Christina
2014-01-01
This study examined gender differences within Black, Latino, and White subgroups in the utilization of comprehensive services and their relation to posttreatment substance use. Survey data were collected during the National Treatment Improvement Evaluation Study (NTIES), a prospective, longitudinal, multisite study of substance abuse treatment programs and their clients in the United States. The analytic sample consisted of 1,812 Blacks (734 women and 1,078 men), 486 Latinos (147 women and 339 men), and 844 Whites (147 women and 339 men) from 59 service delivery organizations. Results related to service utilization indicated that compared to men, women in all racial and ethnic groups needed and received more services targeted to their needs and reported more positive relations with service providers. Gender was a significant moderator of the relationship between service receipt and treatment outcomes for all racial and ethnic groups, but especially for the Latino subsample. Findings point to the need to consider race-specific gender differences in the development of culturally competent, comprehensive substance abuse treatment. PMID:24560127
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Ayanore, Martin Amogre; Pavlova, Milena; Groot, Wim
2016-01-16
Identifying relevant measures of women's reproductive health needs is critical to improve women's chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa. Evidence on outcomes and determinants of unmet reproductive health needs among women of childbearing age in diverse multicultural, religious, and ethnic settings in West African countries was systematically reviewed. The review included recent English language publications (from January 2009 - March 2014). Clinical studies particularly on obstetric care services and reproductive services in relation to HIV/AIDS were excluded. We acknowledge the possibility to have excluded non-English publications and yet-to-be-published articles related to the study aim and objectives. Outcomes and determinants were assessed and defined at three main levels; contraceptive use, obstetric care, and antenatal care utilization. Results show increasing unmet need for women's reproductive health needs. Socio-cultural norms and practices resulting in discontinuation of service use, economic constraints, travel distance to access services and low education levels of women were found to be key predictors of service utilization for contraception, antenatal and obstetric care services. Outcome measures were mainly assessed based on service utilization, satisfaction, cost, and quality of services available as core measures across the three levels assessed in this review. Evidence from this review indicates that currently applied measures of women's reproductive health needs might be inadequate in attaining best maternal outcomes since they appear rather broad. More support and research for developing and advancing context-related measures may help to improve women's maternal health.
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Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P.; Krettek, Alexandra
2014-01-01
Background Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps. PMID:25119066
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EXPLAINING THE GAP IN ANTENATAL CARE SERVICE UTILIZATION BETWEEN YOUNGER AND OLDER MOTHERS IN GHANA.
Boamah, Sheila A; Amoyaw, Jonathan; Luginaah, Isaac
2016-05-01
Over two-thirds of pregnant women (69%) have at least one antenatal care (ANC) coverage contact in sub-Saharan Africa. However, to achieve the full life-saving potential that ANC promises for women and babies, a nuanced understanding of age-specific gaps in utilization of ANC services is required. Using the 2008 Ghana Demographic and Health Survey of 1456 individuals, this study examined the disparities in the use of ANC services between younger and older mothers by applying four counterfactual decomposition techniques. The results show that cross-group differences in the explanatory variables largely account for the differentials in ANC service utilization between younger and older mothers. Birth order (parity) accounts for the largest share of the contribution to the overall explained gap in ANC utilization between the younger and older mothers, suggesting that ANC differentials between the two groups are probably due to biosocial factors. To a lesser extent, wealth status of the two groups also contributes to the overall explained gap in ANC service utilization. The policy implications of these findings are that in order to bridge the ANC service utilization gap between the two groups, policymakers must systematically address gaps in cross-group differences in the explanatory variables in order to increase the utilization of ANC to attain the minimum recommendation of four visits as per World Health Organization guidelines.
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Pérez-Perdomo, R; Súarez-Pérez, E; Torres, D; Morell, C
1999-01-01
To describe the prevalence and pattern of utilization of medical services in insured of SSS with a diagnosis of asthma during 1996 and 1997. The medical claims of SSS insured whose main diagnosis was asthma (ICD-9 9 493-493.9) were selected for analysis. The prevalence and medical service utilization (medical visits, emergency and hospital admissions) were estimated. Differences in health service utilization by age group were analyzed by the Poisson model. The asthma prevalence was 14.5%, being larger in patients younger than 18 years of age and in females. 54.3% of the asthmatic patients visited medical offices and the larger proportion of users was observed in the younger group (< 18 years). However, the larger proportion of users of the emergency room was observed in the 18-44 age group, while the hospital admissions was larger in the 45-64 age group. More than half (56%) of the cost per service was attributed to hospital admissions while 31% was for pharmacy services. 65.9% of the insurers with asthma had prescriptions for short relief beta-antagonist. The prevalence of asthma in this study was high and similar to rates of the disease reported in Puerto Ricans residing in the U. S. and in other areas of the island. Similarly, the prevalence differed by age in the utilization of medical services as well as the high cost of hospital admissions. Prevalence studies using other sources as well as a standard definition of the condition may be helpful to confirm these results.
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ERIC Educational Resources Information Center
Dumont, Richard G.
This study assesses the utility of the Armed Services Vocational Aptitude Battery (A.S.V.A.B.) in predicting the academic success of students enrolled in the Automotive Service Specialist curriculum at the State University of New York Agricultural and Technical College (Alfred, New York). This document, part I of a two-part study, describes the…
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Predictors of Healthcare Service Utilization for Mental Health Reasons
Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean
2014-01-01
This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874
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Schuster, Alexander K; Pick, Julia; Saalmann, Frauke; Pfeiffer, Norbert
2018-04-10
Eye diseases causing visual impairment increase with age. Thus, seeking eye care has a higher probability in older people. In this study, the rate of utilization of outpatient eye care services in Germany was analyzed. The analyses focused on older persons and persons in need of either home-based or facility-based long-term care. A descriptive secondary data analysis of health insurance data of the AOK Baden-Württemberg from 2016 was conducted. The study population comprised all insured persons on 1 January 2016. The cohort of older persons (60 years+) was further stratified by the type of care (home-based/facility-based) and the level of care (0-3). The utilization of outpatient eye care services was defined by the reimbursement for an ophthalmologist's provision of service. While 39.3% of the study population 60+ years old sought eye care, the utilization rate was lower among people in need of home-based (33.0%) and facility-based care (19.3%). The utilization rates showed comparable age-dependent patterns, except for persons in need of facility-based care where rates were similar for all age groups. Utilization rates were negatively associated with increasing care levels. Only people with care level 0 showed lower utilization rates than people with care level 1. Utilization rates of eye healthcare services among older persons are considerably influenced by the need of long-term care, by the form of care as well as by the level of care.
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2013-01-01
Background The validity of survey-based health care utilization estimates in the older population has been poorly researched. Owing to data protection legislation and a great number of different health care insurance providers, the assessment of recall and non-response bias is challenging to impossible in many countries. The objective of our study was to compare estimates from a population-based study in older German adults with external secondary data. Methods We used data from the German KORA-Age study, which included 4,127 people aged 65–94 years. Self-report questions covered the utilization of long-term care services, inpatient services, outpatient services, and pharmaceuticals. We calculated age- and sex-standardized mean utilization rates in each domain and compared them with the corresponding estimates derived from official statistics and independent statutory health insurance data. Results The KORA-Age study underestimated the use of long-term care services (−52%), in-hospital days (−21%) and physician visits (−70%). In contrast, the assessment of drug consumption by postal self-report questionnaires yielded similar estimates to the analysis of insurance claims data (−9%). Conclusion Survey estimates based on self-report tend to underestimate true health care utilization in the older population. Direct validation studies are needed to disentangle the impact of recall and non-response bias. PMID:23286781
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McCue, Michael J
2002-01-01
The objective of this study was to evaluate the utilization and financial performance of children's services after the Balanced Budget Act of 1997. The author analyzed these performance factors by hospital ownership, HMO penetration, and disproportionate share hospitals. Using data from California hospitals and conducting an analysis from 1997 to 1999, the author found that public hospitals were able to increase their profits from pediatric and neonatal intensive care services. The study also revealed that DSH hospitals located in high HMO penetration markets reduced their operating losses in nursery and pediatric services.
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Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country
Olusanya, Bolutife A.; Ashaye, Adeyinka O.; Owoaje, Eme T.; Baiyeroju, Aderonke M.; Ajayi, Benedictus G.
2016-01-01
Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa. PMID:26957847
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Gupta, Madhu; Bhatnagar, Nidhi; Bahugana, Pankaj
2015-01-01
Adolescents are a heterogeneous, vulnerable, and sexually active group. Geographical and educational health disparities exist among urban, rural, and slum adolescents and among out-of-school and school-going adolescents, respectively. Adolescent reproductive and sexual health (ARSH) services should be implemented in a manner to minimize health inequities among them. To ascertain the extent of awareness and utilization of ARSH services provided under reproductive and child health(RCH) program among adolescents in Chandigarh. A cross-sectional study was conducted among 854 adolescents (402 household, 200 out-of-school, and 252 school-going adolescents) in Chandigarh using pretested validated interview schedule on awareness and utilization of adolescent reproductive and sexual health services from February to April 2011 in North Indian Union Territory of Chandigarh. Ordinal regression analysis was done to study the association of socio-demographic variables with awareness and utilization of ARSH. Results: Awareness about contraception and health services was significantly less among rural (12.7% and 1.1%, respectively) adolescents as compared to slum (17.9% and 4.6%, respectively) and urban adolescents (33.5% and 7.8%, respectively) (P < 0.05). Out-of-school adolescents were utilizing the preventive [odds ratio (OR) 0.39, P < 0.001] and curative services significantly lesser (OR = 0.54, P < 0.001) and had higher substance abuse (OR = 4.26, P= 0.006). Awareness was significantly associated with older age of adolescents (OR = 4.4,P < 0.001), poor education of father (OR = 0.5, P = 0.002), rural area (OR = 0.56, P = 0.001), and out-of-school status (OR = 0.35, P < 0.001). Awareness and utilization of ARSH services was inequitable and was more among urban and school-going adolescents. Educational status was the most important factor affecting it.
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Aston-Brown, Roberta E; Branson, Bonnie; Gadbury-Amyot, Cynthia C; Bray, Kimberly Krust
2009-03-01
National reports outlining disparities in oral health care in the United States have focused attention on ways to encourage health care providers to become more involved in the public health arena. Utilization of service-learning in professional health education programs is one method being explored. The purpose of this study was to conduct a retrospective review of a service-learning rotation within a dental hygiene public health course. The study utilized data sources generated by students as part of a course evaluation. These sources included student journals (qualitative/quantitative) and Likert-scaled (quantitative) and open-ended (qualitative) student satisfaction survey items. Mixed methodology data analysis techniques were used to analyze and triangulate data in order to form conclusions related to the effectiveness of service-learning as a teaching strategy in dental hygiene. This investigation suggests that service-learning is an effective learning strategy for increasing student awareness of underserved populations, cultural diversity, and ethical patient care. The study also suggests that service-learning helped students to determine their level of interest in public health as a career choice by giving them a real-world experience in public health patient care.
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Kurowski, Brad G; Wade, Shari L; Kirkwood, Michael W; Brown, Tanya M; Stancin, Terry; Taylor, H Gerry
2013-12-01
To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents. Multicenter cross-sectional study. Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital. Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury. Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist. Mental health service utilization measured by the Service Assessment for Children and Adolescents. Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01). A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
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Dental services utilization by women of childbearing age by socioeconomic status.
Kaylor, Mary B; Polivka, Barbara J; Chaudry, Rosemary; Salsberry, Pamela; Wee, Alvin G
2010-04-01
For women of childbearing age, oral health not only affects their physical and psychological well-being but also that of their children. This study used the 2003-2004 Ohio Family Health Survey (N = 9,819) to examine dental need and utilization by women in Ohio. Predisposing, enabling, and need variables were examined as they effect dental health service utilization by women of childbearing age at different socioeconomic status (SES) levels. The proportion of women in the low SES group self reporting a dental need (18%) was 3 times that of the proportion of women in the higher SES group with a self reported need (6%). Results of bivariate analysis showed that having a dental visit in the past year varied significantly by SES, race, insurance status, provider density, and need. A racial disparity in dental service utilization was noted in the bivariate analysis of the middle SES group. While dental need and type of dental coverage varied by SES, both were significantly associated with utilization of dental services within all 3 SES categories in the logistic regressions. These results suggest that measures need to be implemented to meet the goal of increasing access and utilization of dental health services by low-income populations.
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Evans, Elizabeth; Padwa, Howard; Li, Libo; Lin, Veronique; Hser, Yih-Ing
2015-12-01
The aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. Data were provided by 4447 women treated for SUD in California during 2000-2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (>6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p<0.05) and employment (OR 0.53, p<0.05) and positively associated with older age (OR 1.04, p<0.001), homelessness (OR 1.68, p<0.05), public assistance (OR 1.76, p<0.01), outpatient SUD treatment (OR 3.69, p<0.01), longer SUD treatment retention (OR 1.00, p<0.01), treatment desire (ORs 1.46, p<0.001), and co-occurring disorder diagnosis (ORs 2.89-44.93, p<0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years. Mental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services. Copyright © 2015 Elsevier Inc. All rights reserved.
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Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi
2014-01-01
Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780
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Miyaguchi, Moe; Yasuoka, Junko; Poudyal, Amod Kumar; Silwal, Ram Chandra; Jimba, Masamine
2014-09-11
Female Community Health Volunteers (FCHVs) are considered service providers for major health problems at the community level in Nepal. However, few studies have been conducted about the roles of FCHVs from the users' perspective. This study sought to examine the current status of FCHV service utilization and identify the determinants of caregivers' utilization of FCHVs' health services in the mid-western region of Nepal. This cross-sectional study targeted 446 caregivers of children under five years of age and whose children had ever fallen ill in the study village development committees (VDCs) of three districts of Nepal. Caregivers were asked about their usual health practices for childhood illness, health service utilization for childhood illness, children's health condition, satisfaction with health services, and socio-demographic status. Descriptive statistics and multiple logistic regression were used for analysis. Among 446 caregivers, 66.8% had never sought care from FCHVs for their children's illnesses in their lifetime, and more than 50% of them were unaware of FCHVs' services for acute respiratory infection and diarrhea. Among 316 caregivers whose child had an illness during the last seven months, 92.3% of them (n = 293) did not take their child to FCHVs. The main reasons were the lack of medicine available from them and their incompetency in providing care. Among the 446 caregivers, those who participated in a mothers' group (n = 82) were more likely to use FCHVs' services in their lifetime (AOR = 3.23, 95% CI =1.81-5.76). Caregivers can gain benefit by using FCHV's health services, but a majority of the caregivers did not seek care from FCHVs due to its limited quality. Raising caregivers' awareness on FCHV is equally important at community level.
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Using Multiattribute Utility Theory as a Priority-Setting Tool in Human Services Planning.
ERIC Educational Resources Information Center
Camasso, Michael J.; Dick, Janet
1993-01-01
The feasibility of applying multiattribute utility theory to the needs assessment and priority-setting activities of human services planning councils was studied in Essex County (New Jersey). Decision-making and information filtering processes are explored in the context of community planning. (SLD)
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2012-01-01
Background Inequity of accessibility to and utilization of reproductive health (RH) services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%), financial accessibility was low (19.1%) resulting in a low overall accessibility (34.5%) to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge on types of providers and services significantly influenced the unmet needs of youths towards RH services. Conclusion Despite the availability of RH services, youth’s accessibility to and utilization of those services were unsatisfactory. The levels of youths’ unmet RH needs were alarmingly high. PMID:23241510
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2014-01-01
Background This study has a dual purpose: 1) identify determinants of healthcare service utilization for mental health reasons (MHR) in a Canadian (Montreal) catchment area; 2) determine the patterns of recourse to healthcare professionals in terms of frequency of visits and type of professionals consulted, and as it relates to the most prevalent mental disorders (MD) and psychological distress. Methods Data was collected from a random sample of 1,823 individuals interviewed after a two-year follow-up period. A regression analysis was performed to identify variables associated with service utilization and complementary analyses were carried out to better understand participants’ patterns of healthcare service utilization in relation to the most prevalent MD. Results Among 243 individuals diagnosed with a MD in the 12 months preceding an interview, 113 (46.5%) reported having used healthcare services for MHR. Determinants of service utilization were emotional and legal problems, number of MD, higher personal income, lower quality of life, inability of individuals to influence events occurring in their neighborhood, female gender and, marginally, lack of alcohol dependence in the past 12 months. Emotional problems were the most significant determinant of healthcare service utilization. Frequent visits with healthcare professionals were more likely associated with major depression and number of MD with or without dependence to alcohol or drugs. People suffering from major depression, psychological distress and social phobia were more likely to consult different professionals, while individuals with panic disorders relied on their family physician only. Concerning social phobia, panic disorders and psychological distress, more frequent visits with professionals did not translate into involvement of a higher number of professionals or vice-versa. Conclusions This study demonstrates the impact of emotional problems, neighborhood characteristics and legal problems in healthcare service utilization for MHR. Interventions based on inter-professional collaboration could be prioritized to increase the ability of healthcare services to take care especially of individuals suffering from social phobia, panic disorders and psychological distress. Others actions that could be prioritized are training of family physicians in the treatment of MD, use of psychiatric consultants, internet outreach, and reimbursement of psychological consultations for individuals with low income. PMID:24712834
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ERIC Educational Resources Information Center
Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.
2014-01-01
This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age…
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Tarekegn, Shegaw Mulu; Lieberman, Leslie Sue; Giedraitis, Vincentas
2014-05-07
Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women's autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. Maternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.
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2014-01-01
Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Methods Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Results Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. Conclusion Maternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women. PMID:24886529
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Economic Evaluation of Hospital and Community Pharmacy Services.
Gammie, Todd; Vogler, Sabine; Babar, Zaheer-Ud-Din
2017-01-01
To review the international body of literature from 2010 to 2015 concerning methods of economic evaluations used in hospital- and community-based studies of pharmacy services in publicly funded health systems worldwide, their clinical outcomes, and economic effectiveness. The literature search was undertaken between May 2, 2015, and September 4, 2015. Keywords included "health economics" and "evaluation" "assessment" or "appraisal," "methods," "hospital" or "community" or "residential care," "pharmacy" or "pharmacy services" and "cost minimisation analysis" or "cost utility analysis" or "cost effectiveness analysis" or "cost benefit analysis." The databases searched included MEDLINE, PubMed, Google Scholar, Science Direct, Springer Links, and Scopus, and journals searched included PLoS One, PLoS Medicine, Nature, Health Policy, Pharmacoeconomics, The European Journal of Health Economics, Expert Review of Pharmacoeconomics and Outcomes Research, and Journal of Health Economics. Studies were selected on the basis of study inclusion criteria. These criteria included full-text original research articles undertaking an economic evaluation of hospital- or community-based pharmacy services in peer-reviewed scientific journals and in English, in countries with a publicly funded health system published between 2010 and 2015. 14 articles were included in this review. Cost-utility analysis (CUA) was the most utilized measure. Cost-minimization analysis (CMA) was not used by any studies. The limited use of cost-benefit analyses (CBAs) is likely a result of technical challenges in quantifying the cost of clinical benefits, risks, and outcomes. Hospital pharmacy services provided clinical benefits including improvements in patient health outcomes and reductions in adverse medication use, and all studies were considered cost-effective due to meeting a cost-utility (per quality-adjusted life year) threshold or were cost saving. Community pharmacy services were considered cost-effective in 8 of 10 studies. Economic evaluations of hospital and community pharmacy services are becoming increasingly commonplace to enable an understanding of which health care services provide value for money and to inform policy makers as to which services will be cost-effective in light of limited health care resources.
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Lee, Hyo Jung; Ju, Young Jun; Park, Eun-Cheol
2017-04-01
Despite the positive effect of community-based mental health centers, the utilization of professional mental health services appears to be low. Therefore, we analyzed the relationship between regional recognition of mental health centers and utilization of professional mental health services. We used data from the Community Health Survey (2014) and e-provincial indicators. Only those living in Seoul, who responded that they were either feeling a lot of stress or depression, were included in the study. Multiple logistic regression analysis using generalized estimating equations was performed to examine both individual- and regional-level variables associated with utilization of professional mental health services. Among the 7338 participants who reported depression or stress, 646 (8.8%) had consulted a mental health professional for their symptoms. A higher recognition rate of mental health centers was associated with more utilization of professional mental health services (odds ratio [OR]=1.05, 95% confidence interval [CI]=1.03-1.07). Accessibility to professional mental health services could be improved depending on the general population's recognition and attitudes toward mental health centers. Therefore, health policy-makers need to plan appropriate strategies for changing the perception of mental health services and informing the public about both the benefits and functions of mental health centers. Copyright © 2017. Published by Elsevier B.V.
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Alonzo, Dana; Conway, Anne; Modrek, Anahid S
2016-01-15
Little is known about the specific factors related to whether or not Latino adolescents with suicide ideation (SI) will seek services. Utilizing Andersen's Behavior Model of Health Services Use (2008) the goal of this study is to identify the factors related to utilization of mental health services by Latino adolescents with SI to inform and improve suicide prevention efforts. Data from Wave 1 of the National Longitudinal Study of Adolescent Health was examined. Predispositional (gender, age), enabling/disabling (income, lack of insurance, difficulty obtaining medical care), and need (depressed mood, suicide attempt, perceived health, impulsivity, mood fluctuations, difficulties with attention, etc.) variables were examined via logistic regression as potential correlates of mental health service utilization. Twenty-eight percent of the Latino adolescents with suicidal ideation (SI) in our sample received mental health services. Need factors such as daily mood fluctuations within the past 12 months (OR=4.78) and frequent difficulty focusing attention within the past week (OR=4.96), but not impulsivity, were associated with an increased likelihood of receiving mental health services. No additional associations were observed. The current study is based on cross-sectional data. Therefore, statements about causality cannot be made. These findings suggest that emotion regulation (e.g., daily mood fluctuations) and neurocognitive factors (e.g., difficulty with focusing attention) may be important factors to consider in the clinical assessment of Latino adolescents with SI. Copyright © 2015. Published by Elsevier B.V.
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Bizuneh, Kelemu Dessie
2017-01-01
HIV/AIDS affects the basic educational sector which is the most productive segment of the population and vital to the creation of human capital. The loss of skilled and experienced teachers due to the problem is increasingly compromising the provision of quality education in most African countries. The study was proposed to determine the magnitude of VCT utilization and assess contributing factors that affect VCT service utilization among secondary school teachers in Awi Zone. A cross-sectional study design was conducted among 588 participants in 2014. Self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 16, presented as frequencies and summary statistics, and tested for presence of significant association with odds ratio at 95% CI. More than half (53.6%) of study participants were tested for HIV. Those who had sexual intercourse, had good knowledge about VCT, were divorced/widowed, were in the age group of 20–29 years, and were married utilized VCT services two, three, four, three, and two times better than their counterparts, respectively. Actions targeting unmarried status, increase of educational level, and teachers with age groups above 30 years are necessary to follow their counterparts to utilize VCT service in order to save loss of teachers. PMID:28512582
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Garbutt, Jane; Kaushik, Gaurav N.
2015-01-01
Objectives. We investigated the development of and service utilization at Supporting Positive Opportunities with Teens (SPOT)—a community-based health and social service facility in St. Louis, Missouri, for youths that focuses on increasing HIV and sexually transmitted infection (STI) testing. Methods. We identified the US-based, co-located youth health and social service models that guided the establishment of the SPOT. We analyzed the first 5 years (2008–2013) of service delivery and utilization data. Results. During the study period, the SPOT provided services for 8233 youths in 37 480 visits. The 5 most utilized services included HIV and STI screening, food, transportation, contraception, and case management. A total of 9812 gonorrhea and chlamydia screenings revealed 1379 (14.1%) cases of chlamydia and 437 (4.5%) cases of gonorrhea, and 5703 HIV tests revealed 59 HIV infections (1.0%); 93.0% of patients found to have an STI were treated within a 5-day window. Conclusions. Co-locating health and social services in informal community settings attracts high-risk youths to utilize services and can prove instrumental in reducing STI burden in this population. PMID:25973833
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More effective and less expensive: lessons from five studies examining community approaches to care.
Browne, G; Roberts, J; Gafni, A; Weir, R; Watt, S; Byrne, C
1995-11-01
Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.
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Trends in Gender-affirming Surgery in Insured Patients in the United States
Ives, Graham C.; Sluiter, Emily C.; Waljee, Jennifer F.; Yao, Tsung-Hung; Hu, Hsou Mei
2018-01-01
Background: An estimated 0.6% of the U.S. population identifies as transgender and an increasing number of patients are presenting for gender-related medical and surgical services. Utilization of health care services, especially surgical services, by transgender patients is poorly understood beyond survey-based studies. In this article, our aim is 2-fold; first, we intend to demonstrate the utilization of datasets generated by insurance claims data as a means of analyzing gender-related health services, and second, we use this modality to provide basic demographic, utilization, and outcomes data about the insured transgender population. Methods: The Truven MarketScan Database, containing data from 2009 to 2015, was utilized, and a sample set was created using the Gender Identity Disorder diagnosis code. Basic demographic information and utilization of gender-affirming procedures was tabulated. Results: We identified 7,905 transgender patients, 1,047 of which underwent surgical procedures from 2009 to 2015. Our demographic results were consistent with previous survey-based studies, suggesting transgender patients are on average young adults (average age = 29.8), and geographically diverse. The most common procedure from 2009 to 2015 was mastectomy. Complications of all gender-affirming procedures was 5.8%, with the highest rate of complications occurring with phalloplasty. There was a marked year-by-year increase in utilization of surgical services. Conclusion: Transgender care and gender confirming surgery are an increasing component of health care in the United States. The data contained in existing databases can provide demographic, utilization, and outcomes data relevant to providers caring for the transgender patient population. PMID:29876180
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Tsala Dimbuene, Zacharie; Amo-Adjei, Joshua; Amugsi, Dickson; Mumah, Joyce; Izugbara, Chimaraoke O; Beguy, Donatien
2017-11-06
There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations.
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Sidney, Kristi; Ryan, Kayleigh; Diwan, Vishal; De Costa, Ayesha
2014-01-01
In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service. A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details. 35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay. The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.
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ERIC Educational Resources Information Center
Kay, Heather C.
2013-01-01
Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of…
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Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F
2015-12-01
Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China.
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Ngugi, Anthony K; Agoi, Felix; Mahoney, Megan R; Lakhani, Amyn; Mang'ong'o, David; Nderitu, Esther; Armstrong, Robert; Macfarlane, Sarah
2017-01-01
Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.
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Delivery of health services to migrant and seasonal farmworkers.
Arcury, Thomas A; Quandt, Sara A
2007-01-01
Farmworkers are low-paid, uninsured employees in an extremely hazardous industry, and they provide an essential service for U.S. society. This review evaluates the delivery of health services to farmworkers. It describes the farmworker population in the United States, noting characteristics (e.g., migratory and immigration status) that limit their access to and utilization of health services. It describes the health services needs of this population, including occupational health, mental health, oral health, and chronic disease treatment. Cultural, structural, legal, financial, and geographic barriers to health services utilization are described. Existing research on health services utilization among farmworkers is discussed. Programs that have been developed to address the barriers to health services utilization among farmworkers are reviewed. Finally, research needed to improve knowledge of farmworker health services utilization is suggested. These research needs include formal evaluations of existing programs and basic research to characterize the health services utilization patterns of farmworkers.
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Turchik, Jessica A; Pavao, Joanne; Hyun, Jenny; Mark, Hanna; Kimerling, Rachel
2012-07-01
Little research has examined factors associated with the utilization of outpatient health care services related to sexual assault experiences. The Veterans Health Administration provides free outpatient treatment services to veterans who report military sexual trauma (MST); this system provides a unique opportunity to examine factors related to the utilization of mental health and non-mental health outpatient services by patients with sexual trauma. The current study examined sociodemographic, military service factors, and primary diagnoses related to utilization and utilization intensity of MST-related care among 4,458 Operation Enduring Freedom/Operation Iraqi Freedom Veterans in a 1-year period after reporting an experience of MST. Of the veterans who reported MST, 75.9% received MST-related care. The most notable factor that influenced receipt and intensity of MST-related care was gender, where male veterans used less care than female veterans. These results have important treatment implications for both veteran and civilian sexual trauma survivors.
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Saramunee, Kritsanee; Krska, Janet; Mackridge, Adam; Richards, Jacqueline; Suttajit, Siritree; Phillips-Howard, Penelope
2014-01-01
Community pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized. To explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use. The study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n=16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n=9), GPs (n=2), and STs (n=3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically. All 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization. Community pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services. Copyright © 2014 Elsevier Inc. All rights reserved.
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Comparing Medical Ecology, Utilization, and Expenditures Between 1996-1997 and 2011-2012.
Johansen, Michael E
2017-07-01
This study compared ecology (number of individuals using a service), utilization (number of services used), and expenditures (dollars spent) for various categories of medical services between primarily 1996-1997 and 2011-2012. A repeated cross-sectional study was performed using nationally representative data mainly from the 1996, 1997, 2011, and 2012 Medical Expenditure Panel Survey (MEPS). These data were augmented with the 2002-2003 MEPS as well as the 1999-2000 and 2011-2012 National Heath and Nutrition Examination Survey. Individuals (number per 1,000 people), utilization, and expenditures during an average month in 1996-1997 and 2011-2012 were determined for 15 categories of services. The number of individuals who used various medical services was unchanged for many categories of services (total, outpatient, outpatient physician, users of prescribed medications, primary care and specialty physicians, inpatient hospitalization, and emergency department). It was, however, increased for others (optometry/podiatry, therapy, and alternative/complementary medicine) and decreased for a few (dental and home health). The number of services used (utilization) largely mirrored the findings for individual use, with the exception of an increase in the number of prescribed medications and a decrease in number of primary care physician visits. There were large increases in dollars spent (expenditures) in every category with the exception of primary care physician and home health; the largest absolute increases were in prescribed medications, specialty physicians, emergency department visits, and likely inpatient hospitalizations. Although the number of individuals with visits during an average month and the total utilization of medical services were largely unchanged between the 2 time periods, total expenditures increased markedly. The increases in expenditure varied dramatically by category. © 2017 Annals of Family Medicine, Inc.
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Schneider, John A; Walsh, Tim; Cornwell, Benjamin; Ostrow, David; Michaels, Stuart; Laumann, Edward O
2012-08-01
In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.
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Utilization of emergency services for non-traumatic dental disease.
Da Silva, Keith; Kunzel, Carol; Yoon, Richard K
2013-01-01
To identify and characterize children who utilize emergency dental services for non-traumatic dental disease. Caregivers of children under 12 years old who seek out emergency services for the treatment of non-traumatic dental disease will be surveyed regarding their child's current oral health status. Patient's clinical data will be obtained and they will be further followed for a period of 2 months to determine if they follow-up with recommendations for comprehensive dental care. One hundred and ninety-eight people participated in the study (97% response rate). Eighty-three percent of the children were diagnosed with dental caries. Seventy-four percent of patients of record presented with an emergency at least once before and 73% had a history of one or more broken appointments. Patients with a history of previous emergency visits (OR = 3.45, CI = 2.05, 5.81) or a history of missed appointments (OR = 2.21, CI = 1.42, 3.58) were significantly more likely to fail to return for comprehensive care (P < .01). This study shows that those who utilize emergency services more than once, or have a history of missed appointments are more likely to continue to utilize emergency dental services as their primary means for dental care.
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Mental health symptoms and treatment utilization among trauma-exposed college students.
Artime, Tiffany M; Buchholz, Katherine R; Jakupcak, Matthew
2018-05-21
Universities have demonstrated growing awareness of students impacted by interpersonal violence (e.g., sexual and physical assault) and veterans/service-members with combat-related trauma because of their sizable presence on campuses and unique vulnerabilities. This study sought to describe impacts of these two forms of trauma exposure on students' mental health and academic functioning and to compare mental health service utilization among students based on their experiences of trauma exposure. To acquire a large, national sample of college students, we examined archival data from the Fall 2015 American College Health Association National College Health Assessment, a yearly, web-based survey which represented a sample of 19,861 students from 40 institutions. Twenty percent of the students had experienced interpersonal victimization in the last 12 months, combat exposure, or both. Compared with other groups, interpersonal violence survivors reported the most negative impacts on mental health and interference with academic performance. Service utilization rates among trauma-exposed students ranged from 52% to 84%, and students who had experienced recent interpersonal violence were the most likely to have received services. With a national sample, this study confirms that trauma-exposed students report poor mental health. Service utilization is high among this population, but campus-based mental health services appear to remain underutilized. Outreach efforts by student life professionals and campus clinicians targeting demographic subgroups could enhance utilization and accessibility of campus resources. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Story, William T; Burgard, Sarah A
2012-12-01
This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service utilization focus on women's reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands' involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Integrated EAP/Managed Behavioral Health Plan Utilization by Persons with Substance Use Disorders
Levy Merrick, Elizabeth S.; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Greenfield, Shelly F.; McCann, Bernard
2011-01-01
New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral healthcare organization's integrated EAP/managed behavioral health care product (N=1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. PMID:21185684
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Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard
2011-04-01
New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. Copyright © 2011 Elsevier Inc. All rights reserved.
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Chen, L M; Wen, S W; Li, C Y
2001-03-01
Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.
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ERIC Educational Resources Information Center
Wattmo, Carina; Wallin, Asa K.; Londos, Elisabet; Minthon, Lennart
2011-01-01
Purpose of the Study: To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and cholinesterase inhibitor treatment (ChEI). Design and Methods: In an open, 3-year, prospective, multicenter study…
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1983-06-06
solubility Hgb F quantitation, alkali denaturation Clot retraction Unstable Ggb studies Cryofibrinogen Methemoglobin Parasitology Blood , Occult and Gross...Performance Standards ........ .................... ... 24 4 Types of Information to be Recorded Under Course of Treatment . 25 5 Factors Contributing to...examine external environmental factors implicating the need for utilization review of ancillary services within an Army Medical Center. (Hereinafter the
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Program factors that influence utilization of adult day care.
Conrad, K J; Hughes, S L; Wang, S
1992-01-01
Health planners, policymakers, and providers urgently require methods and information that explain the factors that affect health services utilization. This information is especially critical for planning programs that are effective in maintaining the burgeoning elderly population in community care. In this study, correlation and regression analyses examined the characteristics of adult day care (ADC) centers that were associated with utilization as operationalized by demand for and actual attendance in 822 centers. Community, client population, services and activities, and structural characteristics were associated with demand per center whereas the social environment of the ADC center was not. The attendance rate was most strongly affected by services and activities and structural characteristics. The significance of the study, its limitations, and future directions for research are discussed. PMID:1399653
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Factors affecting the extent of utilization of physiotherapy services by physicians in Saudi Arabia
Alshehri, Mansour Abdullah; Alhasan, Hammad; Alayat, Mohamed; Al-subahi, Moayad; Yaseen, Khalid; Ismail, Ayah; Tobaigy, Abdullah; Almalki, Obaid; Alqahtani, Abdulfattah; Fallata, Basmah
2018-01-01
[Purpose] To investigate physicians’ attitudes, opinions and experiences towards physiotherapy services as well as to identify the potential factors that may affect the extent of utilization of physiotherapy services (based on physicians’ beliefs) in Saudi Arabia (SA). [Subjects and Methods] A cross-sectional study was conducted. [Results] A total of 108 respondents met the inclusion criteria. The respondents’ attitude towards physiotherapy was slightly low (53.5%), while their opinions and experiences of physiotherapy indicated some important issues. For example, 50% of them believed that physiotherapists did not create a good awareness about physiotherapy services and 55.5% admitted that they did not have enough information about physiotherapy services. The most potential factor reported by physicians that may affect the extent of utilization of physiotherapy services was the lack of physiotherapist’s skills and knowledge to assess and treat patients (55.3%), followed by the limited knowledge of physicians regarding the types of physiotherapy services (44.5%) and the lack of cooperation between physicians and physiotherapists (40.7%). [Conclusion] There were some factors that limited the extent of utilization of physiotherapy services in SA. Physiotherapy academics and clinicians should attempt to change physicians’ negative attitudes, promoting awareness to provide them with a better understanding of physiotherapy services. PMID:29545681
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[Use of health services by a population of 60-year olds and older in Mexico].
Borges-Yáñez, S A; Gómez-Dantés, H
1998-01-01
To describe the sociodemographic characteristics and determinants of health services utilization by the Mexican population of 60 years of age or more. Information obtained from the National Health Survey II (ENSA-II) allowed analysis of 4,628 elderly people. Prevalence of chronic diseases was analyzed and the determinants of individuals who had used the health services in the two weeks prior to the interview. The chronic diseases most frequently reported were: hypertension, diabetes and heart disease. The utilization and hospitalization rates of that age group were 11.4 and 5.5%, respectively. The services most frequently used were: the private physician, social security (IMSS, ISSSTE) welfare services (Ministry of Health--SSA- and IMSS-Solidaridad). Interestingly, 25 to 45% of social security insurance holders did not use the services, instead they consulted a private physician. The most important explanatory variables for health services utilization were: the perceived illness, not having worked for the previous week and being a social security insurance holder. Gender, area of residence and level of education were not significant in the explanation of health services utilization. This study demonstrates the need to strengthen preventive and support programs for the elderly population, since they only demand health services when they feel sick.
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A comparison of mail-service and retail community pharmacy claims in 5 prescription benefit plans.
Clark, Bartholomew E; Siracuse, Mark V; Garis, Robert I
2009-06-01
Little evidence has been presented to date that would either support or refute a widely held belief that mail-service pharmacy utilization routinely produces savings in drug benefit costs for prescription benefit plan sponsors. To present a comparative analysis of mail-service and community pharmacy service drug benefit costs for 5 employer-sponsored prescription drug benefit plans. A cross-sectional comparison of 17,725 matched transaction pairs of community and mail-service prescriptions from a data set comprised 484,987 prescription claims from a convenience sample of 5 employer-sponsored prescription benefit plans. Differences between community pharmacy and mail-service prescription transactions were examined at the per-unit level of analysis for drug ingredient costs, dispensing fees, co-payments, dollar amounts paid by plan sponsor, and total dollar amounts. Overall, the total cost of prescriptions was lower through mail-service pharmacies for all 5 plans studied. Two of 5 plans had co-payment incentives to use mail-service, yet plan sponsors paid more for mail-service drugs; respectively, 4.5% and 8.3% more overall, 25.0% and 21.4% more for generic medications; and 3.0% and 7.0% more for brand name medications. Mail-service co-payments were 48.9% and 51.7% lower. Mail-service utilization rates were 15.2% and 31.5% of the total number of prescriptions dispensed in the period studied. Three of 5 plans had no co-payment incentive to use mail-service and paid less for mail-service drugs; respectively, 18.7%, 6.6%, and 15.7% less overall; 17.4%, 15.6%, and 7.9% less for generic medications; and 18.8%, 5.2%, and 16.6% less for brand name medications. Mail-service co-payments were 10.5% more, 5.2% less, and 1.8% more than community pharmacy co-payments, respectively. Mail-service utilization rates were 0.8%, 1.2%, and 4.4%. Co-payment incentives to use mail-service pharmacies instead of community pharmacies were associated with higher mail-service utilization rates and with higher costs to plan sponsors. Absence of a co-payment incentive to use mail-service pharmacies was associated with lower mail-service utilization rates and with lower costs to plan sponsors.
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Shannon, Candice A; Rospenda, Kathleen M; Richman, Judith A
2007-03-01
This study constitutes the first national longitudinal survey to address the relationship between workplace harassment and service utilization. We examine how patterns of sexual harassment and generalized workplace harassment are linked to utilization of mental health, health, legal, spiritual, and work-related services, and whether and how gender influences these relationships. Data derive from a random digit dial telephone survey with a continental US sample of employed adults. Eligibility criteria were being 18 years of age or over, and being employed at least 20 h per week at some time in the 12 months prior to the wave 1 survey. Out of 4116 households with eligible individuals, 2151 agreed to participate at wave 1. At wave 2, 1418 participated, thus, the overall response rate was 34.5%. We show that the patterning of workplace harassment over two time points (chronic, remission, onset, never harassed) is associated with the use of different types of services. Gender partially moderated the relationship between workplace harassment and services.
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Improving surgeon utilization in an orthopedic department using simulation modeling
Simwita, Yusta W; Helgheim, Berit I
2016-01-01
Purpose Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time. Methods The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization. Results The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services. Conclusion This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. PMID:29355193
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Zhang, Jingya; Lin, Senlin; Liang, Di; Qian, Yi; Zhang, Donglan; Hou, Zhiyuan
2017-09-01
There have been obstacles for internal migrants in China in accessing local public health services for some time. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, and demographic characteristics and public health services utilization. Our results showed that internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The years of living in the city of residence were positively associated with the utilization of public health services. Compared to migration within the city, migration across provinces significantly reduced the probability of using health records (OR = 0.88, 95% CI: 0.86-0.90), health education (OR = 0.97, 95% CI: 0.94-1.00), and health education on non-communicable diseases (OR = 0.92, 95% CI: 0.89-0.95) or through the Internet (OR = 0.96, 95% CI: 0.94-0.99). This study concludes that public health services coverage for internal migrants has seen great improvement due to government subsidies. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps.
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42 CFR 456.245 - Number of studies required to be performed.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... mental hospital must, at least, have one study in progress at any time and complete one study each...
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42 CFR 456.245 - Number of studies required to be performed.
Code of Federal Regulations, 2011 CFR
2011-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... mental hospital must, at least, have one study in progress at any time and complete one study each...
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42 CFR 456.145 - Number of studies required to be performed.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan..., at least, have one study in progress at any time and complete one study each calendar year. ...
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42 CFR 456.145 - Number of studies required to be performed.
Code of Federal Regulations, 2011 CFR
2011-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan..., at least, have one study in progress at any time and complete one study each calendar year. ...
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2011-01-01
Background Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households. Methods This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Results Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI: 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS. Conclusions Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu. PMID:22132828
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Fasoli, DiJon R; Glickman, Mark E; Eisen, Susan V
2010-04-01
Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes. This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes. Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes. This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.
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Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India
Singh, Prashant Kumar; Rai, Rajesh Kumar; Alagarajan, Manoj; Singh, Lucky
2012-01-01
Background Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. Methodology/Principal Findings Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions. Conclusions The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization. PMID:22355386
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Public Health Services for Foreign Workers in Malaysia.
Noh, Normah Awang; Wahab, Haris Abd; Bakar Ah, Siti Hajar Abu; Islam, M Rezaul
2016-01-01
The objective of this study was to know the status of the foreign workers' access to public health services in Malaysia based on their utilization pattern. The utilization pattern covered a number of areas, such as frequency of using health services, status of using health services, choice and types of health institutions, and cost of health treatment. The study was conducted on six government hospitals in the Klang Valley area in Kuala Lumpur, Malaysia. Data were collected from 600 foreign patients working in the country, using an interview method with a structured questionnaire. The results showed that the foreign workers' access to public health services was very low. The findings would be an important guideline to formulate an effective health service policy for the foreign workers in Malaysia.
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Lin, Heui-Fen; Wu, Ying-Tai; Tsauo, Jau-Yih
2012-08-16
Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.
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Responses to prospective payment by rural New Mexico hospitals.
Smith, H L; Piland, N F; Phillipp, A M
1991-12-01
A cross-sectional study is used to determine how rural New Mexico hospitals altered service diversification, inpatient service emphasis, and service promotion during Medicare's prospective payment system (PPS) transition and posttransition phases. Results suggest that the hospitals implemented distinct strategies in response to PPS. The posttransition strategies were examined for their association with improved revenue and utilization indicators. Few of the service diversification and promotional strategies were consistent predictors of performance. Emphasis on fine-tuning inpatient services was the most promising predictor of higher utilization and revenue measures. The implications for other rural hospitals are discussed.
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Responses to prospective payment by rural New Mexico hospitals.
Smith, H L; Piland, N F; Phillipp, A M
1991-01-01
A cross-sectional study is used to determine how rural New Mexico hospitals altered service diversification, inpatient service emphasis, and service promotion during Medicare's prospective payment system (PPS) transition and posttransition phases. Results suggest that the hospitals implemented distinct strategies in response to PPS. The posttransition strategies were examined for their association with improved revenue and utilization indicators. Few of the service diversification and promotional strategies were consistent predictors of performance. Emphasis on fine-tuning inpatient services was the most promising predictor of higher utilization and revenue measures. The implications for other rural hospitals are discussed. PMID:1743969
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Hagos, Goshu; Tura, Gurmesa; Kahsay, Gizienesh; Haile, Kebede; Grum, Teklit; Araya, Tsige
2018-06-05
Abortion remains among the leading causes of maternal death worldwide. Post-abortion contraception is significantly effective in preventing unintended pregnancy and abortion if provided before women leave the health facilty. However, the status of post-abortion family planning (PAFP) utilization and the contributing factors are not well studied in Tigray region. So, we conduct study aimed on family planning utilization and factors associated with it among women receiving abortion services. A facility based cross-sectional study design was conducted among women receiving abortion services in central zone of Tigray from December 2015to February 2016 using a total of 416 sample size. Women who came for abortion services were selected using systematic random sampling technique.. The data were collected using a pre-tested interviewer administered questionnair. Data were coded and entered in to Epi info 7 and then exported to SPSS for analysis. Descriptive statisticslike frequencies and mean were computed to display the results. Both Bivariable and multivariable logistic regression was used in the analysis. Variables statistically significant at p < 0.05 in the bivariable analysis were checked in multivariable logistic regration to identify independently associated factors. Then variables which were significantly associated with post abortion family planning utilization at p-value < 0.05 in the multivariable analysis were declared as significantly associated factors. A total of 409 abortion clients were interviewed in this study with 98.3% of response rate. Majority 290 (70.9%) of study participants utilized contracepives after abortion. Type of health facility, the decision maker on timing of having child, knowledge that pregnancy can happen soon after abortion and husband's opposition towards contraceptives were significantly associated with Post-abortion family planning ustilization. About one-third of abortion women failed to receive contraceptive before leaving the facility. Private facilities should strengthen utilization of contraceptives on post abortion care service. Health providers should provide counseling on timing of fertility-return following abortion before women left the facility once they receive abortion care. Women empowerment through enhancing community's awareness focusing on own decision making in the family planning utilization including the partner should be strengthened.
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Considering Context, Place, and Culture: The National Latino and Asian American Study
Alegria, Margarita; Takeuchi, David; Canino, Glorisa; Duan, Naihua; Shrout, Patrick; Meng, Xiao-Li; Vega, William; Zane, Nolan; Vila, Doryliz; Woo, Meghan; Vera, Mildred; Guarnaccia, Peter; Aguilar-Gaxiola, Sergio; Sue, Stanley; Escobar, Javier; Lin, Keh-Ming; Gong, Fong
2009-01-01
This paper provides a rationale and overview of procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization of Latinos and Asian Americans in the United States. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication; NCS-R) and African Americans (from the National Survey of American Life; NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research. PMID:15719529
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Scoping study of integrated resource planning needs in the public utility sector
DOE Office of Scientific and Technical Information (OSTI.GOV)
Garrick, C J; Garrick, J M; Rue, D R
Integrated resource planning (IRP) is an approach to utility resource planning that integrates the evaluation of supply- and demand-site options for providing energy services at the least cost. Many utilities practice IRP; however, most studies about IRP focus on investor-owned utilities (IOUs). This scoping study investigates the IRP activities and needs of public utilities (not-for-profit utilities, including federal, state, municipal, and cooperative utilities). This study (1) profiles IRP-related characteristics of the public utility sector, (2) articulates the needs of public utilities in understanding and implementing IRP, and (3) identifies strategies to advance IRP principles in public utility planning.
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Kilgore, Meredith L; Grabowski, David C; Morrisey, Michael A; Ritchie, Christine S; Yun, Huifeng; Locher, Julie L
2009-03-01
Home health and hospice services can constitute important elements in the continuum of care for older adults diagnosed with cancer. The Balanced Budget Act (BBA) of 1997 included provisions affecting those services. The first objective of this study is to assess the effect of the BBA of 1997 on home health and hospice service utilization in older cancer patients. The second objective is to estimate the effect of the BBA of 1997 on costs associated specifically with home health and hospice services and on total costs of care. The final objective is to evaluate the effect of the BBA of 1997 on mortality in these patients. Longitudinal analysis using the Surveillance, Epidemiology, and End Results-Medicare Database, covering a service area that includes 26% of the US population. Community-dwelling Medicare beneficiaries 65 years of age and older. Utilization rates of home health and hospice services; costs associated with those services, and total costs of care; and mortality. Home health utilization rates dropped substantially and hospice utilization rates increased after the BBA. Medicare costs for home health services declined as did total Medicare costs but hospice costs increased. There was no discernable effect on mortality rates. The BBA was successful in containing the costs of home health services and resulted in savings in overall costs of care for older cancer patients. Reduction in utilization of home health services did not seem to negatively affect outcomes. The BBA may have contributed to the trend of increasing use of hospice care.
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Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele
2016-01-01
Introduction The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. Methods A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Result Only 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. Conclusion The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization. PMID:26986563
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Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele
2016-01-01
The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization.
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Vertical equity of healthcare in Taiwan: health services were distributed according to need
2013-01-01
Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform. PMID:23363855
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Vertical equity of healthcare in Taiwan: health services were distributed according to need.
Wang, Shiow-Ing; Yaung, Chih-Liang
2013-01-31
To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan's experience can serve as a reference for health reform.
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Hualapai Tribal Utility Development Project
DOE Office of Scientific and Technical Information (OSTI.GOV)
Hualapai Tribal Nation
The first phase of the Hualapai Tribal Utility Development Project (Project) studied the feasibility of establishing a tribally operated utility to provide electric service to tribal customers at Grand Canyon West (see objective 1 below). The project was successful in completing the analysis of the energy production from the solar power systems at Grand Canyon West and developing a financial model, based on rates to be charged to Grand Canyon West customers connected to the solar systems, that would provide sufficient revenue for a Tribal Utility Authority to operate and maintain those systems. The objective to establish a central powermore » grid over which the TUA would have authority and responsibility had to be modified because the construction schedule of GCW facilities, specifically the new air terminal, did not match up with the construction schedule for the solar power system. Therefore, two distributed systems were constructed instead of one central system with a high voltage distribution network. The Hualapai Tribal Council has not taken the action necessary to establish the Tribal Utility Authority that could be responsible for the electric service at GCW. The creation of a Tribal Utility Authority (TUA) was the subject of the second objective of the project. The second phase of the project examined the feasibility and strategy for establishing a tribal utility to serve the remainder of the Hualapai Reservation and the feasibility of including wind energy from a tribal wind generator in the energy resource portfolio of the tribal utility (see objective 2 below). It is currently unknown when the Tribal Council will consider the implementation of the results of the study. Objective 1 - Develop the basic organizational structure and operational strategy for a tribally controlled utility to operate at the Tribe’s tourism enterprise district, Grand Canyon West. Coordinate the development of the Tribal Utility structure with the development of the Grand Canyon West Power Project construction of the power infrastructure at Grand Canyon West. Develop the maintenance and operations capacity necessary to support utility operations. Develop rates for customers on the Grand Canyon West “mini-grid” sufficient for the tribal utility to be self-sustaining. Establish an implementation strategy for tribal utility service at Grand Canyon West Objective 2 - Develop a strategy for tribal utility takeover of electric service on the Reservation. Perform a cost analysis of Reservation electrical service. Develop an implementation strategy for tribal takeover of Reservation electrical service. Examine options and costs associated with integration of the Tribe’s wind resources.« less
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2018-01-01
Victim support services, in mature societies, aim to help victims recover after suffering a traumatic event. The effectiveness of victim support has traditionally been evaluated through rates of service utilization and incidence of psychopathology such as posttraumatic stress disorder. The current study, instead, inquires into service users’ unmet needs and satisfaction, and identifies factors that mediate such subjective measures, using data from a national cross-sectional survey on victims and surviving families of violent crime in Taiwan in 2011. The results reveal: 1) a gap between available and expected services, and 2) a correlation between service utilization and satisfaction, both consistent with previous studies. In addition, the current study identifies unsatisfied service users: They are homicidally bereaved, live with their spouse, suffer from post-crime financial distress and are still waiting for a court verdict on the incident. Victim support that helps victims heal through tailored services incorporating relationship counseling is proposed. PMID:29466463
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ERIC Educational Resources Information Center
Meyer, Rachel Heather
2012-01-01
The current study investigated the motivation of college students with disabilities to disclose their disability(s) to the university and to utilize disability support services. Eleven college students with a diversity of invisible disabilities from a large university were interviewed using a narrative approach. Analysis involved a combination of…
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Socioeconomic disparities in home health care service access and utilization: a scoping review.
Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie
2012-10-01
Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage. Education, rurality and race were less frequently reported. In contrast to well-documented socioeconomic gradient seen with primary and acute care services, we found general agreement that persons of lower socioeconomic status are favored and not disadvantaged in terms of home health care services. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Community Determinants of Latinos’ Use of Mental Health Services
Aguilera, Adrian; Regeser López, Steven
2014-01-01
Objective This study examined the role of community in understanding Latino adults’ (18–64 years of age) use of community mental health services. Methods Service utilization data from the Los Angeles County Department of Mental Health were analyzed from 2003 in two service provider areas. Demographic data, including foreign-born status, language, education, and income for the Latino population, were obtained from the 2000 U.S. Census. The study sample consisted of 4,133 consumers of mental health services in 413 census tracts from an established immigrant community and 4,156 consumers of mental health services in 204 census tracts from a recent immigrant community. Negative binomial regression analyses were conducted to examine associations between locales, community characteristics, and use of services. Results Community of residence and foreign-born status were significantly associated with Latinos’ service use. Latinos from the established immigrant community were more likely to use services than Latinos from the recent immigrant community. Across both communities, census tracts with a higher percentage of foreign-born noncitizen residents showed lower service use. Within the established immigrant community, as income levels increased there was little change in utilization. In contrast, in the recent immigrant community, as income levels increased utilization rates increased as well (β=.001, p<.001). Conclusions The findings point out the importance of locale and community determinants in understanding Latinos’ use of public mental health services. PMID:18378840
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A price- and-time-slot-negotiation mechanism for Cloud service reservations.
Son, Seokho; Sim, Kwang Mong
2012-06-01
When making reservations for Cloud services, consumers and providers need to establish service-level agreements through negotiation. Whereas it is essential for both a consumer and a provider to reach an agreement on the price of a service and when to use the service, to date, there is little or no negotiation support for both price and time-slot negotiations (PTNs) for Cloud service reservations. This paper presents a multi-issue negotiation mechanism to facilitate the following: 1) PTNs between Cloud agents and 2) tradeoff between price and time-slot utilities. Unlike many existing negotiation mechanisms in which a negotiation agent can only make one proposal at a time, agents in this work are designed to concurrently make multiple proposals in a negotiation round that generate the same aggregated utility, differing only in terms of individual price and time-slot utilities. Another novelty of this work is formulating a novel time-slot utility function that characterizes preferences for different time slots. These ideas are implemented in an agent-based Cloud testbed. Using the testbed, experiments were carried out to compare this work with related approaches. Empirical results show that PTN agents reach faster agreements and achieve higher utilities than other related approaches. A case study was carried out to demonstrate the application of the PTN mechanism for pricing Cloud resources.
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Atilola, Olayinka
2016-06-01
The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health 'ignorance' has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes 'ignorance', and that correcting such 'ignorance' will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization. © The Author(s) 2015.
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Roebuck, M Christopher; Liberman, Joshua N
2009-06-01
To study the impact of various elements of pharmacy benefit design on both the absolute and relative utilization of generics, brands, retail pharmacy, and mail service. Panel data on 1,074 plan sponsors covering 21.6 million individuals over 12 calendar quarters (2005-2007). A retrospective analysis of pharmacy claims. To control for potential endogeneity, linear fixed effects models were estimated for each of six dependent variables: the generic utilization rate, the brand utilization rate, the generic dispensing rate (GDR), the retail pharmacy utilization rate, the mail service utilization rate, and the mail distribution rate. Most member cost-share variables were nonlinearly associated with changes in prescription drug utilization. Marginal effects were generally greater in magnitude for brand out-of-pocket costs than for generic out-of-pocket costs. Time dummies, as well as other pharmacy benefit design elements, also yielded significant results. Prior estimates of the effect of member cost sharing on prescription drug utilization may be biased if complex benefit designs, mail service fulfillment, and unmeasured factors such as pharmaceutical pipelines are not accounted for. Commonly cited relative utilization metrics, such as GDR, may be misleading if not examined alongside absolute prescription drug utilization.
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Lim, Kim-Lian; Jacobs, Philip; Klarenbach, Scott
2006-01-15
A retrospective, population-based analysis. To analyze the utilization of a variety of healthcare services for persons with and without a chronic back disorder, and to identify factors associated with specific patterns of healthcare resource use. Although there have been studies of how chronic back disorders influence the use of specific healthcare services, we do not currently have a broad, population-based overview of how this condition influences healthcare service utilization. Person-level data were taken from the 2000-2001 Canadian Community Health Survey (CCHS), a nationwide cross-sectional survey of health determinants, health status, and health system utilization of Canadians. A series of binary logistic regressions examining healthcare resource utilization were performed on a full study sample (n = 113,229), as well as a restricted sample (n = 36,713) with attention focused on subjects with a single diagnosis of a chronic back disorder. Persons with chronic back disorders were more likely to use physician resources (multivariate odds ratio [OR] = 1.2; 95% confidence interval, 1.1-1.2), and nonphysician resources (OR range, 2.1-3.6) compared with persons without the condition, with chiropractic care having an odds ratio of 3.6 (95% confidence interval, 3.5-3.8). Higher socioeconomic status, the presence of activity-limiting pain, and depressive symptoms were associated with a significant increase in utilization of almost all healthcare services. With increasing disability as indicated by the presence of pain and functional limitations, and the presence of depressive symptoms, the higher the utilization of physician and nonphysician resources, with the exception of chiropractic care, which appears to be used by those with less severe symptoms. Lower socioeconomic status was associated with significantly lower receipt of services for almost all healthcare providers.
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Koo, Kelly H; Madden, Erin; Maguen, Shira
2015-05-01
The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan. A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization. Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women. Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.
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Villa, Kathleen F.; Reaven, Nancy L.; Funk, Susan E.; McGaughey, Karen; Black, Jed
2018-01-01
Background Healthcare utilization and the cost implications associated with undiagnosed and/or misdiagnosed narcolepsy have not been evaluated, and there is scant literature characterizing the newly diagnosed population with narcolepsy with respect to treatment patterns and resource utilization. Objective To analyze the changes in medication use, healthcare utilization, and the associated costs after a new diagnosis of narcolepsy. Methods In this retrospective cohort study, we used data from the Truven Health Analytics MarketScan Research Databases, between January 2006 and March 2013, to identify patients who had a probable new diagnosis of narcolepsy—defined as a de novo medical claim for a multiple sleep latency test—which was preceded by ≥6 months of continuous insurance and was followed by a de novo diagnosis of narcolepsy. The utilization and cost of medical services and the percentage of patients filling prescriptions for narcolepsy-related medications were evaluated in 3 consecutive 1-year periods from the date of a positive multiple sleep latency test result (ie, index date), and each year's findings were compared with the annualized results from the 6-month preindex period. Results A total of 3757 patients who met the definition of a new diagnosis of narcolepsy were identified. The total medical service utilization decreased each year from a preindex average of 28.2 visits per patient per year (PPPY) to 26.9 visits (P <.05), 23.1 visits (P <.0001), and 22.5 visits (P <.0001) PPPY in years 1, 2, and 3 postdiagnosis, respectively. In each outpatient service category, the medical services utilization decreased from preindex to year 3 postdiagnosis, including hospital outpatient and physician visits (P <.0001), and other outpatient and emergency department visits (P <.05). The percentage of patients receiving narcolepsy-related medications increased from 54.0% preindex to 77.4%, 70.0%, and 66.9% for years 1, 2, and 3 postindex (all P <.0001 vs preindex). The total medical service cost PPPY was $12,159 preindex and decreased to $10,708, $8543, and $9136 in years 1, 2, and 3 postindex (all P <.0001 vs preindex). Conclusions In this study, the confirmation of a diagnosis of narcolepsy was associated with decreasing utilization and associated costs of medical services in the first 3 years after diagnosis. The total costs encompassing medical services and pharmacy costs were relatively stable during this period.
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Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An
2012-01-01
To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists. © 2011 National Rural Health Association.
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Analysis of Fractured Teeth Utilizing Digital Microscopy: A Pilot Study
2016-06-01
ANALYSIS OF FRACTURED TEETH UTILIZING DIGITAL MICROSCOPY: A PILOT STUDY by Thomas Gene Cooper, D.M.D., M.P.H. Lieutenant Commander, Dental Corps...United States Navy A thesis submitted to the Faculty of the Endodontic Graduate Program Naval Postgraduate Dental School Uniformed Services...Postgraduate Dental School Uniformed Services University of the Health Sciences Bethesda, Maryland CERTIFICATE OF APPROVAL MASTER’S THESIS This is to
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ERIC Educational Resources Information Center
Hofmann, Paul N.
2010-01-01
This study examined factors of acculturative stress experienced by international students as they affect utilization of campus-based health and counseling services. Eight hundred thirty-eight international students studying at 11 four-year public institutions in the State of Ohio were surveyed to determine how frequently they had experienced 20…
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Amjad, Halima; Wong, Stephanie K; Roth, David L; Huang, Jin; Willink, Amber; Black, Betty S; Johnston, Deirdre; Rabins, Peter V; Gitlin, Laura N; Lyketsos, Constantine G; Samus, Quincy M
2018-02-01
To investigate effects of a novel dementia care coordination program on health services utilization. A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use. © Health Research and Educational Trust.
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Effects of the West Africa Ebola Virus Disease on Health-Care Utilization – A Systematic Review
Brolin Ribacke, Kim J.; Saulnier, Dell D.; Eriksson, Anneli; von Schreeb, Johan
2016-01-01
Significant efforts were invested in halting the recent Ebola virus disease outbreak in West Africa. Now, studies are emerging on the magnitude of the indirect health effects of the outbreak in the affected countries, and the aim of this study is to systematically assess the results of these publications. The methodology for this review adhered to the Prisma guidelines for systematic reviews. A total of 3354 articles were identified for screening, and while 117 articles were read in full, 22 studies were included in the final review. Utilization of maternal health services decreased during the outbreak. The number of cesarean sections and facility-based deliveries declined and followed a similar pattern in Guinea, Liberia, and Sierra Leone. A change in the utilization of antenatal and postnatal care and family planning services was also seen, as well as a drop in utilization of children’s health services, especially in terms of vaccination coverage. In addition, the uptake of HIV/AIDS and malaria services, general hospital admissions, and major surgeries decreased as well. Interestingly, it was the uptake of health service provision by the population that decreased, rather than the volume of health service provision. Estimates from the various studies suggest that non-Ebola morbidity and mortality have increased after the onset of the outbreak in Sierra Leone, Guinea, and Liberia. Reproductive, maternal, and child health services were especially affected, and the decrease in facility deliveries, cesarean sections, and volume of antenatal and postnatal care visits might have significant adverse effects on maternal and newborn health. The impact of Ebola stretches far beyond Ebola cases and deaths. This review indicates that indirect health service effects are substantial and both short and long term, and highlights the importance of support to maintain routine health service delivery and the maintenance of vaccination programs as well as preventative and curative malaria programs, both in general but especially in times of a disaster. PMID:27777926
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Karim, R M; Abdullah, M S; Rahman, A M; Alam, A M
2015-04-01
Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Discussion (FGD), key informants interview and data for measuring the utilization status were collected by an interviewer administered pretested semi-structured questionnaire. About 95% of the respondents were Muslims and 5% were Hindus. The average age of the respondents was 23.38 (SD ± 4.15) years and almost all of them are home makers. The average monthly expenditure of their family was 7462.92 (SD ± 2545) BDT equivalent to 95 (SD ± 32) US$. To measure lay peoples' perception and satisfaction regarding primary health care service quality two scales e.g. Slim Haddad's 20-item scale for measuring perceived quality of primary health care services (PQPCS) validated in Guinea and Burkina Fuso and primary care satisfaction survey for women (PCSSW) developed by Scholle and colleagues 2004; is a 24-item survey tool validated in Turkey were chosen as a reference tools. Based on those, two psychometric research instruments; 24 items PQPCS scale (chronbach's α =0.89) and 22-items Community Clinic Service Satisfaction (CCSS) scale (chronbach's α = 0.97), were constructed and validated for measuring perceived service quality and satisfaction in Bangladesh context. This study showed mothers with preprimary education [(χ2 = 4.20, p = 0.04), AOR with 95% CI = 1.89 (1.03, 3.53)] utilized the limited curative care services more than educated mothers. On the contrary, higher income families [for income group 5000-10,000 BDT χ2 = 8.83, p = 0.003 and AOR with 95% CI = 0.37(0.19, 0.71)] and [for income group above 10,000 BDT χ2 = 5.02, p = 0.025 and AOR with 95% CI = 0.40 (0.18, 0.89)] and families having cultivable lands [for 5-10 decimal group χ2 = 5.51, p = 0.19, and AOR with 95% CI = 0.56 (0.35, 0.91)] and [for > 10 decimal group χ2 = 6.70, p = 0.010, and AOR with 95% CI = 0.50 (0.29, 0.84)] utilized the limited curative care services less than their poorer and landless counterpart. The same relationship was observed in case of health education and Antenatal Care (ANC) and Postnatal Care (PNC) services. Women who lived in their own residence used health education services more frequently than those who lived in a rental house [χ2 = 24.00, p = 0.000 and AOR with 95% CI = 1.21, (1.12, 1.30)] and they also increasingly used maternal and child health services χ2 = 27.49, p = 0.000 and AOR with 95% CI 1.61, (1.35, 1.93)]. Perceptions concerning skill and competence of the health care provider [χ2 = 16.90, p = 0.000 and AOR with 95% CI = 1.14, (1.07, 1.22)] and satisfaction indicating interpersonal communication and attitude of the care provider [χ2 = 7.07, p = 0.008 AOR with 95% CI = 1.08, (1.02, 1.15)] were found significant predictors for limited curative care service utilization of CC. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues also played significant role on CC's services utilization. Besides parental education and income, client's perception and satisfaction played significant role in CC service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers .to improve quality of primary health care services, realizing providers' and patients' ideas of CC service quality.
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Memon, Zahid; Zaidi, Shehla; Riaz, Atif
2016-01-01
Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902
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Utilization and costs of home care for patients with colorectal cancer: a population-based study
Liu, Ning; Porter, Joan; Seung, Soo Jin; Isogai, Pierre K.; Saskin, Refik; Cheung, Matthew C.; Leighl, Natasha B.; Hoch, Jeffrey S.; Trudeau, Maureen; Evans, William K.; Dainty, Katie N.; Earle, Craig C.
2014-01-01
Background The utilization and costs of home care services provided for people with colorectal cancer is not well-known. We conducted an analysis to determine the utilization and costs of such services associated with each stage of colorectal cancer among patients in the province of Ontario. Methods We included cases of colorectal cancer diagnosed in Ontario between Jan. 1, 2005, and Dec. 31, 2009. Data were extracted from the Ontario Cancer Registry and linked to data from a home care administrative database. The types of services used were stratified by stage of disease and by phase of care (initial phase = 180 d after diagnosis, terminal phase = 180 d before death, continuing phase = interval between initial and terminal phases). Overall utilization rates and costs were determined, and regression analysis was used to examine associated factors. Results A total of 36 195 patients had colorectal cancer diagnosed during the study period; the median age was 71 (interquartile range 61–79) years. Home care services were provided to 24 641 patients (68.1%). The number of services per patient-year was 27.5, at a cost of $2180 per patient-year. The number of services provided per patient-year increased with increasing disease severity at diagnosis (15.5 at stage I, 25.5 at stage II, 32.5 at stage III and 62.5 at stage IV; 22.6 for unstaged disease). The cost of services per patient-year also increased with disease severity at diagnosis ($1170 at stage I, $1995 at stage II, $2727 at stage III and $5541 at stage IV). Publicly funded home care services and associated costs decreased with increasing income group, but they increased among patients who had a history of high health resource utilization. The mean 30-day cost of home care services decreased from the initial phase of care ($323) to the continuing phase ($160) but increased during the terminal phase ($616). Interpretation More than two-thirds of the patients with colorectal cancer in this study used home care services. Those who received home care services used about 2 services per month in a one-year period, at a cost of about $2000 per year. This information can aid policy-makers in future decisions regarding resource allocations. PMID:25077120
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Calhoun, Patrick S; Bosworth, Hayden B; Stechuchak, Karen A; Strauss, Jennifer; Butterfield, Marian I
2006-06-01
The present study examined the impact of comorbid posttraumatic stress disorder (PTSD) on health-related quality of life and objective measures of health service utilization in 165 male veterans who have primary schizophrenia. Comorbid PTSD was assessed with the PTSD Checklist. Comorbid PTSD was significantly associated with decreased quality of life and increased medical service utilization, including increased psychiatric hospitalization and increased outpatient physical health visits, even after controlling for other clinical and demographic variables among this sample of patients who had primary schizophrenia. Veterans who have schizophrenia should be screened carefully for exposure to trauma and posttraumatic stress disorder.
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Wu, Qiaobing; Chow, Julian Chun-Chung
2013-01-01
Drawing upon a sample of 296 new immigrant women in Hong Kong, this study investigated how social service utilization, family functioning, and sense of community influenced the depressive symptoms of new immigrant women. Results of the structural equation modeling suggested that family functioning and sense of community were both significantly and negatively associated with the depression of new immigrant women. Utilization of community services also influenced the depression of immigrant women indirectly through the mediating effect of sense of community. Implications of the research findings for mental health intervention were discussed. PMID:23629592
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Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.
Boissonnault, William G; Lovely, Karen
2016-11-01
Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. A descriptive survey was conducted. Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption. © 2016 American Physical Therapy Association.
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Factors associated with institutional delivery service utilization in Ethiopia.
Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew
2016-01-01
Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government's efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel-Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I (2) test. People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women's autonomy was not significantly associated with institutional delivery service utilization. Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended.
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L'Hommedieu, Coles E; Gera, James J; Rupp, Gerald; Salin, Jeffery W; Cox, John S; Duwelius, Paul J
2016-09-01
Controversy exists as to which surgical approach is best for total hip arthroplasty (THA). Previous studies suggested that the tissue-sparing anterior approach should result in a more rapid recovery requiring fewer postacute services, ultimately decreasing overall episodic cost. The purpose of this cross-sectional study was to determine if any significant differences exist between the anterior vs posterior approaches on postacute care service utilization, readmissions, or episodic cost. Claims data from 26,773 Medicare fee-for-service beneficiaries receiving elective THAs (Medical Severity-Diagnosis Related Groups (MS-DRGs) 469/470) were analyzed. Claims data were collected from the 2-year period, January 2013 through December 2014. The posterior surgical approach was performed on 23,653 patients while 3120 patients received the anterior approach. Data analysis showed negligible effect sizes in postacute care service utilization, readmission rate, and cost between the surgical approaches for elective THA (MS-DRG 469 and 470). Average THA total episode cost was negligibly higher for procedures using the anterior approach compared to the posterior approach ($22,517 and $22,068, respectively). Statistically significant differences were observed in inpatient rehab and home health cost and service utilization. However, the effect sizes of these comparisons are negligible when accounting for the large sample size. All other comparisons showed minimal and statistically insignificant variation. The results indicate that surgical approach alone is not the primary driver of postacute care service utilization, quality outcomes, or cost. Other factors such as physician-led patient-focused care pathways, care coordination, rapid rehabilitation protocols, perioperative pain management protocols, and patient education are integral for effective patient care. Copyright © 2016 Elsevier Inc. All rights reserved.
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Madsen, Trine; Andersen, Søren Bo; Karstoft, Karen-Inge
2016-10-01
Investigating the use of mental health services by combat veterans can help illuminate utilization and unmet needs of this population. The aims of this study were to estimate the use of mental health services and to examine how such use is associated with self-reported symptoms of posttraumatic stress disorder (PTSD) in soldiers before and after deployment to Afghanistan. Prospectively, 703 Danish soldiers who deployed from January 2009 to August 2009 were followed up with 6 assessments from predeployment to 2.5 years postdeployment in 2012. At assessments, the soldiers responded to a comprehensive questionnaire including a measure of PTSD symptoms (the PTSD Checklist-Civilian version). These self-reported data were combined with individual-level records of receiving psychotherapy from the Military Psychological Division at the Danish Defense and psychiatric treatment from the Danish registers. The prevalence of PTSD symptoms increased over time, and almost 10% of the sample reported high levels of PTSD symptoms 2.5 years postdeployment. Overall, 37% of the soldiers utilized mental health services; 6% utilized psychiatric services, and 12.4% redeemed a prescription for psychiatric medicine. Approximately one-third received psychotherapy at the Military Psychological Division. In those reporting high PTSD symptomatology, 83% utilized 1 or more types of mental health service. At predeployment and homecoming, high PTSD symptomatology was significantly (P < .01) associated with attending psychotherapy, but not with psychiatric treatment or redemption of psychiatric medicine. With time, more soldiers report high PTSD symptoms. Among Danish soldiers with high symptomatology, the utilization of mental health services was high. Most frequently, soldiers with high PTSD symptomatology received psychotherapy at the Military Psychological Division and less frequently received psychiatric treatment. © Copyright 2016 Physicians Postgraduate Press, Inc.
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Factors associated with institutional delivery service utilization in Ethiopia
Kebede, Alemi; Hassen, Kalkidan; Nigussie Teklehaymanot, Aderajew
2016-01-01
Background Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. Objective The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I2 test. Results People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and recommendation Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended. PMID:27672342
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Chapman, Susan A; Phoenix, Bethany J; Hahn, Talia E; Strod, Deborah C
2018-06-01
Expanded insurance coverage through the Affordable Care Act and parity in behavioral health coverage have increased demand for services. Yet there is a persistent shortage in the behavioral health workforce. Psychiatric Mental Health Nurse Practitioners (PMHNPs) may be part of the solution to shortages but are not yet fully utilized. The purpose of this study was to describe how PMHNPs are utilized, identify barriers to full utilization, and assess PMHNPs' economic contribution in public behavioral health systems. This study used a mixed methods approach, selecting counties for use of PMHNPs, geography, population size, rural/urban, and availability of financial data. The authors conducted 1- to 2-day site visits in 2014-2015 including semi-structured interviews with management and clinical leaders and collected PMHNP staffing and billing data. Thematic analysis of interview data was conducted and aggregate staffing and billing data were analyzed to determine net PMHNP financial contribution. The primary billed service for PMHNPs is medication management. Barriers to full utilization included system-level barriers to hiring PMHNPs, lack of role-appropriate job descriptions, confusion related to scope of practice/supervision requirements, and challenges in recruitment and retention. Fiscal analysis showed a positive net contribution from PMHNP services. PMHNPs can make a significant contribution to behavioral healthcare delivery, particularly in public mental health settings, yet greater understanding of their role and addressing barriers to practice is needed. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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ERIC Educational Resources Information Center
Fleming, Padraic; McGilloway, Sinead; Barry, Sarah
2017-01-01
Background: Day services for people with intellectual disabilities are experiencing a global paradigm shift towards innovative person-centred models of care. This study maps changing trends in day service utilization to highlight how policy, emergent patterns and demographic trends influence service delivery. Methods: National intellectual…
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Stevans, Joel M; Fitzgerald, G Kelley; Piva, Sara R; Schneider, Michael
2017-06-01
Nontraumatic knee pain (NTKP) is highly prevalent in adults 65 years of age and older. Evidence-based guidelines recommend early use of rehabilitation; however, there is limited information comparing differences in health care utilization when rehabilitation is included in the management of NTKP. To describe the overall health care utilization associated with the management of NTKP; estimate the proportion of people who receive outpatient rehabilitation services; and evaluate the timing of outpatient rehabilitation and its association with other health care utilization. Rretrospective cohort study was conducted using a random 10% sample of 2009-2010 Medicare claims. The sample included 52,504 beneficiaries presenting within the ambulatory setting for management of NTKP. Exposure to outpatient rehabilitative services following the NTKP index ambulatory visit was defined as 1) no rehabilitation; 2) early rehabilitation (1-15 days); 3) intermediate rehabilitation (16-120 days); and 4) late rehabilitation (>120 days). Logistic regression models were fit to analyze the association of rehabilitation timing with narcotic analgesic use, utilization of nonsurgical invasive procedure, and knee surgery during a 12-month follow-up period. Only 11.1% of beneficiaries were exposed to outpatient rehabilitation services. The likelihood of using narcotics, nonsurgical invasive procedures, or surgery was significantly less (adjusted odds ratios; 0.67, 0.50, 0.58, respectively) for those who received early rehabilitation when compared to no rehabilitation. The exposure-outcome relationships were reversed in the intermediate and late rehabilitation cohorts. This was an observational study, and residual confounding could affect the observed relationships. Therefore, definitive conclusions regarding the causal effect of rehabilitation exposure and reduced utilization of more aggressive interventions cannot be determined at this time. Early referral for outpatient rehabilitation may reduce the utilization of health services that carry greater risks or costs in those with NTKP. © 2017 American Physical Therapy Association
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Carter, Elizabeth A; Morin, Pamela E; Lind, Keith D
2017-11-01
Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States. To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older. A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse. Adults 50 and older enrolled in commercial plans and adults 65 and older enrolled in MA plans between 2009 and 2014. Costs and utilization of 16 low-value services in the following categories: cancer screening, imaging, and invasive procedures. The most commonly performed low-value service was imaging of the head for syncope, at rates of 33%-39% in commercial enrollees and 45% in MA enrollees. The least common service was peripheral artery stenting (<1%) in commercial enrollees, and laminectomy (0.15% in 2009) and renal artery stenting in MA enrollees (0.07% in 2014). Renal artery stenting decreased by roughly 75% over the study period, the largest decrease in utilization, with ∼$30 million and $10 million in reduced spending for commercial and MA plans and enrollees, respectively. Spending on these services in 2014 totaled $317.6 million for commercial and $100.8 million for MA health plans. Clinicians, researchers, and policymakers should strive to reach consensus on methods for more reliably and accurately identifying low-value service utilization. Greater consistency would facilitate monitoring use of low-value services and changing clinical practice patterns over time.
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Inequities in utilization of reproductive and maternal health services in Ethiopia.
Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie
2017-06-19
Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.
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Rurangirwa, Akashi Andrew; Mogren, Ingrid; Nyirazinyoye, Laetitia; Ntaganira, Joseph; Krantz, Gunilla
2017-05-15
In Rwanda, a majority of pregnant women visit antenatal care (ANC) services, however not to the extent that is recommended. Association between socio-demographic or psychosocial factors and poor utilization of antenatal care services (≤2 visits during the course of pregnancy irrespective of the timing) among recently pregnant women in Rwanda were investigated. This population-based, cross sectional study included 921 women who gave birth within the past 13 months. Data was obtained using an interviewer-administered questionnaire. For the analyses, bi-and multivariable logistic regression was used and odds ratios were presented with their 95% confidence intervals. About 54% of pregnant women did not make the recommended four visits to ANC during pregnancy. The risk of poor utilization of ANC services was higher among women aged 31 years or older (AOR, 1.78; 95% CI: 1.14, 2.78), among single women (AOR, 2.99; 95% CI: 1.83, 4.75) and women with poor social support (AOR, 1.71; 95% CI: 1.09, 2.67). No significant associations were found for school attendance or household assets (proxy for socio-economic status) with poor utilization of ANC services. Older age, being single, divorced or widowed and poor social support were associated with poor utilization of ANC services. General awareness in communities should be raised on the importance of the number and timing of ANC visits. ANC clinics should further be easier to access, transport should be available, costs minimized and opening hours may be extended to facilitate visits for pregnant women.
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Cruz-Feliciano, Miguel A; Ferraro, Aimee; Witt Prehn, Angela
2017-03-01
This study described herein explored the association of stressful life events with the utilization of substance use treatment-related services among substance users living in Puerto Rico. A secondary data analysis was conducted using data collected by a research project entitled Puerto Rico Drug Abuse Research Development Program II (PRDARDP II). The study population consisted of 378 individuals from 18 to 35 years of age who were residents of the San Juan metropolitan area and who presented evidence of substance use in the 30 days prior to the interview. The analysis considered demographic data, information on patterns of substance use, substance use treatment history, stressful events, and depression and anxiety symptomatology. As the number of stressful life events increased, substance users were more likely to report having utilized substance use treatment-related services (OR = 1.11, 95% CI [1.06, 1.17], p < 0.001). Relapsing, the inability to afford drugs, and poor working conditions were statistically significant stressful life events associated with the utilization of substance use treatment-related services. Despite the structural limitations associated with access to and with the quality of the services in the substance use treatment-related system of Puerto Rico, findings suggest that stressful life events play a significant role in the utilization of those services. Researchers and clinicians should consider screening for stressful life events in outreach and engagement strategies. At the same time, the assessment of stressful life events should be integrated into the treatment planning stage to support the recovery process of people with substance use disorders.
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Xiao, Lily Dongxia; Habel, Lesley; De Bellis, Anita
2015-09-01
The majority of Vietnamese Australians migrated to Australia as refugees to escape a war and this unique migration background may affect their ability to access and utilize healthcare services in Australia. Inability to utilize dementia services is associated with higher levels of caregiver burden, higher rates of morbidities and mortality and hospitalization. The aim of the study was to explore the perceived challenges of dementia care from Vietnamese family caregivers and Vietnamese care workers. Gadamer's philosophical hermeneutics was used to interpret and describe the experiences of the participants. Data were collected from in-depth interviews with six Vietnamese family caregivers and a focus group with Vietnamese care workers using purposive sampling. Participants were recruited from a Vietnamese community care organization in South Australia. Five themes were identified from the data analysis namely: (1) a need for culturally and linguistically appropriate dementia education programs; (2) a willingness and unwillingness to seek help; (3) poor knowledge of health care service availability related to dementia; (4) the effect of language barrier in accessing services; and (5) the main sources of services utilized. The study revealed that Vietnamese family caregivers and Vietnamese care workers held different views on the association of stigma with dementia. Findings also revealed factors that impacted accessing and utilizing dementia services. These findings facilitate a more comprehensive understanding of Vietnamese family caregivers' needs and have implications for developing individualized support for family caregivers and for consumer-directed dementia services in Australia.
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A Case Study of the Institutionalization of Service-Learning at a Baptist College
ERIC Educational Resources Information Center
Long, Jody Thomas
2013-01-01
This qualitative study, utilizing the case study method, sought to address the issues associated with the lack of institutionalization of service-learning practices on college campus by describing the institutionalization of service-learning practices at a Baptist-affiliated college. The study describes the development and institutionalization of…
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Code of Federal Regulations, 2011 CFR
2011-10-01
... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...
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Code of Federal Regulations, 2010 CFR
2010-10-01
... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...
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Code of Federal Regulations, 2012 CFR
2012-10-01
... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...
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Code of Federal Regulations, 2013 CFR
2013-10-01
... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...
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Code of Federal Regulations, 2014 CFR
2014-10-01
... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...
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Perceived barriers to utilization of maternal health services in rural Cambodia.
Matsuoka, Sadatoshi; Aiga, Hirotsugu; Rasmey, Lon Chan; Rathavy, Tung; Okitsu, Akiko
2010-05-01
The aim of this study was to identify the underlying causes of Cambodian women's non-use of maternal health services provided by skilled birth attendants. A qualitative study of 66 reproductive-age women was conducted in Kampong Cham Province, Cambodia. Data were collected through 30 semi-structured interviews and 6 focus groups. We identified 5 barriers to the utilization of maternal health services: (i) financial barriers; (ii) physical barriers; (iii) cognitive barriers; (iv) organizational barriers; and (v) psychological and socio-cultural barriers. The Cambodian Ministry of Health and its development partners should take these barriers into account when promoting the use of maternal health services. These barriers should be addressed proactively. A successful approach to increasing use of maternal health services should involve changes to both service programs and public education. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.
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The Utility of the Metacognitive Awareness Inventory for Teachers among In-Service Teachers
ERIC Educational Resources Information Center
Kallio, Heli; Virta, Kalle; Kallio, Manne; Virta, Arja; Hjardemaal, Finn Rudolf; Sandven, Jostein
2017-01-01
The purpose of the present study is to explore the utility of the compressed version of the Metacognitive Awareness Inventory for Teachers (MAIT-18) among in-service teachers. Knowledge of teachers' awareness of metacognition is required to support students' self-regulation, with the aim of establishing modern learning methods and life-long…
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Madsen, T; Sadowa Vedtofte, M; Nordentoft, M; Ravnborg Nissen, L; Bo Andersen, S
2017-06-01
Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively. A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics. Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population. Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Zhang, Jingya; Lin, Senlin; Liang, Di; Qian, Yi; Zhang, Donglan; Hou, Zhiyuan
2017-01-01
There have been obstacles for internal migrants in China in accessing local public health services for some time. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, and demographic characteristics and public health services utilization. Our results showed that internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The years of living in the city of residence were positively associated with the utilization of public health services. Compared to migration within the city, migration across provinces significantly reduced the probability of using health records (OR = 0.88, 95% CI: 0.86–0.90), health education (OR = 0.97, 95% CI: 0.94–1.00), and health education on non–communicable diseases (OR = 0.92, 95% CI: 0.89–0.95) or through the Internet (OR = 0.96, 95% CI: 0.94–0.99). This study concludes that public health services coverage for internal migrants has seen great improvement due to government subsidies. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps. PMID:28862682
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Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.
Whitehead, J; Shaver, John; Stephenson, Rob
2016-01-01
Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
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Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations
Whitehead, J.; Shaver, John; Stephenson, Rob
2016-01-01
Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405
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Two years post-tsunami in Thailand: who still needs assistance?
Isaranuwatchai, Wanrudee; Guerriere, Denise; Andrews, Gavin J; Coyte, Peter C
2013-06-01
On 26 December 2004, 280 000 people lost their lives in the Asia-Pacific region. A massive earthquake struck Indonesia, triggering a tsunami that affected several countries, including Thailand. This tsunami had important implications for the health status of Thai citizens and health planning, and thus there is a need to study its long-term impact. This cohort study identified determinants of health service utilization (outpatient services, inpatient services, home care, medications and informal care) 1 and 2 years post-tsunami in Thailand. A two-part model with a multivariate logistic regression for each part was used to identify determinants of the propensity and intensity of utilization. Of 1943 participants, 1889 (97.2%) participated at 1 year and 1814/1889 (96.0%) at 2 years. Common determinants of health service utilization in post-tsunami settings were age, marital status, education level, employment status, number of health conditions and (physical and mental) health status. Knowing the determinants of health service use, health providers may be able to establish programmes for, or to carefully monitor populations, who are more likely to use services. The study results may be used to inform requests for health resources or to assist the development of guidelines for long-term disaster recovery planning.
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Noorani, Qayyum Ali; Azam, Iqbal; Shaikh, Babar T; Ranasinghe, Tharanga; Abbas, Shazia; Wali, Shakeela; Rippey, Paul; Javed, Wajiha
2013-10-11
Maternal and infant mortality rates in the district of Chitral in Pakistan are alarmingly high. One of the major reasons for this is the inability of women to access skilled care due to the high costs associated with traveling and utilizing such services. The Aga Khan Health Services, Pakistan (AKHSP) in partnership with the national and provincial Maternal, Neonatal and Child Health (MNCH) program, deployed 28 community midwives (CMWs) in remote villages of Chitral district. This program has also established Community-Based Savings Groups (CBSGs) to support and facilitate access to MNCH services, in particular those delivered by the CMWs. CBSGs are a simple yet cost-effective and sustainable means of providing basic financial services to low income, marginalized, rural populations.The link between CBSGs and utilization of MNCH services is not well understood. This study will assess the relationship between women membership of CBSGs and their utilization of MNCH services, specifically those offered by CMWs, in the community. The research question will be answered through guided interviews of women in the target population who have delivered within one month. The outcome variable will be the utilization of full continuum of skilled MNCH care (disaggregated by 1+ ANC, 1+ PNC and skilled delivery). The primary independent variable of interest will be participation in a CBSG.Focus Group Discussions (FGDs) will be conducted to generate further understanding and information about the social and financial factors that contribute to health behavior and health provider decision-making during pregnancy.Analysis will be tailored to answer how CBSGs, directly or indirectly, facilitate greater financial and/or social access to CMW services for pregnant women. Furthermore, the extent to which financial or social empowerment through a CBSG leads to greater utilization of CMW services. The role of CBSGs and their interlink with the CMWs services to be replicated in other comparable areas in Pakistan as a viable mean to increase MNCH service utilization amongst rural, low income, and marginalized communities. Findings from this research will be disseminated through community, national, and international channels consisting of policy makers and social society groups.
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Lai, Hsien-Tang; Kung, Pei-Tseng; Tsai, Wen-Chen
2014-12-01
Women with intellectual disabilities (ID) have cognitive impairment and communication difficulties; for both caregivers and clinical personnel, discovering the early symptoms of breast cancer among women with ID is challenging. The mammography utilization rate of women with ID was significantly lower than that of women in the general population. This study employed a 2008 database of people with disabilities in Taiwan as a research target and analyzed the mammography utilization rate of women with ID aged 50–69 years. In addition, relevant factors influencing mammography utilization among women with ID were also investigated. A total of 4370 participants were recruited and the majority were illiterate or had elementary-level educations (82.27%). The majority of the participants had ID that was more severe than mild (83.80%). The mammography utilization rate of women with ID was 4.32%, which was significantly lower than that of women in the general population (12%). The mammography utilization rate among women with ID who were married, had higher education levels, and had been diagnosed with cancer, diabetes, or mild ID was significantly higher. However, the mammography utilization rate among women with ID, who had elementary-level educations or were illiterate, was only 4.03%. The utilization rate among women with profound ID was only 2.65%. Women with ID who had undergone pap smears or had utilized adult preventive health services demonstrated a significantly higher mammography utilization rate. This study identified that education level, a diagnosis of diabetes, and the application of pap smears or adult preventive health services were primary factors that influenced the mammography utilization rate among women with ID. This study also observed that in Taiwan, the mammography utilization rate of women with ID was lower than that of pap smears and adult preventive health services, and was only half of that of people with disabilities. An unequal situation existed in regard to the acceptance of breast cancer screening among women with ID, and a different form of strategic planning must be adopted in public health policy. Because ID differs from other disabilities and most women with ID are illiterate, tailored courses are required to train primary caregivers and clinical personnel in providing knowledge and services. The objectives are to diagnose breast cancer at an early stage to decrease the risk of mortality and ensure their rights to health.
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Qian, Yuyan; Zhou, Zhongliang; Yan, Ju'e; Gao, Jianmin; Wang, Yuping; Yang, Xiaowei; Xu, Yongjian; Li, Yanli
2017-10-27
The Chinese government has long been committed to eliminating the inequality in the utilization of health services; however, it still lacks an analysis or measurement of the economy-related inequality in the utilization of women's health services. The economy-related utilization of health services in women aged 15 years and above was assessed by the horizontal inequity index of a two-week outpatient rate and annual inpatient rate from the 5th National Health Service Survey of Shaanxi Province. The concentration index of each factor was decomposed into the contribution of each factor to the economic-related inequality of health service utilization based on the Probit regression model. The horizontal inequity indexes of the two-week outpatient rate was 0.0493, and the horizontal inequity indexes of the annual impatient rate was 0.0869. The contributions of economic status to the two indexes were 190.71% and 115.80%, respectively. Economic status, age, basic medical insurance, educational status, marital status, urban/rural area, and self-rated health were the main impact factors that affected the inequality in women's health services utilization in Shaanxi. Health service utilization was different between women with different social demographic characteristics, and unequal health service utilization is evident among women in Shaanxi.
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Chartier, Karen G.; Caetano, Raul
2011-01-01
Background During the early 1990s in the U.S., changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10-year period from 1991-1992 to 2001-2002 among U.S. Whites, Blacks and Hispanics. Method Data come from two household surveys of the U.S. adult population. The 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted face-to-face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUD). Results From 1991-1992 to 2001-2002, drinking-related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, Blacks and Hispanics were less likely than Whites to use private health professional care. Hispanics with AUDs were less likely than Whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, Blacks and Hispanics were less likely than Whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for Blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions Our findings showed increases from 1991-1992 to 2001-2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to Whites. These utilization trends for Blacks and Hispanics may reflect underlying disparities in health care access for minority groups, and language and logistical barriers to utilizing services. PMID:21575015
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Turan, Janet M.; Onono, Maricianah; Steinfeld, Rachel L.; Shade, Starley B.; Owuor, Kevin; Washington, Sierra; Bukusi, Elizabeth A.; Ackers, Marta L.; Kioko, Jackson; Interis, Evelyn C.; Cohen, Craig R.
2015-01-01
Background Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. The current study aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes. Methods ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or non-integrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), while control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. Results HIV care enrollment was higher in intervention compared to control clinics (69% versus 36%, Odds Ratio (OR)=3.94, 95% Confidence Interval (CI): 1.14–13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio (HR)=2.20, 95% CI: 1.62–3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%, OR=3.22, 95% CI: 1.81–5.72). Infant testing was more common in the intervention arm (25% versus 18%), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Conclusions Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions. PMID:25967269
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Variation in outpatient mental health service utilization under capitation.
Chou, Ann F; Wallace, Neal; Bloom, Joan R; Hu, Teh-Wei
2005-03-01
To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services. This study assessed outpatient service delivery to Medicaid-eligible consumers under this program. This paper is among the first to study variations in the delivery of specific types of outpatient mental health services under capitated financing systems. This study uses claims data (1994-1997) from Colorado's Medicaid and Mental Health Services Agency. The fee-for-service (FFS) model served as the comparison model. Two capitated models under evaluation are: (i) direct capitation (DC), where the state contracts with a non-profit entity to provide both the services and administers the capitated financing, and (ii) managed behavioral health organization (MBHO), which is a joint venture between a for-profit company who manages the capitated financing and a number of non-profit entities who deliver the services. A sample of severely mentally ill patients who reported at least one inpatient visit was included in the analysis. Types of outpatient services of interest are: day-treatment visits, group therapy, individual therapy, medication monitoring, case management, testing, and all other services. Comparisons were set up to examine differences in service utilization and cost between FFS and each of the two capitated models, using a two-part model across three time periods. Results showed differences in service delivery among reimbursement models over time. Capitated providers had higher initial utilization in most outpatient service categories than their FFS counterparts and as a result of capitation, outpatient services delivered under these providers decreased to converge to the FFS pattern. Findings also suggest substitution between group therapy and individual psychotherapy. Overall, more service integration was observed and less complex service packages were provided post capitation. IMPLICATION FOR HEALTH CARE PROVISION AND POLICIES: Financing models and organizational arrangements have an impact on mental health service delivery. Changes in utilization and costs of specific types of outpatient services reflect the effects of capitation. Understanding the mechanism for these changes may lead to more streamlined service delivery allowing extra funding for expanding the range of cost-effective treatment alternatives. These changes pose implications for improving the financing of public mental health systems, coordination of mental health services with other healthcare and human services, and provision of services through a more efficient financing system.
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47 CFR 101.521 - Spectrum utilization.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 47 Telecommunication 5 2012-10-01 2012-10-01 false Spectrum utilization. 101.521 Section 101.521 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All...
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47 CFR 101.521 - Spectrum utilization.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 47 Telecommunication 5 2014-10-01 2014-10-01 false Spectrum utilization. 101.521 Section 101.521 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All...
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47 CFR 101.521 - Spectrum utilization.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 47 Telecommunication 5 2013-10-01 2013-10-01 false Spectrum utilization. 101.521 Section 101.521 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES FIXED MICROWAVE SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All...
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Code of Federal Regulations, 2010 CFR
2010-10-01
... and/or distribution service, quality assurance, system reliability, system operation and maintenance... CONTRACTING ACQUISITION OF UTILITY SERVICES Acquiring Utility Services 41.202 Procedures. (a) Prior to executing a utility service contract, the contracting officer shall comply with parts 6 and 7 and 41.201 (d...
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Yadav, Awdhesh; Kesarwani, Ranjana
2016-01-01
This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.
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Lee, Jin Yong; Jo, Min-Woo; Yoo, Weon-Seob; Kim, Hyun Joo; Eun, Sang Jun
2014-12-01
This study aims to estimate the volume of unnecessarily utilized hospital outpatient services in Korea and quantify the total cost resulting from the inappropriate utilization. The analysis included a sample of 27,320,505 outpatient claims from the 2009 National Inpatient Sample database. Using the Charlson Comorbidity Index (CCI), patients were considered to have received 'unnecessary hospital outpatient utilization' if they had a CCI score of 0 and were concurrently admitted to hospital for treatment of a single chronic disease - hypertension (HTN), diabetes mellitus (DM), or hyperlipidemia (HL) - without complication. Overall, 85% of patients received unnecessary hospital services. Also hospitals were taking away 18.7% of HTN patients, 18.6% of DM and 31.6% of HL from clinics. Healthcare expenditures from unnecessary hospital outpatient utilization were estimated at: HTN (94,058 thousands USD, 38.6% of total expenditure); DM (17,795 thousands USD, 40.6%) and HL (62,876 thousands USD, 49.1%). If 100% of patients who received unnecessary hospital outpatient services were redirected to clinics, the estimated savings would be 104,226 thousands USD. This research proves that approximately 85% of hospital outpatient utilizations are unnecessary and that a significant amount of money is wasted on unnecessary healthcare services; thus burdening the National Health Insurance Service (NHIS) and patients.
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Shannon, Candice A.; Rospenda, Kathleen M.; Richman, Judith A.
2007-01-01
This study constitutes the first national longitudinal survey to address the relationship between workplace harassment and service utilization. We examine how patterns of sexual harassment and generalized workplace harassment are linked to utilization of mental health, health, legal, spiritual, and work-related services, and whether and how gender influences these relationships. Data derive from a random digit dial telephone survey with a continental U.S. sample of employed adults. Eligibility criteria were being 18 years of age or over, and being employed at least 20 hours per week at some time in the 12 months prior to the wave 1 survey. Out of 4,116 households with eligible individuals, 2,151 agreed to participate at wave 1. 1,418 participated at wave 2, thus, the overall response rate was 34.5%. We show that the patterning of workplace harassment over two time points (chronic, remission, onset, never harassed) is associated with the use of different types of services. Gender partially moderated the relationship between workplace harassment and services. PMID:17166642
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2011-01-01
Background Large numbers of unmarried migrants are on the continuous move from rural-to-urban areas within China mainland, meanwhile their Reproductive Health (RH) is underserved when it is compared with the present urban RH policies. The purpose of this study is to investigate the RH knowledge and the utilization of RH services among unmarried migrants. Methods A cross-section survey was performed in three cities in China-Shenzhen, Guangzhou and Wuhan. A total of 3,450 rural-to-urban unmarried migrants were chosen according to a purposive sampling method. Around 3,412 (male: 1,680, female: 1,732) were qualified for this study. A face-to-face structured questionnaire survey was used, which focused on the knowledge concerning "fertility, contraception and STD/AIDS," as well as RH service utilization. Results Among unmarried migrants the RH knowledge about pregnancy-fertilization (29.4%) and contraception (9.1%) was at its lowest level. Around 21% of unmarried migrants had pre-marital sexual experience and almost half (47.4%) never used condoms during sexual intercourse. The most obtained RH services was about STD/AIDS health education (female: 49.6%, male: 50.2%) and free prophylactic use of contraceptives and/or condoms (female: 42.5%, male: 48.3%). As for accessing RH checkup services it was at its lowest level among females (16.1%). Those who migrated to Shenzhen (OR = 0.64) and Guangzhou (OR = 0.53) obtained few RH consultations compared to those in Wuhan. The white collar workers received more RH consultations and checkup services than the blue collar workers (all group P < 0.01). Conclusion RH knowledge and the utilization of RH services amongst unmarried migrants remain insufficient in the three studied major cities. This study reveals the important gaps in the RH services' delivery, and highlights the requirements for tailored interventions, including further research, to address more effectively the demands and the needs of the unmarried migrant populations. PMID:21284893
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Grazier, Kyle L; Eisenberg, Daniel; Jedele, Jenefer M; Smiley, Mary L
2016-04-01
This study evaluated utilization of mental health and substance use services among enrollees at a large employee health plan following changes to benefit limits after passage in 2008 of federal mental health parity legislation. This study used a pre-post design. Benefits and claims data for 43,855 enrollees in the health plan in 2009 and 2010 were analyzed for utilization and costs after removal of a 30-visit cap on the number of covered mental health visits. There was a large increase in the proportion of health plan enrollees with more than 30 outpatient visits after the cap's removal, an increase of 255% among subscribers and 176% among dependents (p<.001). The number of people near the 30-visit limit for substance use disorders was too few to observe an effect. Federal mental health parity legislation is likely to increase utilization of mental health services by individuals who had previously met their benefit limit.
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ERIC Educational Resources Information Center
Smith, Kristi Johnson
2010-01-01
This qualitative study explores the impact of experienced teachers' stories on pre-service teachers. Specifically, it examines what stories pre-service teachers hear and remember, if/how those stories impact thoughts or actions, and what factors influence impact. Analyzing pre-service teachers' reactions to stories and utilizing their direct…
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1999-01-01
published in December of 1998. In addition, Mr. Drake is the author of a theme article entitled: "Measuring Software Quality: A Case Study...and services may run on different platforms in differing combinations , • Partial application failure (e.g., a client running, service down) is...result in a combined utility function that is some aggregation of the underlying utility functions. The benefit a client receives from a service
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Chung, Shiu-Dong; Liu, Shih-Ping; Li, Hsien-Chang; Lin, Herng-Ching
2014-01-01
This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001) as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001) than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001) as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001) as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.
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Effects of Educational Beliefs on Attitudes towards Using Computer Technologies
ERIC Educational Resources Information Center
Onen, Aysem Seda
2012-01-01
This study, aiming to determine the relationship between pre-service teachers' beliefs about education and their attitudes towards utilizing computers and internet, is a descriptive study in scanning model. The sampling of the study consisted of 270 pre-service teachers. The potential relationship between the beliefs of pre-service teachers about…
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Exploring Service Learning Outcomes in Students: A Mixed Methods Study for Nursing
ERIC Educational Resources Information Center
Martin, John F.
2017-01-01
This mixed methods study exploring student outcomes of service learning experiences is inter-disciplinary, near the intersection of higher education research, moral development, and nursing. The specific problem examined in this study is that service learning among university students is utilized by educators, but largely without a full…
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Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F
2015-01-01
ABSTRACT Background: Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. Methods: The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. Conclusion: The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China. PMID:27398940
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Sánchez-García, Sergio; de la Fuente-Hernández, Javier; Juárez-Cedillo, Teresa; Mendoza, José Manuel Ortega; Reyes-Morales, Hortensia; Solórzano-Santos, Fortino; García-Peña, Carmen
2007-01-01
Background The aging population poses a challenge to Mexican health services. The aim of this study is to describe recent oral health services utilization and its association with socio-demographic characteristics and co-morbidity in Mexican Social Security beneficiaries 60 years and older. Methods A sample of 700 individuals aged 60+ years was randomly chosen from the databases of the Mexican Institute of Social Security (IMSS). These participants resided in the southwest of Mexico City and made up the final sample of a cohort study for identifying risk factors for root caries in elderly patients. Sociodemographic variables, presence of cognitive decline, depression, morbidity, medication consumption, and utilization of as well as reasons for seeking oral health services within the past 12 months were collected through a questionnaire. Clinical oral assessments were carried out to determine coronal and root caries experience. Results The sample consisted of 698 individuals aged 71.6 years on average, of whom 68.3% were women. 374 participants (53.6%) had made use of oral health services within the past 12 months. 81% of those who used oral health services sought private medical care, 12.8% sought social security services, and 6.2% public health services. 99.7% had experienced coronal caries and 44.0% root caries. Female sex (OR = 2.0), 6 years' schooling or less (OR = 1.4), and caries experience in more than 22 teeth (OR = 0.6) are factors associated with the utilization of these services. Conclusion About half the elderly beneficiaries of social security have made use of oral health services within the past 12 months, and many of them have to use private services. Being a woman, having little schooling, and low caries experience are factors associated with the use of these services. PMID:18154658
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Need, access, and the reach of integrated care: A typology of patients.
Bridges, Ana J; Villalobos, Bianca T; Anastasia, Elizabeth A; Dueweke, Aubrey R; Gregus, Samantha J; Cavell, Timothy A
2017-06-01
This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Predictors of safe delivery service utilization in arsi zone, South-East ethiopia.
Abera, Mulumebet; Gebremariam, Abebe; Belachew, Tefera
2011-08-01
Evidence show that lack of access to and use of, essential obstetric care services to be a crucial factor that contributes to the high maternal morbidity and mortality. Skilled attendance during labor, delivery and early post-partum period could reduce deaths due to obstructed labor, hemorrhage, sepsis and eclampsia. There is limited information on the mothers' use of skilled delivery services in the study area. This study assessed the predictors of safe delivery service utilization in Arsi Zone, Southeast Ethiopia. A cross- sectional community based study using quantitative and qualitative methods was conducted from February 15(th) to March 15(th) 2006. A total of 1089 women who had at least one birth one year prior to the study were involved in the study from nine rural and four urban kebeles in three Woredas (Districts) selected using a systematic sampling method from all households in the study area. A pre-tested structured interviewer administered questionnaire was used to collect data. Information on the utilization of safe delivery service and socio-demographic, individual and institutional factors and past obstetric history were collected. Focus Group Discussion guide was used for qualitative data collection. The data were edited, cleaned, and entered into a computer and analyzed using SPSS for windows version 12.0. One thousand seventy four women who had at least one birth were interviewed making a response rate 98.6%. Two hundred seventy one (75.0%) of urban and 373(52.0%) rural women received antenatal care from skilled health professional at least once during their last pregnancy. Thirty-one (4.3%) of rural and 145 (40.4%) of urban women delivered in health institution. In multivariate analysis showed that residential area OR= 8.5, 95%CI; (5.1,13.9), parity OR=0.18, 95%CI; (0.08, 0.42), and ANC service use OR= 4.5, 95%CI; (2.2,8.9), and maternal education OR=4.6, 95%CI; (1.7,12.8), were most significant predictors of safe delivery service use by mothers (P< 0.01). Birth attended by skilled personnel was low in the study area. Maternal education, her birth experience and her use of prenatal services are important predictors. Promoting information, education and communication on safe delivery service utilization, expansion of health service and empowerment of women are needed.
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Health-care utilization and associated factors in Gauteng province, South Africa.
Abera Abaerei, Admas; Ncayiyana, Jabulani; Levin, Jonathan
2017-01-01
More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88-2.53; p < 0.001), being White compared to being African (OR = 2.28, 95% CI: 1.84-2.74; p < 0.001), and having medical insurance (OR = 5.41, 95% CI: 4.06-7.23; p < 0.001). Lower odds of seeking health-care were associated with being an immigrant (OR = 0.61, 95% CI: 0.53-0.70; p < 0.001). The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.
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Cunningham, Chinazo O; Sohler, Nancy L; McCoy, Kate; Heller, Daliah; Selwyn, Peter A
2005-10-01
As part of a multisite initiative to evaluate outreach targeting underserved HIV-infected individuals, we describe baseline characteristics of unstably housed HIV-infected individuals from New York City, and their health care access and utilization patterns. Interviews with 150 HIV-infected single room occupancy (SRO) hotel residents on health care access and utilization, barriers to accessing health care, demographic characteristics, history of incarceration, severity of HIV disease, depressive symptoms, substance use, and exposure to violence were conducted. Most participants were 40 years of age or older, male, black or Latino, had public insurance, a history of substance use, depressive symptoms, and a CD4(+) count above 200 cells/mm(3). Access to and utilization of care was high with 91% reporting having a regular provider, 95% identifying a non-emergency department (ED) clinic or office as their usual location of care, 89% reporting at least one ambulatory visit, and 82% reporting optimal (>/=2) ambulatory visits during the previous 6 months. Additionally, 45% reported at least one ED visit, and 30% at least one hospitalization within the previous 6 months. Among black and Latino marginalized SRO hotel residents in New York City, this study found surprisingly high measures of access to and utilization of ambulatory care services, along with high use of acute care services. Understanding HIV-related health services access and utilization patterns among marginalized populations is essential to improve their HIV care. These patterns of high levels of access to and utilization of health care services contradict clinical experiences and other studies, and require further exploration.
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ERIC Educational Resources Information Center
Velez Ortiz, Daniel
2009-01-01
The main purpose of this study was to examine the role of mental health services structure in community senior centers and how it interacts with Puerto Rican older adults' historical, social, and cultural experiences to relate to their perceptions, awareness, and utilization of mental health services. The study was carried out within a concurrent…
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Huang, Ren-Yeong; Lin, Yuh-Feng; Kao, Sen-Yeong; Shieh, Yi-Shing; Chen, Jin-Shuen
2014-01-01
To determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD). A total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000-2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy. OPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD. Patients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study.
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Utility Energy Services Contracts: Enabling Documents
DOE Office of Scientific and Technical Information (OSTI.GOV)
Thomas, Karen; Vasquez, Deb
The Federal Energy Management Program's 'Utility Energy Service Contracts: Enabling Documents' provide legislative information and materials that clarify the authority for federal agencies to enter into utility energy service contracts, or UESCs.
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Negero, Melese Girmaye; Mitike, Yifru Berhan; Worku, Abebaw Gebeyehu; Abota, Tafesse Lamaro
2018-01-30
Because of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as "Women's Health Development Army" (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known. A community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service. About 45% of women have received skilled delivery care. A significant heterogeneity was observed between "Women's Health Development Teams (clusters)" for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization. In this study, significant variation among clusters of WHDA was observed. Both individual and cluster level variables were identified to predict skilled delivery service utilization. Encouraging women to have frequent ANC visits (- 4 and above), enhancing awareness creation towards the delivery care attendance, constructing more health facilities and roads in hard to reach areas and establishing telemedicine services are recommended.
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ERIC Educational Resources Information Center
Cheng, Tyrone C.; Lo, Celia C.
2010-01-01
This research is a secondary data analysis of the impact of adolescents' mental/substance-use disorders and dual diagnosis on their utilization of drug treatment and mental health services. By analyzing the same teenagers who participated in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, logistic…
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ERIC Educational Resources Information Center
Chen, Chuan-Yu; Liu, Chieh-Yu; Su, Wen-Chuan; Huang, Su-Ling; Lin, Keh-Ming
2008-01-01
The present study examines urbanicity-related differences in help-seeking process among preschool children with autism and investigates the factors associated with utilization of autism-related services within the year of diagnosis. Using the 1997-2004 National Health Insurance Research Database (NHIRD) in Taiwan, we identified a total of 3495…
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ERIC Educational Resources Information Center
Clifasefi, Seema L.; Collins, Susan E.; Tanzer, Kenneth; Burlingham, Bonnie; Hoang, Sara E.; Larimer, Mary E.
2011-01-01
Public service utilization data are often used as key outcomes in studies on homelessness. Although self-report data on these outcomes are accessible and cost-effective, various factors may affect retrospective recall in homeless populations. It is therefore necessary to establish validity of self-report to ensure the integrity of studies…
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Fottler, Myron D; Dickson, Duncan; Ford, Robert C; Bradley, Kenneth; Johnson, Lee
2006-02-01
The measurement of patient satisfaction is crucial to enhancing customer service and competitive advantage in the health-care industry. While there are numerous approaches to such measurement, this paper provides a case study which compares and contrasts patient and staff perceptions of customer service using both survey and focus group data. Results indicate that there is a high degree of correlation between staff and patient perceptions of customer service based on both survey and focus group data. However, the staff and patient subgroups also provided complementary information regarding patient perceptions of their service experience. Staff members tended to have more negative perceptions of service attributes than did the patients themselves. The focus group results provide complementary information to survey results in terms of greater detail and more managerially relevant information. While these results are derived from a pilot study, they suggest that diversification of data sources beyond patient surveys may enhance the utility of customer service information. If further research can affirm these findings, they create exciting possibilities for gathering valid, reliable and cost-effective customer service information.
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Rothbard, Aileen B; Kuno, Eri; Hadley, Trevor R; Dogin, Judith
2004-01-01
A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs.
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Does quality influence utilization of primary health care? Evidence from Haiti.
Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E
2018-06-20
Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.
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Saito, Eiko; Gilmour, Stuart; Yoneoka, Daisuke; Gautam, Ghan Shyam; Rahman, Md Mizanur; Shrestha, Pradeep Krishna; Shibuya, Kenji
2016-01-01
Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers. PMID:26856362
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Baer, John S; Garrett, Sharon B; Beadnell, Blair; Wells, Elizabeth A; Peterson, Peggy L
2007-12-01
A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth.
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Outreach in the Delivery of Mental Health Services to Hispanic Elders.
ERIC Educational Resources Information Center
Szapocznik, Jose; And Others
1979-01-01
The study investigated the effectiveness of two outreach/education modalities established to increase the utilization of mental health services by Hispanic elders: (1) a service delivery modality, and (2) a mass media modality. (NQ)
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Luginaah, Isaac N; Kangmennaang, Joseph; Fallah, Mosoka; Dahn, Bernice; Kateh, Francis; Nyenswah, Tolbert
2016-07-01
In Liberia, 75% of those who died from 2014 Ebola epidemic were women and the effects of this gruelling epidemic were more severely felt by pregnant women. This immediately raised fears about the long-term impacts of the epidemic on maternal and child health. As part of a larger study, this paper uses Andersen's behavioural model of health care utilization and Goffman's stigma theory to explain the timing and utilization of maternal health services before the outbreak of the Ebola epidemic as a background to the potential long-term effects on maternal health. We conducted survival and multiple regression analysis using the 2007 (N = 3524) and 2013 (N = 5127) Liberia's Demographic and Health Survey (LDHS) data. Our sample consisted of women of reproductive age (15-49 years) that had given birth in the last five years preceding the survey year. The findings show that from 2007 to 2013, there was an overall improvement in the timing of first antenatal care (ANC) visits (TR = 0.92, p < 0.001), number of ANC visits and delivery with skilled birth attendants. The results also show county and regional disparities in the utilization of ANC services with South Eastern A region emerging as a relatively vulnerable place. Also, access to ANC services defined by distance to a health facility strongly predicted utilization. We argue that the Ebola epidemic likely eroded many of the previous gains in maternal health care, and may have left a lingering negative effect on the access and utilization of maternal health services in the long-term. The study makes relevant policy recommendations. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Kawazoe, Nobuo; Liu, Guoxiang; Chiang, Chifa; Zhang, Yan; Aoyama, Atsuko
2015-01-01
ABSTRACT A new public health insurance scheme has been gradually introduced in rural provinces in China since 2003. This would likely cause an increment in the use of health services. It is known that the association between health insurance coverage and health service utilization varies among different age groups. This study aims to examine the association between extending health insurance coverage and increment in outpatient service utilization of small children in rural China, and to identify other factors associated with the outpatient service utilization. A household survey was conducted in 2 counties in north China in August 2010, targeting 107 selected households with a child aged 12–59 months. The questionnaire included modules on demographic information such as ages of children and parents, enrollment status of health insurance, the number of episodes of illness as perceived by parents, month of incidence of episode and outpatient service utilization at each episode. Based on the utilization at each episode of illness, a random effects logistic regression model was employed to analyze the association. It was found that eligibility for the reimbursement of outpatient medical expenses was not significantly associated with decision to seek care or choice of health facility. This might be in part due to the low level of reimbursement which could discourage the use of insured, and to the close relationship with village clinic workers which would encourage the use of uninsured. Three other factors were significantly associated with increment in the outpatient service utilization; age of children, mother’s education, and number of children in a household. PMID:26412893
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Nathan, Lisa M.; Shi, Quihu; Plewniak, Kari; Zhang, Charles; Nsabimana, Damien; Sklar, Marc; Mutimura, Eugene; Merkatz, Irwin R.; Einstein, Mark H.; Anastos, Kathryn
2015-01-01
To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB. PMID:25652061
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Khairnar, Rahul; Mishra, Mark V; Onukwugha, Eberechukwu
2018-02-16
Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.
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2012-01-01
Background Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients’ functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Methods Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. Results The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). Conclusions In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet. PMID:22898402
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Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis.
Worku, Abebaw Gebeyehu; Yalew, Alemayehu Worku; Afework, Mesganaw Fantahun
2013-04-15
The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.
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Electric utilities, fiscal illusion and the provision of local public services
NASA Astrophysics Data System (ADS)
Dowell, Paula Elizabeth Kay
2000-10-01
Restructuring activity in the electric utility industry is threatening a once stable and significant source of revenue for local governments. Potentially declining revenues from electric utilities leaves local policymakers with the unpopular decision of raising taxes or reducing the level of public services provided. This has led to pressure on state governments to introduce legislation aimed at mitigating potential revenue loss for local government due to restructuring activity. However, before imposing such legislation, a better understanding of the potential distortionary effects of internal subsidization by electric utilities is needed. Two models of the demand for local public services--a structural model using the Stone-Geary utility framework and a reduced form model--are developed in an attempt to model the behavioral responses of local public expenditures to revenue contributions from electric utilities. Empirical analysis of both models is conducted using a panel data set for 242 municipalities in Tennessee from 1988 to 1998. Aggregate spending and expenditures on four specific service functions are examined. The results provide evidence of a positive flypaper effect. Furthermore, the source of the flypaper effect is attributed to fiscal illusion caused by price distortions. The stimulative effect of electric utility revenue contributions on the level of local public services indicate that a 1.00 change in electric utility subsidies results in a change in local expenditures ranging from 0.22 to 1.32 for the structural model and 1.97 to 2.51 for the reduced form model. The amount of the marginal effect directly attributed to price illusion is estimated to range from 0.04 to $0.85. In addition, the elasticities of electric utility revenue contributions are estimated to range from 0.05 to 0.90. The results raise a number of interesting issues regarding municipal ownership of utilities and legislation regarding tax treatment of utilities after restructuring. The fact that the current study suggests that electric utility subsidies give rise to fiscal illusion raises new questions regarding the justification of safeguarding the exclusive franchise of municipally-owned utilities and revenues from electric utilities in the era of restructuring.
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Nie, Juan; Unger, Jennifer Anna; Thompson, Susan; Hofstee, Marisa; Gu, Jing; Mercer, Mary Anne
2016-07-23
Increasingly popular mobile health (mHealth) programs have been proposed to promote better utilization of maternal, newborn and child health services. However, women who lack access to a mobile phone are often left out of both mHealth programs and research. In this study, we determine whether household mobile phone ownership is an independent predictor of utilization of maternal and newborn health services in Timor-Leste. The study included 581 women aged 15-49 years with a child under the age of two years from the districts of Manufahi and Ainaro in Timor-Leste. Participants were interviewed via a structured survey of knowledge, practices, and coverage of maternal and child health services, with additional questions related to ownership and utilization of mobile phones. Mobile phone ownership was the exposure variable, and the dependent variables included having at least four antenatal care visits, skilled birth attendance, health facility delivery, a postnatal checkup within 24 h, and a neonatal checkup within 24 h for their youngest child. Logistic regression models were applied to assess for associations. Sixty-seven percent of women reported having at least one mobile phone in the family. Women who had a mobile phone were significantly more likely to be of higher socioeconomic status and to utilize maternal and newborn health services. However, after adjusting socioeconomic factors, household mobile phone ownership was not independently associated with any of the dependent variables. Evaluations of the effects of mHealth programs on health in a population need to consider the likelihood of socioeconomic differentials indicated by mobile phone ownership.
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Impact of referral transport system on institutional deliveries in Haryana, India.
Prinja, Shankar; Jeet, Gursimer; Kaur, Manmeet; Aggarwal, Arun Kumar; Manchanda, Neha; Kumar, Rajesh
2014-06-01
Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Female gender (OR=77.7), rural place of residence (OR=5.96) and poor socio-economic status (poorest wealth quintile OR=2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI=-137.4 to 146.4) district. The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres.
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Gao, Jianmin; Zhou, Zhongliang; Yan, Ju’e; Xu, Yongjian; Yang, Xiaowei; Li, Yanli
2017-01-01
Objective This study sought to examine the sources of inequity in health examination service utilization by women from underdeveloped areas in western China. Methods Based on data from the 5th National Health Service Survey in Shaanxi province, women’s utilization of health examination services was examined according to gynecological, cervical smear, and breast examination rates. The equity of health examination service utilization by 15- to 64-year-old women and the factors contributing to inequity were determined using the health concentration index, decomposition of the concentration index, and the horizontal inequity index. Results The examination rates for gynecological, cervical smear, and breast exams for 15- to 64-year-old women in Shaanxi province were 40.61%, 27.08%, and 24.59%, respectively. The horizontal inequity indices of gynecological, cervical smear, and breast examination rates were 0.0480, 0.0423, and 0.0764, respectively, and each examination rate was higher for wealthy individuals. The contribution rates of economic status to the inequalities in gynecological, cervical smear, and breast examination rates were 65.80%, 74.31%, and 56.49%, respectively. The contribution rates of educational status to the inequalities in gynecological, cervical smear, and breast examination rates were 21.01%, 14.83% and 30.00%, respectively. The contribution rates of age to the inequalities in gynecological, cervical smear, and breast examination rates were 25.77%, 26.55%, and 18.40%, respectively. Conclusions Women’s health examination rates differed between populations with different socio-demographic characteristics. There is pro-wealth inequality in each examination rate. This study found that financial status, age, and education level were the main reasons for the unequal utilization of health examination services. PMID:29065129
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Morina, Nexhmedin; Emmelkamp, Paul M G
2012-05-11
The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.
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2012-01-01
Background The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. Methods 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Results Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. Conclusion War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population. PMID:22578096
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Patel, Rachana; Ladusingh, Laishram
2015-01-01
This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007–08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women’s residing in more urbanized districts increased the utilization. “Inter-district” variation was 14 percent whereas “between-villages” variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation. PMID:26689199
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Patel, Rachana; Ladusingh, Laishram
2015-01-01
This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007-08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women's residing in more urbanized districts increased the utilization. "Inter-district" variation was 14 percent whereas "between-villages" variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation.
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Perceptions about Iranian-Kurds' ethnic-inequality in health.
Yari, Arezoo; Nedjat, Saharnaz; Asadi-Lari, Mohsen; Majdzadeh, Reza
2017-09-12
Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people's perception on inequality of health in Iranian-Kurds and its determinants. The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel. Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization. Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People's awareness, resources management and allocation are factors requiring more consideration when choosing policy options.
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Lee, Minsun; Takeuchi, David; Gellis, Zvi; Kendall, Philip; Zhu, Lin; Zhao, Shanyang; Ma, Grace X
2017-08-01
The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.
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Jiang, Ying; Zeng, Qingqi; Ji, Ying; Wang, Yanling; Zheng, Yunting; Chang, Chun
2015-01-01
To investigate health literacy and enterprise provided health service utilization among migrants in construction sites and explore the influencing factors of enterprise provided health service utilization. All 652 migrants in 10 construction sites in Xi'an and Tongchuan were selected using stratified cluster sampling method, and health literacy level, occupational health awareness and enterprise provided health service utilization of migrants were investigated in 2013 April to June.Score and pass rate was used to describe status of health literacy and occupational health awareness of migrants. Chi-square was used to analyze the difference of occupational health awareness and enterprise provided health service utilization between migrants of different levels of health literacy. And logistic regression was used to analyze the influencing factors of enterprise provided health service utilization. Average score of health literacy among migrants in construction site was (3.75 ± 2.17) (9 score totally). Migrants who knew enterprise should provide health training, physical examination, safety training, occupational protection and pay health insurance for workers accounted for 28.2% (174/616), 43.5% (268/616), 52.8% (325/616), 54.9% (338/616) and 37.7% (230/616) respectively, and the percentage of migrants who thought there were noise and dust in their working environment were 46.4% (201/627) and 44.8% (281/627) respectively.61.1% (373/610) received none of health training, occupational training, physical examination and first-aid kit, and only 0.8% (5/610) had utilized all of the above health service in workplace. And logistic regression showed that migrants whose health literacy score was higher than 5 had 1.819 times probability to utilize enterprise provided health service (OR = 1.82, 95%CI:1.13-2.92) , and migrants who were educated for more than 13 years had 3.812 times probability to utilize enterprise provided health service than those who were educated for less than 6 years (OR = 3.81, 95%CI:1.75-8.31) .However, occupational health awareness had no significant influence to the utility of enterprise provided health service utilization in logistic regression (χ(2) = 3.50, P = 0.061). Occupational health awareness and enterprise provided health service utilization were both low among migrants in construction site, level of health literacy and school years were the main factors that influence enterprise provided health service utilization.
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The Emotional Component of Service-Learning
ERIC Educational Resources Information Center
Carson, Russell L.; Domangue, Elizabeth A.
2013-01-01
The interest in and acceptance of service-learning has insufficiently addressed the inextricable emotional linkage to all of its functions. Utilizing Coles' (1993) conceptualization of the intricate role of emotion in service-learning, this study explored how and why emotion and feeling are central to college students' service-learning…
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Beliveau, Peter J H; Wong, Jessica J; Sutton, Deborah A; Simon, Nir Ben; Bussières, André E; Mior, Silvano A; French, Simon D
2017-01-01
Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
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Williams, Uzma; Rosenbaum, Peter; Gorter, Jan Willem; McCauley, Dayle; Gulko, Roman
2018-05-25
'About My Child' 19-item version (AMC-19) is a parent-report measure developed to assess the complexity of a child's life due to biological, psychological, social and environmental issues, that can be completed in approximately 5 min. AMC measures two dimensions of complexity: parental concerns and impact on the child. This paper examines the psychometric properties and parent-reported utility of the AMC-19 for children with disabilities or special health care needs. Data were gathered from two Canadian studies at CanChild: the 'AMC-19 Pilot' study and the 'Service Utilization and Outcomes (SUO)' study. The AMC-19 Pilot study data allowed us to explore internal consistency and test-retest reliability, as well as parental responses to two open-ended questions on the utility of the AMC-19. The SUO study provided data for analyses of internal consistency and scale property validation with type of diagnosis and service needs. The test-retest ICC was r = 0.83 for concerns and r = 0.87 for impact. Cronbach's alpha across both studies ranged from 0.80 to 0.90. Parents' comments on the AMC-19's utility indicated support for the AMC-19, in particular to identify therapy needs and goals. The AMC-19 demonstrates strong psychometric properties supporting it as a valuable measure for describing the level of complexity among children with disabilities. We recommend using the AMC-19 in health services research and clinical settings to build dialogue between family and therapists due to its utility reported by parents.
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Kerr, Zachary Y; Miller, Katye R; Galos, Dylan; Love, Randi; Poole, Charles
2013-02-01
Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who recorded the study methodology, participant demographics, challenges and coping strategies, and recommendations. A number of challenges affecting those in the HIV services field were noted, particularly interpersonal and organizational issues. Coping strategies were problem- and emotion-focused. Summarized research recommendations called for increased support, capacity-building, and structural changes. Future research on challenges and coping strategies must provide up-to-date information to the HIV services field while creating, implementing, and evaluating interventions to manage current challenges and reduce the risk of burnout.
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Psychiatric Disorders and Mental Health Service Use in Patients with Advanced Cancer
Kadan-Lottick, Nina S.; Vanderwerker, Lauren C.; Block, Susan D.; Zhang, Baohui; Prigerson, Holly G.
2006-01-01
BACKGROUND. Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence of diagnosable psychiatric illnesses, and 2) describe the mental health services received and predictors of service utilization in patients with advanced cancer. METHODS. This was a cross-sectional, multi-institutional study of 251 eligible patients with advanced cancer. Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age ≥20 years, stamina for the interview, English or Spanish-speaking, and adequate cognitive ability. Trained interviewers administered the Structured Clinical Interview for the Diagnostic Statistical Manual IV (DSM-IV) modules for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, and a detailed questionnaire regarding mental health service utilization. RESULTS. Overall, 12% met criteria for a major psychiatric condition and 28% had accessed a mental health intervention for a psychiatric illness since the cancer diagnosis. Seventeen percent had discussions with a mental health professional; 90% were willing to receive treatment for emotional problems. Mental health services were not accessed by 55% of patients with major psychiatric disorders. Cancer patients who had discussed psychological concerns with mental health staff (odds ratio [OR] = 19.2; 95% confidence interval [95% CI], 8.90-41.50) and non-Hispanic white patients (OR = 2.7; 95% CI, 1.01-7.43) were more likely to receive mental health services in adjusted analysis. CONCLUSIONS. Advanced cancer patients experience major psychiatric disorders at a prevalence similar to the general population, but affected individuals have a low rate of utilizing mental health services. Oncology providers can enhance utilization of mental health services, and potentially improve clinical outcomes, by discussing mental health concerns with their patients. PMID:16284994
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Workplace Stress, Organizational Factors and EAP Utilization.
Azzone, Vanessa; McCann, Bernard; Merrick, Elizabeth Levy; Hiatt, Deirdre; Hodgkin, Dominic; Horgan, Constance
2009-01-01
This study examined relationships between workplace stress, organizational factors and use of EAP counseling services delivered by network providers in a large, privately-insured population. Claims data were linked to measures of workplace stress, focus on wellness/prevention, EAP promotion, and EAP activities for health care plan enrollees from 26 employers. The association of external environment and work organization variables with use of EAP counseling services was examined. Higher levels of EAP promotion and worksite activities were associated with greater likelihood of service use. Greater focus on wellness/prevention and unusual and significant stress were associated with lower likelihood of service use. Results provide stakeholders with insights on approaches to increasing utilization of EAP services.
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Workplace Stress, Organizational Factors and EAP Utilization
Azzone, Vanessa; McCann, Bernard; Merrick, Elizabeth Levy; Hiatt, Deirdre; Hodgkin, Dominic; Horgan, Constance
2013-01-01
This study examined relationships between workplace stress, organizational factors and use of EAP counseling services delivered by network providers in a large, privately-insured population. Claims data were linked to measures of workplace stress, focus on wellness/prevention, EAP promotion, and EAP activities for health care plan enrollees from 26 employers. The association of external environment and work organization variables with use of EAP counseling services was examined. Higher levels of EAP promotion and worksite activities were associated with greater likelihood of service use. Greater focus on wellness/prevention and unusual and significant stress were associated with lower likelihood of service use. Results provide stakeholders with insights on approaches to increasing utilization of EAP services. PMID:24058322
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Story, William T.; Burgard, Sarah A.
2012-01-01
This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556
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Greenberg, L; Cultice, J M
1997-01-01
OBJECTIVE: The Health Resources and Services Administration's Bureau of Health Professions developed a demographic utilization-based model of physician specialty requirements to explore the consequences of a broad range of scenarios pertaining to the nation's health care delivery system on need for physicians. DATA SOURCE/STUDY SETTING: The model uses selected data primarily from the National Center for Health Statistics, the American Medical Association, and the U.S. Bureau of Census. Forecasts are national estimates. STUDY DESIGN: Current (1989) utilization rates for ambulatory and inpatient medical specialty services were obtained for the population according to age, gender, race/ethnicity, and insurance status. These rates are used to estimate specialty-specific total service utilization expressed in patient care minutes for future populations and converted to physician requirements by applying per-physician productivity estimates. DATA COLLECTION/EXTRACTION METHODS: Secondary data were analyzed and put into matrixes for use in the mainframe computer-based model. Several missing data points, e.g., for HMO-enrolled populations, were extrapolated from available data by the project's contractor. PRINCIPAL FINDINGS: The authors contend that the Bureau's demographic utilization model represents improvements over other data-driven methodologies that rely on staffing ratios and similar supply-determined bases for estimating requirements. The model's distinct utility rests in offering national-level physician specialty requirements forecasts. Images Figure 1 PMID:9018213
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Feurer, D A; Weaver, C L; Gallagher, K C
1980-01-01
Until April 1, 1979, the Public Service Commission had been vested with exclusive jurisdiction over the regulation of rates and service of utilities. As of that date two new agencies, the Energy Regulatory Commission (ERC) and the Utility Regulatory Commission (URC), have replaced the Public Service Commission. The ERC consists of three full-time members appointed by the governor for four year terms and is responsible for enforcing the provisions of the Kentucky statutes relating to electric and gas utilities. The three-member URC is responsible for enforcing the provisions relating to non-energy utilities such as telephone, sewer, and water utilities. Themore » statutes vest all regulatory authority over public utilities in either the ERC or the URC. Local governments retain only the power to grant local franchises. However, it should be noted, that any utility owned or operated by a political subdivision of the state is exempt from regulation. Thus, local government has complete authority over utilities which are self-owned. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less
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Garvey Wilson, Abigail L; Messer, Stephen C; Hoge, Charles W
2009-06-01
Health care utilization studies of mental disorders focus largely on the ICD-9 category 290-319, and do not generally include analysis of visits for mental health problems identified under V-code categories. Although active duty service members represent a large young adult employed population who use mental health services at similar rates as age-matched civilian populations, V-codes are used in a larger proportion of mental health visits in military mental health care settings than in civilian settings. However, the utilization of these diagnoses has not been systematically studied. The purpose of this study is to characterize outpatient behavioral health visits in military health care facilities prior to Operation Iraqi Freedom, including the use of diagnoses outside of the ICD-9 290-319 range, in order to evaluate the overall burden of mental health care. This study establishes baseline rates of mental health care utilization in military mental health clinics in 2000 and serves as a comparison for future studies of the mental health care burden of the current war. All active duty service members who received care in military outpatient clinics in 2000 (n = 1.35 million) were included. Primary diagnoses were grouped according to mental health relevance in the following categories: mental disorders (ICD-9 290-319), mental health V-code diagnoses (used primarily by behavioral health providers that were indicative of a potential mental health problem), and all other diagnoses. Rates of service utilization within behavioral health clinics were compared with rates in other outpatient clinics for each of the diagnostic groups, reported as individuals or visits per 1,000 person-years. Cox proportional hazard regression was used to produce hazard ratios as measures of association between each of the diagnostic groups and attrition from military service. Time to attrition in months was the difference between the date of military separation and the date of first clinic visit in 2000. Data were obtained from the Defense Medical Surveillance System. The total number of individuals who utilized behavioral health services in 2000 was just over 115 per 1,000 person-years, almost 12% of the military population. Out of every 1,000 person-years, 57.5 individuals received care from behavioral health providers involving an ICD-9 290-319 mental disorder diagnosis, and an additional 26.7 per 1,000 person-years received care in behavioral health clinics only for V-code diagnoses. Attrition from service was correlated with both categories of mental health-related diagnoses. After 1 year, approximately 38% of individuals who received a mental disorder diagnosis left the military, compared with 23% of those who received mental health V-code diagnoses and 14% of those who received health care for any other reason (which included well visits for routine physicals). This study establishes baseline rates of pre-war behavioral healthcare utilization among military service members, and the relationship of mental health care use and attrition from service. The research indicates that in the military population the burden of mental illness in outpatient clinics is significantly greater when V-code diagnoses are included along with conventional mental disorder diagnostic codes.
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The effect of an enhanced employee assistance program (EAP) intervention on EAP utilization.
Zarkin, G A; Bray, J W; Karuntzos, G T; Demiralp, B
2001-05-01
An enhanced employee assistance program (EAP) intervention was developed that delivers comprehensive EAP outreach services to all employees who may have alcohol-related and other workplace problems; standard EAP materials traditionally targeted at white men were enhanced to include women and minorities. This study evaluates whether the enhanced EAP intervention increased EAP utilization. The enhanced EAP intervention was developed at a large community-based not-for-profit EAP located in Rockford, Illinois. Two primary worksites and 16 other newly contracted worksites received the enhanced EAP intervention and served as intervention sites; the 107 other worksites serviced by the EAP were used as comparison sites. We used time series data from 1991 to 1998 and included repeated measures on each firm's quarterly EAP utilization. The enhanced EAP intervention increased the mean number of women and minority cases per worksite by 58%, white male cases by 45% and total EAP cases by 53%. This study shows that, for a modest cost, the enhanced EAP intervention successfully increased utilization of EAP by all employees, especially utilization by women and minority employees. It also shows that traditional EAP services and outreach materials can be made more appealing to women and minorities without adversely affecting their utilization by white men.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Barnes, P.R.; Van Dyke, J.W; McConnell, B.W.
It is estimated that electric utilities use about 40 million distribution transformers in supplying electricity to customers in the United States. Although utility distribution transformers collectively have a high average efficiency, they account for approximately 61 billion kWh of the 229 billion kWh of energy lost annually in the delivery of electricity. Distribution transformers are being replaced over time by new, more efficient, lower-loss units during routine utility maintenance of power distribution systems. Maintenance is typically not performed on units in service. However, units removed from service with appreciable remaining life are often refurbished and returned to stock. Distribution transformersmore » may be removed from service for many reasons, including failure, over- or underloading, or line upgrades such as voltage changes or rerouting. When distribution transformers are removed from service, a decision must be made whether to dispose of the transformer and purchase a lower-loss replacement or to refurbish the transformer and return it to stock for future use. This report contains findings and recommendations on replacing utility distribution transformers during routine maintenance, which is required by section 124 of the Energy Policy Act of 1992. The objectives of the study are to evaluate the practicability, cost-effectiveness, and potential energy savings of replacing or upgrading existing transformers during routine utility maintenance and to develop recommendations on ways to achieve the potential energy savings. Using survey data obtained from utilities and analyses of the economics of refurbishment versus replacement of distribution transformers that are removed from service, it is found that on average utilities are implementing reasonable decisions on refurbishment versus replacement.« less
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Health services utilization of women following a traumatic birth.
Turkstra, E; Creedy, D K; Fenwick, J; Buist, A; Scuffham, P A; Gamble, J
2015-12-01
This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.
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Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study
2013-01-01
Background During the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece. Methods A pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson’s ×2 test, ×2 test for trend, Student’s t-test, analysis of variance and Pearson’s correlation coefficient. Results Only 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001). Conclusions The empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services. PMID:24034077
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Trute, B; Hiebert-Murphy, D; Wright, A
2008-05-01
Potential service outcome measures were tested for their utility in the assessment of the quality of 'family centred' service coordination in the provincial network of children's disability services in Manitoba, Canada. This study is based on in-home survey data provided by 103 mothers at 6 and 18 months following assignment of a 'dedicated' service coordinator. Service outcome indicators included measures of parent self-esteem, parenting stress, family functioning and the need for family support resources. Hierarchical regression analyses showed no relationship between level of quality of family-centred service coordination and standardized psychosocial measures of parent and family functioning. However, family centredness of service coordination was found to predict significant reduction in level of family need for psychosocial support resources after 18 months of contact with a service coordinator. Outcome measures that are focused on specific and tangible results of service coordination appear to be of higher utility in service quality assessment than are more global, standardized measures of parent and family functioning.
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Analyzing a Service-Learning Experience Using a Social Justice Lens
ERIC Educational Resources Information Center
Tinkler, Barri; Hannah, C. Lynne; Tinkler, Alan; Miller, Elizabeth
2014-01-01
This mixed methods study explores a service-learning experience embedded in a social foundations course in a teacher education program. The authors differentiate learning outcomes for social justice and charity service-learning, and utilize this framework to examine whether the service-learning experience fosters a social justice perspective. The…
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The association between hospital outcomes and diagnostic imaging: early findings.
Lee, David W; Foster, David A
2009-11-01
Resource use variation across the United States prompts the important question of whether "more is better" when it comes to health care services. The aim of this study was to examine correlations between the use of 4 common imaging modalities (CT, MR, ultrasound, and radiography) and in-hospital mortality and costs. Using clinical and utilization data for 1.1 million inpatient admissions at 102 US hospitals during 2007, two hospital-specific, risk-adjusted imaging utilization measures for each modality were constructed that controlled for patients' demographic and clinical characteristics and for hospital characteristics were constructed for each modality. First, logistic regression was used to estimate the odds that each type of imaging service would be provided during an admission. Second, the mean number of services per admission was estimated using output from a two-part ordinary least squares model. Hospital-specific, risk-adjusted inpatient mortality and total hospital costs were also computed, and correlations between the imaging utilization measures and the mortality and cost outcome measures were then assessed using Pearson's correlation coefficients (P < .05). The correlation analyses were weighted by hospital admission volume. Hospitals in which patients were more likely to receive imaging services during admissions had lower mortality, even after controlling for potential confounders. Correlation coefficients were -0.2 for all modalities (P = .02-.05). Weaker correlations existed between mean services per admission and mortality, while costs trended insignificantly higher with greater utilization. This study lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization.
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Bahramian, Hoda; Mohebbi, Simin Z; Khami, Mohammad Reza; Quinonez, Rocio Beatriz
2018-05-10
Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women's dental service utilization. Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software. Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists' unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies. Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.
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Gross-Panico, Michelle L; Freeman, Wilbur K
2012-01-01
Minority children and children from lower income families are more likely to experience the burden of oral disease. Since oral disease reduces quality of life, it is a priority to utilize preventive dental services. The research questions ask if affiliated practice increases utilization of preventive dental services by underserved children from birth to 18 years of age, and what the barriers to receiving preventive dental services are and their level of importance. A survey was administered to parents/guardians of patients from birth to 18 years of age who received preventive dental services from Catholic Healthcare West East Valley Children's Dental Clinic, an affiliated practice dental clinic in Chandler, Arizona. Thirty-four surveys were completed: 21 completed in English and 13 completed in Spanish. The data was analyzed to provide descriptive statistics and non-parametrically analyzed using the Friedman's, Kendall's W and Wilcoxon Signed Ranks Tests. The cost of preventive dental services is more important to this population than both convenience of appointment time and distance traveled. As the cost increases for preventive dental services, this population will utilize preventive dental services less frequently. The study indicated that the increase of self-reported utilization of preventive dental services by underserved children, ranging in age from birth to 18 years old, in Arizona affiliated practice dental clinics, was primarily impacted by perceived reduced costs of receiving care. Funding efforts, reimbursement mechanisms and legislative policies should support this dental care delivery model to provide care to underserved children, adults and seniors throughout the U.S.
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Integrated care in rural health: Seeking sustainability.
Peterson, Mary; Turgesen, Jeri; Fisk, Laura; McCarthy, Seamus
2017-06-01
The increased awareness of the financial impact associated with social determinants of health coincides with expectations of the Affordable Care Act (HR 3590) to improve care while reducing costs. The integration of behavioral health providers (BHPs) into primary care has demonstrated improved clinical outcomes. This study was designed with 2 aims, including the evaluation of the financial viability of an integrated care model in a rural setting and the demonstration of incorporating practice-based research into clinical work. A rural health plan caring for 22,000 members funded a pilot project placing BHPs in 3 clinics to provide integrated care. Patient utilization of medical services for 6 months following BHP services was compared with baseline utilization. The BHPs treated 256 unique patients, with a total of 459 consultations. The percentage of patients receiving BHP services varied between clinics (Clinic A = 1.4%, Clinic B = 2.7%, and Clinic C = 3.9%). A between-clinic analysis showed differences in medical claims data between baseline and post-BH services. The overall effect sizes for reduced medical utilization for patients at clinics B and C were very large, Hedge's g = -2.31 and -4.79, respectively. Utilization of 4 of the services (emergency, lab, outpatient, and primary care) showed the large reductions in their costs. In contrast, the data for Clinic A showed no change. Patients receiving behavioral health services within the integrated care model may decrease utilization of medical services following treatment, resulting in cost offset. Potential reasons for variability between clinics are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Nguyen, Phuong H; Kim, Sunny S; Nguyen, Tuan T; Tran, Lan M; Hajeebhoy, Nemat; Frongillo, Edward A; Ruel, Marie T; Rawat, Rahul; Menon, Purnima
2016-01-01
Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2-4.2), repeated use (PR 3.2, 95% CI: 2.4-4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6-8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3-1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility-based IYCF counselling services in Viet Nam, and may be relevant for increasing and sustaining use of nutrition services in similar contexts.
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Nguyen, Phuong H.; Kim, Sunny S.; Nguyen, Tuan T.; Tran, Lan M.; Hajeebhoy, Nemat; Frongillo, Edward A.; Ruel, Marie T.; Rawat, Rahul; Menon, Purnima
2016-01-01
Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2–4.2), repeated use (PR 3.2, 95% CI: 2.4–4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6–8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3–1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility-based IYCF counselling services in Viet Nam, and may be relevant for increasing and sustaining use of nutrition services in similar contexts. PMID:26962856
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Health Services Utilization among Children with and without Autism Spectrum Disorders
ERIC Educational Resources Information Center
Cummings, Janet R.; Lynch, Frances L.; Rust, Kristal C.; Coleman, Karen J.; Madden, Jeanne M.; Owen-Smith, Ashli A.; Yau, Vincent M.; Qian, Yinge; Pearson, Kathryn A.; Crawford, Phillip M.; Massolo, Maria L.; Quinn, Virginia P.; Croen, Lisa A.
2016-01-01
Using data from multiple health systems (2009-2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)--including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic…
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Mobile Phone Applications in Academic Library Services: A Students' Feedback Survey
ERIC Educational Resources Information Center
Karim, Nor Shahriza Abdul; Darus, Siti Hawa; Hussin, Ramlah
2006-01-01
Purpose: This study seeks to explore the utilization of mobile phone services in the educational environment, explore the nature of mobile phone use among university students, and investigate the perception of university students on mobile phone uses in library and information services. Design/methodology/approach: The study used a review of…
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2013-01-01
Background The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data. Methods Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization. Results The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and −0.0108[95% confidence interval (−0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively. Conclusions Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China. PMID:23688260
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7 CFR 4280.182 - Servicing feasibility study grants.
Code of Federal Regulations, 2014 CFR
2014-01-01
... performance report shall describe current progress and identify any problems, delays, or adverse conditions... 4280.182 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE LOANS AND GRANTS Rural Energy for...
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7 CFR 4280.182 - Servicing feasibility study grants.
Code of Federal Regulations, 2012 CFR
2012-01-01
... performance report shall describe current progress and identify any problems, delays, or adverse conditions... 4280.182 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE LOANS AND GRANTS Rural Energy for...
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7 CFR 4280.182 - Servicing feasibility study grants.
Code of Federal Regulations, 2013 CFR
2013-01-01
... performance report shall describe current progress and identify any problems, delays, or adverse conditions... 4280.182 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE LOANS AND GRANTS Rural Energy for...
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Utilization of medical services in the public health system in the Southern Brazil.
Bastos, Gisele Alsina Nader; Duca, Giovâni Firpo Del; Hallal, Pedro Curi; Santos, Iná S
2011-06-01
To estimate the prevalence and analyze factors associated with the utilization of medical services in the public health system. Cross-sectional population-based study with 2,706 individuals aged 20-69 years carried out in Pelotas, Southern Brazil, in 2008. A systematic sampling with probability proportional to the number of households in each sector was adopted. The outcome was defined by the combination of the questions related to medical consultation in the previous three months and place. The exposure variables were: sex, age, marital status, level of schooling, family income, self-reported hospital admission in the previous year, having a regular physician, self-perception of health, and the main reason for the last consultation. Descriptive analysis was stratified by sex and the analytical statistics included the use of the Wald test for tendency and heterogeneity in the crude analysis and Poisson regression with robust variance in the adjusted analysis, taking into consideration cluster sampling. The prevalence of utilization of medical services in the three previous months was 60.6%, almost half of these (42.0%, 95%CI: 36.6;47.5) in public services. The most utilized public services were the primary care units (49.5%). In the adjusted analysis stratified by sex, men with advanced age and young women had higher probability of using the medical services in the public system. In both sexes, low level of schooling, low per capita family income, not having a regular physician and hospital admission in the previous year were associated with the outcome. Despite the expressive reduction in the utilization of medical health services in the public system in the last 15 years, the public services are now reaching a previously unassisted portion of the population (individuals with low income and schooling).
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Utilization of hospital services for cancer care in Mexico.
Hernández-Ávila, Juan Eugenio; Palacio-Mejía, Lina Sofía; González-González, Leonel; Morales-Carmona, Evangelina; Espín-Arellano, Lucino Iván; Fernández-Niño, Julián Alfredo; Mohar-Betancourt, Alejandro; Hernández-Ávila, Mauricio
2016-04-01
To analyze the utilization of hospital services for cancer care by location, sex, age group and care institution in Mexico from 2004-2013. Time series study from 2004-2013, based on administrative records of hospital discharges for cancer in the health sector, including the private sector. The utilization rate increased significantly from 290 to 360 per 100 000 inhabitants. A total of 62% of hospital discharges related to malignant tumors were concentrated in eight types of cancer. Leukemia, breast and colorectal cancers almost doubled in the period. While lung cancer showed a decline among men, it increased among women. A total of 63.1% of cancer patients were women, and 81% of cases occurred in the public sector. From 2011, the Ministry of Health was the main provider of hospital services for cancer care. Increases in utilization were mainly found in the Ministry of Health, quite possibly as a result of the implementation of universal insurance.
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Caregiver stress: does states' expenditure on home- and community-based services matter?
Hong, Michin; Casado, Banghwa Lee
2015-01-01
This study examined how state expenditure on home- and community-based services (HCBS) and individual factors are associated with caregiver stress. A total of 1,849 cases from the 2004 National Long-Term Care Survey were included. Gender, education, perceived physical strain, and economic hardship, as well as the number of limitations in instrumental activities of daily living (IADL) for the care recipient, were associated with caregiver stress. The cross-level interaction between service utilization and state expenditure on HCBS was significant, suggesting that living in states with a higher expenditure on HCBS is associated with reduced stress regardless of service utilization.
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Fiscal mapping autism spectrum disorder funds: a case study of Ohio.
Joyce, Hilary D; Hoffman, Jill; Anderson-Butcher, Dawn; Moodie-Dyer, Amber
2014-01-01
Individuals with autism spectrum disorders (ASDs) have complex needs requiring regular service utilization. Policymakers, administrators, and community leaders are looking for ways to finance ASD services and systems. Understanding the fiscal resources that support ASD services is essential. This article uses fiscal mapping to explore ASD funding streams in Ohio. Fiscal mapping steps are overviewed to assist ASD stakeholders in identifying and examining ASD-related funding. Implications are drawn related to how fiscal mapping could be used to identify and leverage funding for ASD services. The resulting information is critical to utilizing existing resources, advocating for resources, and leveraging available funds.
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Shein, Steven L; Slain, Katherine; Wilson-Costello, Deanne; McKee, Bryan; Rotta, Alexandre T
2017-12-01
Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis. Analysis of the multicenter Pediatric Health Information System database. Forty-seven U.S. children's hospitals. PICU patients less than 2 years old with bronchiolitis undergoing mechanical ventilation between 2006 and 2015. None. Annual rates of utilization of neuropharmacologic medications (sedatives, analgesics, etc) and of neuro-rehabilitation services (physical therapy, neurologic consultation, etc) over the 10-year study period were compared. Neuropharmacologic medications prescribed on greater than or equal to 2 days were extracted. Utilization of MRI of the brain, neurologic consultation, swallow evaluation, occupational therapy, and physical therapy was also extracted. Among 12,508 subjects, the median age was 2.8 months, ~50% had comorbid conditions, and the median duration of mechanical ventilation was 7 days. The percentage of children prescribed greater than or equal to five drugs/drug classes increased over the study period from 36.5% to 55.8% (p < 0.001). There were significant increases over time in utilization of 10 of the 15 individual drugs/drug classes analyzed. More than half of subjects (6,294 [50.3%]) received at least one service that evaluates/treats neurologic morbidity. There were significant increases in the use of greater than or equal to one service (36.3% in 2006 to 59.6% in 2015; p < 0.001) and in the use of greater than or equal to two services (20.8% to 34.8%; p < 0.001). Utilization of each of the five individual resources increased significantly during the study period, but use of vasoactive medications and mortality did not. Prescription of neuropharmacologic agents increased over time using metrics of both overall drug burden and specific drug usage. Concurrently, the utilization of services that evaluate and/or treat neurologic morbidity was common and also increased over time.
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Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine
2017-05-22
The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.
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Utility Computing: Reality and Beyond
NASA Astrophysics Data System (ADS)
Ivanov, Ivan I.
Utility Computing is not a new concept. It involves organizing and providing a wide range of computing-related services as public utilities. Much like water, gas, electricity and telecommunications, the concept of computing as public utility was announced in 1955. Utility Computing remained a concept for near 50 years. Now some models and forms of Utility Computing are emerging such as storage and server virtualization, grid computing, and automated provisioning. Recent trends in Utility Computing as a complex technology involve business procedures that could profoundly transform the nature of companies' IT services, organizational IT strategies and technology infrastructure, and business models. In the ultimate Utility Computing models, organizations will be able to acquire as much IT services as they need, whenever and wherever they need them. Based on networked businesses and new secure online applications, Utility Computing would facilitate "agility-integration" of IT resources and services within and between virtual companies. With the application of Utility Computing there could be concealment of the complexity of IT, reduction of operational expenses, and converting of IT costs to variable `on-demand' services. How far should technology, business and society go to adopt Utility Computing forms, modes and models?
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Cardio-Vascular Disease and Cancer
Mitchell-Fearon, K.; Willie-Tyndale, D.; Waldron, N.; Holder-Nevins, D.; James, K.; Laws, H.; Eldemire-Shearer, D.
2015-01-01
Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services. PMID:28138475
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Chalmers, Jane M.; Kuthy, Raymond A.; Momany, Elizabeth T.; Chi, Donald L.; Bacon, Robert A.; Lindgren, Scott D.; Askelson, Natoshia M.; Damiano, Peter C.
2012-01-01
Purpose To determine dental utilization and type of dental services for Medicaid enrolled adults identified as having intellectual and developmental disabilities (IDD). Methods Using Iowa claims data, identified adults who met any of five IDD criteria for inclusion during calendar year 2005. Service utilization rates, including use of preventive dental, routine restorative, and complex restorative services, were determined. Results Approximately 60% of adults with IDD had at least one dental visit in 2005. Of adults with at least one dental visit, 83% received a preventive service, 31% a routine restorative service, and 16% a complex dental service. Those age 65 and older had fewer preventive dental services than other age groups. Conclusion In Iowa, dental utilization for adults 22-64 years of age with IDD was reasonably high (64%) in 2005, but individuals over age 65 had lower utilization (45%). PMID:21235610
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Effects of mental health benefits legislation: a community guide systematic review.
Sipe, Theresa Ann; Finnie, Ramona K C; Knopf, John A; Qu, Shuli; Reynolds, Jeffrey A; Thota, Anilkrishna B; Hahn, Robert A; Goetzel, Ron Z; Hennessy, Kevin D; McKnight-Eily, Lela R; Chapman, Daniel P; Anderson, Clinton W; Azrin, Susan; Abraido-Lanza, Ana F; Gelenberg, Alan J; Vernon-Smiley, Mary E; Nease, Donald E
2015-06-01
Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence was limited for other mental health outcomes. Published by Elsevier Inc.
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Effects of Mental Health Benefits Legislation
Sipe, Theresa Ann; Finnie, Ramona K.C.; Knopf, John A.; Qu, Shuli; Reynolds, Jeffrey A.; Thota, Anilkrishna B.; Hahn, Robert A.; Goetzel, Ron Z.; Hennessy, Kevin D.; McKnight-Eily, Lela R.; Chapman, Daniel P.; Anderson, Clinton W.; Azrin, Susan; Abraido-Lanza, Ana F.; Gelenberg, Alan J.; Vernon-Smiley, Mary E.; Nease, Donald E.
2015-01-01
Context Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Evidence acquisition Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Evidence synthesis Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Conclusions Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence is limited for other mental health outcomes. PMID:25998926
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The effects of fee bundling on dental utilization.
Porter, J; Coyte, P C; Barnsley, J; Croxford, R
1999-01-01
OBJECTIVE: To examine dental utilization following an adjustment to the provincial fee schedule in which preventive maintenance (recall) services were bundled at lower fees. DATA SOURCES/STUDY SETTING: Blue Cross dental insurance claims for claimants associated with four major Ontario employers using a common insurance plan over the period 1987-1990. STUDY DESIGN: This before-and-after design analyzes the dental claims experience over a four-year period for 4,455 individuals 18 years of age and older one year prior to the bundling of services, one year concurrent with the change, and two years after the introduction of bundling. The dependent variable is the annual adjusted payment per user. DATA COLLECTION/EXTRACTION METHODS: The analysis was based on all claims submitted by adult users for services received at recall visits and who reported at least one visit of this type between 1987 and 1990. In these data, 26,177 services were provided by 1,214 dentists and represent 41 percent of all adult service claims submitted over the four years of observation. PRINCIPAL FINDINGS: Real per capita payment for adult recall services decreased by 0.3 percent in the year bundling was implemented (1988), but by the end of the study period such payments had increased 4.8 percent relative to pre-bundling levels. Multiple regression analysis assessed the role of patient and provider variables in the upward trend of per capita payments. The following variables were significant in explaining 37 percent of the variation in utilization over the period of observation: subscriber employment location; ever having received periodontal scaling or ever having received restorative services; regular user; dentist's school of graduation; and interactions involving year, service type, and regular user status. CONCLUSIONS: The volume and intensity of services received by adult patients increased when fee constraints were imposed on dentists. Future efforts to contain dental expenditures through fee schedule design will need to take this into consideration. Issues for future dental services research include provider billing practices, utilization among frequent attenders, and outcomes evaluation particularly with regard to periodontal care and replacement of restorations. PMID:10536976
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Bridges, Ana J.; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.; Gomez, Debbie
2014-01-01
Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos. PMID:25309845
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Martinez, Kathryn A.; Friese, Christopher; Kershaw, Trace; Given, Charles W.; Fendrick, A. Mark; Northouse, Laurel
2015-01-01
Purpose/Objectives To examine differences in healthcare service utilization among patients with advanced cancer participating in a nurse-led psychoeducational intervention. Design Secondary analysis of trial data. Setting Four Michigan cancer centers. Sample 484 patients with advanced cancer. Methods Patients were randomized to three groups: brief intervention, extensive intervention, or control. Medical chart review took place at baseline, three months, and six months to measure patients’ healthcare service utilization, defined as emergency department (ED) visits or inpatient hospitalizations. Multivariable logistic regression was used to examine the odds, by study arm, of visiting the ED and being hospitalized, controlling for patient sociodemographic and health status factors, as well as baseline health-related quality of life (QOL). Main Research Variables Study arm (brief, extensive, or control), ED visitation (one or more times versus none), inpatient hospitalizations (one or more times versus none), and covariates. Findings No significant differences in ED visits or inpatient hospitalizations were observed among study arms. ED visits were more frequent for patients with lung or colorectal cancer, more comorbidities, and lower baseline QOL. Baseline QOL was associated with inpatient hospitalizations in the adjusted analysis. Conclusions The psychoeducational intervention, either in brief or extensive format, is unlikely to increase healthcare service utilization. Implications for Nursing Efficacious nurse-led psychoeducational interventions to improve QOL do not place undue burdens on the healthcare system and may improve care. PMID:26148327
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Berg, Gregory D; Wadhwa, Sandeep; Johnson, Alan E
2004-10-01
To investigate the utilization and financial outcomes of a telephonic nursing disease-management program for elderly patients with heart failure. A 1-year concurrent matched-cohort study employing propensity score matching. Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana. A total of 533 program participants aged 65 and older matched to nonparticipants. Disease-management heart failure program employing a structured, evidence-based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services. Medical service utilization, including hospitalizations, emergency department visits, medical doctor visits, skilled nursing facility (SNF) days, selected clinical indicators, and financial effect. The intervention group had considerably and significantly lower rates of acute service utilization than the control group, including 23% fewer hospitalizations, 26% fewer inpatient bed days, 22% fewer emergency department visits, 44% fewer heart failure hospitalizations, 70% fewer 30-day readmissions, and 45% fewer SNF bed days. Claims costs were 1,792 dollars per person lower in the intervention group than in the control group (inclusive of intervention costs), and the return on investment was calculated to be 2.31. The study demonstrates that a commercially delivered heart failure disease-management program significantly reduced hospitalizations, emergency department visits, and SNF days. The intervention group had 17% lower costs than the control group; when intervention costs were included, the intervention group had 10% lower costs.
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Barrera, Terri L; Mott, Juliette M; Hundt, Natalie E; Mignogna, Joseph; Yu, Hong-Jen; Stanley, Melinda A; Cully, Jeffrey A
2014-01-01
This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings. Published by Elsevier Inc.
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Rosman, David A; Duszak, Richard; Wang, Wenyi; Hughes, Danny R; Rosenkrantz, Andrew B
2018-02-01
The objective of our study was to use a new modality and body region categorization system to assess changing utilization of noninvasive diagnostic imaging in the Medicare fee-for-service population over a recent 20-year period (1994-2013). All Medicare Part B Physician Fee Schedule services billed between 1994 and 2013 were identified using Physician/Supplier Procedure Summary master files. Billed codes for diagnostic imaging were classified using the Neiman Imaging Types of Service (NITOS) coding system by both modality and body region. Utilization rates per 1000 beneficiaries were calculated for families of services. Among all diagnostic imaging modalities, growth was greatest for MRI (+312%) and CT (+151%) and was lower for ultrasound, nuclear medicine, and radiography and fluoroscopy (range, +1% to +31%). Among body regions, service growth was greatest for brain (+126%) and spine (+74%) imaging; showed milder growth (range, +18% to +67%) for imaging of the head and neck, breast, abdomen and pelvis, and extremity; and showed slight declines (range, -2% to -7%) for cardiac and chest imaging overall. The following specific imaging service families showed massive (> +100%) growth: cardiac CT, cardiac MRI, and breast MRI. NITOS categorization permits identification of temporal shifts in noninvasive diagnostic imaging by specific modality- and region-focused families, providing a granular understanding and reproducible analysis of global changes in imaging overall. Service family-level perspectives may help inform ongoing policy efforts to optimize imaging utilization and appropriateness.
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Socioeconomic Determinants of the Utilization of Antenatal Care and Child Vaccination in India.
Zuhair, Mohd; Roy, Ram Babu
2017-11-01
Antenatal care and child vaccination services are adopted worldwide to reduce the risk of child mortality, maternal mortality, and burden of infectious diseases. This article examines the effect of socioeconomic factors on the utilization of antenatal care and child vaccination services in India. The generalized linear model has been used along with the Indian National Family Health Survey data for the period 2005-2006. The analysis shows that the health insurance plan has a significant effect on the use of antenatal care but not in the child vaccination. Furthermore, there is inequality in the utilization of antenatal care as well as child vaccination services and it is positively related to the wealth. The study suggests that there is a need to improve the socioeconomic status of the financially weaker section of the society for improving the use of child and maternal care services.
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Electrical service reliability: the customer perspective
DOE Office of Scientific and Technical Information (OSTI.GOV)
Samsa, M.E.; Hub, K.A.; Krohm, G.C.
1978-09-01
Electric-utility-system reliability criteria have traditionally been established as a matter of utility policy or through long-term engineering practice, generally with no supportive customer cost/benefit analysis as justification. This report presents results of an initial study of the customer perspective toward electric-utility-system reliability, based on critical review of over 20 previous and ongoing efforts to quantify the customer's value of reliable electric service. A possible structure of customer classifications is suggested as a reasonable level of disaggregation for further investigation of customer value, and these groups are characterized in terms of their electricity use patterns. The values that customers assign tomore » reliability are discussed in terms of internal and external cost components. A list of options for effecting changes in customer service reliability is set forth, and some of the many policy issues that could alter customer-service reliability are identified.« less
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Saito, Eiko; Gilmour, Stuart; Yoneoka, Daisuke; Gautam, Ghan Shyam; Rahman, Md Mizanur; Shrestha, Pradeep Krishna; Shibuya, Kenji
2016-09-01
Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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An Examination of Pre-Service History Teachers' Metaphors Regarding the Concept of "Freedom"
ERIC Educational Resources Information Center
Guven, Aydin
2015-01-01
The purpose of this research study is to examine the metaphors generated by pre-service history teachers regarding the concept of freedom. Qualitative method is used in the research study and phenomenology is utilized as a research design. Semi-structured forms are used as a data collection tool in the study. Each pre-service history teacher is…
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Factors associated with the utilization of institutional delivery services in Bangladesh.
Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael
2017-01-01
Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression. According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; p<0.001; 95%CI: 0.467-0.604), and participants aged between 30 and 49 years had a 23.6% higher prevalence of institutional delivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062-1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; p<0.001; 95%CI: 1.650-2.624), and similarly, husbands with higher educational attainment exhibited an approximately 71% higher service utilization of institutional delivery facilities compared to those without formal education (OR = 1.709; p<0.001; 95%CI: 1.412-2.069). Wealth status was also a significant predictor of institutional delivery service use, with participants belonging to the highest economic stratum being more likely to receive skilled care compared to the lowest economic stratum (OR = 2.507; p<0.001; 95%CI: 2.118-2.968). In addition, results indicated that households of average economic class had a 27% higher level of institutional delivery service utilization compared to those of lower economic status (OR = 1.272; p = 0.011; 95%CI: 1.057-1.531). Furthermore, institutional health service use was 18% higher among participants who were aware of community clinical services compared to those who were hardly aware of these services (OR = 0.816; p = 0.012; 95%CI: 0.696-0.957). Lastly, the odds of utilizing delivery services was 1.553 times more likely for participants who use family planning compared to those who do not (p<0.001; 95%CI: 1.374-1.754), and 3.639 times more likely for those who receive antenatal care compared to those who do not (p<0.001; 95%CI: 3.074-4.308). These were found to be significant predictors of the choice of delivery services. Our results suggest that efforts towards reducing national maternal mortality in Bangladesh could be aided by investments into education, poverty reduction and the strengthening of reproductive healthcare services through community clinics, with particular focus on rural areas.
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Latency of TCP applications over the ATM-WAN using the GFR service category
NASA Astrophysics Data System (ADS)
Chen, Kuo-Hsien; Siliquini, John F.; Budrikis, Zigmantas
1998-10-01
The GFR service category has been proposed for data services in ATM networks. Since users are ultimately interested in data service that provide high efficiency and low latency, it is important to study the latency performance for data traffic of the GFR service category in an ATM network. Today much of the data traffic utilizes the TCP/IP protocol suite and in this paper we study through simulation the latency of TCP applications running over a wide-area ATM network utilizing the GFR service category using a realistic TCP traffic model. From this study, we find that during congestion periods the reserved bandwidth in GFR can improve the latency performance for TCP applications. However, due to TCP 'Slow Start' data segment generation dynamics, we show that a large proportion of TCP segments are discarded under network congestion even when the reserved bandwidth is equal to the average generated rate of user data. Therefore, a user experiences worse than expected latency performance when the network is congested. In this study we also examine the effects of segment size on the latency performance of TCP applications using the GFR service category.
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Ewen, Heidi H; Washington, Tiffany R; Emerson, Kerstin G; Carswell, Andrew T; Smith, Matthew Lee
2017-03-22
Background: The majority of older adults prefer to remain in their homes, or to "age-in-place." To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results : When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions : Findings suggest that older adults' residential environment is associated with their health status and HCBS utilization. Building upon the Person-Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.
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Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee
2017-01-01
Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place. PMID:28327507
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Oryema, Paul; Babirye, Juliet N; Baguma, Charles; Wasswa, Peter; Guwatudde, David
2017-02-27
The global vaccine action plan 2011-2020 was endorsed by 194 states to equitably extend the benefits of immunization to all people. However, gaps in vaccination coverage remain in developing countries such as Uganda. One of the strategies used to tackle existing inequities is implementation of outreach immunization services to deliver services to those with poor geographical access. However, reports of inconsistent use of these services prevail; therefore understanding the factors associated with use of these services is critical for improving service delivery. This study examined the factors associated with utilization of outreach immunization services among children aged 10-23 months in Hoima District, Uganda. Overall, 87.4% (416/476) of the children had ever utilized outreach immunization services. Of these, 3.6% (15/416) had completed their entire immunization schedules from outreach immunization sessions. Use of outreach services was associated with reports that the time of outreach sessions was convenient [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.32-6.51], community mobilization was done prior to outreach sessions (AOR 4.9, 95% CI 1.94-12.61), the caretaker knew the benefits of childhood immunizations (AOR 2.1, 95% CI 1.30-4.42), and the caretaker was able to name at least four vaccine preventable diseases (AOR 3.0, 95% CI 1.13-7.88). Utilization of outreach immunization services in Hoima District was high but reduced with subsequent vaccine doses. Therefore, strategies targeted at retaining service users for the entire immunization schedule need to be developed and implemented. Such strategies could include health education emphasizing the benefits of childhood immunization.
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Li, Chuanlin; Shi, Leiyu; Huang, Jiayan; Qian, Xu; Chen, Yingyao
2016-01-14
Knowledge of the factors that influence maternal serum screening (MSS) service utilization can be used to develop health policies to promote equitable access to MSS and further diagnostic tests. The purpose of this study was to find the factors associated with utilization of MSS as well as the current status of service utilization in mainland China. This was a hospital-based cross-sectional study with respondents interviewed with a questionnaire designed based on Andersen's behavioral model. Descriptive statistics, univariate analysis, and multilevel logistic regression analysis were used to identify the factors associated with MSS utilization, and to explore potential methods to improve screening uptake. A total of 8110 women who had given birth within the previous 7 days in one of 111 participating institutions from six provinces in mainland China were interviewed. Approximately 36% of the participants had used MSS. Women between 20 and 35 years, who resided in urban areas, were educated, were in a stable occupation, who had health knowledge, who attended maternal preparation classes, who had received eight or more prenatal checkups, who were from a region of higher social economic status, and who delivered in a tertiary healthcare institution were significantly more likely to use MSS than their counterparts. As compared with other factors, insufficient education is the single most important demographic factor for service underutilization. Efforts should not only be made to target the population that underuses MSS, but the overall organization of MSS service delivery should be assessed during policy development to make access to MSS equitable to the entire population of mainland China.
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Kerkenaar, Marlies M E; Maier, Manfred; Kutalek, Ruth; Lagro-Janssen, Antoine L M; Ristl, Robin; Pichlhöfer, Otto
2013-10-01
Although migrants form a large part of the Austrian population, information about mental health of migrants in Austria is scarce. Therefore, we compared the prevalence of dysphoric disorders (depression and anxiety) and the corresponding utilization of health care services of Eastern European, western and other migrants with the non-migrant population in Austria. We performed a telephone survey on a random sample of the general population of Austria aged 15 years and older (n=3509) between October 2010 and September 2011. Depression and anxiety were measured with the Patient Health Questionnaire-4 and utilization of health care services in the last 4 weeks was inquired. 15.0% of our sample had a migration background. Female migrants from Eastern Europe, first and second generation, had a higher prevalence of dysphoric disorders (29.7% and 33.4% respectively) than Austrian women (15.2%) (p<0.001). The prevalence in the other migrant groups did not differ significantly from the Austrian population. There was no gender difference in dysphoric disorders in the Austrian population. After adjustment for age and chronic diseases, having a dysphoric disorder was associated with a higher utilization of health care services among migrant and Austrian women, but not among men. Because of the explorative nature of the study multiple testing correction was not performed. The reason for health care utilization was not assessed. Mental health of female migrants from Eastern Europe should be studied in more detail; men could be an underserved group, both in migrants and Austrians. © 2013 Elsevier B.V. All rights reserved.
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Namasivayam, Amrita; Arcos González, Pedro; Castro Delgado, Rafael; Chi, Primus Che
2017-10-03
Maternal mortality rates can be adversely affected by armed conflict, implying a greater level of vulnerability among women, and is often linked to the lack of or limited access to maternal healthcare during conflict. Previous research in Uganda has shown that armed conflict negatively impacts women's utilization of maternal healthcare services for a multitude of reasons at the individual, health-system and political levels. This study compared aggregated Demographic and Health Surveys data from 13 districts in Northern Uganda, a conflict-affected region, with data from the rest of the country, for the use of maternal healthcare services for the years 1988, 1995, 2000, 2006 and 2011, using statistical analyses and logistic regression. Specific indicators for maternal healthcare utilization included contraceptive use, antenatal care, skilled assistance at birth and institutional delivery. Use of contraception and institutional deliveries among women in Northern Uganda was significantly lower compared to the rest of the country. However, skilled assistance at birth among women in Northern Uganda was significantly higher. The findings in this study show that armed conflict can have a negative impact on aspects of maternal healthcare such as contraceptive use and institutional deliveries; however, other indicators such as skilled assistance at birth were seen to be better among conflict-affected populations. This reiterates the complex nature of armed conflict and the interplay of different factors such as conflict intensity, existing health systems and services, and humanitarian interventions that could influence maternal healthcare utilization. Armed conflict, maternal health utilization, Northern Uganda, contraception, skilled assistance at birth, antenatal care, institutional delivery.
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Moineddin, Rahim; Meaney, Christopher; Agha, Mohammad; Zagorski, Brandon; Glazier, Richard Henry
2011-08-19
Emergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research. Data regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic. The CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases. Using a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.
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Witvorapong, Nopphol; Foshanji, Abo Ismael
2016-03-01
While existing research suggests that health-related conditional cash transfer (CCT) programs have positive impacts on the utilization of CCT-targeted health services, little is known as to whether they also influence the utilization of non-targeted health services-defined as general health services for which program participants are not financially motivated. Based on a sample of 6649 households in a CCT program that took place in May 2009-June 2011 in Afghanistan, we evaluate the impact of the receipt of CCTs on the utilization of non-targeted health services both by women, who were direct beneficiaries of the program, and by members of their households. We estimate the outcomes of interest through four probit models, accounting for potential endogeneity of the CCT receipt and dealing with lack of credible exclusion restrictions in different ways. In comparison with the control group, the receipt of CCTs is found to be associated with an increase in the probability of utilizing non-targeted services among household members across regression models. The results are mixed, with regard to the utilization by women, suggesting that there exist non-economic barriers to health care, unique to women, that are not captured by the data. The results confirm the importance of accounting for direct as well as indirect effects in policy evaluation and suggest that future studies investigate more deeply the role of community health workers in removing non-economic barriers for Afghan women and the possibility of introducing an incentive structure to motivate them to contribute more actively to population health in Afghanistan. Copyright © 2016 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Zainudin, WNRA; Ramli, NA
2017-09-01
In 2016, Tenaga Nasional Berhad (TNB) had introduced an upgrade in its Billing and Customer Relationship Management (BCRM) as part of its long-term initiative to provide its customers with greater access to billing information. This includes information on real and suggested power consumption by the customers and further details in their billing charges. This information is useful to help TNB customers to gain better understanding on their electricity usage patterns and items involved in their billing charges. Up to date, there are not many studies done to measure public understanding on current electricity bills and whether this understanding could contribute towards positive impacts. The purpose of this paper is to measure public understanding on current TNB electricity bills and whether their satisfaction towards energy-related services, electricity utility services, and their awareness on the amount of electricity consumed by various appliances and equipment in their home could improve this understanding on the electricity bills. Both qualitative and quantitative research methods are used to achieve these objectives. A total of 160 respondents from local universities in Malaysia participated in a survey used to collect relevant information. Using Ordered Probit model, this paper finds respondents that are highly satisfied with the electricity utility services tend to understand their electricity bills better. The electric utility services include management of electricity bills and the information obtained from utility or non-utility supplier to help consumers manage their energy usage or bills. Based on the results, this paper concludes that the probability to understand the components in the monthly electricity bill increases as respondents are more satisfied with their electric utility services and are more capable to value the energy-related services.
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76 FR 13125 - Announcement of Grant Application Deadlines and Funding Levels; Correction
Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-10
... DEPARTMENT OF AGRICULTURE Rural Utilities Service Announcement of Grant Application Deadlines and Funding Levels; Correction AGENCY: Rural Utilities Service, USDA. ACTION: Notice of Solicitation of Applications; correction. SUMMARY: The United States Department of Agriculture's (USDA) Rural Utilities Service...
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76 FR 12017 - Announcement of Grant Application Deadlines and Funding Levels
Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-04
... DEPARTMENT OF AGRICULTURE Rural Utilities Service Announcement of Grant Application Deadlines and Funding Levels AGENCY: Rural Utilities Service, USDA. ACTION: Notice of solicitation of applications. SUMMARY: The United States Department of Agriculture's (USDA) Rural Utilities Service (RUS) announces the...
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ERIC Educational Resources Information Center
Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An
2012-01-01
Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…
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Olusile, Adeyemi Oluniyi; Adeniyi, Abiola Adetokunbo; Orebanjo, Olufemi
2014-11-27
There is scarce information available on oral health service utilization patterns and common oral hygiene practices among adult Nigerians. We conducted the 2010-2011 national oral health survey before the introduction of the national oral health policy to determine the prevalence of oral health service utilization, patterns of oral hygiene practices, and self reported oral health status, among adults in various social classes, educational strata, ethnic groups and geopolitical zones in Nigeria. We conducted a cross-sectional survey in North-Central, North-West, South-East, South-South and South-West geopolitical zones of Nigeria. Multi-stage cluster sampling method was used for the sample selection. We administered a structured questionnaire to a total of 7,630 participants. Information on the socio-demographic characteristics, oral hygiene practices and oral health services utilization pattern of participants was obtained. We interviewed 7, 630 participants (55.6% female). The participants ages ranged between 18 and 81 years, mean age was 37.96 (SD = 13.2). Overall 21.2% of the participants rated their oral health status as very good, 37.1% as good and 27.4% as fair. Only 26.4% reported having visited the dentist at least once prior to the conduct of the survey. More than half of these visits (54.9%) were for treatment purpose. Utilization of oral health services was significantly (p < 0.05) associated with being older, more educated and being engaged in a skilled profession. More educated persons, females and younger persons used toothbrushes for daily tooth cleaning. Age, sex, marital status, level of education and occupation were significantly related to daily frequency of tooth cleaning (p < 0.05). Our results show that while most Nigerian adults have a positive view of their oral health status, majority reported poor oral health utilization habits. Older persons resident in the northern zones of the country and less educated persons displayed poorer oral hygiene practices. The study findings suggest that there is low oral health service utilization among adult Nigerians and that socio-demographic variables influence oral health utilization habits and oral hygiene behavior among adult Nigerians Further studies to identify other factors influencing oral health behavior are suggested.
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van Hasselt, Martijn; McCall, Nancy; Keyes, Vince; Wensky, Suzanne G; Smith, Kevin W
2015-02-01
To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Individual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. © Health Research and Educational Trust.
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Controller Evaluation of Initial Data Link Air Traffic Control Services, Mini Study 1, Volume 2
DOT National Transportation Integrated Search
1988-09-01
This report details the results of Mini Study 1. This mini study was conducted : at the Federal Aviation Administration (FAA) Technical Center utilizing the Data : Link testbed. Initial Data Link air traffic control services were evaluated : under pa...
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Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza
2015-03-06
A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. © 2015 by Kerman University of Medical Sciences.
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Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza
2015-01-01
Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. PMID:25905478
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Value-Added Electricity Services: New Roles for Utilities and Third-Party Providers
DOE Office of Scientific and Technical Information (OSTI.GOV)
Blansfield, J.; Wood, L.; Katofsky, R.
New energy generation, storage, delivery, and end-use technologies support a broad range of value-added electricity services for retail electricity customers. Sophisticated energy management services, distributed generation coupled with storage, and electric vehicle charging are just a few examples of emerging offerings. Who should provide value-added services — utilities or third parties, or both, and under what conditions? What policy and regulatory changes may be needed to promote competition and innovation, to account for utility costs to enable these services, and to protect consumers? The report approaches the issues from three perspectives: utilities, third-party service providers, and consumers: -Jonathan Blansfield andmore » Lisa Wood, Institute for Electric Innovation -Ryan Katofsky, Benjamin Stafford and Danny Waggoner, Advanced Energy Economy -National Association of State Utility Consumer Advocates« less
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ERIC Educational Resources Information Center
Chouliara, Zoe; Karatzias, Thanos; Scott-Brien, Georgia; Macdonald, Anne; MacArthur, Juliet; Frazer, Norman
2011-01-01
This study aimed to elicit perceptions and experiences of talking therapy services for CSA survivors and professionals utilizing qualitative interviews and analyzing transcripts using Interpretative Phenomenological Analysis. Participants included 13 adult survivors and 31 professionals in statutory and voluntary services in Scotland. Main themes…
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ERIC Educational Resources Information Center
Huang, Yong-Ming
2017-01-01
Team messaging services represent a type of cloud computing applications that support not only the messaging among users but also the collaboration in a team. Accordingly, team messaging services have great potential to facilitate students' collaboration. However, only few studies utilized such services to support students' collaboration and…
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Utilizing Service Learning in a College-Level Human Sexuality Course
ERIC Educational Resources Information Center
Jenkins, Dusty D.
2017-01-01
Implementing service learning into college courses has been shown to have positive benefits for both students and community members; however, service learning has not been largely evaluated in the literature on human sexuality courses. Thus, the purpose of the current study was to design, implement, and evaluate a service learning project in a…
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Integrated centralized utility services to a chemical complex on Jurong Island, Singapore.
Yan, Y G; Wong, P C Y; Tan, C G; Tang, K F
2003-01-01
SUT pioneered centralized utility services for the chemical industry on Jurong Island, which are cost-effective due to economies of scale, reliable due to inter-connection of satellite operations, and customer tailored for special requirements. The utility services range from the supply of steam and water, wastewater treatment, incineration, terminalling, service corridor to fire fighting. Among the services, water management achieves the complete cycle from wastewater treatment to effluent recycling.
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42 CFR 456.242 - UR plan requirements for medical care evaluation studies.
Code of Federal Regulations, 2010 CFR
2010-10-01
... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Medical Care Evaluation Studies § 456.242 UR plan requirements for medical care... evaluation studies in the mental hospital; (2) Documents for each study— (i) Its results; and (ii) How the...
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NASA Technical Reports Server (NTRS)
Won, Young-In; Vollimer, Bruce; Theobald, Mike; Hua, Xin-Min
2008-01-01
The Atmospheric Infrared Sounder (AIRS) instrument suite is designed to observe and characterize the entire atmospheric column from the surface to the top of the atmosphere in terms of surface emissivity and temperature, atmospheric temperature and humidity profiles, cloud amount and height, and the spectral outgoing infrared radiation on a global scale. The AIRS Data Support Team at the GES DISC provides data support to assist others in understanding, retrieving and extracting information from the AIRS/AMSU/HSB data products. Because a number of years has passed since its operation started, the amount of data has reached a certain level of maturity where we can address the climate change study utilizing AIRS data, In this presentation we will list various service we provide and to demonstrate how to utilize/apply the existing service to long-term and short-term variability study.
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47 CFR 101.521 - Spectrum utilization.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 47 Telecommunication 5 2011-10-01 2011-10-01 false Spectrum utilization. 101.521 Section 101.521... SERVICES 24 GHz Service and Digital Electronic Message Service § 101.521 Spectrum utilization. All... contain detailed descriptions of the modulation method, the channel time sharing method, any error...
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24 CFR 982.517 - Utility allowance schedule.
Code of Federal Regulations, 2010 CFR
2010-04-01
... for tenant-installed air conditioners. (3) The cost of each utility and housing service category must... services according to the following general categories: space heating; air conditioning; cooking; water... services. The PHA must provide a utility allowance for tenant-paid air-conditioning costs if the majority...
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Drug Treatment Service Utilization and Outcomes for Hispanic and White Methamphetamine Abusers
Niv, Noosha; Hser, Yih-Ing
2006-01-01
Objective To examine differences in drug treatment service needs, utilization, satisfaction, and outcomes between Hispanic and white methamphetamine (meth) abusers. Data Sources Intake assessments and follow-up interviews of 128 Hispanic and 371 non-Hispanic white meth abusers admitted during 2000–2001 to 43 drug treatment programs in 13 counties across California. Study Design A prospective longitudinal study comparing ethnic differences in problem severity during pre- and posttreatment periods, as well as in services received during treatment. Data Collection/Extraction Methods The Addiction Severity Index (ASI) was administered at both intake and the 9-month follow-up to assess clients' problem severity in a number of domains. Service utilization and satisfaction were assessed 3 months following treatment admission. Principal Findings Hispanics were less educated and reported more employment difficulties than whites. Whites were more likely to be treated in residential programs than Hispanics despite similar severity in drug and alcohol use, legal, medical and family/social problems, and psychiatric status. Significantly more whites than Hispanics received psychiatric services, likely because more of them were treated in residential programs. Whites also reported receiving greater numbers of total services and services addressing alcohol and psychiatric problems. While no ethnic differences were found in treatment satisfaction and several other outcomes, Hispanics demonstrated better family and social outcomes than whites. Conclusions Both Hispanic and white meth abusers improved after treatment, although benefits from treatment can be further enhanced if services underscore different facets of their psychosocial problems. PMID:16899005
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Reduced health resource use after acupuncture for low-back pain.
Moritz, Sabine; Liu, Ming F; Rickhi, Badri; Xu, Tracy J; Paccagnan, Patricia; Quan, Hude
2011-11-01
Acupuncture is commonly used to treat low-back pain (LBP) and clinical trials have demonstrated its efficacy. However, less is known about how the utilization of acupuncture impacts public health service utilization in the real world. This study investigates the association between acupuncture utilization for LBP and health care utilization by assessing whether patients who undergo acupuncture subsequently use fewer health care resources and whether those patients differ in their health care use from the general population with LBP. This study employed the design of a two-group pre/post secondary data analysis. There were two study populations. To identify patients who received acupuncture for LBP in 2000, patient charts at Alberta registered acupuncture clinics were reviewed. The comparison group was identified from the Alberta physician claims administrative database. Acupuncture group cases were matched with four comparison cases from the general population with LBP based on gender and age. Number of physician visits and physician service cost for LBP-related services for 1 year pre- and postacupuncture treatment period were calculated from the physician claims data for both study groups. For the 201 cases and 804 controls, the mean age was 48 years and 54% were female. The number of physician visits for the 1-year period postacupuncture decreased 49% for the acupuncture group (p<0.01) compared to the 1-year period preacupuncture. For the comparison there was a decrease of 2% in physician visits (p=0.59) for the same time periods. Corresponding to the decrease, physician services cost declined 37% for the case group (p=0.01) and 1% for the comparison (p=0.86). Results suggest that patients with LBP were less likely to visit physicians for LBP after acupuncture treatment. This led to reduced health services spending on LBP. © Mary Ann Liebert, Inc.
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Measurement and analysis of equity in health: a case study conducted in Zhejiang Province, China.
Sun, Xueshan; Zhang, Hao; Hu, Xiaoqian; Gu, Shuyan; Zhen, Xuemei; Gu, Yuxuan; Huang, Minzhuo; Wei, Jingming; Dong, Hengjin
2018-03-22
Equity is the core of primary care. The issue of equity in health has become urgent, and China has attached increasing attention to it. With rapid economic development and great changes in medical insurance policy, the pattern of equity in health has changed tremendously. The reform of healthcare in Zhejiang Province is at the forefront in China, and studies on Zhejiang Province are of great significance to the entire country. This paper aimed to measure health equity from the perspectives of health needs and health-seeking behavior and to provide suggestions for the next policy formulations, with respect to timeliness. The investigator's household survey was conducted in August 2016. A sample of 1000 households, which included2807 individuals in Zhejiang, China, was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and chi-square tests were adopted in the analysis. The value of the concentration index was used to measure the equity. This study found that the poor have more urgent health needs and poorer health situations than the rich. Through studies on health-seeking behavior, the utilization of outpatient services was almost equitable, while the utilization of hospitalization showed a pro-rich inequity (i.e., the rich use more services). Individuals with employer-based medical insurance used more outpatient services than those with rural and urban medical insurance. More people in the poorer income groups did not use inpatient services due to financial difficulties. Absolute medical prices and medical insurance may explain the equity in the utilization of outpatient services and the inequity in the utilization of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor.
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Edu, Betta Chimaobim; Agan, Thomas U; Monjok, Emmanuel; Makowiecka, Krystyna
2017-06-15
Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.
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Diagnostic Imaging Services in Magnet and Non-Magnet Hospitals: Trends in Utilization and Costs.
Jayawardhana, Jayani; Welton, John M
2015-12-01
The purpose of this study was to better understand trends in utilization and costs of diagnostic imaging services at Magnet hospitals (MHs) and non-Magnet hospitals (NMHs). A data set was created by merging hospital-level data from the American Hospital Association's annual survey and Medicare cost reports, individual-level inpatient data from the Healthcare Cost and Utilization Project, and Magnet recognition status data from the American Nurses Credentialing Center. A descriptive analysis was conducted to evaluate the trends in utilization and costs of CT, MRI, and ultrasound procedures among MHs and NMHs in urban locations between 2000 and 2006 from the following ten states: Arizona, California, Colorado, Florida, Iowa, Maryland, North Carolina, New Jersey, New York, and Washington. When matched by bed size, severity of illness (case mix index), and clinical technological sophistication (Saidin index) quantiles, MHs in higher quantiles indicated higher rates of utilization of imaging services for MRI, CT, and ultrasound in comparison with NMHs in the same quantiles. However, average costs of MRI, CT, and ultrasounds were lower at MHs in comparison with NMHs in the same quantiles. Overall, MHs that are larger in size (number of beds), serve more severely ill patients (case mix index), and are more technologically sophisticated (Saidin index) show higher utilization of diagnostic imaging services, although costs per procedure at MHs are lower in comparison with similar NMHs, indicating possible cost efficiency at MHs. Further research is necessary to understand the relationship between the utilization of diagnostic imaging services among MHs and its impact on patient outcomes. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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Gudu, William; Addo, Bright
2017-05-31
Ghana's current Maternal Mortality Ratio (MMR) of 319 per 100,000 live births makes achievement of the Sustainable Development Goal of 70 maternal deaths per 100,000 live births or less by 2030 appear to be illusory. Skilled assistance during childbirth is a critical strategy to reducing maternal mortality, yet the proportion of deliveries taking place within health facilities where such assistance is provided is very low in Ghana, with huge disparity between urban and rural women. To address the gap in skilled attendance in rural Upper East Region, the Ghana Health Service (GHS) in 2005 piloted a program that involved training of Community Health Officers (CHOs) as midwives. This study explored factors associated with skilled delivery services utilization in a predominantly rural district in Ghana. A cross-sectional study, data was collected from a sample of 400 women between the ages of 15 and 49 years who had given birth a year prior to the study. We used frequencies and percentages for descriptive analysis and chi-square (χ 2 ) test for relationship between independents factors and utilization of skilled delivery services. Of the 400 women included in the analysis, 93.3% of them delivered in a health facility. Almost all of the mothers (97.3%) attended or received antenatal care at their last pregnancy with 75.0% of them having four or more ANC visits. The proportion of women who received ANC and utilized skilled delivery services was high (91.5%). Mother's educational attainment, ANC attendance, frequency of ANC visits, satisfaction with ANC services and possession of valid NHIS card significantly associated with utilisation of skilled delivery services. For a predominantly rural district, the percentage of women who deliver within health facilities where skilled assistance is available is very encouraging and a significant stride towards reducing Ghana's overall MMR. Having four or more ANC visits and improving on the quality of care provided has a great potential of improving uptake of skilled delivery services.
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Taksler, Glen B; Pfoh, Elizabeth R; Stange, Kurt C; Rothberg, Michael B
2018-05-08
The number of preventive care guidelines is rapidly increasing. It is unknown whether the number of guideline-recommended preventive services is associated with utilization. The authors used Poisson regression of 390,778 person-years of electronic medical records data from 2008 to 2015, in 80,773 individuals aged 50-75 years. Analyses considered eligibility for 11 preventive services most closely associated with guidelines: tobacco cessation; control of obesity, hypertension, lipids, or blood glucose; influenza vaccination; and screening for breast, cervical, or colorectal cancers, abdominal aortic aneurysm, or osteoporosis. The outcome was the rate of preventive care utilization over the following year. Results were adjusted for demographics and stratified by the number of disease risk factors (smoking, obesity, hypertension, hyperlipidemia, diabetes). Data were collected in 2016 and analyzed in 2017. Preventive care utilization was lower when the number of guideline-recommended preventive services was higher. The adjusted rate of preventive care utilization decreased from 38.67 per 100 (95% CI=38.16, 39.18) in patients eligible for one guideline-recommended service to 31.59 per 100 (95% CI=31.29, 31.89) in patients eligible for two services and 25.43 per 100 (95% CI=24.68, 26.18) in patients eligible for six or more services (p-trend<0.001). Results were robust to disease risk factors and observed for all but two services (tobacco cessation, obesity reduction). However, for any given number of guideline-recommended services, patients with more disease risk factors had higher utilization rates. The rate of preventive care utilization was lower when the number of guideline-recommended services was higher. Prioritizing recommendations might improve utilization of high-value services. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Use of Six Sigma for eliminating missed opportunities for prevention services.
Gittner, LisaAnn S; Husaini, Baqar A; Hull, Pamela C; Emerson, Janice S; Tropez-Sims, Suzanne; Reece, Michelle C; Zoorob, Roger; Levine, Robert S
2015-01-01
Delivery of primary care preventative services can be significantly increased utilizing Six Sigma methods. Missed preventative service opportunities were compared in the study clinic with the community clinic in the same practice. The study clinic had 100% preventative services, compared with only 16.3% in the community clinic. Preventative services can be enhanced to Six Sigma quality when the nurse executive and medical staff agree on a single standard of nursing care executed via standing orders.
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Forma, Leena; Rissanen, Pekka; Aaltonen, Mari; Raitanen, Jani; Jylhä, Marja
2009-06-01
We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services. Data were derived from multiple national registers. The sample consisted of 56,001 persons, who died during years 1998-2000 at the age of > or = 70, and their pairs matched on age, gender and municipality of residence, who were alive at least 2 years after their counterpart's death. Data include use of hospitals, long-term care and home care. Decedents' utilization within 2 years before death and survivors' utilization in the same period of time was assessed in three age groups (70-79, 80-89 and > or = 90 years) and by gender. Decedents used hospital and long-term care more than their surviving counterparts, but the time patterns were different. In hospital care the differences between decedents and survivors rose in the last months of the study period, whereas in long-term care there were clear differences during the whole 2-year period. The differences were smaller in the oldest age group than in younger age groups. Closeness of death is an important predictor of health and social service use in old age, but its influence varies between age groups. Not only the changing age structure, but also the higher average age at death affects the future need for services.
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Maxwell, Annette E.; Glenn, Beth A.; Herrmann, Alison K.; Chang, L Cindy; Crespi, Catherine M.; Bastani, Roshan
2017-01-01
The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N = 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect = 0.166, SE = 0.07, p<.05; direct effect = 0.296, SE = 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population. PMID:29057278
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O'Keefe, Daniel; Davis, Jessica; Yakuna, Glenda; Van Gemert, Caroline; Morgan, Chris
2011-01-01
Maternal health across Papua New Guinea (PNG) is of extreme public health concern. In response, the National Department of Health explicitly prioritized improving maternal, neonatal and child health services, envisaging increased collaboration between the formal health system and community-based initiatives as one method for achieving this. This study examined the patterns of formal and non-formal service utilization during pregnancy and childbirth in one province. We analysed the activity database of the East Sepik Women and Children's Health Project's Village Health Volunteer (VHV) program, an informal health service in East Sepik Province of PNG, estimating VHV activity and coverage for two maternal health care services (first antenatal care visit and VHV-attended deliveries) and comparing these to the volume and estimated coverage of these services delivered by the formal health system in East Sepik over the years 2007 to 2010. We found a significant increase in women's utilization of VHVs for first antenatal care and for an attended delivery. Reported coverage of these services delivered by the formal health service declined or at best remained static over the same time period. Our data cannot illuminate the causes of an apparent and highly concerning decline in health facility usage for assisted delivery, nor the reasons for increased usage of VHVs. The factors contributing to these trends in service provision require urgent study, to improve our understanding of the drivers of utilization of critical maternal health services. Our study demonstrates that VHVs deliver a substantial proportion of maternal health services in East Sepik. This finding alone highlights the importance of considering this cadre when planning health service improvements and suggests that a national VHV policy that builds on the work of the National Health Plan in defining the most appropriate role for VHVs in maternal health care is long overdue.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Barnes, P.R.; Van Dyke, J.W.; McConnell, B.W.
It is estimated that electric utilities use about 40 million distribution transformers in supplying electricity to customers in the United States. Although utility distribution transformers collectively have a high average efficiency, they account for approximately 61 billion kWh of the 229 billion kWh of energy lost annually in the delivery of electricity. Distribution transformers are being replaced over time by new, more efficient, lower-loss units during routine utility maintenance of power distribution systems. Maintenance is typically not performed on units in service. However, units removed from service with appreciable remaining life are often refurbished and returned to stock. Distribution transformersmore » may be removed from service for many reasons, including failure, over- or underloading, or line upgrades such as voltage changes or rerouting. When distribution transformers are removed from service, a decision must be made whether to dispose of the transformer and purchase a lower-loss replacement or to refurbish the transformer and return it to stock for future use. This report contains findings and recommendations on replacing utility distribution transformers during routine maintenance, which is required by section 124(c) of the Energy Policy Act of 1992. The objectives of the study are to evaluate the practicability, cost-effectiveness, and potential energy savings of replacing or upgrading existing transformers during routine utility maintenance and to develop recommendations on was to achieve the potential energy savings.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Peterson, E.
1979-01-01
The socioeconomic studies of the present plant site community and fuelwood harvest region include the following: population, housing, income and employment, education, community services, health and social services, crime, and economic base. The potential plant impacts on the following are discussed: employment, income, state revenues, population, housing, education, community services, health services, and the wood products industry. (MHR)
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Levers supporting tariff growth for water services: evidence from a contingent valuation analysis.
Guerrini, Andrea; Vigolo, Vania; Romano, Giulia; Testa, Federico
2018-02-01
The backwardness of the water utilities sector necessitates urgent investment in infrastructure to improve water quality and efficiency in water supply networks. A policy of tariff growth represents the main source to sustain such investments. Therefore, customer engagement in the form of willingness to pay (WTP) is highly desirable by water utilities to obtain social legitimization and support. This study examines the determinants of consumers' WTP for improvement programs for three drinking water issues: quality of water sources, renewal of water mains, and building of new wastewater treatment plants. The study is based on a survey conducted among a sample of 587 customers of a water utility located in the province of Verona in the north of Italy. The contingence valuation method is used to measure WTP. Specifically, an ordinal logistic regression model yields the following significant determinants of WTP: quality of water and services provided, preference for privatization of the water utility, sustainable consumption of water, and some socio-demographic variables. The findings provide interesting insights into the drivers of WTP as well as managerial recommendations for water utilities. In particular, the findings show that water utilities need to improve service and water quality to increase customers' acceptance of tariff growth. In addition, utilities should invest in customer education and communication activities focusing on specific age groups (e.g., older customers) to enhance their WTP. Finally, communication strategies should reinforce the possible role of liberalization and privatization in supporting infrastructure investments. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Controller Evaluation of Initial Data Link Air Traffic Control Services: Mini Study 2 Volume II
DOT National Transportation Integrated Search
1989-03-01
This report details the results of Mini Study 2. This Mini Study was conducted at the Federal Aviation Administration (FAA) Technical Center utilizing the Data Link test bed. Initial Data Link air traffic control services were evaluated under part ta...
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Controller Evaluation of Initial Data Link Air Traffic Control Services: Mini Study 2 Volume I
DOT National Transportation Integrated Search
1989-03-01
This report details the results of Mini Study 2. This Mini Study was conducted at the Federal Aviation Administration (FAA) Technical Center utilizing the Data Link test bed. Initial Data Link air traffic control services were evaluated under part ta...
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Controller Evaluation of Initial Data Link Air Traffic Control Services, Mini Study 1, Volume 1
DOT National Transportation Integrated Search
1988-09-01
This report details the results of Mini Study 1. This mini study was conducted : at the Federal Aviation (FAA) Technical Center utilizing the Data Link testbed. : Initial Data Link air traffic control services were under part task simulation : condit...
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Liu, Chuan-Fen; Sales, Anne E; Sharp, Nancy D; Fishman, Paul; Sloan, Kevin L; Todd-Stenberg, Jeff; Nichol, W Paul; Rosen, Amy K; Loveland, Susan
2003-01-01
Objective To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. PMID:14596393
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Tumwebaze, Flora; Akakimpa, Denis; Kityo, Cissy; Mugyenyi, Peter; Abongomera, George
2018-01-01
Background UNAIDS has set a new target 90-90-90 by 2020. To achieve this target, current programs need to address challenges that limit access, availability, and utilization of HIV testing and treatment services. Therefore, the aim of this study was to identify the barriers that influence access, availability, and utilization of HIV services in rural Uganda within the setting of a large donor funded program. Methods We conducted key informant interviews with stakeholders at the district level, staff of existing HIV/AIDS projects, and health facilities in 19 districts. Data were also collected from focus group discussions comprised of clients presenting for HIV care and treatment. Data were transcribed and analyzed using content analysis. Results. Barriers identified were as follows: (1) drug shortages including antiretroviral drugs at health facilities. Some patients were afraid to start ART because of worrying about shortages; (2) distance and (3) staffing shortages; (4) stigma persistence; (5) lack of social and economic support initiatives that enhance retention in treatment. Conclusions In conclusion, our study has identified several factors that influence access, availability, and utilization of HIV services. Programs need to address drug and staff shortages, HIV stigma, and long distances to health facilities to broaden access and utilization in order to realize the UNAIDS target. PMID:29750175
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Electroconvulsive Therapy Practice in New Zealand.
Fisher, Mark Wilkinson; Morrison, John; Jones, Paul Anthony
2017-06-01
The aim of this study was to describe the contemporary practice of electroconvulsive therapy (ECT) in New Zealand. A 53-item questionnaire was sent to all services providing ECT as of December 2015. Electroconvulsive therapy was provided by 16 services covering 15 district health boards funded by the New Zealand government. No private facilities provided ECT. All services providing ECT responded to an online survey questionnaire. Rates of ECT utilization were low relative to similar countries. Survey results indicated ECT was practiced to an overall good standard. Several resource and logistical issues potentially contributing to low ECT utilization were identified. Electroconvulsive therapy in New Zealand is provided using modern equipment and practices. However, overall rates of utilization remain low, perhaps as a result of controversy surrounding ECT and some resourcing issues.
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Hoge, Charles W; Auchterlonie, Jennifer L; Milliken, Charles S
2006-03-01
The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment. To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service. Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner. Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service. The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program. Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.
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1979-05-01
Classification) A Study of the Utility of a Participative Approach to Employee Attitude Surveys as a Management Tool at the Audie L. Murphy Memoria VA...Engineering-49, Medical-38, Laboratory-32, Social Work-23, and RMS-19.) The responses of employees in all other services would be collectively identified...Laboratory 47 Social Work 78 All Others 50 TABLE 3 Positive Responses to Question Thirteen By Service Comparing responses by salary level the average positive
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Brown, H J; Miller, J K; Pinchoff, D M
1975-01-01
The Information Dissemination Service at the Health Sciences Library, State University of New York at Buffalo, was established June 1970 through a three-year grant from the Lakes Area Regional Medical Program, Inc. Analysis of two samples of user request forms yielded results which significantly substantiate findings in prior biomedical literature utilization studies. The findings demonstrate comparable utilization patterns by user group, age of material, journal titles, language, time to process request, source of reference, and size of institution. PMID:1148441
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Reducing barriers to older persons' use of dental services.
Kiyak, H A
1989-06-01
In the United States elderly persons are the least likely of any age group to utilize dental services. With the increase in the elderly population and expansion of interest in their dental care, our understanding of the barriers to that care is particularly important. Studies have indicated that cost of treatment, fear of dentistry, functional independence and poor general health are of little significance in explaining the low utilization patterns of this age group. Perceived need seems to be the strongest predictor in deciding whether dental services are sought by an individual. Two programmes established by The University of Washington aimed to enhance the utilization of dental services by the elderly. One provided free screenings for over 65's on low incomes, coupled with a low cost dental care scheme. Although it was found that the convenient location of a dental clinic was a valuable incentive for the increased uptake of services, the difficulty remained one of patient perception of need. The second programme sought to overcome this latter problem by providing information on the importance of oral health to the independent elderly. This included a weekly class for small groups conducted by a health educator over a 6-week period together with a self-monitoring chart for each participant. It is anticipated that the heightened awareness aroused by this education programme will translate into perceived need and thus greater dental service utilization by the participants.
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Lam, Linda Chiu-Wa; Wong, Corine Sau-Man; Wang, Min-Jung; Chan, Wai-Chi; Chen, Eric Yu-Hai; Ng, Roger Man-Kin; Hung, Se-Fong; Cheung, Eric Fuk-Chi; Sham, Pak-Chung; Chiu, Helen Fung-Kum; Lam, Ming; Chang, Wing-Chung; Lee, Edwin Ho-Ming; Chiang, Tin-Po; Lau, Joseph Tak-Fai; van Os, Jim; Lewis, Glyn; Bebbington, Paul
2015-09-01
Data on mental disorder prevalence and health service utilization required to inform healthcare management and planning are lacking in Hong Kong. The current study determined the prevalence of common mental disorders (CMD), and examined the patterns of mental health service utilization and associated factors. We analyzed data from the Hong Kong Mental Morbidity Survey (HKMMS) of 5,719 Chinese adults aged 16-75 years in the general Hong Kong population, using the Chinese Revised Clinical Interview Schedule (CIS-R). The weighted prevalence estimate for any past-week CMD was 13.3 %, with mixed anxiety and depressive disorder being the most frequent diagnoses. CMD was positively associated with female gender, being divorced or separated, alcohol misuse, substance dependence, lack of regular physical exercise, and a family history of mental disorder. Among individuals with CMD, only 26 % had consulted mental health services in the past year; less than 10 % consulted general practitioners or family physicians. Lack of mental health service usage was significantly more likely in men and those with lower educational attainment. Apart from attention to psychosocial risks, health and lifestyle factors are important considerations for mental health promotion. Service utilization for individuals with CMD in Hong Kong remains suboptimal, and would be enhanced by strengthening community primary care.
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Demonstration of Essential Reliability Services by Utility-Scale Solar
Essential Reliability Services by Utility-Scale Solar Photovoltaic Power Plant: Q&A Demonstration of Essential Reliability Services by Utility-Scale Solar Photovoltaic Power Plant: Q&A Webinar Questions & Answers April 27, 2017 Is photovoltaic (PV) generation required to provide grid supportive
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77 FR 10501 - Northeast Utilities Service Company; Notice of Petition for Declaratory Order
Federal Register 2010, 2011, 2012, 2013, 2014
2012-02-22
... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL12-25-000] Northeast Utilities Service Company; Notice of Petition for Declaratory Order Take notice that on February 8, 2012, Northeast Utilities Service Company (NUSCO), on behalf of the Connecticut Light and Power Company, Public...
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The development of an instrument to match individuals with disabilities and service animals.
Zapf, S A; Rough, R B
There has been an increase in the use of service animals assisting persons with disabilities in the past decade. However many of the service dog agencies do not utilize an assessment that is designed to match the person to the animal in the rehabilitation and psycho-social domains. The purpose of this study was to develop the Service Animal Adaptive Intervention Assessment (SAAIA) and to measure the content validity, inter-rater reliability and clinical utility of the assessment. Two subject groups were used. Subject group one had 43 subjects who measured the content validity and clinical utility of the SAAIA Survey. Subject group two had 12 subjects who measured the inter-rater reliability by completing the SAAIA using information obtained through a video-taped client case scenario. Content validity results indicated a good to high percentage of agreement and a fair percentage of agreement for clinical utility. Inter-rater reliability results indicate good to high agreement on six of the eight variables of the SAAIA. However, the Kappa score indicates low inter-rater reliability. Results indicate the SAAIA has good content validity and inter-rater reliability and fair clinical utility based on percent agreement. However, further research is needed on the reliability of the SAAIA.
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Singh, Jitendra Kumar; Kadel, Rajendra; Acharya, Dilaram; Lombard, Daniel; Khanal, Saval; Singh, Shri Prakash
2018-06-14
Capacity development of health volunteers and text messaging to pregnant women through mobile phones have shown improved maternal and child health (MCH) outcomes and is associated with increased utilisation of MCH services. However, such interventions are uncommon in Nepal. We aim to carry out an intervention with the hypothesis that capacity building and text messaging intervention will increase the MCH service utilisation. MATRI-SUMAN is a 12-month cluster randomized controlled trial (RCT). The trial involves pregnant women from 52 clusters of six village development committees (VDCs) covering 66,000 populations of Dhanusha district of Nepal. In the intervention clusters, Female Community Health Volunteers (FCHVs) will receive capacity development skills through reinforcement training, supervision and monitoring skills for the promotion of health seeking behaviour among pregnant women and study participants will receive periodic promotional text messaging service about MCH components through mobile phones. A sample of 354with equal numbers in each study arm is estimated using power calculation formula. The primary outcomes of this study are the rate of utilization of skilled birth attendants and consumption of a specified diversified meal. The secondary outcomes are: four antenatal (ANC) visits, weight gain of women during pregnancy, delivery of a baby at the health facility, postnatal care (PNC) visits, positive changes in child feeding practices among mothers, performance of FCHVs in MCH service utilization. The intervention is designed to enhance the capacity of health volunteers for the promotion of health seeking behaviour among pregnant women and text messaging through a mobile phone to expecting mothers to increase MCH service utilization. The trial if proven effective will have policy implications in poor resource settings. ISRCTN60684155, ( https://doi.org/10.1186/ISRCTN60684155 ). The trial was registered retrospectively.
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Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas
Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A
2011-01-01
Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855
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Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis
2010-01-01
Background There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. Methods This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level. Results Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households. Conclusions There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform. PMID:20222988
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Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis
2013-01-01
Background The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. Methods A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve “kebeles” of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. Result About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Conclusion Factors operating at individual and “kebele” levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women. PMID:23587369
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Code of Federal Regulations, 2011 CFR
2011-01-01
... SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM... subpart does not apply to Water and Waste Programs of the Rural Utilities Service, Watershed loans, or..., this subpart is inapplicable to Farm Service Agency, Farm Loan Programs. [52 FR 26134, July 13, 1987...
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Code of Federal Regulations, 2010 CFR
2010-01-01
... SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM... subpart does not apply to Water and Waste Programs of the Rural Utilities Service, Watershed loans, or..., this subpart is inapplicable to Farm Service Agency, Farm Loan Programs. [52 FR 26134, July 13, 1987...
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Household Response to Inadequate Sewerage and Garbage Collection Services in Abuja, Nigeria
2017-01-01
Provision of sanitation and garbage collection services is an important and yet challenging issue in the rapidly growing cities of developing countries, with significant human health and environmental sustainability implications. Although a growing number of studies have investigated the consequences of inadequate delivery of basic urban services in developing countries, few studies have examined how households cope with the problems. Using the Exit, Voice, Loyalty, and Neglect (EVLN) model, this article explores how households respond to inadequate sewerage and garbage collection services in Abuja, Nigeria. Based on a qualitative study, data were gathered from in-depth interviews with sixty households, complemented with personal observation. The findings from grounded analysis indicated that majority (62%) and about half (55%) of the respondents have utilized the informal sector for sewerage services and garbage collection, respectively, to supplement the services provided by the city. While 68% of the respondents reported investing their personal resources to improve the delivery of existing sewerage services, half (53%) have collectively complained to the utility agency and few (22%) have neglected the problems. The paper concludes by discussing the public health and environmental sustainability implications of the findings. PMID:28634496
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Utility deregulation and AMR technology. [Automated Meter Reading
DOE Office of Scientific and Technical Information (OSTI.GOV)
Moore, G.
1991-06-15
This article reviews the effects of deregulation on other utilities and services and examines how the electric utilities can avoid the worst of these effects and capitalize of the best aspects of competition in achieving marketing excellence. The article presents deregulation as a customer service and underscores the need for utilities to learn to compete aggressively and intelligently and provide additional services available through technology such as automated meter reading.
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Equity in health care utilization in Chile.
Núñez, Alicia; Chi, Chunhuei
2013-08-12
One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.
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Utilization and expenditure at public and private facilities in 39 low-income countries.
Saksena, Priyanka; Xu, Ke; Elovainio, Riku; Perrot, Jean
2012-01-01
To document the patterns of health service utilization and health payments at public and private facilities across countries. We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared. Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider. The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation. © 2011 Blackwell Publishing Ltd.
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A transaction assessment method for allocation of transmission services
NASA Astrophysics Data System (ADS)
Banunarayanan, Venkatasubramaniam
The purpose of this research is to develop transaction assessment methods for allocating transmission services that are provided by an area/utility to power transactions. Transmission services are the services needed to deliver, or provide the capacity to deliver, real and reactive power from one or more supply points to one or more delivery points. As the number of transactions increase rapidly in the emerging deregulated environment, accurate quantification of the transmission services an area/utility provides to accommodate a transaction is becoming important, because then appropriate pricing schemes can be developed to compensate for the parties that provide these services. The Allocation methods developed are based on the "Fair Resource Allocation Principle" and they determine for each transaction the following: the flowpath of the transaction (both real and reactive power components), generator reactive power support from each area/utility, real power loss support from each area/utility. Further, allocation methods for distributing the cost of relieving congestion on transmission lines caused by transactions are also developed. The main feature of the proposed methods is representation of actual usage of the transmission services by the transactions. The proposed method is tested extensively on a variety of systems. The allocation methods developed in this thesis for allocation of transmission services to transactions is not only useful in studying the impact of transactions on a transmission system in a multi-transaction case, but they are indeed necessary to meet the criteria set forth by FERC with regard to pricing based on actual usage. The "consistency" of the proposed allocation methods has also been investigated and tested.
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Klinger, Christopher A; Howell, Doris; Marshall, Denise; Zakus, David; Brazil, Kevin; Deber, Raisa B
2013-02-01
Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day. While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.
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Developing a uniformed assessment tool to evaluate care service needs for disabled persons in Japan.
Takei, Teiji; Takahashi, Hiroshi; Nakatani, Hiroki
2008-05-01
Until recently, the care services for disabled persons have been under rigid control by public sectors in terms of provision and funding in Japan. A reform was introduced in 2003 that brought a rapid increase of utilization of services and serious shortage of financial resources. Under these circumstances, the "Services and Supports for Persons with Disabilities Act" was enacted in 2005, requiring that the care service provision process should be transparent, fair and standardized. The purpose of this study is to develop an objective tool for assessing the need for disability care. In the present study we evaluate 1423 cases of patients receiving care services in 60 municipalities, including all three categories of disabilities (physical, intellectual and mental). Using the data of the total 106 items, we conducted factor analysis and regression analysis to develop an assessment tool for people with disabilities. The data revealed that instrumental activities of daily living (IADL) played an essential role in assessing disability levels. We have developed the uniformed assessment tool that has been utilized to guide the types and quantity of care services throughout Japan.
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Acculturation and Dental Service Use Among Asian Immigrants in the U.S.
Luo, Huabin; Wu, Bei
2016-12-01
The objective of this study was to assess dental service utilization across different Asian immigrant groups and to examine the relationship between acculturation and dental service utilization among Asian immigrants in the U.S. Data were from the 2013 and 2014 National Health Interview Surveys. Multiple logistic regression models were used to examine the association between acculturation and having a dental visit in the previous 12 months, controlling for predisposing, enabling, and need factors. Acculturation was measured by length of stay in the U.S., English language proficiency, and U.S. citizenship. The sample was 2,948 adult Asian immigrants who were dentate. Data were analyzed in 2016. Dental service utilization varied across Asian immigrant groups. High English proficiency and longer length of stay were significantly associated with having a dental visit (p<0.05). In the final model, after adding enabling factors-dental insurance and family income levels-length of stay in the U.S. (≥5 years) remained significant, whereas English language proficiency was not a significant correlate of having a dental visit. Length of stay in the U.S. is a significant factor affecting dental service utilization among Asian immigrants. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Franzini, Luisa; White, Chapin; Taychakhoonavudh, Suthira; Parikh, Rohan; Zezza, Mark; Mikhail, Osama
2014-01-01
Objective To measure the contribution of market-level prices, utilization, and health risk to medical spending variation among the Blue Cross Blue Shield of Texas (BCBSTX) privately insured population and the Texas Medicare population. Data Sources Claims data for all BCBSTX members and publicly available CMS data for Texas in 2011. Study Design We used observational data and decomposed overall and service-specific spending into health status and health status adjusted utilization and input prices and input prices adjusted for the BCBSTX and Medicare populations. Principal Findings Variation in overall BCBSTX spending across HRRs appeared driven by price variation, whereas utilization variation factored more prominently in Medicare. The contribution of price to spending variation differed by service category. Price drove inpatient spending variation, while utilization drove outpatient and professional spending variation in BCBSTX. The context in which negotiations occur may help explain the patterns across services. Conclusions The conventional wisdom that Medicare does a better job of controlling prices and private plans do a better job of controlling volume is an oversimplification. BCBSTX does a good job of controlling outpatient and professional prices, but not at controlling inpatient prices. Strategies to manage the variation in spending may need to differ substantially depending on the service and payer. PMID:24919408
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Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children
Coker, Tumaini R.; Elliott, Marc N.; Kataoka, Sheryl; Schwebel, David C.; Mrug, Sylvie; Grunbaum, Jo Anne; Cuccaro, Paula; Peskin, Melissa F.; Schuster, Mark A.
2015-01-01
Objective The aim of this study was to examine racial/ethnic differences in fifth grade children’s mental health care utilization. Methods We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization. Results Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P <.001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models. Conclusions Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children. PMID:19329099
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Siddique, Md Kaoser Bin; Islam, Sheikh Mohammed Shariful; Banik, Palash Chandra; Rawal, Lal B
2017-08-22
Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh. This analytical study was conducted among 318 patients with type 2 diabetes (T2DM) attending two large tertiary hospitals in Dhaka, Bangladesh between August 2014 and January 2015. Interviewer assisted semi-structured survey questionnaire was used to collect data on diabetes knowledge (measured by a validated Likert scale) and self-reported utilization of service for diabetes. Univariate and bivariate analyses were conducted to determine the factors associated with diabetes knowledge and healthcare utilization. The mean (±SD) age of participants was 52 (±10) years. Majority of the participants were females (58%) and urban residents (74%). Almost two-third (66%) of the participants had an average level of knowledge of T2DM. One-fifth (21%) of the participants had poor knowledge which was significantly associated with gender (P < 0.002), education (P < 0 .001) and income (P < 0.001). The median travel and waiting time at the facility was 30 and 45 min respectively. More than one-third (37%) of the participants checked their blood glucose monthly. Most patients were satisfied regarding the family (55%) and hospital (67%) support. T2DM patients had average knowledge of diabetes which might affect the utilization of healthcare services for diabetes management. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income.
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Building brand equity and customer loyalty
DOE Office of Scientific and Technical Information (OSTI.GOV)
Pokorny, G.
Customer satisfaction and customer loyalty are two different concepts, not merely two different phrases measuring a single consumer attitude. Utilities having identical customer satisfaction ratings based on performance in areas like power reliability, pricing, and quality of service differ dramatically in their levels of customer loyalty. As competitive markets establish themselves, discrepancies in customer loyalty will have profound impacts on each utility`s prospects for market retention, profitability, and ultimately, shareholder value. Meeting pre-existing consumer needs, wants and preferences is the foundation of any utility strategy for building customer loyalty and market retention. Utilities meet their underlying customer expectations by performingmore » well in three discrete areas: product, customer service programs, and customer service transactions. Brand equity is an intervening variable standing between performance and the loyalty a utility desires. It is the totality of customer perceptions about the unique extra value the utility provides above and beyond its basic product, customer service programs and customer service transactions; it is the tangible, palpable reality of a branded utility that exists in the minds of consumers. By learning to manage their brand equity as well as they manage their brand performance, utilities gain control over all the major elements in the value-creation process that creates customer loyalty. By integrating brand performance and brand equity, electric utility companies can truly become in their customers` eyes a brand - a unique, very special, value-added energy services provider that can ask for and deserve a premium price in the marketplace.« less
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A Little Bit Can Go a Long Way: An Examination of Required Service in the Basic Communication Course
ERIC Educational Resources Information Center
McIntyre, Kristen A.; Sellnow, Deanna D.
2014-01-01
This study examines the utility of service-learning pedagogy in the general education basic communication course to meet service-learning outcomes, with an emphasis on civic engagement. Results of the data suggest that students in both a one-time service site and multiple-site condition indicated that the service experience enhanced three of the…
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42 CFR 456.22 - Sample basis evaluation of services.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 456.22 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: All Medicaid Services § 456... available services and facilities the Medicaid agency must have procedures for the on-going evaluation, on a...
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ERIC Educational Resources Information Center
Austin, Michael J.; And Others
The Office of Career Planning and Curriculum Development for the Human Services was established in September 1972 to study the problems associated with manpower utilization and the lack of career mobility within the Florida Department of Health and Rehabilitative Services (HRS). Objectives of the study were: (1) to identify the contributing…
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2014 QuickCompaof TRICARE Child Beneficiaries: Utilization of Medicaid Waivered Services
2015-02-12
Utilization of Medicaid Waivered Services 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHORISI Sd. PROJECT NUMBER Tinney, R., Dr. Se. TASK...from the 2014 QuickCompass ofTRlCARE Child Beneficiaries: Utilization of Medicaid Waivered Services (2014 QTCB). The 2014 QTCB survey was...Family Member Program (EFMP), TRICARE Extended Care Health Option (ECHO), Medicaid , and Medicaid Home and Community Based Services (HCBS) Waivers. 16
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Inequalities in Use of Health Services among Jews and Arabs in Israel
Baron-Epel, Orna; Garty, Noga; Green, Manfred S
2007-01-01
Objectives To compare the levels of utilization of health services in Jews and Arabs taking into account differences in levels of socioeconomic status (SES) in a country with a National Health Insurance Law (NHIL). Data Source/Study Setting A cross-sectional National Health Interview Survey was carried out in Israel based on a random sample of telephone numbers as part of the EUROHIS project (WHO European Health Interview Survey 2003–2004). Study Design A random telephone survey included 9,352 interviews. Questions included use of health care services, health status, and socioeconomic variables. Principal Findings After adjusting for sex, age, income, education, marital status, and self-reported chronic diseases, Arabs more often reported visiting a family physician (odds ratio [OR] = 1.56, 95 percent confidence interval [CI] = 1.35–1.81) and less often reported visiting a specialist (OR = 0.73, 95 percent CI = 0.60–0.89) compared with Jews. In addition, the odds ratio for hospitalization was similar among Arabs and Jews (OR = 1.16, 95 percent CI = 0.97–1.38). SES was associated with utilization of health care services only in the Jewish population. Conclusions A different pattern of utilization of health care services was observed in Arabs and Jews. This was not explained by differences in socioeconomic levels. More research is needed regarding the distribution of services between Jews and Arabs. PMID:17489901
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Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam.
Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur
2015-01-01
This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.
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Outsourcing decision factors in publicly owned electric utilities
NASA Astrophysics Data System (ADS)
Gonzales, James Edward
Purpose. The outsourcing of services in publicly owned electric utilities has generated some controversy. The purpose of this study was to explore this controversy by investigating the relationships between eight key independent variables and a dependent variable, "manager perceptions of overall value of outsourced services." The intent was to provide data so that utilities could make better decisions regarding outsourcing efforts. Theoretical framework. Decision theory was used as the framework for analyzing variables and alternatives used to support the outsourcing decision-making process. By reviewing these eight variables and the projected outputs and outcomes, a more predictive and potentially successful outsourcing effort can be realized. Methodology. A survey was distributed to a sample of 323 publicly owned electric utilities randomly selected from a population of 2,020 in the United States. Analysis of the data was made using statistical techniques including the Chi-Square, Lambda, Spearman's coefficient of rank correlation, as well as the Hypothesis Test, Rank Correlation, to test for relationships among the variables. Findings. Relationships among the eight key variables and perceptions of the overall value of outsourced services were generally weak. The notable exception was with the driving force (reason) for outsourcing decisions where the relationship was strongly positive. Conclusions and recommendations. The data in support of the research questions suggest that seven of the eight key variables may be weakly predictive of perceptions of the overall value of outsourced services. However, the primary driving force for outsourcing was strongly predictive. The data also suggest that many of the sampled utilities did not formally address these variables and alternatives, and therefore may not be achieving maximal results. Further studies utilizing customer perceptions rather than those of outsourcing service managers are recommended. In addition, it is recommended that a smaller sample population be analyzed after identifying one or more champions to ensure cooperation and legitimacy of data. Finally, this study supports the position that a manager's ability to identify and understand the relationships between these eight key variables and desired outcomes and outputs may contribute to more successful outsourcing operations.
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Screening Mammography and Digital Breast Tomosynthesis: Utilization Updates.
Boroumand, Gilda; Teberian, Ida; Parker, Laurence; Rao, Vijay M; Levin, David C
2018-05-01
There have been many recent developments in breast imaging, including the 2009 revision of the U.S. Preventive Services Task Force's breast cancer screening guidelines and the approval of digital breast tomosynthesis (DBT) for clinical use in 2011. The objective of this study is to evaluate screening mammography utilization trends among the Medicare population from 2005 to 2015 and examine the volume of DBT studies performed in 2015, the first year for which procedural billing codes for DBT are available. We reviewed national Medicare Part B Physician/Supplier Procedure Summary master files from 2005 to 2015, to determine the annual utilization rate of screening mammography on the basis of procedure codes used for film-screen and digital screening mammography. We also used the Physician/Supplier Procedure Summary master files to determine the volume of screening and diagnostic DBT studies performed in 2015. The utilization rate of screening mammography per 1000 women in the Medicare fee-for-service population increased gradually every year, from 311.5 examinations in 2005 to a peak of 322.9 examinations in 2009, representing a compound annual growth rate of 0.9%. In 2010, the utilization rate abruptly decreased by 4.3% to 309.2 examinations, and it has not since recovered to pre-2010 levels. In 2015, 18.9% of screening and 16.2% of diagnostic digital mammography examinations included DBT as an add-on procedure. In contrast to the annual increase in screening mammography utilization from 2005 to 2009, an abrupt sustained decline in screening occurred beginning in 2010, coinciding with the release of U.S. Preventive Services Task Force recommendations. DBT utilization was somewhat limited in 2015, occurring in conjunction with less than 20% of digital mammography examinations.
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Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud
2017-01-01
Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities.
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Using Decision Support to Address Racial Disparities in Mental Health Service Utilization
ERIC Educational Resources Information Center
Rawal, Purva H.; Anderson, Tanya R.; Romansky, Jill R.; Lyons, John S.
2008-01-01
Unfortunately, racial disparities are well documented in the delivery of behavioral health services. This study examines the effects of implementing a decision support process, integrating clinical information into the administration of mental health services, on racial disparities in psychiatric hospital admissions for children in state custody.…
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Singh, Prashant Kumar; Kumar, Chandan; Rai, Rajesh Kumar; Singh, Lucky
2014-08-01
Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth. Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.
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Day, S R
1984-01-01
The relevance of home care research to policy questions is discussed as framework for study on "effects" (precursors and sequelae) of home care. This study used a large, multi-service agency's longitudinal (8-year) case records (N = 2436) to examine a system model for relationships among entry characteristics, utilization of services, and need for services upon discharge from home care. Deducing case-mix from utilization patterns, pay plan at entry was identified as best of the available predictors of both duration and intensity (using multivariate analysis). Duration and intensity, dual contributors to "total visits," were found to vary inversely and were predicted by different entering pay plans. While 1/3 of all cases were discharged to informal or self care, that was the most prevalent exit status of the clients (49%) who entered directly from hospital care. The methods used in disaggregating and analyzing these retrospectively-coded case records suggest that home services research: 1. distinguish type, intensity, and duration as components of "total visits" which combine to account for costs of care; 2. find concomitants of functional level (such as pay plan) which are accessible for designating case mix for purpose of projecting service use; 3. measure effectiveness in terms relevant to stated objectives of the long term care system, which need to acknowledge mortality and to separate service needs at entry room those at exist from the series of formal and informal providers on a continuum of care.
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29 CFR 4.120 - Contracts for public utility services.
Code of Federal Regulations, 2010 CFR
2010-07-01
... McNamara-O'Hara Service Contract Act Specific Exclusions § 4.120 Contracts for public utility services. The Act, in paragraph (5) of section 7, exempts from its provisions “any contract for public utility... regulation, are not exempt from the Act. Among the contracts included in the exemption would be those between...
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ERIC Educational Resources Information Center
Bowen, Mary Elizabeth; Gonzalez, Hector M.
2008-01-01
Purpose: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization. Design and Methods: The study used 12 years of longitudinal…
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Turner, James C; Keller, Adrienne
2015-01-01
This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Participating schools uploaded de-identified electronic health records from student health services monthly. During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non-sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses.
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Turner, James C.; Keller, Adrienne
2015-01-01
Abstract Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded de-identified electronic health records from student health services monthly. Results: During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non–sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. Conclusions: CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses. PMID:26086428
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Baron, Kelly G; Lattie, Emily; Ho, Joyce; Mohr, David C
2013-03-01
Counseling interventions have the potential to improve health and quality of life for primary care patients, but there are few studies describing the interest in and utilization of counseling among this patient population in the USA. The purpose of the study was to evaluate interest in mental health and specialty behavioral medicine counseling and predictors of utilization over 1 year among US primary care patients. Participants in this two-survey longitudinal study included 658 primary care patients in an urban US academic medical center (461 females, age M = 51.05, SD = 15.46 years). Retention rate was 61.2% at survey 2. Patient demographics, depression, anxiety, and interest in counseling services were assessed through a survey mailed 1 week following an outpatient appointment. Respondents to survey 1 were re-contacted 1 year later to assess. Interest and use of the following counseling services were evaluated in the relevant subgroups: mental health (the entire sample and patients with elevated anxiety and/or depression), health/lifestyle (overweight and obese participants), smoking cessation (current and occasional smokers), and pain management (participants with elevated daily pain ratings). At survey 1, 45.7% of the sample reported interest in mental health counseling, and 58.9% of the sample reported interest in behavioral medicine counseling. Among overweight or obese participants, 59.9% were interested in health/lifestyle counseling. Among smokers, 55.3% were interested in smoking cessation, and among participants with chronic pain, 33.8% were interest in pain management. Rates of utilization of services at survey 2 were 21.3% for mental health, 7.7% for health/lifestyle, 6.7% for smoking cessation, and 6.6% for pain management. Interest in receiving services at survey 1 was the strongest predictor of utilization. Results demonstrate high interest but low utilization over 1 year among US primary care patients. Identifying patients interested in counseling services and reducing barriers may help facilitate receipt of services for those with interest and need for behavioral treatments.
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Rhoades, Harmony; Winetrobe, Hailey; Rice, Eric
2014-01-01
As many as 25% of homeless persons have pets. To our knowledge, pet ownership has not been studied quantitatively with homeless youth. This study examined pet ownership among 398 homeless youth utilizing two Los Angeles drop-in centers. Twenty-three percent of homeless youth had a pet. The majority of pet owners reported that their pets kept them company and made them feel loved; nearly half reported that their pets made it more difficult to stay in a shelter. Pet owners reported fewer symptoms of depression and loneliness than their non-pet owning peers. Pet ownership was associated with decreased utilization of housing and job-finding services, and decreased likelihood of currently staying in a shelter. These findings elucidate many of the positive benefits of pet ownership for homeless youth, but importantly highlight that pet ownership may negatively impact housing options. Housing and other services must be sensitive to the needs of homeless youth with pets. PMID:24728815
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Rhoades, Harmony; Winetrobe, Hailey; Rice, Eric
2015-04-01
As many as 25 % of homeless persons have pets. To our knowledge, pet ownership has not been studied quantitatively with homeless youth. This study examined pet ownership among 398 homeless youth utilizing two Los Angeles drop-in centers. Twenty-three percent of homeless youth had a pet. The majority of pet owners reported that their pets kept them company and made them feel loved; nearly half reported that their pets made it more difficult to stay in a shelter. Pet owners reported fewer symptoms of depression and loneliness than their non-pet owning peers. Pet ownership was associated with decreased utilization of housing and job-finding services, and decreased likelihood of currently staying in a shelter. These findings elucidate many of the positive benefits of pet ownership for homeless youth, but importantly highlight that pet ownership may negatively impact housing options. Housing and other services must be sensitive to the needs of homeless youth with pets.
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Liu, Zhi-Yong; Li, Jiang; Hong, Yang; Yao, Lan
2016-12-01
Reproductive health (RH) education and services of female migrants in China have become an important health issue. This research aimed to investigate the RH knowledge and utilization among married female migrants, and to explore the influencing factors from the perspectives of population and sociology. We conducted a cross-section survey in Shenzhen and Wuhan, China, using the purposive sampling method. A total of 1021 rural-to-urban married migrants were recruited, with 997 valid survey results obtained. A face-to-face structured questionnaire survey was used, with primary focus on knowledge of fertility, contraception, family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome (STD/AIDs), and RH service utilization. The results showed that the RH service utilization (38.0%) was at a low level in married migrants and the accessibility of RH service was poor. Females who migrated to (OR=0.32) Wuhan obtained fewer RH consultations than those in Shenzhen. The workers with high school education received additional RH consultations and checkup services than those with other background education, apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers (P<0.05). We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China. RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.
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Gormley, Matthew J; Pinho, Trevor; Pollack, Brittany; Puzino, Kristina; Franklin, Melanie K; Busch, Chelsea; DuPaul, George J; Weyandt, Lisa L; Anastopoulos, Arthur D
2018-02-01
To test if the relationship between ADHD and academic achievement is mediated by service utilization and/or study skills, and if these mediation effects are moderated by parental education level. A bootstrapping method within structural equation modeling was used with data from 355 first year college students meeting strict criteria for ADHD or clearly without ADHD to test the mediation and moderation effects. Study skills, but not service utilization, significantly mediated the relationship between ADHD status and GPA; however, this relationship was not significant among students with at least one parent holding a master's degree or higher. Among first year college students study skills may be a more salient predictor of educational outcomes relative to ADHD status. Additional research into support services for college students with ADHD is needed, however, results suggest interventions targeting study skills may hold particular promise for these students.
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Zuckerberg, Gabriel S; Scott, Andrew V; Wasey, Jack O; Wick, Elizabeth C; Pawlik, Timothy M; Ness, Paul M; Patel, Nishant D; Resar, Linda M S; Frank, Steven M
2015-07-01
Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs. For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization. Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines. © 2015 AABB.
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McManus, Beth M; Lindrooth, Richard; Richardson, Zachary; Rapport, Mary Jane
2016-01-01
To describe urban/rural differences in physical (PT) and occupational therapy (OT) service utilization and spending among a sample of young Medicaid-enrolled children with developmental conditions. We analyzed Colorado Children's Medicaid administrative claims from 2006 to 2008. The sample included children who were younger than 36 months of age, had a select developmental condition, and were continuously eligible for each study year up to their third birthday. The study outcomes were number of PT/OT claims, type of PT/OT service, and Medicaid PT/OT spending. Multivariable analyses examined urban/rural differences in PT/OT utilization and spending, adjusting for child, family, and health service characteristics. The sample included 20,959 children. In adjusted analyses, urban children had 2-fold higher odds (odds ratio 2.18, 95% confidence interval 1.89, 2.51) of receiving PT/OT compared to their rural peers. Median annual per-child Medicaid PT/OT spending was $99 higher ($98.79 [$3.23, $194.35]) for urban children versus rural children. When place of PT/OT service and PT/OT procedures was included, this spending difference was drastically reduced. Even accounting for child, family, and health service characteristics, Medicaid PT/OT spending is lower for rural children compared to their urban peers. The difference in spending is largely attributable to utilization of services that are less specialized than urban peers, thus suggesting disparities in access to appropriate PT/OT services. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
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Agricultural Commodity and Utility Carriers Hours of Service Exemption Analysis.
DOT National Transportation Integrated Search
2010-05-01
The study was conducted in two phases. Phase 1 compares the safety performance of agricultural and non-agricultural carriers for the period 2005 through 2008, and also examines two additional industries: livestock and utility carriers, whose operatio...
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Analytical Utility of Campylobacter Methodologies
USDA-ARS?s Scientific Manuscript database
The National Advisory Committee on Microbiological Criteria for Foods (NACMCF, or the Committee) was asked to address the analytical utility of Campylobacter methodologies in preparation for an upcoming United States Food Safety and Inspection Service (FSIS) baseline study to enumerate Campylobacter...
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Ikeda, Shunya; Crawford, Bruce; Sato, Masayo
2016-01-12
Type 2 diabetes poses an increasing healthcare burden in Japan. Although insulin treatment has diversified in recent years, the literature on the utilization of healthcare services among patients with type 2 diabetes undergoing different insulin therapy regimens is scarce. The current study aimed to characterize the real-world insulin treatment patterns and associated utilization of healthcare services among patients with type 2 diabetes who initiated insulin therapy during the study period. We examined data from a hospital-based database consisting of administrative and laboratory data from 121 acute-phase hospitals throughout Japan from April 2008 to August 2012. Patients diagnosed with type 2 diabetes and receiving continuous insulin therapy, defined by three insulin claims or more, were included in the analysis. Of the 2,145 insulin initiators, at initiation 46.5% received rapid-acting insulin alone, 36.6% received an intensive regimen, 11.4% received long-acting insulin alone, and 5.5% received pre-mixed insulin alone. Patients treated with rapid-acting insulin alone were older, experienced more comorbid conditions, had lower HbA1c, and more often had initiated their insulin treatment at inpatient admission, compared to patients treated with other types of insulin. Inpatient admission was more common and longer for patients taking rapid-acting insulin and an intensive regimen than those taking long-acting or pre-mixed insulin, and most were readmitted within 1 year. Utilization of outpatient clinics was approximately once per month, and emergency department visits were observed to be rare. This retrospective observational descriptive study found varied treatment and healthcare service utilization patterns, as well as disparities in patient characteristics across insulin regimens. Future research should assess the basis for these various utilization patterns associated with insulin to conduct robust analyses of clinical and economic outcomes.
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Long-term Outcomes among Drug Dependent Mothers Treated in Women-only versus Mixed-gender Programs
Hser, Yih-Ing; Evans, Elizabeth; Huang, David; Messina, Nena
2011-01-01
This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n=500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years pre-admission and 8 years post-admission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health service utilization. Limited long-term gain is shown in the reductions in post-treatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women. PMID:21466942
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Inequalities in maternal health care utilization in Benin: a population based cross-sectional study.
Yaya, Sanni; Uthman, Olalekan A; Amouzou, Agbessi; Ekholuenetale, Michael; Bishwajit, Ghose
2018-05-31
Ensuring equitable access to maternal health care including antenatal, delivery, postnatal services and fertility control methods, is one of the most critical challenges for public health sector. There are significant disparities in maternal health care indicators across many geographical locations, maternal, economic, socio-demographic factors in many countries in sub-Sahara Africa. In this study, we comparatively explored the utilization level of maternal health care, and examined disparities in the determinants of major maternal health outcomes. This paper used data from two rounds of Benin Demographic and Health Survey (BDHS) to examine the utilization and disparities in factors of maternal health care indicators using logistic regression models. Participants were 17,794 and 16,599 women aged between15-49 years in 2006 and 2012 respectively. Women's characteristics were reported in percentage, mean and standard deviation. Mean (±SD) age of the participants was 29.0 (±9.0) in both surveys. The percentage of at least 4 ANC visits was approximately 61% without any change between the two rounds of surveys, facility based delivery was 93.5% in 2012, with 4.9% increase from 2006; postnatal care was currently 18.4% and contraceptive use was estimated below one-fifth. The results of multivariable logistic regression models showed disparities in maternal health care service utilization, including antenatal care, facility-based delivery, postnatal care and contraceptive use across selected maternal factors. The current BHDS showed age, region, religion were significantly associated with maternal health care services. Educated women, those from households of high wealth index and women currently working were more likely to utilize maternal health care services, compared to women with no formal education, from poorest households or not currently employed. Women who watch television (TV) were 1.31 (OR = 1.31; 95% CI = 1.13-1.52), 1.69 (OR = 1.69; 95% CI = 1.20-2.37) and 1.38 (OR = 1.38; 95% CI = 1.16-1.65) times as likely to utilize maternal health care services after adjusting for other covariates. The findings would guide stakeholders to address inequalities in maternal health care services. More so, health care programmes and policies should be strengthened to enhance accessibility as well as improve the utilization of maternal care services, especially for the disadvantaged, uneducated and those who live in hard-to-reach rural areas in Benin. The Benin government needs to create strategies that cover both the supply and demand side factors at attain the universal health coverage.
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Lu, Liming; Zeng, Jingchun; Zeng, Zhi
2017-02-02
Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test's P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725). This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China's healthcare system reform.
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ERIC Educational Resources Information Center
American Nurses' Association, New York, NY.
This analysis is intended to assist public health nurses and others to apply the principles and standards of professional nursing conduct and practice to the development and utilization of home health aide services. Part I, "Development of a Home Health Aide Service" covers (1) agency organization and policies, including such topics as legal…