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Biomedical subjects

B Starfield

Publications and source records attributed to B Starfield.

At least 109 records · Page 6Linked to original sources
PubMed1990

Health care use by children receiving mental health services.

Reduction in medical care utilization is one criteria for assessing the impact of mental health treatment for children with psychosocial problems. This reduction has been termed the "offset" effect. Almost all published research concerning offset after mental health treatment concerns adults, and the few studies in pediatric populations are limited by methodologic problems. A study of health care utilization after mental health treatment for children was conducted. Mental health treatment for psychosocial problems was significantly associated with decreased use of medical care only for older children, after potentially confounding variables were controlled for. Furthermore, this decreased use was found only for nonmental health specialty care visits. No reduction in primary care visits occurred. Other factors such as previous patterns of use and the presence of other morbidity were stronger predictors of subsequent primary health care use than was mental health treatment. Mental health treatment does not have a major impact on the high utilization of most children with psychosocial problems in pediatric settings. Because the reasons for this may be particular morbidity patterns in these children, future studies should include some measure of case mix as a potentially important variable in assessment of mental health treatment effects.

Child↗
PubMed1988

Poverty, race, and hospitalization for childhood asthma.

This study uses Maryland hospital discharge data for the period 1979-82 to determine whether Black children are more likely to be hospitalized for asthma and whether this difference persists after adjustment for poverty. The average annual asthma discharge rate was 1.95/1000 children aged 1-19; 3.75/1000 for Black children, and 1.25/1000 for White. Medicaid-enrolled children of both races had increased discharge rates for asthma compared to those whose care was paid for by other sources: 5.68/1000 vs 2.99/1000 for Blacks, and 3.10/1000 vs 1.11/1000 for Whites. When ecologic analyses were performed, populations of Black and White children had nearly equal asthma discharge rates after adjustment for poverty. The statewide adjusted rate was 2.70/1000 (95% CL = 1.93, 3.78) for Black children and 2.10/1000 (1.66, 2.66) for White children. Among Maryland counties and health planning districts, variation in asthma discharge rates was not associated with the supply of hospital beds or the population to primary-care physician ratio. We conclude that Black children are at increased risk of hospitalization for asthma, but that some or all of this increase is related to poverty rather than to race.

Adolescent↗
PubMed1988

Morbidity and use of ambulatory care services among poor and nonpoor children.

Using data from the Child Health Supplement to the 1981 National Health Interview Survey, illness and use of physician services are compared for children under 18 years old in three family income groups. The results indicate that although annual prevalence of many health problems does not differ greatly by income level, disability as measured by bed days is greater among low income children. A substantial minority of children from all socioeconomic levels are afflicted by multiple health problems. The impact of multiple conditions, as measured by days spent ill in bed, appears much greater for children from low income families. Use of physician services was found to be similar for children of all socioeconomic levels when no significant health problems were present, but low income children with health problems used fewer physician visits on an adjusted basis than their higher income counterparts.

Ambulatory Care↗
PubMed1987

Family health. Utilization and effects of family membership.

The purpose of this study was to determine the extent to which members of families have similar and interrelated health behavior. Utilization and morbidity data from more than 80,000 ambulatory visits by 693 families enrolled in a prepaid health plan for 6 consecutive years were examined using family membership as the major unit of analysis. Family members were found to resemble one another in their rates of use of services (r = 0.44; P less than 0.001). Parental influence on children's utilization is significant, mothers generally being two to three times more powerful than fathers in this regard. Apart from family size, structural characteristics of families contribute little to family health behavior. Family membership explains nearly one third of the variance of individual utilization even after family size and age and sex of family members are considered. A small proportion of families (5%) accounts for a disproportionately large share (12.3%) of health care utilization. Intrafamilial patterns of morbidity were apparent for several major groupings of diagnoses, most notably for acute health problems. Intrafamilial correlations were greatest among high-utilizing families. Families establish patterns of health behavior that are stable over time and therefore may be amenable to selective interventions. We conclude that health care planning, whether for service delivery or health education intervention, should consider family health data as an important information source.

Adult↗
PubMed1986

Ill health and use of medical care. Community-based assessment of morbidity in children.

The purpose of this study was to assess the relationship between morbidity and ambulatory care utilization in a randomly selected sample of children with stable patterns of use of services in a prepaid multispecialty group practice. The unique features of the approach were a focus on long-term relationships (over 8 years) and on assessment of health status by a combination of parent reports, child reports, teacher reports, and physical examination. Domains of health status that were assessed included types and frequencies of health conditions and disability associated with them, functional status (physical health, mental health, social health, general well-being), school absence, vision and hearing screening, and physical abnormalities. Children with persistently high levels of use of services in a 6-year period (1974-79) were more likely to have health problems of all types, both concurrent and in a subsequent 2-year period (1980-81) than children with lower levels of use. As these findings were in agreement with those obtained in a study where morbidity was determined by diagnoses recorded in medical records, it is likely that the measures could be more generally useful to assess child health status in the community. Moreover, they distinguish groups of children who differ in their pattern of use of services and hence may be useful in the planning and budgeting of services for child populations.

Ambulatory Care↗
PubMed1986

Primary care in the United States.

In the United States many of the cardinal features of primary care are absent. Medical practitioners usually do not provide services to a defined panel of patients and are not distributed according to the extent or type of health needs in the population or to population size. Findings from research indicate the benefits of longitudinality, comprehensiveness, first contact care, and coordination. Some of the new developments in the organization and financing of services may facilitate the attainment of some of these characteristics, but the implementation of even a rudimentary primary care system will require a greater commitment to the training of primary care personnel and better deployment of resources. In the absence of a societal commitment to a health system based upon levels of care and community orientation, a research agenda to determine the benefits and costs of various alternative approaches is suggested.

Adolescent↗
PubMed1985

Postneonatal mortality.

In the field of infant mortality I believe we are facing a slower rate of decline in the death rate over the next decade than we have experienced in the past. This follows because a low point has already been reached for the age division beyond one month and because of the stationary condition of the high rate in the first four weeks of life.... It is the concentration of effort upon the causes of infant mortality beyond one month of age which brought about this reduction.

Birth Weight↗
PubMed1985

Motherhood and apple pie: the effectiveness of medical care for children.

The impact upon health of changes in public policy regarding health services has not been systematically assessed. The long-term, and largely irreversible, effects of reduced support for health services to children present special challenges to collaborative research between clinical and public health approaches. Preliminary evidence from such a collaborative study of a variety of illnesses and interventions is persuasive of real benefit from prompt access to medical care.

Acidosis↗
PubMed1985

Utilization and morbidity: random or tandem?

Earlier studies have shown that one in eight children persist in being high users of health care services over long periods of time and, conversely, about the same proportion of children are consistently low users. As these studies failed to discover reasons for these persistent deviations from average, this study explored three possible explanations: persistent morbidity, mental health problem, and familial patterns of use. Although all three phenomena were associated with both persistence of high utilization of services as well as an overall large number of visits, the number of types of morbidity was the most significant correlate of high use. Children who were constantly low users of services were much more likely to have only a few types of morbidity whereas children who were constantly high users were much more likely to experience a wide variety of types of problems. These findings suggest that an understanding of the demand for health services requires an understanding of the interrelationships of illnesses within individuals rather than a focus on particular illnesses or particular types of illnesses.

Acute Disease↗
PubMed1985

Styles of care provided to children in the United States: a comparison by physician specialty.

This study was based on findings from a national survey of physicians that was conducted from 1975 to 1977. The data concern face-to-face encounters with children in the ambulatory care setting. Over one half of the practices of pediatricians consisted of infants and preschoolers, whereas well over 50 percent of the child patients of other types of physicians were 10 to 19 years old. The proportion of visits dealing with a problem already under care was consistently greater for specialists other than primary care physicians; the proportion of visits for preventive care was much lower in the practices of these specialists than in primary care practice. These findings suggest that other specialists are functioning in ways different from primary care physicians. As compared with family physicians, pediatricians performed more diagnostic tests for all diagnoses and more immunizations and counseling about growth and development, were more likely to have seen children previously for problems other than the one dealt with in the visit under consideration, and were more likely to report that no specific therapy was required (except for well-child care). However, family physicians did more counseling about family and sex matters than pediatricians, were much more likely to have seen musculoskeletal and skin problems among 10- to 19-year-old patients, and were much more likely to have administered cauterization, cryotherapy, or suturing for skin problems. Family physicians provided more counseling of all types and did more minor surgical procedures than general practitioners. These and other findings show the existence of systematic differences across specialties in the care of children, even for apparently similar problems.

Acute Disease↗
PubMed1984

Morbidity in childhood--a longitudinal view.

We examined all the morbidity experienced in a six-year period by a total of 2591 children who were continuously enrolled in a prepaid medical plan. The children had received 19,291 diagnoses, each of which was assigned to one of 14 types of morbidity, and the frequency of each type was determined. Although the typical child had at least one problem in 5 of the 14 types of morbidity in the six-year period, over 20 per cent of children had at least 8 different types of problems during that time. Children with a greater variety of acute problems and more frequent acute problems were also more likely to have nonacute problems during the six-year period. Conversely, children with nonacute problems had more acute problems than other children. Our findings indicate that morbidity, like use of health services, occurred in clusters in this population of children. Therefore, an understanding of the cause and projected outcome of morbidity among children will be incomplete if the focus is only on specific diseases or specific types of illnesses.

Adolescent↗
PubMed1984

Preventive care and overall use of services. Are they related?

The relationship between the use of services of children constantly enrolled in a prepaid group practice medical plan for six years and the completeness of their preventive care were examined. Children who were consistently low users of services were more likely to be lacking one or more components of standard preventive care, particularly general health assessments in older children and vision, hearing, and tuberculosis screening in younger children. Teenage children who were low users were at some risk of not receiving their tetanus-diphtheria immunization on time. The relationship between low use of services and incomplete preventive care persisted after controlling for the severity of morbidity, although children with more severe morbidity were somewhat less likely to be missing preventive care. Health facilities and practitioners should pay special attention to assessing the need for standard preventive care in children who are infrequent users of services.

Adolescent↗