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Biomedical subjects

D Mechanic

Publications and source records attributed to D Mechanic.

At least 109 records · Page 6Linked to original sources
PubMed1988

Factors associated with Medicare beneficiaries' interest in HMOs.

In this study we explore the demographic and health status factors associated with HMO awareness and enrollment interest among 314 Medicare beneficiaries. The results reveal that older adults most aware of HMOs were more demographically advantaged than others. In contrast, those most interested in information and HMO enrollment reported more financial vulnerability. An unanticipated finding was that self-reported health status and health care utilization were not associated significantly with HMO awareness or enrollment interest. If replicated, the findings suggest that relatively healthy Medicare beneficiaries with financial vulnerabilities could be enrolled in HMOs without necessarily increasing the proportion of high medical care utilizers.

Aged↗
PubMed1987

Gender differences in the acquisition of prescribed drugs: an epidemiological study.

It is often assumed that women received more prescribed drugs because they have different attitudes towards illness and medical care, higher anxiety and more time to visit physicians, or because physicians are biased. This study examines an alternative explanation, that is, much of the excess is associated with women's reproductive role. The study involved a detailed audit of the medical and pharmacy records of 862 men and women. Results showed that women received more prescribed drugs during the 2-year study period. However, the differences between men and women were not the same for all age groups. As expected, the differences were most apparent during the peak child-bearing years. Further analysis showed that the gender differences were virtually eliminated after excluding women with female-specific diagnoses and excluding the drug categories used to prevent or treat female-specific conditions. Previous studies based on gross measures of self-reported drug use seem to have underestimated the importance of factors that relate to women's reproductive role.

Adolescent↗
PubMed1987

Seeking help for psychologic problems. A replication and extension.

Patterns of seeking help for psychologic problems were investigated using interview and medical record data in a representative community sample and a sample of mental health clinic users from the same eligible population. In multivariate analyses, users of psychiatric services, compared with nonusers, were significantly younger, more likely to be separated or divorced, more psychologically distressed, and physically symptomatic. They were also more likely to use a large multispecialty clinic, compared with satellite clinics, and less likely to have membership in the prepaid medical plan established by the multispecialty clinic. Users had a greater reported propensity to seek help for anxiety and were more likely to know other mental health services users. Confiding social support was not significantly associated with use of mental health services, controlling for psychologic symptoms. Substantial social selection in seeking help was evident at both high and low levels of psychologic distress. Mental health users, compared with nonusers, reported more of most types of symptoms studied, except withdrawal, obsessive-compulsive symptoms, and alcohol consumption. Particular social characteristics and symptoms were associated with seeking help in general and other characteristics were more specifically linked to choice of a particular provider.

Adult↗
PubMed1987

Correcting misconceptions in mental health policy: strategies for improved care of the seriously mentally ill.

In the decades immediately following World War II a strong coalition of professionals and reformers emerged to shape agendas, debates, and national policy on caring for the mentally ill. The heterogeneity of mental health problems, the demographic shifts in populations at risk, and the realities of designing and implementing effective programs, were often overlooked; yet profound elements of change have taken place. Components essential for maintenance of function and rehabilitation have yet to be linked into a responsible alternative to long-term or episodic hospital care.

Community Mental Health Services↗
PubMed1986

The challenge of chronic mental illness: a retrospective and prospective view.

The challenge of chronic mental illness lies in developing effective service delivery systems that will preserve patients' functioning and limit their disability. The author uses a review of changes and excesses of the past 30 years--including deinstitutionalization, relocation of patients to nursing homes, the domination of psychodynamic concepts, and the naivety and partial successes of the community mental health movement--as a basis for outlining manageable ways to meet this challenge. Care for the chronic patient must be developed within a long-term rehabilitative context and with wiser use of available benefits and funds, including consolidation of funding sources. Mental health advocates should coordinate activities rather than compete with one another, and case management should be based on more sophisticated concepts and training.

Chronic Disease↗
PubMed1986

Health care for the poor: some policy alternatives.

Changes in the financing and organization of medical care are most likely to affect adversely the poor who have significant needs for care, but face increasingly stringent eligibility criteria in Medicaid and other public programs. Americans estimated to have neither private nor public health insurance coverage number 33 million persons, and with increased cost pressures, voluntary and proprietary hospitals are less willing to treat such patients. One quarter of hospitals provide 60 percent of all care to the poor, and many of these nonprofit and public hospitals face economic difficulties and an erosion of public commitment. Alternative solutions include publicly subsidized premiums for the poor and near poor and assistance to financially stressed hospitals caring for large numbers of such persons. Mechanisms include all-payer systems, taxes on net hospital revenue or insurance premiums, or contributions from general tax revenues. Financing poses special problems, but it is also necessary to address the special needs of children and the elderly, the appropriate balance between technical and cognitive services, and new ways to maintain health and promote effective functioning. These issues pose challenges and opportunities for family practice.

Adult↗
PubMed1985

Introspectiveness and adolescent symptom reporting.

A new measure of introspectiveness--the tendency to devote diffuse attention to thoughts and feelings about the self--was used to investigate adolescent symptom reporting. Introspectiveness was correlated with psychological distress (r = .40) and with physical symptoms (r = .27) in a random sample of college freshmen, and remained the strongest correlate of distress and symptoms when controlling for a variety of other measures. Women, Jews, and certain Hispanic groups were higher on introspectiveness than other students. An unanticipated, but possibly significant, result was that economic discontinuities and discontinuities involving significant others had markedly different relationships with health. Strong associations between perceptions of parental characteristics, adolescent introspectiveness, and health suggested the importance of socialization processes for understanding distress and symptoms. Finally, measures of emotional sensitivity and time spent alone were associated with introspectiveness and symptom reporting. Taken together, these findings suggest the importance of introspectiveness and its correlates for understanding the processes leading to adolescent symptom reporting.

Adaptation, Psychological↗