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PubMedDate not supplied

Health care utilization and receipt of cholesterol testing by veterans with and those without mental illness.

OBJECTIVE: We examined the relationship between mental illness, health care utilization and rates of cholesterol testing. METHODS: We conducted a retrospective cohort study using Veterans Affairs (VA) administrative data on 64,490 United States veterans who used VA New England Health Care System outpatient services between January 1998 and June 2001. A total of 10,100 veterans (15.7%) had a mental illness treated with medication. We examined the interaction between mental illness and outpatient service utilization with respect to the likelihood of receiving a cholesterol test, adjusting for major demographic and clinical covariates. RESULTS: Among veterans using VA outpatient services infrequently, those with mental illness were less likely than non-mentally ill control subjects to receive a cholesterol test during the study period (first quartile adjusted OR=0.45, 95% CI=0.37-0.54; second quartile adjusted OR=0.50, 95% CI=0.45-0.57). Mentally ill subjects with more frequent utilization of VA services were as likely as (third quartile adjusted OR=1.01, 95% CI=0.91-1.13) or more likely than (fourth quartile adjusted OR=2.73, 95% CI=2.46-3.03) non-mentally ill subjects to receive cholesterol testing. CONCLUSIONS: Mental illness was associated with a lower likelihood of cholesterol testing in subjects who used fewer VA outpatient services. The observed disparity attenuated at higher levels of service utilization.

Adult↗
PubMedDate not supplied

Patient satisfaction with an outpatient endoscopic service.

The competitive health care market, increasing demand for patient involvement in establishing directions for health care and implementation of hospital accreditation have all driven hospitals toward evaluation of patient satisfaction with the service they receive from the health care venue. Although the concept of patient involvement in health care evaluation and quality assurance is not new, relatively little literature exists on patient satisfaction with outpatient endoscopic services. This study was designed to explore patient satisfaction with endoscopic services and factors influencing their perceptions. The sample (N = 151) included patients undergoing outpatient endoscopic examination over a 1-month period. The 14-item questionnaire included demographics and patients' perceptions of their experiences pre, interim, and postprocedure. Patients' age, referral source, procedure characteristics, perception of the quality of preprocedure information all influenced perceptions of the service provided by the endoscopic unit. Overall, service satisfaction was good. The results of this study have provided the multidisciplinary team with direction for planning improvements in care, and they may be relevant to other outpatient endoscopic services.

Adolescent↗
PubMedDate not supplied

[Use of antibiotics in otorhinolaryngologic practice].

INTRODUCTION: This study investigated utilization of antibacterial agents at the Ear, Nose and Throat Department of the Outpatient Service of the Health Center Novi Sad-Liman and at the Ear, Nose and Throat Clinic of the Clinical Center Novi Sad, in the period February-March 2001. MATERIAL AND METHODS: All antibacterial agents were classified as group J, regarding Anatomic-Therapeutic-Chemical Classification. Data on drug utilization were presented in Defined Daily Doses (DDD). Patients who were under observation were all treated with antibiotics. RESULTS: In regard to prescribed treatment in the Ear, Nose and Throat Department of the Outpatient Service of the Health Center Novi Sad-Liman, most outpatients were treated with macrolide antibiotics--in 26.21%; combination of penicillin and beta-lactamase inhibitors in 20.83% and pyranosides in 16.12%. At the Ear, Nose and Throat Clinic of the Clinical Center Novi Sad, macrolides and lincosamines were most frequently used--in 20.46%; cephalosporins in 19.87% and penicillins susceptible to beta-lactamase in 18.85%. It is extremely positive and in agreement with current pharmacotherapeutic principles that in both institutions peroral ampicillins have not been prescribed. Aminoglycosides have been prescribed in less than 1% of patients of the Ear, Nose and Throat Department of the Outpatient Service of the Health Center Novi Sad-Liman, whereas they were much more frequently prescribed at the Ear, Nose and Throat Clinic of the Clinical Center Novi Sad--in 11.25%. Although there is a positive postantibiotic effect in regard to these antibiotics and it is recommended to use them once a day, in both examined institutions aminoglycosides were given twice a day. In regard to bacterial identification it was done in 80.76% of patients of the Ear, Nose and Throat Department of the Outpatient Service of the Health Center Novi Sad-Liman, while in the Ear, Nose and Throat Clinic of the Clinical Center Novi Sad it was done only in 32.42%. CONCLUSIONS: Although treatment performed on empirical basis and clinical findings is usually correct, a greater percentage of antibiotic prescriptions should be confirmed by antibiograms providing optimal therapy and decreased degree of resistance.

Ambulatory Care Facilities↗
PubMedDate not supplied

An early view of the impact of deregulation and managed care on hospital profitability and net worth.

This study shows the impact of the removal of hospital rate regulation followed by the growth of managed care on hospitals' profitability and net worth. New Jersey emerged from a regulated prospective payment system in 1992. The transition to a freely competitive market structure had a negative impact on hospital profitability, net worth, patient length of stay, and other measures of capacity utilization. Similarly, the doubling of the HMO penetration rate in the state between 1995 and 1997 is shown to have negatively influenced hospital financial viability. Hospitals have responded in part by increasing usage of outpatient services. The use of discounted fee-for-service instead of per diem reimbursement for outpatient services provides an incentive for hospitals to favor outpatient over inpatient services. The effect of these changes is detailed, along with data showing that the larger discounts given by hospitals to managed care organizations, Medicare, and Medicaid played an important role in explaining the diminished profitability of hospitals.

Ambulatory Care↗
PubMed2005

Exploring the relationship between race/ethnicity, age of first school-based services utilization, and age of first specialty mental health care for at-risk youth.

This study investigated race/ethnic variations in age of entry into school-based services and specialty mental health outpatient services among 1552 high-risk youths served in a publicly funded system of care. Non-Hispanic White youths were more likely to receive school-based services as compared to ethnic minority groups, and to begin use at an earlier age. In addition, the earlier a child was identified for school-based services, the earlier the child first utilized specialty outpatient mental health services. Multiple regression models showed that inclusion of race/ethnicity as a predictor significantly increased the overall variance explained in the model predicting age of first school-based services, and both race/ethnicity and first use of school-based services increased the overall variance explained in the model predicting age of first specialty mental health outpatient service use. The results suggest that involvement in school-based services may play an important role in facilitating specialty outpatient mental health service use for youths.

Adolescent↗
PubMedDate not supplied

The impact of community rehabilitation for acquired brain injury on carer burden: an exploratory study.

OBJECTIVES: This study evaluated the relative efficacy of a community rehabilitation service and a more traditional outpatient service for carers of people with an acquired brain injury. METHODS: Seventeen carers who had received a community intervention were retrospectively compared with 24 carers who had received an outpatient service. Dependent variables were level of met family need, a measure of family dysfunction, carer psychopathology, and carer emotional acceptance. RESULTS: The community sample fared significantly better on all measures except carer psychopathology. CONCLUSIONS: These results suggest that community-based services have efficacy for the carer and family. There is a clear need for large clinical trials using standardized instruments to establish what models of service delivery benefit carers.

Adult↗
PubMed1979

Survey of outpatient pharmaceutical services in university hospitals.

The results of a 1978 survey of outpatient pharmacies in university-affiliated hospitals are reported. A questionnaire with 55 items was sent to 75 university-affiliated hospitals with outpatient clinics. Sixty hospitals responded. Of the 47 usable responses, 44 were from hospitals with outpatient pharmacies. The outpatient pharmacies served a mean of 163 patients/day, dispensing a mean of 295 prescriptions/day. Prescriptions from outpatient clinics accounted for a mean of 57% of the outpatient pharmacies' prescriptions. Only four outpatient pharmacies provided 24-hour, seven-day/week services; the remainder provided a mean 11.1 hours of service per day on weekdays. The mean number of full-time equivalent pharmacists employed in the outpatient pharmacies (2.9) correlated positively with the number of prescriptions dispensed daily. The straight-fee pricing system was used by 62% of outpatient pharmacies but pricing systems varied with the type of product dispensed. Computer services were used in 28% of the outpatient pharmacies but were restricted mainly to accounting and inventory functions. Only 15% of the outpatient pharmacies maintained patient profiles for all patients served, and only 21% conducted special patient education programs in drug therapy.

Drug Prescriptions↗
PubMed2002

The influence of military service on outpatient care use among racial/ethnic groups in Department of Veterans Affairs medical centers.

This study examines race-specific military service effects on outpatient care utilization in the Department of Veterans Affairs (VA) using data from the 1992 National Survey of Veterans. The study population consisted of 4,791 male veterans. After controlling for predisposing, enabling, and need variables, black veterans were 3.7 times more likely than white veterans to use VA outpatient care. Veterans discharged from the military for medical release were less likely to use VA outpatient care (odds ratio = 0.76) than veterans discharged at the end of their normal terms. Hispanic veterans discharged for medical release were 5.3 times more likely than white veterans discharged for the same reason to use VA outpatient care. Korean conflict and mixed war period veterans were more likely to use VA outpatient care than World War II veterans. Racial/ethnic differences in military service characteristics influence the use of VA outpatient care and should be understood in delivering outpatient care to veterans.

Adolescent↗
PubMed1996

A survey of general practitioners: implications for the hospital/community interface.

This paper presents the results of a survey that was conducted under the auspices of a Commonwealth-funded Ambulatory Care Reform Project. The survey was undertaken in all telephone areas of South Australia (08, 085, 086, 087, 088) to investigate issues of access to, and availability of, clinical allied health outpatient services at the Royal Adelaide Hospital with respect to general practitioners. Six hundred and twenty general practitioners in South Australia received a mailed survey enclosing a reply-paid envelop. Forty-nine per cent of the general practitioners responded. The highest response was from practitioners in the metropolitan area (08 telephone area) and the immediate Adelaide country area (085 telephone area). General practitioners supplied quality and in-depth responses that clearly indicated issues they felt impeded full use of clinical allied health services at the Royal Adelaide Hospital. These issues have implications not only for the clinical allied health outpatient services at the Royal Adelaide Hospital, but for all clinical allied health outpatient services in the public hospital system.

Adult↗
PubMedDate not supplied

Antenatal testing, mobile outpatient monitoring service.

At Good Samaritan Medical Center in Phoenix, Arizona, a group of perinatal nurses examined the potential for improving care for antepartum, high-risk pregnant women on restricted activities in their homes. An antenatal testing, mobile outpatient monitoring service was developed and implemented within three months. The goal is to reduce frequent admissions to the hospital caused by the interruption of bed rest for weekly and biweekly outpatient evaluation and monitoring. The service has resulted in reduced hospital admissions and improved patient awareness of the need for and adherence to activity restrictions.

Ambulatory Care↗
PubMed1991

Outpatient prospective payment.

In September of this year, the Health Care Financing Administration (HCFA) will present Congress with its recommendations for developing a prospective payment system for all Medicare outpatient services. Whichever plan is ultimately adopted, this system of payment will greatly impact the structure and management of outpatient services and, in particular, reimbursement for radiology services and use of technologies. While a system is perhaps at least two years away from full-scale implementation, providers are already witnessing diminishing reimbursement as a result of incremental payment changes since the early 1980's. With the across-the-board cuts of six percent for all hospital outpatient services, authorized for the first time last year by Congress, some providers are experiencing an escalation of payment short-falls. Further, if current experience with implementation of the inpatient prospective payment system is replicated in the outpatient arena, payments will not only be less but they will be dramatically different for various providers. Since implementation of DRGs, Medicare has achieved savings of $18 billion for inpatient care. While some hospitals have reported their best years financially, others are consolidating or closing. A prospective payment system for outpatients will also have such "winners and losers," but as a single policy initiative it will probably have a greater impact than both DRGs and the resource-based relative value scale (RBRVS) combined. Because fixed payments for inpatients have proliferated the push to outpatient care, a DRG-like system for outpatients will result in capping payments for the entire continuum of services provided in hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1987

Medicare program; limitation on reasonable charges for physician services in outpatient settings--HCFA. Final rule.

This rule revises the Medicare regulations governing reasonable charges for certain physician services furnished in outpatient settings. We are expanding the current payment limitation on these services to apply to the services of physicians who are reimbursed on a compensation-related charge basis and to surgical services that are routinely furnished in physicians' offices and are not included on the list of covered ambulatory surgical center services. These changes are being made to eliminate inappropriate Medicare payment.

Ambulatory Care↗
PubMed1992

The components of satisfaction with outpatient pharmacy services.

The true objective of a pharmacy manager is not just to measure satisfaction, but to improve it by identifying and meeting the needs of the patient. This study was undertaken with the objective of determining the relevant components of outpatient pharmacy service which impact the patient's perception of satisfaction, and to develop an on-going instrument to track satisfaction with pharmacy services over time. A survey was mailed to 391 outpatients. Simple correlation was used to identify the salient components of patient satisfaction. Multiple regression was used to determine the relative contribution of each of these components to overall satisfaction. Principle components analysis (PCA) provided the basis for delineating the underlying dimensions of which patient satisfaction is comprised. The two most meaningful factors derived from these data can be defined as professional communication and the physical and emotional well-being of the patient. By understanding the dynamics of the components of satisfaction, pharmacy managers can emphasize those areas which will produce a more satisfied patient, repeat patronage, and enhanced viability for the pharmacy.

Factor Analysis, Statistical↗
PubMed1997

Ethnicity, equity and the use of health services in the British NHS.

This paper addresses the extent to which equity of treatment is received by people of different ethnic groups from the British National Health Service. Using data from the General Household Surveys of 1984-91 it examines the use of general practitioner, outpatient services using three different methods to adjust for need and for other possible confounding variables. The results do not suggest there is any gross pattern of inequity between ethnic groups, except perhaps with respect to the Chinese population which displays consistently low levels of utilisation. However, while use of GP services by minority ethnic groups is in general as high or higher than the white population, use of outpatient service is low. Some of the results also suggest that there may be important ethnic differences underlying the broader finding of equity. For example, females of Pakistani origin report low levels of GP use. More generally, excess use of GP services among several minority ethnic groups appears to be associated with need, while people from most minority ethnic groups who do not report illness display especially low use of outpatient services relative to the corresponding group in the white population. The paper examines the implications of these findings.

Adolescent↗
PubMed2003

Mental health service delivery following health system reform in Colombia.

BACKGROUND: In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. AIMS OF THE STUDY: In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. METHODS: Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. RESULTS: While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. DISCUSSION: The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a change in the pattern of mental health service delivery from a reliance on costly inpatient care to more efficient outpatient services. CONCLUSIONS: Health reform in Colombia improved access to health services for the general medical services, but not for specialized mental health services. Although the primary goal of the health reform was to provide universal medical coverage, by not including mental health services in the standardized benefits package, inequities in the delivery of mental health services appear to have been perpetuated or even exacerbated. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: If health reform in Colombia and elsewhere is to provide universal coverage and adequate access to comprehensive health care, mental health services must be added to the standardized package of health benefits and efforts to develop accessible and effective mental health treatment at the primary care level should continue. IMPLICATIONS FOR FUTURE RESEARCH: Mental health services research in Colombia should focus future studies on the differential impact of health reform on access to mental health services across regions, and between urban and rural areas.

Colombia↗
PubMed1991

[Expansion of outpatient clinics and use of hospital beds in psychiatric care].

The past 15-year period has seen an increase in use of psychiatric outpatient services. Hospital capacity has been reduced, concurrently. In this study, the number of admissions, and the use of hospital beds, are compared prior to and following the expansion of outpatient services for a particular catchment area in Southern Norway. No significant change was found in either number of admissions or length of hospital stay, despite a threefold increase in outpatient services. Possible explanations are discussed.

Bed Occupancy↗