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PubMed1993

The effect of insurance benefit changes on use of child and adolescent outpatient mental health services.

Use of outpatient mental health services by dependent children younger than 18 years of age enrolled in the Blue Cross and Blue Shield Federal Employees Plan (FEP) is examined in 1978 and 1983 focusing on a cut in benefits and a shift from high- to low-option plan enrollment between those years. While use rates increased from 2.13% to 2.76% by 1983, the average number of visits decreased from 18.9 to 12.8. High-option plan use exceeded low-option plan use in both years--2.26% versus 0.81% in 1978 and 3.58% versus 1.93% in 1983. In addition to benefit plan, ethnicity, parent's education, type of provider, and type of treatment setting also significantly predicted amount of use. Despite the strong evidence of the effects of benefit coverage, it is likely that need exceeded use even in this insured population of children and adolescents. Implications of the findings are discussed in the context of recent dramatic changes in mental service delivery including privatization, managed care initiatives to cut costs, and growing pressures for national health insurance.

Adolescent↗
PubMed2001

The costs of childhood epilepsy in Italy: comparative findings from three health care settings.

PURPOSE: To determine the direct costs of epilepsy in a child neurology referral population, stratified by disease, duration, and severity, comparing three different health care settings [i.e., teaching or clinical research (CR) hospitals, general hospitals, and outpatient services]. METHODS: Patients were accepted if they had confirmed epilepsy and were resident in the center catchment area. Eligible subjects were grouped in the following categories: (a) newly diagnosed patients; (b) patients with epilepsy in remission; (c) patients with active non-drug-resistant epilepsy; and (d) those with drug-resistant epilepsy. Over a 12-month period, data regarding the consuming of all resources (i.e., consultations, tests, hospital admissions, drugs), were collected for each patient. Using the Italian National Health Service tariffs, the unit cost of each resource was calculated and indicated in Euros, the European currency. RESULTS: A total of 189 patients was enrolled by two teaching-CR hospitals, two general hospitals, and two outpatient services. The patients were evenly distributed across the four categories of epilepsy. The mean annual cost per person with epilepsy was 1,767 Euros. Drug-resistant epilepsy was the most expensive category (3,268 Euros) followed by newly diagnosed epilepsy (1,907 Euros), active non-drug-resistant epilepsy (1,112 Euros), and epilepsy in remission (844 Euros). Costs were generally highest in teaching-CR hospitals and lowest in outpatient services. Hospital services were the major cost in all epilepsy groups, followed by drugs. CONCLUSIONS: The cost of epilepsy in children and adolescents in Italy tends to vary significantly depending on the severity and duration of the disease Hospitals services and drugs are the major sources of costs. The setting of health care plays a significant role in the variation of the costs, even for patients in the same category of epilepsy.

Adolescent↗
PubMed2000

Hospital outpatient and emergency services in rural Victoria.

Outpatient and emergency services in rural hospitals have rarely been studied. This paper analyses routinely collected data, together with data from a survey of hospitals, to provide a picture of these services in Victorian public hospitals. The larger rural hospitals provide the bulk of rural outpatients and emergency services, particularly so for medical outpatients. Cost per service varies with the size of the hospital, possibly reflecting differences in complexity. Funding policies for rural hospital outpatient and emergency services should be sufficiently flexible to take into account the differences between rural hospitals.

Data Interpretation, Statistical↗
PubMedDate not supplied

Risk factors for unexplained dyspermia in infertile men: a case-control study.

This study was conducted to analyze risk factors for dyspermia in infertile subjects in a population of men attending outpatient services for infertility in Milan, Northern Italy. Between September 1989 and November 1990 we conducted a case-control study on risk factors for dyspermia. Cases included infertile men with a diagnosis of unexplained dyspermia consecutively observed for the first time during the study period at the Outpatient Service for Infertility of the First Obstetric and Gynecologic Clinic of the University of Milan. Specific work-up was done to exclude the major known or potential causes of dyspermia and infertility in patients and their partners. Two control groups were selected. The first included normospermic men of infertile couples with negative work-up for any disease that might affect fertility, observed in the same outpatient service where cases had been identified. The second control group included fertile men of unknown semen quality who were the partners of women who gave birth at term (> 37 w gestation) to health infants in randomly selected days at the same clinic. In comparison with those who have never smoked, current smokers were at increased risk of dyspermia versus both normospermic men of infertile couples and fertile men of unknown semen quality, and the risk increased with number of cigarettes smoked per day and duration of smoking. The risk of dyspermia increased with the number of cups of coffee drunk per day compared with men drinking no or one cup per day. Likewise, alcohol drinkers were at increased risk and the risk increased with number of drinks/d.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed2005

Accuracy of psychiatric diagnosis performed under indirect supervision.

This work aimed at comparing the accuracy of the psychiatric diagnoses made under indirect supervision to the diagnoses obtained through Structured Clinical Interview for DSM-III-R (SCID). The study was conducted in 3 university services (outpatient, inpatient and emergency). Data from the emergency service were collected 3 years later, after changes in the training process of the medical staff in psychiatric diagnosis. The sensitivity for Major Depression (outpatient 10.0%; inpatients 60.0%, emergency 90.0%) and Schizophrenia (44.4%; 55.0%; 80.0%) improved over time. The reliability was poor in the outpatient service (Kw = 0.18), and at admission to the inpatient service (Kw = 0.38). The diagnosis elaborated in the discharge of the inpatient service (Kw = 0.55) and in the emergency service (Kw = 0.63) was good. Systematic training of supervisors and residents in operational diagnostic criteria increased the accuracy of psychiatric diagnoses elaborated under indirect supervision, although excellent reliability was not achieved.

Adult↗
PubMed1999

Healthcare utilization associated with dyspepsia in patients with arthritis.

OBJECTIVE: To compare gastrointestinal-related healthcare resource utilization in arthritis patients with and without dyspepsia. STUDY DESIGN: A historical cohort study based on a claims database. PATIENTS AND METHODS: Data were obtained from the MarketScan database. Adult patients with a diagnosis of arthritis (International Classification of Diseases, 9th Revision [ICD-9] codes 714.0-715.9) during 1992 and 1993 were included; individuals with a diagnosis of dyspepsia within the first 3 months of their arthritis diagnosis were considered study case patients. Each case patient was matched with 4 nondyspeptic arthritis patients based on age, gender, employment status, and type of insurance plan. Healthcare resource utilization in terms of outpatient services and inpatient admissions during the first year after the initial arthritis diagnosis was compared between the case and control groups. RESULTS: A total of 503 case and 2146 control patients were identified. There were no significant differences in demographic characteristics between the 2 groups. Dyspeptic patients (cases) had a significantly higher rate of claims for endoscopic procedures (odds ratio [OR] = 10.0, P < .01) than nondyspeptic patients (controls). Patients with dyspepsia also had a significantly higher claim rate of gastrointestinal ulcer or bleeding (OR = 4.2, P < .01) and were more likely to be hospitalized at least once (OR = 1.4, P < .01). Dyspeptic patients had overall higher frequencies of use of outpatient services (53.9 vs 32.5 claims per patient, P < .001) and higher costs for both inpatient admission and outpatient services than nondyspeptic patients. CONCLUSION: Dyspeptic arthritis patients have higher healthcare resource utilization and associated costs than nondyspeptic arthritis patients.

Adult↗
PubMedDate not supplied

[Utilization of the ophthalmology service at the outpatient clinic of the "El Españoleto" de Xátiva Health Service of Valencia].

This is a descriptive paper on the use of the Ophthalmology Service which operates from to 10 in the morning in the Valencia Outpatient Service, "El Españoleto", of Xàtiva, Valencia. An average of 24.48 consultations are made daily, which average 4 minutos 54 seconds each. The general rate of consultations per individual health service card per month reaches a value of 0.024 consultations. 29.62% of the most frequently made diagnoses are for refraction, 26.54% unknown and 7.73% for presbytia.

Adolescent↗
PubMed2004

[Esophageal tumors at our outpatient clinic].

INTRODUCTION: In the 1984-1997 period 1179 tumorous patients presented themselves at the oesophagus consultation of the Ist. Department of Surgery of Semmelweis University. The authors examined the changes in the characteristic features of these patients and the task of supply. OBJECT: The aim of analysis was estimating of the place and importance of the therapeutic methods applicable to ambulatory patients. METHODS: Essential task of the outpatients service was to summarize the diagnostic results and to supply the lacks for the therapeutic plan of the patients. Having possession of the results they had to make decisions of the necessary and possible method of therapy. From the 1179 patients it was necessary the ward admittance of 787 patients, in 512 cases in hope of resective operation, and in 275 cases in order to carry out palliative intervention under hospitalized circumstances. 392 patients were treated as outpatients. To outpatients in 296 cases tube endoprosthesis was implanted by endoscopic method for palliative purposes, there were made 14 dilating nasogastric tube treatments, in 2 cases percutaneous endoscopic gastrostomy, and in the case of 116 patients there were collaborations in intraluminal after-loading irradiation treatments. RESULTS: It appeared from the age-characteristics of the patients that the incidence in the examined period increased in the younger age-groups. The patients' main complaint was dysphagia, their average anamnesis-time was 4.03 months and it did not change during the 13 years. The incidence of the oesophago-respiratory fistula was 11.1% in the patient-population, and the incidence of reflectory dysphagia was 13.2%. There was an improvement in respect of the medical check-up of patients and the verification by histological examination of the tumorous process. In the case of 597 patients it was observed dysphagia requiring palliation and in 482 cases it succeeded to perform it by implanting endoprosthesis. There were 36 unsuccessful implantation attempts and in the case of 79 patients there were no conditions of intervention. CONCLUSIONS: In the treatment of oesophageal tumorous patients the interventions made in favour of the palliative improvement of agglutination were executable within the frame of the outpatient service, from among of which the implantation of endoscopic tube appeared to be the method improving the patients' quality of life and survival with the best result. In the course of years palliative treatments were made more and more in the frame of outpatient service. The authors feel it necessary to consider all the condition-ameliorating treatment possibilities and applications, which may not be alternatives of each other but complementaries.

Adult↗
PubMed1980

The cost of outpatient physicians' services at a Veterans Administration hospital.

The cost of an average outpatient visit to a physician at a Veterans Administration hospital in 1976 was estimated from hospital records to have been $80.35 ($104.46 in 1979 dollars). When productivity was used to measure relative cost, cost per visit ranged from a low of $32.66 (1979: $42.46) for hypertension clinic to a high of $243.48 (1979; $316.52) for hematology clinic. The average patient was seen 12.6 times annually at a cost of $1012 (1979: $1315). The major cost category for a physician visit was salaries, with nonphysician salaries costing twice as much as physician salaries. The cost of medical equipment was minimal. The findings suggest that the outpatient bookkeeping system was inadequate for cost accounting, the cost per visit was expensive, there were an excessive number of visits, and problems in the institutional delivery system of ambulatory care lowered productivity of physicians.

Cost Allocation↗
PubMedDate not supplied

Cataract surgery: an analysis of patient satisfaction with medical care.

INTRODUCTION: Patient satisfaction is a good performance indicator for measuring the quality of health care delivered by hospitals. Satisfaction is understood to be the positive difference between users' perceptions of their experience at the moment of discharge and their expectations at the moment of admission. OBJECTIVE: To evaluate the expectations and the perceived quality of care in cataract surgery patients attending Hospital Clinic (HC). METHOD: A two-stage descriptive study carried out at the HC in Barcelona, Spain. The target population consisted of patients operated on for cataracts during the 1996 calendar year. Two study groups were established: Group I, patients attending outpatient service before admission; and Group II, patients attending outpatient service after surgery. After informed consent was obtained, the patients were directly interviewed by three researchers especially trained for that purpose. The questionnaire included demographic variables and 31 questions related to expectations, all to be answered by means of a 7 points Likert's visual scale. All statistical calculations were performed using the SPSS program for Microsoft Windows. RESULTS: A total of 148 interviews were performed: 80 (54.1%) in Group I and 68 (45.9%) in Group II. The mean age was 64.2 +/- 11.6 years. The difference between scores at admission and at discharge was nearly significant (p = 0.064) for the "information" component. CONCLUSIONS: The study of several fields where the patient's expectations are higher or lower contributes to prioritizing efforts to improve quality. There is a need for a frequent review and update of any patient satisfaction evaluation tools that are used.

Cataract Extraction↗
PubMed2001

Information as a distinct dimension for satisfaction assessment of outpatient psychiatric services.

The purpose of this study is to verify whether information on services would appear as a distinct dimension of satisfaction in a multidimensional scale. Data collection was performed in two phases: 263 patients received the original version of the questionnaire and 200 received an adapted version of the scale. The findings suggest that not only is it important to consider information as a distinct dimension of satisfaction but it is equally important to examine three categories, consisting of satisfaction with information on; patients' problems/illness; distinct treatment components such as medication and psychotherapy; and patients' treatment progress.

Adolescent↗
PubMedDate not supplied

The importance of sperm motility for the fertilization of human oocytes in vivo and in vitro.

Motility behaviour of spermatozoa in 289 ejaculates was investigated by laser-Doppler-spectroscopy in the andrology-laboratory of the University Hospital for Gynecology and Obstetrics, Graz/Austria. Conventional spermiograms, performed on the same ejaculates, permitted comparisons between estimated motility and laser-measurements, comprising the following parameters: Total sperm motility, mean sperm velocity, percentages of progressive motile spermatozoa and mean progressive velocity. In order to elucidate the importance of sperm motility for the fertilization of oocytes in vivo and in vitro, ejaculates of six different groups of patients were evaluated. In vivo: 173 patients from the andrologic outpatient service (group A); 38 patients from the andrologic outpatient service, whose wives became pregnant (group B) and 20 donors with recently proved fertility (group C). In vitro: 8 patients, whose ejaculates failed to fertilize the oocytes (group D); 39 patients with successful fertilization (group E) and 12 patients with ongoing, clinical pregnancy of their wives after ivF (group F). In addition, motility behaviour was assessed in native ejaculates 24 hours after ejaculation, as well as changes in sperm motility after capacitation. Statistical evaluations of group comparisons revealed a good correlation between estimated results and laser measurements. Mean sperm velocity and progressive sperm motility are the most selective parameters within the group differences in oligozoospermic ejaculates. Besides motility, morphology is of importance in vivo as well as in vitro. Based on the results of measurements obtained in the different groups, the following guidelines for standard values in laser-Doppler-spectroscopy are proposed: Total sperm motility greater than 53%; mean sperm velocity greater than 42 microns/sec.; progressive sperm motility greater than 34% and mean progressive velocity greater than 68 micron/sec. If these values are not reached, medical treatment is recommended.

Ejaculation↗
PubMedDate not supplied

The impact of outpatient drug services on abstinence among pregnant and parenting women.

Although there is an increasing number of outpatient drug programs, there remains little consensus on which service components are most effective for pregnant and parenting women seeking treatment. In this investigation, we studied 48 women who remained in treatment for 5 consecutive months to: (1) examine differences between clients who maintained 30 to 90 days of abstinence and those who did not and (2) test the association between services and abstinence. Although we found no demographic differences between abstinent and nonabstinent women, we did find that significantly more abstinent women received family therapy services compared to nonabstinent women as they remained in treatment. Furthermore, we found that clients who were abstinent tended to receive more services overall than those who were not. Providers need to consider their population when deciding on which service components will be included: and family therapy is one service component that should be available to pregnant and parenting women.

Adolescent↗
PubMed1979

[Acupuncture as a part of a program of detoxification and weaning from opiates: 25 cases].

Presents results of a detoxification and habit loosing program carried out in 25 morphine-like substances addicts (mainly heroine) aged 19-26. The therapeutic treatment based on gabaergic drugs (l-glutamine, sodium valproate and piridoxine), low doses psychodrugs (tricyclics and benzodiacepines) and acupuncture, began in 13 subjects at the hospital and continued at the outpatients' service, while 12 subjects were treated only at the outpatients' service. Follow up: 6 subjects of the hospitalized group free from the addiction (5 subjects from more than 1 year after their discharge); 3 subjects of the outpatients' group abstinent from no more than 4 months after discharge. Biochemical mechanisms involved in this therapeutic program are extensively discussed.

Acupuncture Therapy↗
PubMed2005

Heart transplant and left ventricular assist device costs.

BACKGROUND: With the increasing clinical success of left ventricular assist devices (LVADs), physicians need to measure device cost efficacy to determine the societal value of this technology. Today's large clinical volume allows comparison of the costs of this innovation as compared with orthotopic heart transplant (OHT). METHODS: We evaluated hospital cost and reimbursement for patients who were discharged after LVAD implantation and returned to the hospital for OHT. To control for patient-specific variables, LVAD therapy and OHT therapy were compared in the same patient; that is, only those patients who received an LVAD were discharged, and returned for OHT were studied. Length of stay (LOS), re-admissions and outpatient services were analyzed, including their respective total actual hospital cost (TAHC) and net revenue (NR). Time periods analyzed were the same for LVAD and OHT. RESULTS: From the LVAD population at Columbia-Presbyterian Medical Center, 36 patients were discharged following HeartMate vented electric (VE) implantation and re-admitted for OHT between December 1996 and June 2000. Mean pre-LVAD implantation LOS was 21.3 +/- 24.1 days. Post-LVAD LOS was 36.8 +/- 22.2 days vs 18.2 +/- 12.2 days post-OHT (p < 0.001). Mean length of LVAD support was 123.4 +/- 77.7 days. Overall total costs for LVADs exceeded that of OHT, whereas revenue was relatively lower. TAHC post-LVAD averaged $197,957 +/- 77,291, whereas TAHC post-OHT averaged $151,646 +/-53,909 (p = 0.005). NR averaged $144,756 +/- 96,656 post-LVAD vs $178,562 +/- 68,571 post-OHT (p = 0.09). LVAD patients had more re-admissions compared with OHT: 1.2/123 days (+/- 1.7) vs 0.3/123 days (+/- 0.6), respectively (p = 0.005). The average LOS during a re-admission was similar between the 2 groups (LVAD 5.6 days [+/- 10.6] vs OHT 9.6 days [+/- 8.2]; p = 0.18). OHT was associated with a significantly greater number of outpatient services compared with LVAD (9.7 [+/- 6.1] vs 3.0 [+/- 4.7]; p < 0.001). In contrast to OHT, revenues did not match the costs of LVAD therapy. CONCLUSIONS: LVAD implantation is associated with longer LOS and higher cost for initial hospitalization compared with OHT. LVAD patients have higher re-admission rates compared with OHT but similar costs and LOS. OHT is associated with a greater number of outpatient services. Reimbursements for LVAD therapy are relatively low, resulting in significant lost revenue. If LVAD therapy is to become a viable alternative, improvements in both cost-effectiveness and reimbursement will be necessary.

Ambulatory Care↗
PubMed1991

State-Aid Cancer Clinics: treatment and follow-up services for indigent patients.

State-Aid Cancer Clinics in South Carolina provide outpatient services for medically indigent patients who have a diagnosed cancer or a suspicious Pap smear and who are referred by a physician. The program pays only for outpatient services provided in one of the nine cancer clinic hospitals. Professional services, transportation and inpatient services are not covered. Although program funds are limited, the State-Aid Cancer Clinics served 3,767 patients in FV 1989; 1,104 of these were new patients and 2,663 were for continuing care. The program's operation is dependent upon the interest and support of the medical profession, particularly those physicians who give of their time and talent without pay to treat the medically indigent patients served in the clinics. This truly is a unique partnership in which the public and private sectors share a common goal of reducing unnecessary mortality and morbidity associated with cancer in South Carolina.

Ambulatory Care↗
PubMedDate not supplied

Does involuntary outpatient commitment lead to more intensive treatment?

Studies of involuntary outpatient commitment (OPC) among persons with severe mental illness have concluded that OPC is only effective in improving treatment outcomes when it is sustained for 6 months or longer and is combined with frequent outpatient services. This article explores factors that influence the delivery of outpatient services to subjects in a randomized trial of OPC and finds 2 general patterns. Outpatient visits were more frequent among all subjects with apparent clinical need, regardless of study assignment, and among subjects whose OPC was sustained beyond an initial court order. These results suggest that, in practice, sustained OPC represents a consensual agreement between clinicians and the court to more intensively address the complex needs of persons with severe and persistent mental illness.

Commitment of Persons with Psychiatric Disorders↗