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PubMed2006

Bullying and peer victimization among children with special health care needs.

BACKGROUND: Dr Van Cleave's current address is Department of Pediatrics, Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, 50 Staniford St, Room 901, Boston, MA 02114. The association between bullying, being bullied, or being a bully/victim and having a special health care need has not been well described in a national sample of children with a broad variety of special needs. OBJECTIVE: We aimed to determine the prevalence of bullying, being bullied, or being a bully/victim in children with special health care needs and associations of behaviors with particular types of special needs. DESIGN: We performed a secondary data analysis using the National Survey of Children's Health, a nationally representative telephone survey conducted by the National Center for Health Statistics of >102,000 US households. METHODS: We measured associations between having a special health care need and being a victim of bullying, bullying other children, and being a bully/victim in children and adolescents aged 6 to 17 years. Multiple logistic-regression models were used to examine the association of children with special health care needs overall, and of particular special needs, with the bullying measures. RESULTS: Overall, children with special health care needs were 21% of the population. In multivariate models adjusting for sociodemographic factors, being a child with special health care needs was associated with being bullied but not with bullying or being a bully/victim. Having a chronic behavioral, emotional, or developmental problem was associated with bullying others and with being a bully/victim. CONCLUSIONS: Having a special health care need generally is associated with being bullied, and having a behavioral, emotional, or developmental problem is associated with bullying others and being a bully/victim. These findings may help pediatricians, mental health providers, and schools use targeted screening and interventions to address bullying for children with special health care needs.

Adolescent↗
PubMed2005

The problems experienced by patients with cancer and their needs for palliative care.

OBJECTIVES: To investigate the problems that patients experience and their met- and unmet needs for professional help. This information is necessary to tailor palliative care to patient needs. PATIENTS AND METHODS: Patients (n=94) with disseminated cancer completed a validated checklist with 90 potential problems and needs for palliative care (PNPC questionnaire). MAIN RESULTS: On average, patients experienced 37 problems (range 0-68) and required more professional attention for eight problems (range 0-71). The five most prevalent problems were: fatigue, heavy housework, coping with the unpredictability of the future, fear of metastases, and frustrations because I can do less than before. The five issues most in need of extra attention were: informational needs, coping with the unpredictability of the future, fear of metastases, fear of physical suffering, and difficulties remembering what was told (during consultations). Younger patients experienced more social, psychological, and financial problems. Some 10% of patients expressed a multitude of problems and needs. CONCLUSIONS: While patients with metastasized cancer experienced a wide variety of problems, they asked for more support for only a few specific problems. Evidently, "problems" are not synonymous with unmet needs. Therefore, not only problems but also needs for care should be assessed. A structural need for support to cope with fears of suffering and loss of autonomy was found. Ten percent of patients expressed a multitude of problems and needs and might benefit either from psychological counseling or better palliative care.

Adult↗
PubMed2004

Assessing population need for mental health care: a review of approaches and predictors.

This review aimed to clarify the concept of need, explore the different approaches used to assess need, and contribute to an improved understanding of predictor and intervening factors in assessing need for mental health services. Two population-based needs assessment approaches have been identified: modeling need for services and surveys of the general population. The most widely used model was that based on the Jarman-8 index of social deprivation. The population-based epidemiological surveys addressed perceived need by seeking direct, self-reported measures of individuals' perceptions of their needs for care. Although many studies have reported correlates of service use, few have attempted to identify correlates of perceived need. The fact that two-thirds to three-quarters of people were identified as meeting criteria for a mental health disorder, but did not report receiving treatment, highlighted a gap between epidemiology and service use. This gap could be explained by a number of intervening factors such as the discordance between diagnosis and disability, the determinants of and barriers to help-seeking behavior, the belief systems concerning appropriate treatments, and choice of health professionals. This review has thus identified the predictor variables which are important for a comprehensive analysis of need for mental health care. Suggestions and challenges have been put forward to address the identified gaps in assessing population need.

Developed Countries↗
PubMed2000

The perception of needs for care in staff and patients in community-based mental health services. The South-Verona Outcome Project 3.

OBJECTIVE: The present study aims to assess needs for care rated by patients and staff and their agreement on needs assessment in a community-based mental health service by using the Camberwell Assessment of Need (CAN). METHOD: The Italian version of the CAN was used in a sample of 247 patient-staff pairs. RESULTS: Patients and staff showed poor agreement on both the presence of a need and on whether need had been met or not. Higher disability predicted a higher number of patient-rated needs, while higher disability, higher number of service contacts and patient unemployment predicted a higher number of staff-rated needs. Lower global functioning predicted higher disagreement in patients and staff ratings of needs. CONCLUSION: Patients and staff show different perceptions of needs for care and therefore multiple perspectives should be taken into account for planning and providing effective needs-led mental health care.

Adult↗
PubMed2003

Assessing substance abuse treatment need: a statewide hospital emergency department study.

STUDY OBJECTIVE: Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug-related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxicologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria. METHODS: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Main outcome measures were the prevalence of diagnosed substance abuse problems, positive bioassay results, denied use, and treatment need. Sensitivity and multivariate analyses were conducted by using varied case definitions of treatment need. RESULTS: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to the privately insured. Excess need was also exhibited by patients reporting 1 or more prior ED visits in the past year (adjusted OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to 2.04). Treatment need was inversely associated with age. Irrespective of case definition, less than 10% of ED patients who needed substance abuse treatment were receiving such treatment. CONCLUSION: EDs can be important venues for detecting persons in need of substance abuse treatment.

Adolescent↗
PubMed2002

Future needs for fixed and removable partial dentures in the United States.

STATEMENT OF PROBLEM: Because of the decline in missing teeth among most adults, prosthodontic advanced training programs are concerned about the need for prosthodontics in the future. PURPOSE: An analysis was conducted to project the unmet need for fixed and removable partial dentures in the years 2005, 2010, and 2020. MATERIAL AND METHODS: Unmet need was calculated as follows: Total need equals the number of persons in each age cohort multiplied by the percentage who need a fixed or removable partial denture multiplied by the average procedure time required to provide the service. Total unmet need then equals total need minus the annual supply of prosthodontic services delivered by prosthodontists and general practitioners. RESULTS: Projected results indicate that total unmet need will increase from 488 million hours in 2005 to 517 million hours in 2010 and to 560 million hours in 2020. CONCLUSION: The significance of the results is that unmet prosthodontic need will increase and exceed the supply of services for the foreseeable 20-year future. Practicing dentists will find that a sizable minority of the population will continue to need fixed and removable partial denture services.

Adult↗
PubMed2003

The paradox of dental need in a population-based study of dentate adults.

BACKGROUND: Studies typically find that predisposing and enabling factors strongly predict dental utilization, but that need factors do not. However, few longitudinal studies have been conducted, and few have comprehensively measured dental need. OBJECTIVES: To describe the paradox of dental need, and to test three hypotheses regarding need and dental care use. MATERIALS AND METHODS: An observational study that included 873 persons who participated for interview and clinical examination at baseline and 24 months, with 6-month telephone interviews in between. RESULTS: Persons who entered the dental care system during follow-up were actually in better dental health than those who did not. The ability of need factors to predict dental care use, and in which direction, varied with how dental need and the dental care use outcome were measured (eg, care of any type, problem-related care, to receive a dental cleaning, to get a dental checkup). CONCLUSIONS: A substantial number of dental problems remained or developed among the population that did not enter the dental care system. The paradox of dental need has three components: (1) need predicts dental care use but is dependent upon how need is measured; (2) however, persons with a higher probability of new dental problems are actually less likely to seek dental care; and (3) self-reported disease and oral pain are associated with a higher likelihood of seeking care, whereas clinically-determined need, such as chewing difficulty, lower self-rating, and satisfaction with oral health, are actually associated with a lower likelihood, the former direction being the predominant and expected direction.

Adult↗
PubMed2006

Personality disorders and unmet needs among psychiatric inpatients.

OBJECTIVE: This study sought to examine the association between unmet need and personality disorders in a sample of psychiatric inpatients. The authors tested the hypothesis that the presence of a personality disorder would be independently associated with a significantly greater number of unmet needs. METHODS: A total of 153 psychiatric inpatients from four acute hospital wards serving an inner-city borough in London, United Kingdom, received standardized assessments of need and personality disorder by use of the Camberwell Assessment of Need Short Assessment Schedule and Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: Fifty-four percent of the sample had a personality disorder. The presence of a personality disorder was associated with greater unmet need. In multiple regression analyses, after adjustment was made for the effects of all covariates, severity of personality disorder was significantly associated with unmet need. Personality disorder was significantly associated with greater need in eight of 22 domains of need: self-care, psychotic symptoms, psychological distress, risk to self, risk to others, alcohol use, sexual expression, and budgeting. CONCLUSIONS: Personality disorder was found to be independently associated with a greater level of unmet need among psychiatric inpatients. The study highlights for the first time the importance of a comprehensive assessment of need for patients with personality disorders.

Adult↗
PubMed2001

Provider perspectives on palliative care needs at a major teaching hospital.

Jericho Metropolitan Hospital (JMH) is a major Australian teaching hospital which lacked a designated palliative care service at the time this study was conducted. A questionnaire addressing palliative care service needs, and educational and support needs of staff, was sent to 267 multi-disciplinary oncology staff at JMH. A response rate of 83% was achieved. Staff identified a number of palliative care needs that were being particularly poorly addressed by existing services. These included: spiritual support, cultural needs, grief and bereavement support, pleasant surroundings, adequate privacy and facilities for families. The majority of respondents identified the following issues as critical problems in palliative care provision: lack of a designated palliative care service, lack of palliative care education of staff, unmanageable caseloads and inadequate physical facilities for the provision of care. Only 24% of respondents reported having had any palliative care education, and 92% of respondents expressed a need for further education. The majority of respondents (79%) expressed a need for improved staff support. There was a significant association between perceived need for improved support and professional discipline (chi2 = 31.33, P < 0.002), with medical staff being significantly less likely than other staff groups to report a need for improved support. Overall, the health providers surveyed identified major deficiencies in the provision of palliative care to cancer patients at JMH and in the palliative care education and support for staff caring for terminally ill cancer patients. The findings support the need for a designated palliative care service at JMH to improve the standard of care of dying cancer patients, and the need for improved palliative care education and support for staff.

Acute Disease↗
PubMed2004

Needs for mental health treatment among general practice attenders.

BACKGROUND: No study has directly assessed the need for mental health care among those consulting in general practice. AIMS: To make a direct assessment of the needs for mental health care in people with non-psychotic disorders consulting their general practitioner. METHOD: In a two-phase study design, consecutive general practice attenders aged 17-65 years were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Needs for care were assessed using the community version of the Medical Research Council Needs for Care Assessment Schedule. RESULTS: Three hundred and thirty-six people were interviewed. The overall prevalence of need was 27.3%. More than half of the consulters (59.6%) had unmet needs and a further 6.2% had partially met needs. Needs were met in 28.1% and unmeetable in 6.2%. The prevalence of unmet need in those with anxiety disorders was 13.9% and depressive disorders 9.5%. CONCLUSIONS: The unmet need for mental health treatment in primary care attenders is high.

Adolescent↗
PubMed2006

Certificate of need regulations and use of coronary revascularization after acute myocardial infarction.

CONTEXT: Certificate of need regulations were enacted to control health care costs by limiting unnecessary expansion of services. While many states have repealed certificate of need regulations in recent years, few analyses have examined relationships between certificate of need regulations and outcomes of care. OBJECTIVE: To compare rates of coronary revascularization and mortality after acute myocardial infarction in states with and without certificate of need regulations. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 1,139,792 Medicare beneficiaries aged 68 years or older with AMI who were admitted to 4587 US hospitals during 2000-2003. MAIN OUTCOME MEASURES: Thirty-day risk-adjusted rates of coronary revascularization with either coronary artery bypass graft surgery or percutaneous coronary intervention and 30-day all-cause mortality. RESULTS: The 624,421 patients in states with certificate of need regulations were less likely to be admitted to hospitals with coronary revascularization services (321,573 [51.5%] vs 323,695 [62.8%]; P<.001) or to undergo revascularization at the admitting hospital (163,120 [26.1%] vs 163,877 [31.8%]; P<.001) than patients in states without certificates of need but were more likely to undergo revascularization at a transfer hospital (73,379 [11.7%] vs 45,907 [8.9%]; P<.001). Adjusting for demographic and clinical risk factors, patients in states with highly and moderately stringent certificate of need regulations, respectively, were less likely to undergo revascularization within the first 2 days (adjusted hazard ratios, 0.68; 95% confidence interval [CI], 0.54-0.87; P = .002 and 0.80; 95% CI, 0.71-0.90; P<.001) relative to patients in states without certificates of need, although no differences in the likelihood of revascularization were observed during days 3 through 30. Unadjusted 30-day mortality was similar in states with and without certificates of need (109,304 [17.5%] vs 90,104 [17.5%]; P = .76), as was adjusted mortality (odds ratio, 1.00; 95% CI, 0.97-1.03; P = .90). CONCLUSIONS: Patients with acute myocardial infarction were less likely to be admitted to hospitals offering coronary revascularization and to undergo early revascularization in states with certificate of need regulations. However, differences in the availability and use of revascularization therapies were not associated with mortality.

Acute Disease↗
PubMed1997

The elderly homeless men in Bloomsbury hostels: their needs for services.

OBJECTIVES: The objectives of this study are: (1) to assess the feasibility and usefulness of using the Needs Schedule on older homeless individuals; (2) to measure the needs of the elderly homeless individual for mental health services and whether these needs could be met by the same services that cater for younger individuals. DESIGN AND SETTING: This article analyses the needs of a subsample of 37 elderly residents in four inner London hostels for homeless people. Their needs were compared with those of 64 younger residents within the same hostels. RESULTS: The data related to demographic characteristics and health problems showed that the elderly homeless were physically frail and socially isolated. This group demonstrated more need for physical health services than the younger sample. However, the needs assessment method used in this study failed to show significant differences between the needs of these elderly and those of the younger residents. CONCLUSIONS: The article discusses ways of improving the assessment of needs for services in the elderly homeless and the way forward in meeting the needs of this disadvantaged group.

Aged↗
PubMed2006

Patient and carer perceptions of need and associations with care-giving burden in an integrated adult mental health service.

OBJECTIVE: To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. METHOD: The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. RESULTS: When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. CONCLUSIONS: Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.

Adult↗
PubMed2006

Need and utilization of psychiatric consultation services among general hospital inpatients.

OBJECTIVE: The aim of the present study was to estimate the need for psychiatric consultation services and psychiatric inpatient referral among inpatients of non-psychiatric hospital departments, and to assess the actual utilization of these services. METHODS: The study was carried out among 728 inpatients of physical rehabilitation wards, medical, surgical, and gynecological wards in Austrian hospitals. Psychiatric case identification was performed by research psychiatrists using the Clinical Interview Schedule (CIS). Diagnoses were given according to DSM-III-R. The assessment of need for consultation and inpatient referral was based on the clinical judgments of research psychiatrists. RESULTS: Overall, 34.2% of the inpatients were cases according to the CIS-criteria, 51.8% of them needing either psychiatric consultation or inpatient referral according to research psychiatrists. In 66.7% of those for whom research psychiatrists had stated a need, this need was not met ("unmet need"), while only 33.3% of them had their need met. In contrast, a psychiatric consultation was performed among 5% of those patients not needing psychiatric services according to the research psychiatrists ("overprovision"). Variables of the health care system (i.e. department type and catchment area of the hospital) were among the predictors for "met needs". CONCLUSION: The rate of actual psychiatric consultations and admissions to psychiatric wards was markedly lower than the need according to research psychiatrists' judgment.

Austria↗
PubMed2005

Needs and quality of life among patients with schizophrenia in five European centres: what is the impact of global functioning scores?

BACKGROUND: Global assessment of functioning, quality of life (QOL) and patient needs have been discussed as inter-related domains important for care planning and outcome assessment in care for the severely mentally ill. The study was conducted to investigate relationships of functioning level, subjective QOL and unmet needs in a cross-sectional study of 404 patients with schizophrenia spectrum disorders in five European centres with a focus on the patient group with low function scores. METHODS: Patient groups with low, medium and high function scores were compared with regard to subjective QOL and unmet needs. QOL variability was assessed in subgroups according to function scores. Regression analyses were used to examine the impact of illness-related and other unmet patient needs on QOL. The influence of individual needs in the low and medium/high function score subgroup was compared. RESULTS: QOL increased and unmet needs decreased from the low to high function score subgroup. There was greater QOL variability in patients with low function scores compared to those with medium and high function scores, with some low-function score patients having relatively high QOL. In the low function score subgroup, both illness-related and other needs had an impact on QOL, whereas non-illness needs influenced QOL in medium and high function score patients. CONCLUSION: Scores of functioning level, in people with schizophrenia spectrum disorders, are related to QOL in a complex way, and types of unmet need impinge on the relationship. In order to improve QOL in people with low function scores, both illness-related and other needs should be met.

Adult↗
PubMed2000

Evaluation and validation of a measure profiling needs and problems of psychiatric patients in the community: a Malaysian study.

BACKGROUND: The Profile of Community Psychiatry Clients (PCPC) was developed in a Sydney-based sample of those with a mental illness as a 35-item measure of likely need for service recognition, review and possible assistance. METHODS: This study has three principal objectives. Firstly, to test the utility of the PCPC measure in a very different region and culture. Secondly, to review the factor structure in an independent sample. Thirdly, to pursue the extent to which the PCPC might serve as a measure of likely need, by obtaining three differing reference viewpoints of need (i.e. clients, their carers, and case managers) and examining responses against PCPC scores. The PCPC was given to a sample of 333 Malaysian clients living in the community, together with two other measures of morbidity and disability. In addition, case managers, family members and clients were requested to directly rate the level of need for service assistance. RESULTS: A principal components analysis favoured a six-factor solution, with PCPC factor scores and total scores intercorrelated with subscale and total scores on the Life Skills Profile (LSP) and Health of the Nation Outcome Scales (HoNOS). The correlation coefficients supported the concurrent validity of the derived PCPC scales. Family members rated the clients' needs as greater than did case managers who, in turn, rated severity of needs greater than the clients themselves. Most importantly, PCPC scores correlated more highly than did LSP and HoNOS scores with need estimates derived by all three rating groups, providing strong support for the PCPC meeting its objective as a measure of putative need. In addition, a refined 23-item version of the PCPC was derived, which retained the capacity of the PCPC to correlate strongly with needs estimates. CONCLUSIONS: This Malaysian study supports the use of the PCPC in a culture where service provision and family support for those with a mental illness vary considerably from Western regions, while its validation as a measure of need for service is supported.

Adult↗
PubMed2004

Unmet need for contraception in Kuwait: issues for health care providers.

Based on a nationally representive household survey of Kuwaiti women held in 1999 (n = 1502) unmet need for contraception was analyzed in Kuwait, an oil-rich Muslim country. It was found that 9.7% currently married women had an unmet need for contraception. Of those, 6.1% wanted to stop child bearing, while 3.6% wanted to space their children. A bivariate comparison of the women with unmet need and current contraceptors showed that the unmet need group comprised of relatively older women with a significantly higher level of parity and ones where husband or wife disapproved of contraception. Also, larger percentages of the unmet need group belonged to relatively lower socio-economic status and were Bedouins. Among the reasons for current non-use, two-third believed that they had a low risk of pregnancy due to infrequent sexual activity or sub-fecundity, and 22% were not using a method because of health concerns. A significantly larger percentage of the unmet need group disapproved of contraception, and believed that Islam forbids family planning, compared to current users (30% and 15%, respectively). The logistic regression analysis showed that the wife's perception of the husband's disapproval of contraceptive use had the strongest negative association with unmet need. We conclude that the contraceptive needs of about 90% of all non-pregnant currently married women who wanted to delay or limit children were being met adequately despite the absence of a formal family planning program, while about 10% women had an unmet need. Issues for health care providers are discussed and family planning counseling is recommended for higher risk older women with unmet need.

Contraception↗
PubMed2005

Health needs assessment tools: progress and potential.

OBJECTIVES: Health needs has attracted the interest of policy-makers, health economists, and health professionals as modern health services try to satisfy individual and population health needs to optimize resource utilization. Health needs can be assessed by administering various types of survey or interview-based instruments. If health needs are to be satisfied in changing health agendas in developed and developing countries, it is essential to employ valid and reliable tools. Despite the importance of needs assessment, no comprehensive review of tools is currently available. We carried out a literature search to define and categorize existing health needs assessment tools. METHODS: We reviewed medical and social search engines for items containing specific health needs-related words to identify needs tools across a range of specialties. Papers were reviewed in terms of design, subject matter, psychometric features, and method of administration method. RESULTS: Thirty-one employed in 52 studies including cancer, mental health, palliative care, multiple sclerosis, and cardiovascular disease tools were identified. CONCLUSIONS: This report summarizes available health needs instruments in a range of diseases to assist researchers in accessing health needs resources more easily and to encourage further research in this field.

Community Participation↗