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PubMed1997

The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability.

OBJECTIVES: This article investigates the prevalence, determinants, and consequences of unmet need for assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and transportation in a randomly selected sample of adults with disability residing in Springfield, Massachusetts. METHODS: Respondents were contacted through random digit dialing, and eligibility was determined through a disability screen. Eligible individuals were stratified by age; 632 people were interviewed (78% of contacted eligibles). The prevalence of need and unmet need for ADLs, IADLs, and transportation assistance was calculated separately by age strata, as was the prevalence of selected negative consequences attributed to inadequate help with specific activities. The determinants of unmet need were modeled using logistic regression. RESULTS: The prevalence of unmet need for assistance with individual ADLs ranged from 4.1% (eating) to 22.6% (transferring) of the full sample. Unmet need for IADLs assistance was higher, ranging from 15.9% (cooking) to 34.6% (heavy housekeeping). Respondents younger than age 65 reported higher levels of unmet need for IADLs and transportation help than respondents age 65 or older; members of the younger group also were more likely to report five of the seven negative consequences attributed to inadequate help with IADLs and transportation (eg, missing medical appointments). Regression results revealed inability to meet expenses, having few or no reliable helpers, and impairment severity to be key determinants of unmet need. CONCLUSIONS: Financial problems, and not age per se, placed working age adults at elevated risk of unmet need in this study. The consequences of inadequate help can impede management of chronic health conditions, and may compromise individuals' ability to maintain a safe and reasonable quality of community living.

Activities of Daily Living↗
PubMed2003

Factors associated with adolescent mental health service need and utilization.

OBJECTIVE: To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. METHOD: Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of 1,120 Dutch adolescents aged 11 to 18 years (78% response rate). RESULTS: 3.1% of the sample had been referred for mental health services within the preceding year, and 3.8% reported unmet need. 7.7% of adolescents at risk for psychopathology, and 17.8% of those indicating a need for help, had been referred. Family stress and adolescent's self-reported problems were most strongly associated with service need and utilization. Internalizing problems, female gender, and low education level were associated with self-perceived unmet need. Adolescent ethnicity and competence in activities and school were associated with service use, but did not influence service need, while the opposite effect was found for adolescent age and parental psychopathology. CONCLUSION: In designing intervention programs aimed at increasing adolescent mental health service use, distinctions should be made between efforts focused at adolescents not recognizing their problems, and those with unmet need.

Adolescent↗
PubMed2004

The effect of matching comprehensive services to patients' needs on drug use improvement in addiction treatment.

AIMS: To examine whether need-service matching in addiction treatment leads to improvements in drug use, and whether treatment duration mediates those improvements. DESIGN, PARTICIPANTS, MEASUREMENTS: This analysis utilizes prospective data from a US cohort of addiction treatment patients who reported service needs beyond core rehabilitative services (n = 3103). 'Drug use improvement' is the difference between the patient's peak drug use frequency (in days per month) in the year before intake and in the year after treatment. Overall and primary use of the major illicit drugs (heroin, powder or crack cocaine and marijuana) are considered separately. 'Need-service match' means that a patient rated a service as important at intake and reported its receipt during treatment. 'Percentage of needs matched' indicates the proportion of five service domains (medical, mental health, family, vocational and housing) so matched. FINDINGS: In mixed regression models controlling for multiple factors, a greater percentage of needs matched tended to improve primary (beta = 0.028, P = 0.09) and overall (beta = 0.049, P = 0.05) drug use in the follow-up year. Exclusion of treatment duration as a covariate doubled the magnitude of these coefficients. The benefits of matching were concentrated among the half of patients reporting needs in four to five rather than one to three domains, and were strongest among patients in long-term residential facilities. Addressing vocational and housing needs exerted the greatest effects. CONCLUSIONS: Matching comprehensive services to needs is a useful addiction treatment practice, especially for high-need patients. Treatment duration might partially mediate its effect.

Cohort Studies↗
PubMed2005

Psychosocial needs of boys in secure care for serious or persistent offending.

BACKGROUND: The mental health of child offenders who are detained in secure settings is a matter of great public and professional concern but there has been little systematic longitudinal research on the outcomes of these problems once the young person has returned to the community. The aims of the present study were to describe the psychosocial outcomes of boys in secure care and to establish if these outcomes were correlated with criminal outcomes. METHOD: Prospective cohort study of 97 boys whose average age was 14 years when they were admitted to secure units in the North West of England. The boys were followed up on average 2 years later, when outcome data were obtained on 81/97 (83%) cases. The main outcome measure was a standardised assessment of mental health, social and educational needs obtained by interview with the young person and corroborated in most cases by information from informants. All data were then reviewed by experienced clinicians who made best-estimate ratings of need 'blind' to the findings from the first phase of the study. RESULTS: The average number of needs requiring an intervention at follow-up (mean=3.4, sd=3.0) was much lower than before admission to secure care (mean=8.2, sd=2.5) (mean difference 4.9 needs, 95% CI 4.0 to 5.7). Educational and occupational needs were particularly well dealt with. However, many mental health problems persisted or worsened. For example, 31% had a need for treatment of substance abuse, a significant increase compared with when they were in secure care (percentage difference 21%, 95% CL 9.0% to 32.7%). No mental disorder predicted subsequent offending. CONCLUSIONS: Boys who have been in secure care continue to have a high rate of mental health problems. The mental health needs of this group are not, however, static but change over time and with changing circumstances. Services need to be designed to meet these changing needs.

Adolescent↗
PubMed2005

Vulnerability and unmet health care needs. The influence of multiple risk factors.

CONTEXT: Previous studies have demonstrated a strong association between minority race, low socioeconomic status (SES), and lack of potential access to care (e.g., no insurance coverage and no regular source of care) and poor receipt of health care services. Most studies have examined the independent effects of these risk factors for poor access, but more practical models are needed to account for the clustering of multiple risks. OBJECTIVE: To present a profile of risk factors for poor access based on income, insurance coverage, and having a regular source of care, and examine the association of the profiles with unmet health care needs due to cost. Relationships are examined by race/ethnicity. DESIGN: Analysis of 32,374 adults from the 2000 National Health Interview Survey. MAIN OUTCOME MEASURES: Reported unmet needs due to cost: missing/delaying needed medical care, and delaying obtaining prescriptions, mental health care, or dental care. RESULTS: Controlling for personal demographic and community factors, individuals who were low income, uninsured, and had no regular source of care were more likely to miss or delay needed health care services due to cost. After controlling for these risk factors, whites were more likely than other racial/ethnic groups to report unmet needs. When presented as a risk profile, a clear gradient existed in the likelihood of having an unmet need according to the number of risk factors, regardless of racial/ethnic group. CONCLUSION: Unmet health care needs due to cost increased with higher risk profiles for each racial and ethnic group. Without attention to these co-occurring risk factors for poor access, it is unlikely that substantial reductions in disparities will be made in assuring access to needed health care services among vulnerable populations.

Adult↗
PubMed1986

Periodontal treatment needs in 12-16-yr-old children from Santo Domingo.

The purpose of this study was to determine the periodontal treatment needs, using the CPITN, in 12-16 yr-old children from private and public schools from Santo Domingo, Dominican Republic. A total of 1080 children was studied (540 in private schools and 540 in public schools). More children from private schools were seen without signs of periodontal disease than in public schools. More children from private schools showed no need for treatment. There was no statistical difference between children from private and public schools regarding the treatment need categories I and III. However, for the treatment need II category (oral hygiene-scaling), the children from public schools showed a slight increase in need over the private schoolchildren. Combining private and public schools, 12.9% of the 1080 children examined needed no treatment, 5.9% needed treatment I, 80.8% needed treatment II, and 0.4% needed treatment III.

Adolescent↗
PubMed1999

Socio-economic status and orthodontic treatment need.

OBJECTIVES: This study aimed to examine the relationship between socio-economic status and both normatively assessed and self perceived need for orthodontic treatment. METHODS: More than six thousand 14-year-old children were assessed for orthodontic treatment by trained and calibrated examiners. The Index of Orthodontic Treatment Need was the measuring instrument along with a questionnaire which asked: "Do you think your teeth need straightening?" RESULTS: Normative need for orthodontic treatment (IOTN >3) was more common amongst deprived children than among their affluent counterparts. The same was found for perceived need. However, the children who wanted treatment were not necessarily those who needed it and vice versa. CONCLUSIONS: Socio-economic status affects normatively measured orthodontic treatment need through, as yet, undefined mechanisms. It also affects a person's perception of need for orthodontic treatment, but these two associations are separate. The mismatch of need and desire for treatment is a problem for orthodontists.

Adolescent↗
PubMed1991

The estimated cost of treating unmet dental restorative needs of Mexican-American children from Southwestern US HHANES, 1982-83.

The dental restorative treatment needs of Mexican-American children, aged 1-17 years, were assessed from the 1982-83 Southwestern US Hispanic Health and Nutrition Examination Survey (HHANES). This report analyzed those needs and applied a dollar cost to them, using 1982 median fees of US general practitioners. The total estimated cost required to meet those needs for the population estimate of 3,396,770 children was $236,856,772 (95% CI: $198,575,174 to $275,138,370). The mean cost per child was $69.73 (SE: 5.75). Although a majority of the children had no unmet need, 15-, 16-, and 17-year-olds had extensive needs for crowns, endodontics, and prosthetic replacement of teeth, with accompanying high costs: mean total cost per examinee was $177 (SE: 28.97), $161 (SE: 32.20), and $237 (SE: 33.26), respectively. The treatment needs were compared with the previously published regional data from the 1979-80 NIDR survey, which used the same dental restorative treatment needs (DRTN) index. The findings indicated a great need for dental treatment among Mexican-American children that appeared to exceed that of the general school-aged population. Our analysis, in providing estimates of the cost of needed treatment, might be useful in planning dental treatment programs and in comparing surveys.

Adolescent↗
PubMed2000

Estimating dental treatment needs among American Indians and Alaska Natives.

OBJECTIVE: This paper describes the treatment needs of the American Indian and Alaska Native (Native American) population estimated from the 1991 Indian Health Service Oral Health Status and Treatment Needs Survey (1991 IHS patient survey). METHODS: The average per capita treatment need for the population is expressed both as the number of dental services and clinical time required to provide these services. Values for service minutes also are used to compare treatment needed with the treatment provided. RESULTS: The need for dental care is greatest among adults aged 25-54 years. We anticipate that needs will increase with population growth and as teeth are retained longer. Large amounts of dental needs go unmet each year in the Native American population: because resources are not available to provide all needed care, dental services are prioritized and rationed. The basic premise upon which care is rationed is changing from basic care for all who have access, to more complex care for fewer individuals. This trend may be driven by the opportunity to generate third party revenue offered by more complex procedures. CONCLUSION: Evaluation is needed of the effects of new approaches on oral health and access to dental care.

Adolescent↗
PubMed2006

Can oral health-related quality of life measures substitute for normative needs assessments in 11 to 12-year-old children?

OBJECTIVES: 1) assess the relationship between a measure of condition-specific oral health-related quality of life (OHRQoL) and the related normative need for dental treatments, and 2) test the diagnostic validity of the condition-specific OHRQoL measure for specific dental conditions in a group of primary school children. METHODS: A cross-sectional study of all 11 to 12 year-olds carried out in a municipal area of Suphanburi province, Thailand. 1034 children (91.8%) were dentally examined to assess their normative needs for 6 types of treatment (dental caries, traumatic dental injuries, enamel defects, periodontal, orthodontic and prosthodontic treatment). OHRQoL was assessed using the Child-OIDP index and its Condition-Specific impacts measure for the 6 treatment types. RESULTS: The prevalence of specific types of normative needs ranged from 3.2% (prosthodontic) to 97.0% (periodontal) and for Condition-Specific oral impacts from 0.7% (prosthodontic) to 50.6% (dental caries). Despite their statistically significant relationship for every treatment type except for periodontal treatment when need was indicated by a CPI score of 1, there were large differences between measures of normative need and oral impacts. High proportions of children had normative need without impacts and vice versa. The biggest differences were for appearance-related conditions (e.g. enamel defects and orthodontic treatment). For every type of treatment, oral impacts poorly predicted the normative needs of individuals. CONCLUSIONS: Although normative needs and OHRQoL are associated, when assessed appropriately, there was considerable discrepancy between them. OHRQoL measures cannot replace normative needs. Instead, both should be used in combination in order to cover different dimensions of oral health.

Attitude to Health↗
PubMed1996

Needs for care from a demand led community psychiatric service: a study of patients with major mental illness.

UNLABELLED: OBJECTIVE--To measure needs for care of patients aged 18-65 years with major mental illness. DESIGN: Identification of everyone in one area seen by a health professional within the previous five years because of a psychotic disorder. Interview of a one in three sample of patients and their main carers with the cardinal needs schedule. SETTING--Hamilton, a socially deprived district of Scotland. SUBJECTS--71 subjects were interviewed from the original sample of 263 patients. MAIN OUTCOME MEASURES--"Cardinal problems" in seven clinical and eight social areas of functioning; these are defined as problems requiring action. "Needs"-cardinal problems for which suitable interventions exist but have not been tried recently. RESULTS--High levels of morbidity were found. 30 interviewed patients (42%; 95% confidence interval 31% to 54%) had one or more clinical needs. 35 (49%; 38% to 61%) had one or more social needs. Skills to deal with all but seven needs in the sample were available at the time of investigation. Patients not being seen by the community mental health team were similar in severity and levels of need to those who were on the community team's caseload. Care was unequivocally and severely inadequate for four patients. Shortcomings in service delivery usually arose from failure to monitor some patients at home. Problems were not due to shortage of acute psychiatric beds nor the absence of an elaborate assertive community care team. CONCLUSIONS--Systematic assessment of needs with research instruments can give valuable insights into the successes and failures of community care of people with major mental illness. Most needs could be dealt with in these patients but in our area (and probably most other parts of the United Kingdom) this would entail diversion of resources from people with less severe disorders.

Adult↗
PubMed2006

Residual need for early orthodontic treatment and orthodontic treatment experience among 13- to 14-year-old school children in Kuwait.

OBJECTIVE: Our purpose was to determine the residual need for early orthodontic treatment and the parameters associated with orthodontic treatment experience in 13- to 14-year-old school children in Kuwait. SUBJECTS AND METHODS: A total of 788 boys and 795 girls, representing about 6.7% of the target population, were selected according to cluster sampling methods. Information on nationality, family income and orthodontic treatment experience was collected through subject and family interviews. The occlusal morphology was recorded in a well-lit classroom or from initial study models of subjects with orthodontic treatment experience. RESULTS: Only 6.7% of the 225 subjects with early treatment need, defined as overjet >or=6.5 mm, and functional posterior and anterior crossbite on 1 or more teeth, had treatment experience. Residual need for early treatment was present in 13.4% of the subjects. Only 26.8% of the subjects with treatment experience met our criteria for early treatment need. The odds of treatment experience were higher in the subjects attending private schools (p < 0.05), in those from families with an income of KWD >2,000 (USD 6,600; p < 0.01) and in subjects meeting the criteria for early treatment need (p < 0.01). CONCLUSIONS: About 15% of each birth cohort of school children in Kuwait need early orthodontic treatment. Less than 10% of those with a need have treatment experience at 13-14 years of age, and about 75% of those with treatment experience at that age do not need early treatment. The predictors for treatment experience at 13-14 years of age are private-school attendance, a high family income and need for early treatment.

Adolescent↗
PubMed2005

Perceived need for mental health treatment in a nationally representative Canadian sample.

OBJECTIVE: The optimal method of determining how many people in the general population need help for emotional problems remains unclear. This study aimed to examine the prevalence and correlates of self-perceived need for mental health services (that is, help seeking and perceived need) in a large, population-based sample. METHODS: Data came from the Canadian Community Health Survey 1.2 (n = 36,816, respondent age 15 years and over, and response rate 77%). Respondents were asked whether they had sought help in the past year from any professional for emotional problems and whether they felt they needed help for emotional symptoms but had not sought treatment. The Composite International Diagnostic Interview (CIDI) was used to make DSM-IV mental disorder diagnoses. RESULTS: The past-year prevalences of help seeking and perceived need were 8.7% and 2.9%, respectively. After adjusting for the presence of DSM-IV disorders assessed in the survey, sociodemographic factors, illness severity, social supports, and the presence of physical health conditions were associated with help seeking and perceived need. Independent of DSM diagnoses, sociodemographics, and social supports, perceived need and help seeking were associated with increased levels of distress, disability, and suicidal ideation and attempts. CONCLUSIONS: This study illustrates that, in addition to the presence of a DSM diagnosis, the respondent's self-perceived need for mental health treatment is important in the assessment of need for mental health services in the community.

Adolescent↗
PubMed2001

Needs during hospitalization: definitions and descriptions made by patients.

Patients are supposed to be given care according to their needs. This concept is, however, difficult to define and patients and caregivers may have different opinions about a patient's needs. Twenty patients were interviewed and asked to give a definition of need, describe their needs while hospitalized and depict what they do to make sure their needs are fulfilled. Ten groups of needs were identified: communication, basic care, contact with other people, behaviour of staff, empathy, competent caregivers, continuity, integrity, participation in decision making, and pain relief. The descriptions patients gave of how they ensured their needs were met could be divided into two groups: openly seeking attention; or not wanting to disturb the staff. Interviews with patients emphasized the importance of recognizing that they have individual needs and varying abilities to see that their needs are fulfilled.

Adult↗
PubMedDate not supplied

Needs of young children with cancer during their initial hospitalization: an observational study.

The aim of this study was to describe young (under the age of 7) children's needs as expressed by their behavior, body language and verbal expression through observations during their initial hospitalization after being diagnosed with cancer. Twelve children under the age of seven were followed during 26 hours with non-participant unstructured observations. Field notes were written after each observation and transcribed into a narrative text, which was analyzed by content analysis at both manifest and latent level. Five themes were identified, of which "need to have the parent close by" was the most prominent. The other themes were "need to play and feel joy," "need for participation in care and treatment," "need for a good relationship with the staff," and "need for physical and emotional satisfaction." The results indicate that the children needed their parents and the parents' presence helped the children to express other needs. Professionals need to support the child and his or her parents so that the parents in their turn can support and alleviate their child's hospitalization and cancer treatment.

Age Factors↗
PubMed2005

The effects of rural residence and other social vulnerabilities on subjective measures of unmet need.

To determine whether self-reports of unmet need are biased measures of access to health care, the authors examine the relationship between rural residence and perceived need for physician services. They perform logistic regression analyses to examine the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. Even after controlling for factors known to be associated with evaluated need, parents of rural children were less likely to report a need for routine or specialty services. Poor children, those whose mothers had less education, and those who were uninsured in the previous year were also less likely to perceive a need for physician services. Findings suggest that rural residence and other social vulnerabilities are associated with decreased perception of need, which may bias subjective measurements of unmet need for these populations.

Adolescent↗
PubMed1982

Health education needs assessment in an HMO: a case study.

Potential health education services for HMO subscribers are numerous and varied, ranging across the entire wellness to sickness spectrum. Because of cost consciousness and limited educational resources, careful needs assessment and selection of priorities are vital to the success of HMO health education efforts. The results of utilizing six needs assessment methodologies are presented in this case study. Consumer and provider involvement in the needs assessment process revealed five top priority health problems or opportunities for health education: membership education needs; overweight/obesity; self-care needs; hypertension; and smoking. These recommendations did not include perinatal and pediatric health education services as top priority needs, an outcome at variance with the results of the other needs assessment methodologies. This variance emphasizes the importance of employing multiple techniques in the needs assessment process. Problems in implementing various needs assessment methodologies are discussed as well as implications for health education practice.

Health Education↗
PubMed2004

Needs assessment for cancer patients and their families.

BACKGROUND: The assessment of needs for cancer care is a critical step in providing high quality care and achieving cancer patients' and families' satisfaction. Instruments can be used to assess needs and guide cancer care planning. This study discusses the importance of the needs assessment, relationships between needs, satisfaction and quality of life; and reviews the assessment instruments of needs experienced by cancer patients and their families. METHODS: A systematic search was conducted in MEDLINE and CANCERLIT data bases. Instruments were evaluated based on their conceptual and measurement models as well as their demonstrated reliability and validity. The authors also sought information pertaining to instruments' burden of administration and responsiveness. Measures compromised by a lack of published psychometric description were not included. RESULTS: This search identified 17 patient needs assessment instruments and seven family needs assessment instruments. The development and psychometric proprieties of most of these instruments were well documented. However, data on their responsiveness and burden of administration were scarce. CONCLUSIONS: Each selected instrument meets some but not all of our criteria for validity, reliability, responsiveness and burden. It is questionable whether any instrument can be developed meeting all the requirements. However, there is still a need to continue researching and developing needs assessment instruments leading to effective intervention and improving quality of cancer care.

Caregivers↗