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PubMed1991

[Realistic possibilities of utilization of a personal computer in the office of a general practitioner].

In May 1990 work on the programme "Computer system of the health community doctor Mic DOKI was" completed which resolves more than 70 basic tasks pertaining to the keeping of health documentation by health community doctors; it resolves automatically the entire administrative work in the health community, makes it possible to evaluate the activity of doctors and nurses it will facilitate the work of control organs of future health insurance companies and contribute to investigations of the health status of the population. Despite some problems ensuing from the contemporary economic situation of the country, the validity of contemporary health regulations and minimal training of our health personnel in the use of personal computers computerization of the health community system can be considered an asset to the reform of the health services which is under way.

Family Practice↗
PubMed1996

Identifying adolescent runaways: the predictive utility of the personality inventory for children.

This study investigated whether runaway behavior could be related to six problematic areas. Selected scales of the Personality Inventory for Children, representative of the six areas, were hypothesized to discriminate between an adolescent runaway group and a control group. Four scales correctly classified 95.1% of the runaway subjects and 100% of the control subjects with a total correct classification rate of 97.52%. It was further hypothesized that the runaway group was not significantly different from a known clinical group with moderate to severe psychopathology. Results indicated that the runaway group was not significantly different except on one scale, Delinquency (DLQ). On the DLQ scale the runaway group had a significantly higher mean score than the clinical group. Application and recommendations are presented.

Adolescent↗
PubMed2005

Borderline personality disorder features and utilization of treatment over two years.

This study assessed the relationship between borderline personality disorder (BPD) features and treatment utilization over a 2-year time period. Participants included 349 18-year-old nonclinical young adults, approximately one-half of whom endorsed significant borderline features. The laboratory phase of the study involved the administration of self-report and interview-based assessments of BPD psychopathology at Wave 1, as well as interviews targeting Axis I psychopathology and treatment utilization history at Wave 2 (2 years later). Results indicated that borderline features prospectively predicted utilization of psychopharmacological treatment above and beyond what was accounted for by gender, lifetime Axis I psychopathology, and nonBPD Axis II psychopathology. The borderline feature most strongly associated with treatment utilization was affective instability.

Adult↗
PubMed1997

Adolescent Multiphasic Personality Inventory and its utility in assessing suicidal and violent adolescents.

Adolescent Multiphasic Personality Inventory profiles of inpatient adolescents were examined to identify differences between suicidal (danger to self, n = 145) and violent (danger to others, n = 36) adolescents. Participants were 181 inpatients (12-17 years old, mean age, 14.7 years) admitted to an adolescent psychiatric unit of a southern California county hospital. Results indicate that the suicide group had significantly higher scores than the violent group on five scales (Hypochondriasis, Psychasthenia, Paranoia, Schizophrenia, and Social Introversion). This scales, singly or in combination, have been found to be indicative of psychotic process. This suggests the presence of psychotic process in suicidal, but not violent, adolescents.

Adolescent↗
PubMed2000

Utilization of services by persons discharged from involuntary chemical dependency treatment.

This report compares services utilization pre-admission and post-discharge in 735 consecutive persons involuntarily committed to a chemical dependency treatment program in Washington State. Patients entering treatment were in their late 30s, had multiple health problems, previous arrests for misdemeanors or felonies, and minimal structured daily activities. Post discharge, there were decreases in the use of costly acute care services including detox, psychiatric hospitalization, and mental health crisis services. Patients who completed the program were less likely to use acute care services and were more likely to participate in outpatient treatment after discharge. The overall death rate of 29.4 per 1000 persons per year was 4 times greater than the age adjusted death rate for the US adult population. Further studies of other involuntary chemical dependency treatment programs are needed to evaluate the results of this report.

Adult↗
PubMed1990

[Epidemiologic study of persons having group 2 insurance in Denmark. 2. Utilization of the health services among persons insured in groups 1 and 2].

Persons insured in Group 2 constitute only approximately 4% of the total number of persons insured. In contrast to the approximately 96% of the population insured in Group 1, persons insured in Group 2 are ensured free choice of general practitioner and practising specialists from time to time on payment of partial payment of the doctor's bill. Group 2 insured persons make less use of assistance from the general practitioner than persons in Group 1. On the other hand, persons in Group 2 make much more use of assistance from practising specialists. Persons in Group 2 thus substitute specialist help for help from the general practitioner. This holds particularly true for the specialties gynaecology and medicine. An age-subdivided analysis of the differences between the utilization of hospital services by the two insurance groups shows that persons insured in Group 2 have lower rates of hospitalization and briefer periods of hospitalization than persons insured in Group 1. A review of the utilization of health services by the two health insurance groups supports the theory that persons in insurance Group 2 are, on the whole, relatively healthy persons with a relatively high demand for the level of service of health treatment.

Adolescent↗
PubMed1996

Health care utilization and outcomes among persons with rheumatoid arthritis in fee-for-service and prepaid group practice settings.

OBJECTIVE: To compare health care utilization and outcomes over an 11-year period among persons with rheumatoid arthritis (RA) in fee-for-service and prepaid group practice settings. DESIGN: Cohort of persons with RA followed up for as long as 11 years. The principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker. SETTING: Persons with RA presenting to a random sample of community rheumatologists in northern California. PATIENTS: Patients were enrolled in 2 cycles: in 1982 and 1983 and in 1989. Study rheumatologists listed all persons meeting criteria for RA presenting to their offices over a 1-month period. Of the 1062 so listed, we enrolled 1025, or 96.5%. Of the 1025 persons with RA, 227 (22.2%) reported receiving care in prepaid group practice settings. MAIN OUTCOME MEASURES: As of the end of 1994, 5295 person-years of observation were available for the analysis of the annual level of the utilization and outcome measures; 341 persons had been followed up for all 11 years of the study. The main utilization outcomes measured included office visits, outpatient surgeries, hospital admissions, and painful joints. RESULTS: The persons with RA in fee-for-service and prepaid group practice settings did not differ in the quantity of health care used in any 1 year for either RA or non-RA reasons. Among those followed up for all 11 years, the persons in fee-for-service and prepaid group practice settings did not differ in the cumulative quantity of health care used over the entire period of study. The 2 groups did not differ on any outcome measure on either an annual or long-term basis. The results of mortality analyses were inconsistent: using Kaplan-Meier estimates, the persons with RA in prepaid group practice settings survived significantly longer (P<.05 by long-rank test); using Cox proportional hazards methods, the proportion dying each year did not differ signficantly. CONCLUSIONS: We could find no evidence that persons with RA in fee-for-service and prepaid group practice settings received different quantities of health care or experienced different outcomes on either an annual or long-term basis.

Adult↗
PubMed2002

Prevalence, expenditures, utilization, and payment for persons with MS in insured populations.

OBJECTIVE: To determine the prevalence, expenditures, and utilization of enrollees with MS relative to all enrollees in privately insured, Medicare, and Medicaid populations. METHODS: The authors used insurer administrative billing data to identify persons with MS, their insured medical expenditures and utilization, and benchmark general insured population expenditures and utilization. Three samples of insurer billing data were analyzed: nationally representative samples for the privately insured (1994 through 1995) and Medicare (1996 though 1997) populations, and Medicaid data for disabled (1991 through 1996) populations from six states. RESULTS: Using 2 years of diagnoses on claims, the prevalence of MS in the privately insured population was 24 per 10,000, 36 per 10,000 in the Medicare population, and 71 per 10,000 in the Medicaid disabled population. Annual insured expenditures were $7,677 per privately insured enrollee with MS vs $2,394 for all privately insured enrollees, $13,048 per Medicare beneficiary with MS compared with $6,006 for all Medicare beneficiaries, and $7,352 per Medicaid disabled recipient with MS vs $4,088 per disabled recipient without MS. Home health expenditures were very high for Medicare beneficiaries with MS and nursing facility expenditures were very high for Medicaid disabled recipients with MS. A small proportion of enrollees with MS accounted for most expenditures. CONCLUSIONS: Insured enrollees with MS are two to three times more expensive than average insured enrollees. If the premiums that employers or governments pay health insurers and the capitation amounts that insurers pay health care providers do not account for these higher costs, a disincentive is created for the enrollment and care of persons with MS.

Adolescent↗
PubMed2003

Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care.

OBJECTIVE: The authors assessed health care costs associated with psychoanalytically oriented partial hospital treatment for borderline personality disorder compared with treatment as usual within general psychiatric services. METHOD: Health care utilization of all borderline personality disorder patients who participated in a previous trial of partial hospital treatment compared with treatment as usual was assessed by using information from case notes and service providers. Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period. RESULTS: There were no cost differences between the groups during pretreatment or treatment. Costs of partial hospital treatment were offset by less psychiatric inpatient care and reduced emergency room treatment. The trend for costs to decrease in the partial hospitalization group during the follow-up period was not apparent in the treatment-as-usual group. CONCLUSIONS: Specialist partial hospital treatment for borderline personality disorder is no more expensive than treatment as usual and shows considerable cost savings after treatment.

Borderline Personality Disorder↗
PubMed2004

Testing an APA practice guideline: symptom-targeted medication utilization for patients with borderline personality disorder.

BACKGROUND: The goal of this study was to test whether the use of psychotropic medication treatment for borderline personality disorder (BPD) was consistent with proposals in the recently published American Psychiatric Association's Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. METHOD: Medication utilization by patients with BPD was assessed prospectively over a 2-year period prior to the publication of the Guideline. Three BPD symptom clusters--cognitive-perceptual, affective dysregulation, and impulsive-behavioral dyscontrol--along with demographic and functioning variables were used to predict the use of five classes of medication. RESULTS: Symptoms of impulsive-behavioral dyscontrol significantly predicted use of both neuroleptics and anticonvulsants. Cognitive-perceptual symptoms were inversely related to anticonvulsant use. CONCLUSION: While some pre-Guideline medication practices with BPD patients were consistent with the recommended algorithms, physicians may also have been influenced by a variety of considerations, including level of functional impairment and the presence of comorbid Axis I conditions.

Adolescent↗
PubMed1996

Patients with personality disorders: functional status, health care utilization, and satisfaction with care.

BACKGROUND: Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk. METHODS: Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical Outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire. RESULTS: Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders. CONCLUSIONS: Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.

Adult↗
PubMed1978

Personality characteristic of the female alcoholic.

Utilized the Personal Reaction Inventory (PRI-100) on a sample of 47 hospitalized female alcoholics and a control group of 47 individually matched nonalcoholic Ss. A measure of drinking behavior was established by the Volume Variability Index (V/V) administered to each S immediately prior to the administration of the PRI-100. A test-retest experimental design over a 2-week period yielded an average reliability coefficient of .88 for the PRI-100. The findings show that the personality characteristics associated with Assertive Antisocial Behavior, one of the factors of the PRI-100, are valuable predictors of drinking behavior. The two other personality factors of the PRI-100, Lack of Order and Lively Social Presence, were found to be unrelated to drinking behavior and therefore inadequate predictors.

Alcohol Drinking↗
PubMed2004

Spouses of persons with dementia: their healthcare problems, utilization, and costs.

Spouses of persons with dementia (PWD) often experience poor health outcomes related to the experience of living with the afflicted spouse. Using the Anderson and Aday Healthcare Utilization Model, we conducted a retrospective review of an administrative database from a private healthcare insurer to compare health problems that precipitate utilization, patterns of utilization, and costs of care of spouses of PWD (n = 979) to those of spouses of persons without dementia (n = 979). Spouses of PWD were treated for more anxiety disorders (OR = 2.97; 95% CI = 1.63-5.44), falls (OR = 7.72; 95% CI = 2.73-21.84), rheumatologic diseases (OR = 2.5; 95% CI = 1.24-5.06), and diabetes with no complications (OR = 1.53; 95% CI = 1.06-2.22), but less pneumonia (OR =.55; 95%; CI =.35-.88) than comparison spouses. Spouses of PWD had a higher number of emergency room (ER) visits (p =.01). There were no differences in costs between the groups. The findings can be used to develop interventions for spouses of PWD.

Accidental Falls↗