Alcohol consumption and utilization of health services in a health maintenance organization

OBJECTIVES: This study examined the relation between alcohol use and utilization of health services during a 3-year period in a sample of 4,264 adult respondents to a member health survey in a health maintenance organization. METHODS: Respondents were categorized as abstainers (no drinks in the past year, n = 1,139), lighter drinkers (less than seven drinks/week, n = 2,330), moderate drinkers (seven to 13 drinks/week, n = 498), and heavier drinkers (> or =14 drinks/week, n = 297). Each drinker group was compared with abstainers on outpatient visits, hospital days, and number of hospitalizations controlling for age, race, and health plan membership. RESULTS: The mean number of outpatient visits was inversely related to the amount of alcohol consumed. Significant differences also were found for mean number of hospitalizations and mean days hospitalized per year. Compared with the three drinker groups, abstainers were significantly higher on both inpatient measures. CONCLUSIONS: These results might be explained by the inclusion in the abstainer group of exdrinkers who quit because of illness, inattention to health problems by heavier drinkers, or lower rates of illness among drinkers. The findings underscore the importance of replicating our study in other cohorts in which problem drinkers can be identified and compared with non-problem drinkers and in which lifelong abstainers can be separated from exdrinkers in the analysis.     

Psychological consultation and services in a general medical hospital.

When psychologists need to see patients who have been admitted to a general medical hospital or are asked to see a patient in a general medical hospital, they must be aware of, and in compliance with, the rules governing consultation, privileging, and privacy. Psychological treatment for patients is an important part of the treatment of patients with medical conditions that may be exacerbated by psychosocial stressors, preexisting anxiety, or depressive symptoms. The role of the psychologist is to have an integrated role with the medical team and work with the patient in effectively managing these symptoms. Models for promoting psychological services to all patients, especially those who are medically ill, have emerged as one of the few growth areas in psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's utilization of outpatient psychiatric services: Some emerging priorities for rehabilitation psychologists.

Provides a brief profile of women's utilization of outpatient psychiatric services, based on a 1975 survey conducted by the National Institute of Mental Health, and focusing on population characteristics that have special implications for rehabilitation psychologists, including race, age, marital status, diagnosis, and type of treatment. Findings reveal that more than 60% of adult admissions (aged 18–64 yrs) were female. Black females had the highest admission rate, followed by Black males, White females, and White males. Most female admissions 14 yrs or older, both Black and White, were married, and depression was the leading diagnosis, suggesting that developing effective rehabilitation strategies for women will require special attention to the causes and consequences of depression. Results also indicate that minorities were less likely than Whites to receive individual psychotherapy, and more than 40% of clients diagnosed as having a depressive disorder received drug therapy. Sources of information on mental health of women and minorities are identified, including reviews of the literature, journals, and research centers that deal specifically with the mental health needs of special populations. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health maintenance organization penetration and the practice location choices of new physicians: a study of large metropolitan areas in the United States

OBJECTIVES: The rapid growth of health maintenance organizations is reshaping the practice opportunities available to physicians. The practice location decisions of new physicians provide a sensitive bellwether of these changes. This study assessed the effect of health maintenance organization penetration on practice location for physicians completing graduate medical education (GME). METHODS: Conditional logit regression analysis was used to determine the effect of health maintenance organization penetration on practice location, controlling for other market characteristics. Subjects were physicians who finished GME between 1989 and 1994 and who located in one of the 98 US metropolitan areas with more than 500,000 population. The outcome measure was the particular metropolitan area chosen by each new physician. RESULTS: Early in the study period, new generalists were significantly more likely to locate in metropolitan areas with high health maintenance organization penetration than in low penetration areas, whereas new specialists' practice location choices were not associated with health maintenance organization penetration. The likelihood of choosing a high penetration relative to a low penetration area declined with time, however, for both generalists and specialists. Consequently, by the end of the study period, health maintenance organization penetration had a weak but significant negative effect on practice location for generalists and a strong negative influence on practice location for specialists. CONCLUSIONS: New generalists who completed graduate medical education between 1989 and 1994 were more likely than new specialists to locate in market areas with high health maintenance organization penetration; however, the proportions of both generalists and specialists who chose high penetration areas decreased during the study period. This finding may reflect reduced practice opportunities in high penetration areas relative to low penetration areas as health maintenance organizations' systems for controlling utilization began to yield results. Alternatively, new physicians may have become more hesitant to accept available positions in high penetration areas.     

Asian-Americans: Use of counseling and psychiatric services on a college campus.

Studied 3,053 Asian-American and non-Asian students in the 1966 freshman class of a large state university over a 4-yr period to determine usage of mental health services. Asian-Americans underutilized the campus psychiatric service but significantly overutilized the counseling center. Possible reasons related to the Asian-Americans' subcultural values explain these findings. Nearly 50% of Chinese-American females utilized mental health services of some kind. This extremely high usage may be due to a domestic vs feminist conflict. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community disasters: Primary prevention and treatment in a health maintenance organization.

In March 1977, members of the Hanafi Muslim sect seized and held hostages at three sites in Washington, D. C. The greatest number, over 100 persons, were held in the B'Nai B'rith National Headquarters for 39 hours. Many of these hostages suffered emotional aftereffects from this ordeal. The mental health staff of a Washington area health maintenance organization (HMO), to which many of the B'Nai B'rith hostages belonged, made its services available to all these men and women, regardless of their health insurance coverage. The symptoms covered a wide spectrum of modalities and ranged in severity and persistence. The case example of a 42-year-old female employee is presented. Treatment interventions followed a primary prevention model using a broad-spectrum behavioral group approach. This article advocates a primary prevention model for the delivery of services in crisis situations. Such a model is also advisable for services provided in an HMO. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical crisis counseling in a health maintenance organization: Preventive intervention.

Mental health clinicians can play a cost-effective role in reducing distressing psychological symptoms accompanying diagnosis of chronic illness. Medical crisis counseling (MCC) is a focal short-term intervention directly addressing illness-related psychosocial problems. A randomized clinical trial tested the effectiveness of MCC. Counseling was offered to patients who had cancer that was newly diagnosed, 1st heart attacks, or adult-onset diabetes and was contrasted with a control group receiving an HMO's standard mental health care. Significant reductions in distress attributable to MCC were noted in some patient groups. No increases in overall medical costs and some decreased mental health utilization and costs were noted with MCC use. Practitioners can easily apply MCC to improving patients' quality of life and mental health, without adding to health care costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients admitted to psychiatric hospital: Presenting problems and resolution at discharge.

Examined a cohort of admissions (N?=?280) to a 150-bed public psychiatric hospital to investigate homogeneity in patient problems and patient subtypes. The interrelationships of presenting problems, treatment provided, length of stay, resolution of presenting problems, and several other variables were also studied. Results indicated that many problems experienced by patients were not psychiatric symptoms. Most presenting problems were addressed but few resolved. The primary form of treatment was psychotropic medication. Many patients were discharged before treatment effectiveness was determined. Little association was found between diagnosis, patients' problems or patient subgroup, and psychotropic drugs prescribed. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace harassment, services utilization, and drinking outcomes.

Given the negative outcomes associated with sexual harassment (SH) and generalized nonsexual workplace harassment (GWH), this study examines the relationship between SH and GWH and help-seeking behavior in a sample of 2,038 university employees. Employees who experienced SH or GWH were more likely to report having sought mental health or health services to deal with workplace issues, compared with those who did not experience SH or GWM, controlling for job stress and prior services use. Women experiencing GWH were more likely to use services than men, but the same was not true for SH. Men experiencing SH who sought services exhibited higher levels of some alcohol outcomes, contrary to expectations. Implications for workplace interventions and for service providers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital

OBJECTIVE: The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. METHODS: A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSA-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatric Symptom Assessment Scale were compared. RESULTS: The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. CONCLUSIONS: The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.     

Mental health services in health maintenance organizations: Implications for psychology.

Contends that roles for psychologists in health maintenance organizations (HMOs) are affected by the nature of HMOs, economic considerations, standards set by federal legislation, claims for the cost-effectiveness of mental health services, and the federal administration's goal of removing mental health services from those required in law. Legislation is not precise concerning the nature or extent of mandated mental health services, and administrative interpretation of this legislation encourages considerable latitude in services provided. Studies do not support arguments for mental health services on the basis of their claimed cost-offset effects as strongly as one might wish. It is concluded that if psychologists are to establish areas of unique worth to HMOs, they may have to do so by adding contributions other than traditional clinical services to meet the need structure of HMOs. Possible ways of doing this are discussed, drawing on contributions that are developing in the field of behavioral health and relating these contributions to the prime purposes of HMOs. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impression management ability in psychiatric hospital samples and normals.

As a partial test of the view that schizophrenia is essentially a manipulatory phenomenon, the abilities of normal, neurotic, alcoholic-character disorder, and single and married schizophrenic groups (N = 180) to manage the impressions they make on others were compared. Ss were administered a semistructured interview twice-once each under instructions to make as bad and as good impressions as possible. All groups proved capable of managing the impressions they made to some degree. However, the single schizophrenics produced higher scores than any of the patient samples. Results argue against the hypothesis that schizophrenics are peculiarly capable impression managers. Moreover, the impression management scores of the groups did not change differentially in response to threat, casting some doubt on the view that schizophrenics are peculiarly inclined to produce spurious abnormal behavior to escape painful stress. Results contradict the view that the behaviors characterized as schizophrenic arise from special impression management tendencies rather than cognitive deficits. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of day hospital and inpatient psychiatric treatment.

Employed a pre–posttreatment control group design to compare the treatment effects of partial hospitalization to those of full-time hospitalization. Ratings of home and community adjustment were obtained from community informants (relatives or close friends) for 2 groups of Ss: (a) 24 day-hospital clients (partial hospitalization condition) matched on age (average age 32 yrs), education, and intelligence with (b) 24 inpatient clients (full-time hospitalization condition), and from an unmatched sample of 79 consecutive inpatient admissions. Treatment outcome was measured by clients' pre- and postscores on the Personal Adjustment and Role Skills scale. Results show that all groups evidenced improvement 2 mo after treatment started, particularly on measures of symptom reduction. Although patterns of improvement were comparable for both settings in univariate data analyses, multiple discriminant function analysis indicated that the day hospital sample evidenced greater gains in attentiveness and in employment. Gains favoring the day hospital sample were more striking for the unmatched 3-group comparison than for the matched 2-group comparison. Findings indicate that partial hospitalization is an attractive alternative to inpatient psychiatric hospitalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lay influences on the utilization and provision of health services: A review.

Empirical evidence reveals that the individual seeking and receiving help in our Canadian culture is highly subject to the influence of lay persons in the natural environment. This review of the literature documenting their influence is organized into 2 domains--the Lay Referral Network and the Lay Treatment Network--and is drawn from both the medical and mental health fields. Current knowledge about the nature of the lay community's impact on the health care of persons is summarized, and future research directions and implications for professional practice are presented. (French abstract) (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The captive client: Dilemmas of psychotherapy in the psychiatric hospital.

The psychiatric hospital is a total institution and has a unique impact on the process of insight-oriented psychotherapy. Hospitalization violates many of the basic characteristics of therapy that are central for its contractual and noncoercive nature: voluntarity, undivided loyalty (including confidentiality and exclusivity), and nondirectiveness. It is harder to form a therapeutic alliance and to differentiate resistance from reality influences. The boundaries of therapy are changed, with specific impact on transference and countertransference, including mutual countertransference reactions among staff. Parallel phenomena can be observed in other total institutions and in the practice of group and family therapy within the institution. While these dilemmas are inevitable in any hospital setting, a functioning therapeutic community may alleviate some of their destructive impact by encouraging open exploration of the underlying issues. (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in the factors related to hospital utilization: results from the 1990 Ontario Health Survey

NIH/3T3 mouse fibroblasts were transfected with the cDNA for manganese superoxide dismutase (MnSOD), and two clones overexpressing MnSOD activity were subsequently characterized by comparison with parental and control plasmid-transfected cells. One clone with a 1.8-fold increase in MnSOD activity had a 1.5-fold increase in glutathione peroxidase (GPX) activity (increased GPX-adapted clone), while a second clone with a 3-fold increase in MnSOD activity had a 2-fold decrease in copper, zinc superoxide dismutase (CuZnSOD) activity (decreased CuZnSOD-adapted clone). Increased reactive oxygen species (ROS) levels compared with parental or control plasmid-transfected cells were observed in nonsynchronous cells in the increased GPX-adapted clone, but not in the decreased CuZnSOD-adapted clone. The two MnSOD-overexpressing clones showed different sensitivities to agents that generate oxidative stress. Flow cytometry analysis of the cell cycle showed altered cell cycle progression in both MnSOD-overexpressing clones. During logarithmic growth, both MnSOD-overexpressing clones showed increased mitochondrial membrane potential compared with parental and control plasmid-transfected cells. Both MnSOD-overexpressing clones showed a decrease in mitochondrial mass at the postconfluent phase of growth, suggesting that mitochondrial mass may be regulated by MnSOD and/or ROS levels. Our results indicate that adaptation of fibroblasts to overexpression of MnSOD can involve more than one mechanism, with the resultant cell phenotype dependent on the adaptation mechanism utilized by the cell.     

Insulin-dependent diabetes and psychiatric pathology: general clinical and epidemiologic review

The objective was to determine the diagnostic sensitivity of spinal and femoral dual x-ray absorptiometry (DXA) and to study whether a combination of both sites may enhance discriminatory capability in regard to the presence of vertebral fractures. Spinal and femoral DXA were obtained in 324 postmenopausal women, of whom 90 had at least one vertebral fracture. Age-adjusted logistic regression analyses, ROC analyses, and sensitivity-specificity statistics were used to assess the discriminatory ability of spinal and femoral bone density (BMD) alone and in combination. The age-adjusted odds ratios per standard deviation decrease in BMD (OR) for spinal and femoral measurements were comparable (Ward's triangle: OR = 1.62; femoral neck: OR = 1.51; total hip: OR = 1.47; spine: OR = 1.34). Combining spinal and femoral bone density measurements did not improve diagnostic sensitivity of DXA considerably as compared to using BMD of a single site and adjusting the "fracture threshold." The conclusion drawn is that spinal and femoral BMD measurements using DXA have a comparable diagnostic sensitivity for vertebral fracture discrimination. Different individuals at risk for osteoporosis may be identified using both methods. The clinical usefulness of a combination of two bone density measurements needs further study in a prospective setting.     

Category knowledge in Alzheimer's disease: Normal organization and a general retrieval deficit.

Three hypotheses that could account for deficits in the retrieval of category information in Alzheimer's disease (AD) were evaluated: abnormal organization, class- or category-specific vulnerability, and limitation by general factors, such as decreased processing speed. Relative to 18 elderly control Ss, 18 patients with AD produced fewer items in a category fluency task and had longer reaction times in a category decision task. The pattern of performance across categories on both tasks was normal in the AD group: The same categories elicited the most (or fastest) responses in both the control group and the AD group. AD patients showed normal performance in ranking of category exemplars by typicality. There was no evidence for differential accessibility by category or by class of information (animate vs inanimate). The authors conclude that a general factor or factors limit(s) retrievability equally across all categories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)