Many individuals, especially those in rural areas, experience barriers to accessing medical care. Some barriers are attitudinal and represent perceived quality of care, such as patient satisfaction; however, some rural residents report elevated patient satisfaction scores, regardless of limited access to these services. Identifying how perceived need for medical care is related to patient satisfaction has not been previously explored. Using an online survey to collect data from a national sample (n=535), the current study used the Patient Satisfaction Questionnaire-Short Form (PSQ-18) and a single-item measure of perceived need to examine the association between these two variables, and further, whether rural status, measured by a single-item measure, moderated this association. Results indicated a significant negative correlation between patient satisfaction and perceived need, r(423)=-.12, p=.012. Although the overall moderation model was significant, F(5, 388)=7.10, p<.001, perceived need was not significantly associated with patient satisfaction, b=-.14, p=.20, and rurality status did not significantly moderate the relationship, F(1, 388)=.44, p=.51, ��R2=0.01. However, the covariates of income, b=.11, p<.001, and sexual orientation, b=.23, p=.01, significantly predicted patient satisfaction. This study identified an association between patient satisfaction with perceived need for medical care that has not been previously explored, although this relationship was no longer significant in a larger model, indicating other important factors likely influence this relationship and contribute to the elevated satisfaction scores identified in some rural areas. The lack of moderation by rurality may be due to consistently high barriers to accessing care across all regions of the United States; while rural areas certainly experience unique barriers to care, the barriers present in urban environments may be significant enough that level of rurality in itself does not significantly affect the relationship between perceived need and patient satisfaction. Furthermore, this study highlights the importance of social determinants of health in patients’ perceptions of quality of care. Sexual orientation and income emerged as significant predictors of patient satisfaction, in that higher satisfaction was associated with those who identified as heterosexual and had higher income, consistent with previous literature. Further investigation is necessary to determine the reasons why these relationships exist; however, it is important to acknowledge that individuals with low-income and who identify as sexual minorities experience stigma and discrimination in healthcare settings. These negative experiences with healthcare likely influence perceptions and health disparities that exist within these individuals and may directly impact patient satisfaction levels, which may be influential to these findings.

Objective: To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. Method:A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. Results: Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. Conclusions: Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions.

Responses to a web-based survey following Hurricane Katrina were evaluated. The 3,140 university student respondents were separated into impact groups based on evacuation experience: high-impact (student evacuated), moderate-impact (friend/family evacuated), and low-impact (neither student nor friends or family evacuated). Students’ responses to items evaluating service utilization, services desired, and psychological distress were examined by gender, race, and impact group. Female students rated services as more supportive, and reported a greater desire for services not provided by the university, compared to male students. Compared to Caucasian students, African American students viewed services as more supportive and desired services not already provided by the university. Students in the high-impact group scored higher than the other impact groups on measures assessing symptoms of psychological distress. Overall, the results may be used by universities and other organizations to implement future programs and policies for responding to natural disasters.

No description available.

Within the next 20 years, mental health problems are projected to be the leading cause of disability in Canada. Given that one in four Canadians is expected to be over the age of 65 by 2036, older adults’ mental health problems are a growing public health concern, especially because the rate of mental health service use is particularly low among this age group. Although there have been several decades of mental health research, it is still not well understood why older adults are not accessing treatment. A possible explanation for this is that identifying reasons for poor access alone does not capture the multifaceted, complex nature of individuals’ experiences with mental health problems and their paths into treatment. To address this gap in the literature, this study explored older adults’ experiences seeking psychological care and the factors that influence this dynamic process using the Network Episode Model-II (NEM-II; Pescosolido & Boyer, 2010; Pescosolido et al., 2013). To achieve this objective I conducted 15 individual semi-structured interviews with adults 60 years of age and older, who were receiving outpatient psychological services from a hospital in Winnipeg, Manitoba. Findings from this study suggest that participants’ background (social content), social support network, and the treatment system influence, and are influenced by, participants’ illness careers. Factors that delayed participants’ help-seeking included: a lack of support, “inappropriate” referrals or advice from treatment professionals, and a lack of knowledge among older adults about mental health and treatment options. This research has implications for researchers, clinicians, and public policy initiatives aimed at enhancing older adults’ access to psychological care. / October 2016

A specialized system of care for co-occurring clients can be an asset to this population, if the services offered deliver adequate results that contribute to the overall wellbeing of this community. Therefore, providers, including social workers and other professionals to determine the effectiveness of these programs, should routinely assess established programs that are design to meet the most basic needs of co-occurring populations. This will permit an increase the knowledge and understanding of outcomes and perhaps develop alternative resources to connect gaps in the delivery of services. This research evaluated the effectiveness of services that co-occurring clients received from Cedar House Life Change Center. It attempted to understand the correlation between graduation success and other variables, such as length in treatment, mental health and substance use diagnosis, types and frequency of services, and the effects of diverse populations on the treatment outcomes.

The purpose of this research study was to explore Mexican women’s perceptions about utilizing mental health services and to explore the barriers encountered during the process. Previous research suggested Mexican women’s diverse experiences when seeking and utilizing mental health services. The study used a qualitative approach with open-ended and closed-ended questions. The sample size of this study was fifteen individuals who self-identified as Mexican women who reside in Southern California recruited using a snowball approach. Major themes identified included Mexican family values and beliefs, cultural barriers, structural barriers, Mexican women’s strengths, and community suggestions for social work practice. This study highlighted their perspective on mental health, cultural and structural barriers, their personal experiences of utilizing mental health services, techniques on managing difficult situations, support systems, identified mental health symptoms, coping methods, cultural values and suggestions to improve mental health services in the general Latino community.

An efficacious treatment is diminished in value if clients will not seek it out and adhere to it (Kazdin, 1978). Thus, the acceptability of a treatment to consumers is an important indicator of the quality/effectiveness of the treatment (APA, 2002). The purpose of this study was to examine acceptability of treatments for depression to adolescent females and to explore factors that might be associated with acceptability. Sixty-seven high school students (36 Hispanic and 31 non-Hispanic White) were recruited from communities in New Jersey and Florida, and interviewed by telephone. Participants were presented with a vignette describing a depressed adolescent and asked to use the Abbreviated Acceptability Rating Profile to indicate their opinion of four single treatments (cognitive-behavioral therapy, interpersonal therapy, family therapy, and pharmacotherapy) for depression and three treatment combinations. Consistent with hypotheses, psychotherapy approaches were generally more acceptable to adolescents than combinations of psychotherapy and pharmacotherapy. Pharmacotherapy used alone was not acceptable, on average. There was preliminary evidence to support the hypotheses that treatment acceptability is related to ethnicity, acculturation, and perceived causes of depression; however, contrary to expectations, treatment acceptability was not associated with symptom severity in this study. Implications for increasing the utilization of mental health services in this population are discussed and directions for future research are offered.

Research Objectives: Osteoporosis has become a significant public health problem in recent years, especially with the growth of the elderly population. Osteoporotic fractures exact a terrible toll on the population with respect to morbidity, cost, and to a lesser extent mortality. These effects can lead to psychological problems, social consequences, functional limitations, and poor quality of life. Thus, knowledge regarding osteoporotic fractures is needed to evaluate the impact of osteoporotic fractures on society, to identify high-risk populations, and to help policymakers to allocate resources accordingly. This study aims to investigate the influence factors of hospital readmissions among osteoporotic fractures patients in Taiwan, and the study results are expected to increase our understanding of the magnitude of the elderly population suffering from osteoporotic fractures and to urge policymakers to develop effective national prevention strategies. Study Design: Using Taiwan¡¦s National Health Insurance database, we identified elderly patients with a hospitalization for osteoporotic fractures between 2001 and 2007. We divided readmissions into different groups (14-day, 30-day, 180-day and over 180-day) and evaluated each group¡¦s demographic, hospital characteristics, and Charlson Comorbidity Index. The claims data are also used to calculate the health services utilization of osteoporotic fractures among those elderly patients with or without readmission of osteoporotic fractures. The data analyses were carried out by Chi-square test, t test, multiple linear regression and multivariate logistic regression. Population Studied: Patients aged 50 or older with osteoporotic fractures were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Principle Findings: Among 5483 osteoporotic fractures patients, 6.9% of them were readmitted within 14 days, 34.7% were readmitted within 30 days and 13.9% were readmitted within 180 days. The medical resource utilizations were significantly higher in patients with readmissions than those without readmission. Age and Charlson Comorbidity Index were significantly affected the probabilities of readmissions. Conclusion: From the perspective of health policy, the issue of osteoporotic fractures will become increasingly important in the future. This national study will help raise awareness of osteoporotic fractures and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent osteoporotic fractures.

The development and the utility of high-tech medical equipments are increasing relative to the health expenditure growth. These high-tech equipments do not necessary benefit the quality of patient care but increase the service utilization for hospitals. This study aims to describe the difference of equipments distribution between academic medical centers and metropolitan hospitals and to examine the association between the change of the kinds, number, and utility of high-tech medical equipments and the health service utilization. Two databases were used in this study. First, a secondary data from the annual hospital survey published in 2003 and 2004 by Taiwan Hospital Association was used. The data contained information on 8 health service volumes, kinds, number and utility of 17 kinds of high-tech medical equipments, 4 hospital characteristics, and 3 kinds of staff ratio. Second, Statistical Yearbook of Department of Social Affairs, Ministry of Interior provided data on Tthe percentage of 65+ years old population in every location. The 8 kinds of health service volumes varience were designed as dependent variables and the 3 independent variables were separately change of kinds, number and utility of high-tech medical equipments. There were 59 samples, 8 academic medical centers and 51 metropolitan hospitals, included. The t-test showed differences between academic medical centers and metropolitan hospitals in change of kinds, number, utility of high-tech medical equipments and health service volumes varience. Person correlation presented how these variables correlated to each other. Regression analyses predicted the health service utilization from those variables. Generally speaking, the academic medical centers only had significant higher varience of average daily emergency roomvisits¡]t = 3.59, p = 0.01¡^than metropolitan hospitals did but there was no significant difference in 3 independent variables. Besides, correlation among medical equipments, health service utilization and themselves shows that the change of total high-tech medical equipment kinds was significant positive correlated with the change of total number of high-tech medical equipments¡]r = 0.44¡^; the change of total number of high-tech medical equipment was significant positive correlated with average daily emergency roomvisits varience¡]r = 0.28¡^and average daily physical examination of outpatient department visits variance¡]r = 0.30¡^; the average utility of high-tech medical equipment was significant positive correlated with average daily outpatient department visits varience¡]r = 0.27¡^. However, the 3 independent variables have no overall significant effect on change of health service utilization. Based on the above findings, although literature indicated that the kinds and number of high-tech medical equipments somehow might stimulate the demand for health service, we did not find the same results. It could be concluded that hospitals¡¦ purchasing of equipment do not impose a significant impact on raising the medical service utilization. Thus, acquisition of high-tech medical equipment might make a hospital a technological leader or give the public a more professional image whether it can help a hospital raise the service quantity is still left to its management.