Breast cancer screening in regional Hispanic populations

Although Hispanics' use of breast cancer screening services has been investigated, to date there have been no published studies of distinct Hispanic populations in different areas of the country. Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer 'En Acción', this study examines ethno-regional differences in breast cancer screening rates among these groups and explores the correlates of screening participation. Data collected through telephone surveys were analyzed for women 40 years of age and older (n = 2082). After controlling for demographic variables traditionally related to breast cancer screening rates, it was found that ethno-regional differences in breast cancer screening practices clearly persisted. In addition to traditional demographic factors, other variables evidently underlie differences in Hispanics' utilization of breast cancer screening services. These variables may be cultural and should be investigated in future research. Meanwhile, researchers should not refer to the 'Hispanic' population at large without identifying, addressing and clarifying the ethno-regional characteristics of their samples.     

Predictors of screening mammography: implications for office practice

BACKGROUND: The completion of annual screening mammography and other preventive health services among women aged 50 years and older remains an important quality of care indicator. METHODS: A biracial sample of 843 rural women (aged > or =50 years) from a population-based sample reported demographic and preventive health services utilization in the last year including the completion of screening mammography. Bivariate analysis and logistic regression were used to investigate the extent to which completion of other screening examinations, including Papanicolaou (Pap) smears and clinical breast examination, is associated with successful completion of mammography relative to demographic and health service variables. RESULTS: The completion of mammography was associated with age, race, education, health insurance, and the presence of a regular primary care physician, but the strongest predictors were the completion of a clinical breast examination and/or a Pap smear. CONCLUSIONS: Women who receive a clinical breast examination and/or a Pap smear appear far more likely to receive screening mammography, suggesting a synergy in screening services. The relative efficacy of interventions to increase the completion of clinical breast examinations as well as other age-appropriate preventive services during routine office visits or during a single preventive services office visit should be further explored in primary care settings. Residency programs should provide training on the successful incorporation of such services into office practice patterns in an effort to continually improve quality of care.     

Use of preventive services by men enrolled in Medicare+Choice plans

Objectives. We examined the effect of demographic and socioeconomic factors on use of preventive services (prostate-specific antigen testing, colorectal cancer screening, and influenza vaccination) among elderly men enrolled in 2 Medicare+Choice health plans.

Methods. Data were derived from administrative files and a survey of 1915 male enrollees. We used multivariate logistic regression to assess the effects of enrollee characteristics on preventive service use.

Results. Age, marital status, educational attainment, and household wealth were associated with receipt of one or more preventive services. However, the effects of these variables were substantially attenuated relative to earlier studies of Medicare.

Conclusions. Some Medicare HMOs have been successful in attenuating racial and socioeconomic disparities in the use of preventive services by older men.

     

Utilization of health services among rural women in Gujarat, India

This study examined the effects of four sets of factors on use of curative health services among rural women living in Gujarat, India. The sets of factors analyzed were as follows: (1) the demographic characteristics of the women; (2) the characteristics of the household in which they lived; (3) the characteristics of the environment in which they lived; and (4) the price and convenience of care. The study focused on rural married women aged 17–45 who had at least one child. Nested multiple logistic regressions were computed on cross-sectional data to assess the simultaneous influences of the independent variables on (1) reports of episodes of illness (2) use of curative services among rural women who reported an illness and (3) use of a specific service. Four types of service were examined as outcomes of interest, namely, private doctors, Aga Khan Health Services centres, government health centres, and traditional healers. Other things being equal, women's education, income, family structure and kinship affiliation were significant predictors of use of service. Women seemed to be more sensitive to travel time to the health service and its associated costs (purdah restrictions, transportation and time costs) than to the direct costs of service. Factors such as women's occupation and sanitation facilities, while associated with use of service in the expected direction, were not significant predictors of use of service. Implications for health planning are offered, including initiatives to implement health promotion and disease prevention programs in addition to increasing access to the existing health services. Avenues for future studies are suggested, particularly in regard to decision-making processes affecting the health-seeking behavior of rural women. It is recommended that such policies and studies should consider the cultural environment in addition to the existing pluralistic health system.     

Examining the transnational preventive healthcare utilisation of a group of Eastern European migrants living full-time in another European state

Migrants in Europe are shown to have consistently lower uptake of preventive healthcare compared to European host populations. This paper examines how the transnational preventive care use of Eastern European migrants in their country of origin may be associated with preventive care uptake in their European host country. Preventive care use data in Ireland was collected on 119 Polish migrants and 123 native Irish from June 2018 to September 2019. Preventive care use data was also collected on the Polish migrant group in Poland during the same period. Preventive care use was captured by examining general practitioner visits, blood or urine test uptake, and cancer screening uptake. Probit models were first estimated to examine whether the Polish migrants were more or less likely to have used each service in Ireland than the native Irish. Second, three bivariate probit models were estimated to examine the use of each service by the Polish migrants only in Ireland and Poland as the two dependant variables. The Polish migrants are less likely to have GP visits, blood or urine test uptake, and cancer screening uptake in Ireland compared to the native Irish. The Polish migrants from this study are also shown to potentially substitute blood or urine test uptake in Ireland for uptake in Poland. Transnational ties can determine the preventive care utilisation of migrants in Europe.     

Australian women seeking counseling have higher use of health services

PURPOSE: Despite a high prevalence of psychological distress and poor mental health in the Australian community, use of counseling services is very low. There has been only limited research examining the profile of those who do access counseling services, mainly in terms of demographic and health behavior variables. To extend our understanding of those who currently access counseling services, this study aimed to examine the broader pattern of health service utilization by women who consulted counselors, psychologists, or social workers in the past year compared with those who did not among a population-based sample of middle-aged Australian women, and to determine whether health service utilization was independently associated with use of counseling services, controlling for other known predictors. METHODS: The cross-sectional population-based mail survey data for this study came from the third survey of the mid-aged cohort of the Australian Longitudinal Study on Women's Health, conducted in 2001. The sample comprised 11,201 women aged 50-55. The main study variable was a question asking whether they had consulted a counselor/psychologist/social worker in the past year. FINDINGS: Only 6.9% of women had consulted a counselor/psychologist/social worker in the past year. After controlling for self-reported mental health status, health behaviors and demographic variables in multivariate analysis, consulting a counselor/psychologist/social worker in the past year was significantly and positively associated with consultations with general practitioners (>/=5 consultations; odds ratio [OR], 4.14; 95% confidence interval [CI], 2.35-7.27; p < .0001), specialist (>/=3 consultations; OR, 2.09; 95% CI, 1.66-2.63; p < .0001), and hospital doctor (OR, 1.35; 95% CI, 1.10-1.66; p = .004). Use of counseling services was not associated with use of other allied and complementary health services in multivariate analyses. CONCLUSIONS: Further research is needed to determine whether the strong independent link between self-reported use of counseling and other medical and health services among middle-aged women is best explained by general practice referral patterns, availability of services, economic factors, or different help-seeking patterns among women.     

Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey

ObjectiveTo examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years.Study designCross-sectional population-based survey.MethodsA sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis.ResultsIn total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram.ConclusionsThis study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies.     

Involving the public and other stakeholders in development and evaluation of a community pharmacy alcohol screening and brief advice service

Objectives

To explore the views of community pharmacy staff, the general public and other stakeholders towards pharmacy-based alcohol screening and advice services.To involve all relevant stakeholders in designing an acceptable and feasible pharmacy-based alcohol screening and advice service.To evaluate a pilot service from the user perspective.

Study design

Mixed methods study involving a range of populations, designed to explore multiple perspectives and enable triangulation of results, to develop an optimal service design, prior to service commissioning.

Methods

Telephone interviews were conducted with relevant stakeholders and a street survey undertaken with the public to explore views on the desirability and feasibility of pharmacy-based alcohol services. Following this, a stakeholder working group was held, involving a nominal group technique, to develop and refine the service design. Finally a pilot service was evaluated from the user perspective through telephone interviews and direct observations by a trained researcher.

Results

All stakeholder groups (pharmacy staff, public, commissioners, alcohol treatment service staff) viewed pharmacy-based alcohol screening services as acceptable and feasible with the potential for integration and/or combination with existing public health services. Privacy was the main concern of the public, but 80% were comfortable discussing alcohol in a pharmacy. These views were not influenced by drinking status age or gender, but people recruited in areas of high deprivation were more likely to accept a pro-active approach or alcohol-related advice from a pharmacist than those from areas of low deprivation. Stakeholder groups were in agreement on the acceptability of a pharmacy screening service, but alcohol treatment service staff viewed direct referral to alcohol support services less beneficial than other stakeholders. Posters in pharmacies and GP surgeries were viewed as most likely to encourage uptake of screening. Involvement of non-pharmacist pharmacy staff was seen as essential.The working group considered accessibility of pharmacies as the key facilitator for alcohol services, but agreed that an optimal service must ensure that poor pharmacy environment did not create a potential barrier, that clear information about the service's availability was necessary. Plus good use of quiet areas. Use of AUDIT-C as a prescreening tool by pharmacy staff, followed when appropriate by completion of full AUDIT by the pharmacist in a private room/quiet area was agreed as optimal to ensure accessibility plus privacy. Direct referral was viewed as desirable.Five pharmacies piloted this service for two months and recruited 164 people for alcohol screening, of whom 113 were low risk (AUDIT score 0–7), 24 increasing risk (8–19) and 28 high risk/possibly dependent drinkers (20 or above). Observations showed that pharmacy support staff were involved in proactively approaching customers, that 20 of the 72 customers observed (28%) during two hours in each pharmacy were invited for screening and that 14 (19%) accepted screening. Promotion of the service was variable dependent on company policies, but was shown to have a positive effect, as two of the ten service users interviewed requested screening. The environment was judged suitable for alcohol services in all pharmacies, but some quiet areas were not audibly discrete. Ten service users interviewed all considered the experience positive and all would recommend the service, but most wanted the service to be delivered in a private area.

Conclusion

The methodology enabled the development of pharmacy-based alcohol screening to be assessed for acceptability and feasibility from multiple perspectives, prior to full service commissioning. Results suggest that the pharmacy environment and concerns about privacy need to be recognized as potential barriers to service delivery. Good promotion is required to maximize service uptake and pharmacy staff need to be involved in both this and in service delivery.     

The association between cognitive impairment and community service use patterns in older people living in Australia

Family plays a vital role in supporting individuals with dementia to reside in the community, thus delaying institutionalisation. Existing research indicates that the burden of care‐giving is particularly high for those caring for a person with dementia. Yet, little is known about the uptake of community services by people with a diagnosis of dementia. Therefore, this study aims to better understand the relationship between cognitive impairment and the receipt of community care services. In order to examine the relationship, secondary data collected across Queensland, Australia, from 59,352 home‐care clients aged 65 and over during 2007–2008 are analysed. This cross‐sectional study uses regression analyses to estimate the relationship between cognitive impairment and service mix, while controlling for socio‐demographic characteristics. The dependent variables include formal services, informal care and total home‐care service hours during a 12‐month period. The findings of this study demonstrate that cognitive impairment is associated with accessing more hours of respite and day centre care but fewer hours of other formal care services. Additionally, the likelihood of support from an informal caregiver increases when a client becomes cognitively impaired. Therefore, this study demonstrates that there is an increased need for respite programmes to support informal caregivers in the future, as the population of people living with dementia increases. These findings support the need for investigations of new and innovative respite models in the future.     

Risk targetting: an approach to cost-containment.

The need for rationing in an insurance-based system of health care is inescapable. The best way to tackle the mismatch between demand and supply is, however, not clear. Of the four general strategies described, increasing the risk of disease in a population is shown to be the most effective way of reducing the outcome cost of a service. This may enable health care systems to provide services which would otherwise be unaffordable. This paper develops a technique for assessing risk using Lorenz curves which could be used by health service managers and clinicians. The paper uses cervical cytology screening to illustrate how variables can be selected in such a way as to maximise the number of potential beneficiaries while minimising the number of people to whom the service is offered.     

Adolescent victimization and subsequent use of mental health counseling services.

PURPOSE: To test the extent to which adolescent victimization predicts subsequent use of mental health services in a prospectively assessed nationwide sample of high school students. METHODS: Data were analyzed from 4590 adolescents participating in Waves I and II of the National Longitudinal Survey of Adolescent Health. In-home self-report data were collected on four types of personal victimization, mental health service use, demographics, psychological symptoms/needs, and family connectedness. Using logistic regression analysis, adolescents' victimization and background variables at Wave I were entered as predictors of subsequent mental health service use, measured at Wave II. RESULTS: In this national sample, 19.6% of the respondents stated that they had experienced at least one of four forms of personal victimization in the prior year. Of those reporting personal victimization, 11.0% stated they had used mental health services at 1-year follow-up, as compared to 9.2% of those who did not report any personal victimization. After controlling for background variables in logistic regression analyses, however, adolescents' victimization reported at Wave I was associated with significantly lower odds of subsequent mental health service use at Wave II. CONCLUSIONS: Evidence does not indicate that adolescents' victimization prompts mental health service use, and rather indicates that in some instances victimization is associated with lower odds of subsequent mental health service use. These findings raise questions about the degree to which adolescents receive needed professional mental health supports in the wake of serious violence exposure.     

History of domestic violence and health service use among mid-aged Australian women

OBJECTIVES: To examine associations between history of domestic violence and health service use among mid-aged Australian women, adjusting for physical and psychological health status and demographic factors. METHODS: Population-based cross-sectional postal survey (1996) of the Australian Longitudinal Study on Women's Health. Of 28,000 women randomly selected, 14,100 (53.5%) aged 45-50 years participated. Logistic regressions were used to assess associations between domestic violence and health service use. RESULTS: After adjusting for demographic variables, multivariate analysis revealed associations between ever having experienced domestic violence and three or more consultations in the previous 12 months with a family doctor (OR 2.07, 95% CI 1.68-2.55), hospital doctor (OR 1.77, 95% CI 1.44-2.I7), or specialist doctor (OR 1.54, 95% CI 1.35-1.75), or being hospitalised (OR 1.36, 95% CI 1.20-1.54). After adjusting for demographic variables and physical and psychological health status, these associations were attenuated: three or more consultations with family doctor (OR 1.36, 95% CI 1.09-1.70), hospital doctor (OR 1.16, 95% CI 0.92-1.45), or specialist doctor (OR 1.14, 95% CI 0.98-1.32), and being hospitalised (OR 1.10, 95% CI 0.96-1.26). CONCLUSIONS: Physical and psychological status accounted for the associations between domestic violence and higher health service use, with the exception of GP consultations, which remained associated with domestic violence. IMPLICATIONS: Physical health status only partially explains the increased health service use associated with domestic violence, while both physical and psychological health status explained higher usage of specialist and hospital services. It seems likely that women who have experienced domestic violence may be seeking consultations from GPs for reasons additional to health status.     

Predictors of health and human services use by persons with dementia and their family caregivers

The aim of this study was to identify predictors of the use of health and human services by community residing persons with dementia and their family caregivers. Telephone interviews were conducted with a sample of 608 primary caregivers of community residing persons with dementia who were randomly selected from a state-wide dementia registry. The Anderson Behavioral Model of Health Care Use was used as the analytic framework. Hierarchical ordinary least squares regression models were developed to analyze predictors of health and human services use. Predisposing, enabling, and need variables explained 40.9% of the variance in service use, 29.8% of the variance in health service use, and 38.1% of the variance in the use of human services. Enabling variables explained more variance in the use of health and human services than did need or predisposing variables. In contrast to the health services utilization literature that points to the importance of need variables, the results of this study lend support to findings in the caregiving literature that indicate that enabling variables are at least as important as need variables in predicting the use of community services by family caregivers of persons with dementia.     

Racial/ethnic disparities in the use of mental health services in poverty areas

OBJECTIVES: This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. METHODS: We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. RESULTS: Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. CONCLUSIONS: Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.     

An Analysis of Perceived Competence Among Managers in Human Service Organizations

The purpose of the research was to survey managers in social service organizations to study the extent and nature of thier perceived competence, with emphasis given to determining the degree to which several demographic variables serve as antecedents in explaining perceptions of self-competence. Based on responses from 299 managers, the results reveal that the managers see themselves as competent individuals in the work setting. Further, no significant differences were found on any of the four competence subscales for the demographic variables of sex, position in agency, organizational level, education, and education major. However, for three of the subscales significant perceptual differences were noted for the demographic variables of age and length of service in present position.     

Health and social services accessed by a cohort of Canadian illicit opioid users outside of treatment

OBJECTIVE: To examine the use of social and health services by illicit opioid users outside of treatment in five Canadian cities ('OPICAN' cohort). METHODS: 677 eligible participants completed an interviewer-administered protocol and 584 supplied saliva samples for HIV and HCV antibody-testing. Chi-squared tests and multivariate analyses of variance (MANOVA) were carried out in order to determine the associations between use of services and specific factors. The explanatory variables of service utilization were determined with multiple regression analysis. RESULTS: The average age of respondents was 35 years, 66% were male and 68% were Caucasian. Women and HIV-positive individuals were more likely to receive health care. Participants who had a history of injection drug use, but had not injected within the previous 30 days, visited doctors more regularly and had a higher uptake of community-based services. Those who reported mental health problems used services less frequently than others. Participants recruited in Vancouver had more visits to needle exchange programs and centres specifically for women. Toronto participants were more likely to use homeless shelters and had a higher uptake of other types of community-based services. CONCLUSION: Our study found a high rate of physical and mental health problems in illicit untreated opioid users in Canada, including the transmission of infectious disease. The availability of services seems to be a predictor of use of services. Setting up, adapting and evaluating front-line services tailored to illicit opioid users outside of treatment should be a policy and program priority.     

Projecting the cost of essential services in Bangladesh

Utilizing a study of the costs of providing essential services in rural areas in Bangladesh projections of the cost of expanding services to the entire rural population are derived. These estimates are based on the current system of primary care, the demographic structure of the population and normatives for desired utilization. Scenarios make use of known demographic characteristics of average rural areas together with information on disease prevalence. The estimates highlight a number of difficulties involved in deriving costs and in comparing the cost-effectiveness of service provision. The integrated nature of much primary care, both in terms of the technical exploitation of joint costs and clinical diagnostic and treatment protocols, means that treating services in isolation is likely to lead to inexact estimates of service cost. The context of any costs derived is required in order to make comparisons.     

Health services accessibility among Spanish elderly

The paper aims to identify the variables that best explain the use of health services by people aged 65 and over in Spain. The data comes from the 1993 Spanish National Health Survey (ENSE 93). The conceptual framework is the model proposed by Andersen, who suggests that utilisation is a function of predisposition to use the services, the ability to use them and of need. A bivariate and multivariate analysis (SPSS-X Discriminant Procedure) is conducted to define the predictors that best discriminate users and non-users. The use of each health service is explained by a different set of variables. The need variables play a more important role in predicting the use of non-discretionary services that are more closely related to healing processes (medical consultations, emergencies and hospitalisation). The predisposing and enabling variables are more relevant in explaining the use of dental services, indicating a certain degree of inequity of these discretionary services.