Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services

Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term “immigrants” masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.     

Major Elements of Parents' Satisfaction and Dissatisfaction With Pediatric Rehabilitation Services

Little is known about the elements of service delivery that underlie parents' satisfaction with the pediatric rehabilitation services their children receive. Determining the most important elements of satisfaction and dissatisfaction will inform health care managers about what should be done in delivering services. In this study, 130 highly satisfied and 101 relatively dissatisfied parents were identified based on their scores on a standardized satisfaction measure (from a pool of 645 parents). Parents' comments (the 3 things they liked most and least about the services received from a children's rehabilitation center or program) were coded using a comprehensive coding scheme based on the medical and rehabilitation literatures. Coding agreement was ensured through a consensus procedure. Highly satisfied parents most often mentioned elements of the service delivery process, particularly respectful and supportive care (i.e., feeling listened to and having a sense of rapport with service providers). Relatively dissatisfied parents most often mentioned structural elements (particularly lack of access to existing services) and process elements (respectful and supportive care, as well as lack of continuity and coordination of care). To ensure parents' satisfaction and prevent dissatisfaction, managers and service providers should reduce waiting lists, provide respectful and supportive care, and ensure services are coordinated across locations and over time. Measures of satisfaction should contain items tapping elements of both process and structure, because structural elements are particularly important in terms of parents' dissatisfaction.     

Parents’ Global Rating of Mental Health Correlates with SF-36 Scores and Health Services Satisfaction

Background Patient satisfaction surveys are often used to measure quality of care. However, patient satisfaction may not be a reliable indicator of service quality because satisfaction can be influenced by clients’ characteristics such as their health status.Methods Parents of children attending a pediatric neurology clinic completed the Short Form Health Survey (SF-36) and global ratings of their physical and mental health. They also completed the Client Satisfaction Questionnaire (CSQ), the Measure of Processes of Care (MPOC), and the Family-Centered Care Survey (FCCS).Results 104 parents completed the survey. The correlation between the global rating of physical or mental health and their corresponding SF-36 scores was high. The majority (88%) of parents were satisfied, with a median CSQ score of 28 (IQR, 24 to 31) and a FCCS score of 4.7 (IQR, 4.2 to 4.9). Logistic regression identified parents’ mental health as a significant predictor of client satisfaction (OR, 1.07; 95% CI, 1.01 to 1.14).Conclusions Given the positive association between parents’ mental health and satisfaction with care, it is important to consider mental status as a covariate in interpreting satisfaction surveys. Parents’ global rating of mental health appears to be a reasonable indicator of their SF-36 mental scores.     

An Investigation of Causes of Patient Satisfaction/Dissatisfaction with Physician Services

To provide the highest level of satisfaction, health care providers must control patients' expectations and perception of treatment quality. This study is designed to gain insight into the perception and attitudes of consumers toward physician services. It attempts to examine the satisfaction/dissatisfaction of patients in association with the cost and quality of medical care; interpersonal skills, copmetence and professional recognition of physicians; information provided and attention given by physicians; waiting time, physical facilities, and receptioninsts and nurses in the physicians office. Data was gathered using telephone interviews from a sample of 245 respondents. Factor analysis techniques in the SPSSX software package were used in data analysis. Findings indicated that there are generally favorable attitudes toward the quality of medical services, and that medical cost has secondary importance.     

Purchase of Mental Health Services

Summary This synopsis of a comprehensive presentation on purchase of service provides a brief overview of the subject. The presentation is based on the systems approach and is organized around five elements: goals and objectives, constraints, scope, controls, and administration. Purchase of Service, when implemented in a systematic manner, is viewed as an important management tool for providing a wide range of mental health services.     

Maximizing School Health Services in a time of Fiscal Restraint

This case study reports a communitywide effort to reduce the fragmentation and duplication of child health services in Boston. Consensus was first reached on what basic health services should be offered and where — school or community — they would be most efficiently and effectively delivered. The planning group then developed strategies to coordinate a network for the delivery of these services. Implementation has begun. The Boston experience offers a mechanism to maximize school health services as available funding for them declines.     

Challenges in Marketing Mental Health Senior Services

No abstract available for this article.     

Managing Patients with Diabetes Mellitus and Mental Health Problems

Diabetes mellitus is the subject of a great many case management programs around the world as it is a prevalent disease with modifiable risk factors and potentially preventable severely disabling complications. Diabetes mellitus represents even greater challenges in the context of mental illness. Patients with psychological complications of diabetes mellitus or with psychiatric disease and comorbid diabetes mellitus present a unique set of problems with which the physician and other care providers must contend. These challenges include: problems with treatment regimens; inability to manage self-care programs; difficulties with negotiating appointments, referrals, and follow-up care; confusion over competing care instructions; potential drug interactions and/or complications which exacerbate diabetes mellitus; and many social difficulties which undermine the effective care of diabetes mellitus.Lack of control of either diabetes mellitus or mental health problems may complicate or exacerbate one or the other of these diseases. Case management for these individuals is one potential way of improving care. Management needs to be team based, coordinated between specialties, simplified, and in one location of care when possible. Excellent coordination and communication is paramount and social factors and supports require special attention.     

Technology, Job Satisfaction, and Retention: Rural Mental Health Practitioners

CONTEXT: Job satisfaction as it relates to retention of mental health professionals is a major problem in rural areas. Several authors have suggested that technology can positively influence job satisfaction and thus improve retention. OBJECTIVES: This study examined technology use and technology expertise in relationship to job satisfaction. It is based on a theoretical framework that asserts as technology use increases, communication among providers and access to educational and consultative resources increase as well, resulting in a boost in professional support and a reduction in isolation. METHODS: Surveys were sent to 320 providers in rural southeast Ohio; 163 returned usable surveys. FINDINGS: There was a statistically significant relationship between the combination of technology use and expertise and job satisfaction. Use alone, however, was not significant. Despite the fact that over 90% of respondents had access to both a computer and the Internet, just 45% used technology to communicate with peers and nearly 96% indicated that they never or rarely used the Internet for educational programs. CONCLUSIONS: The results challenge the assertion that technology plays a major role in job satisfaction and rural retention since access and perceived expertise did not guarantee technology usage. Decisions to stay or leave a rural practice involve a complex array of factors. Technology, with its ability to link providers to resources outside the geographic bounds of an individual's practice, may play a role, but since its adoption can be costly in both time and money, future studies need to determine its place in the retention model.     

Eliminating The Wait For Mental Health Services

Timely access to mental health services is critical to successful treatment of adults with severe and persistent mental illness, and timeliness is a key quality indicator in calls for improvement to the health care system. Waiting weeks for a psychiatric appointment results in increased psychiatric hospitalizations, decompensation, and risk for suicide. However, many community mental health administrators assume that waiting lists for services are inevitable given the high demand for services. The present study evaluates the successful efforts of a large urban community mental health center to eliminate the wait for psychiatric services in an adult outpatient setting. Through systematic changes in the service delivery system, the wait time for a psychiatric appointment was reduced from 13 days to 0 days, and the no-show rate dropped from 52 to 18%. Furthermore, these changes were associated with reduced psychiatric hospitalizations and improved staff morale and teamwork. The change processes implemented can be successfully applied to other systems problems confronting mental health agencies.     

Mixed-Effects Models for Mental Health Services Research

A common theme in mental health services research is multi-stage sampling i.e., sampling of responses within subjects and sampling of subjects within populations. For example, in prospective longitudinal studies, subjects are repeatedly sampled and rated on measures of well being, mental and physical level of functioning, quality of life, and these subjects are sampled from a population, often stratified on the basis of type or amount of service utilization. Like all behavioral characteristics, these outcome measures exhibit individual differences. We should be interested in not just the mean trend, but in the distribution of these trends in the population of subjects. Then we can speak of the number or proportion of subjects who are functioning more or less positively, at such and such a rate. We can describe the behavioral relationship, not as a fixed law, but as a family of laws, the parameters of which describe the individual behavioral tendencies of the subjects in the population. This view of behavioral research leads to Bayesian methods of data analysis.The purpose of this paper is to explore application of mixed-effects regression models to common statistical problems encountered in mental health services research. Previous work in this area has led to widespread use of mixed-effects regression models for the analysis of longitudinal mental health services data. Generalizations of the model lead to mixed-effects probit and logistic regression for binary, ordinal and nominal response data, full-information item factor analysis, and multivariate generalizations of probit analysis. These models are critical to mental health services research in that they provide statistically rigorous approaches to both the definition and analysis of outcome which is invariably multidimensional and based on qualitative factors.