Do minorities in the United States receive fewer mental health services than whites?

Older studies have found that minorities in the United States receive fewer mental health services than whites. This analysis compares rates of outpatient mental health treatment according to race and ethnicity using more recent, population-based data, from the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The authors calculated visit rates per 1,000 population to either primary care or psychiatric providers for mental health counseling, psychotherapy, and psychiatric drug therapy. In the primary care setting, Hispanics and blacks had lower visit rates (per 1,000 population) for drug therapy than whites (48.3 and 73.7 vs. 109.0; P <.0001 and P < .01, respectively). Blacks also had a lower visit rate for talk therapy (mental health counseling or psychotherapy) than whites (23.6 vs. 42.5; P < .01). In the psychiatric setting, Hispanics and blacks had lower visit rates than whites for talk therapy (38.4 and 33.6 vs. 85.1; P < .0001 for both comparisons) and drug therapy (38.3 and 29.1 vs. 71.8; P < .0001 for both comparisons). These results indicate that minorities receive about half as much outpatient mental health care as whites.     

Giving office-based physicians electronic access to patients' prior imaging and lab results did not deter ordering of tests

Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40-70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.     

Can Medicaid managed care provide continuity of care to new Medicaid enrollees? An analysis of tenure on Medicaid.

OBJECTIVES: The purpose of this study was to analyze duration of coverage among new Medicaid enrollees. METHODS: The 1991 Survey of Income and Program Participation was used to examined the duration of coverage for individuals who did not have Medicaid in January 1991 and obtained coverage by May 1993. RESULTS: Of new Medicaid enrollees, 38% (90% confidence interval [CI] = 34%, 42%) remained covered 1 year later; 26% (90% CI = 21%, 31%) remained covered at 28 months. Of those older than 65 years, 54% (90% CI = 31%, 77%) retained Medicaid for 28 months, vs 20% (90% CI = 14%, 26%) of children. Of people who lost Medicaid, 54% (90% CI = 31%, 77%) had no insurance the following month. CONCLUSIONS: Almost two thirds of new Medicaid recipients lose coverage within 12 months. It is unlikely that Medicaid managed care will enhance continuity of care for new recipients.     

Midwives, labour induction and the Wooden Spoon award part I

Labour induction rates have rocketed, largely due to consumer demands and provider convenience. This increase has been a significant factor in rapidly increasing caesarean birth rates and adverse perinatal outcomes. It is important that midwives understand the risks associated with labour induction. The article overviews those factors contributing to increasing induction rates and the associated risks. Midwives are challenged to consider the evidence for an intervention contributing to a cascade of birth interventions.     

Midwives, labour induction and the Wooden Spoon award Part 2

Rates of labour induction without clear medical indication have risen exponentially. This trend has not been without consequence of increased perinatal mortality and morbidity. Midwives must understand the importance of educating pregnant women and other obstetrical providers, about the risks associated with labour induction. Maternal-child health policy that minimises unnecessary interventions is urgently needed and prevention strategies are described in the second part of this article. Midwives are challenged to consider their role in reducing unnecessary labour inductions in a rapidly changing birth culture reflecting high intervention.     

Motor planning in children with cerebral palsy: A longitudinal perspective

Introduction: Motor planning is important for daily functioning. Deficits in motor planning can result in slow, inefficient, and clumsy motor behavior and are linked to disruptions in performance of activities of daily living in children with cerebral palsy (CP). However, the evidence in CP is primarily based on cross-sectional data. Method: Data are presented on the development of motor planning in children with CP using a longitudinal design with three measurement occasions, each separated by 1 year. Twenty-two children with CP (9 boys, 13 girls; age in years;months, M = 7;1, SD = 1;2) and 22 age-matched controls (10 boys, 12 girls, M = 7;1, SD = 1;3) participated. Children performed a bar transport task in which some conditions (“critical angles”) required participants to sacrifice initial posture comfort in order to achieve end-state comfort. Performance on critical trials was analyzed using linear growth curve modeling. Results: In general, children with CP showed poor end-state planning for critical angles. Importantly, unlike in controls, motor planning ability did not improve across the three measurement occasions in children with CP. Conclusion: These longitudinal results show that motor planning issues in CP do not resolve with development over childhood. Strategies to enhance motor planning are suggested for intervention.