EFFECT OF CASE MANAGEMENT ON UNMET NEEDS AND UTILIZATION OF MEDICAL CARE AND MEDICATIONS AMONG HIV-INFECTED PERSONS

SummaryWhile a country’s health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users’ perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child’s socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children’s chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers’ views to manage the illness. The survey also recorded household socioeconomic data. Logistic regression was used to examine the data. The results reveal that unmet needs for additional medical care were 5·4% for children with acute illnesses, and 30·2% for children with chronic illnesses. For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0·42 (95% CI: 0·28–0·64) times that for sick children of the very poor households. The critically high unmet needs for children’s chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.

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Predictors of quality of life in people with severe mental illness

The British Journal of Psychiatry ◽

10.1192/bjp.175.5.426 ◽

1999 ◽

Vol 175 (5) ◽

pp. 426-432 ◽

Cited By ~ 60

Author(s):

Thomas Fahy ◽

Andy Kent ◽

Theresa Tattan ◽

Elizabeth Van Horn ◽

Ian White

Keyword(s):

Quality Of Life ◽

Mental Illness ◽

Case Management ◽

Severe Mental Illness ◽

Unmet Needs ◽

Subjective Quality ◽

Improve Quality ◽

Subjective Quality Of Life ◽

Clinical Variables

BackgroundIt is not clear which model of case management is most likely to improve quality of life in people with severe mental illness.AimsTo use baseline data derived from the UK700 Case Management Trial to assess the relative importance of clinical, social and unmet needs variables as predictors of subjective quality of life in patients with severe mental illness.MethodPatients (n=708) were assessed on quality of life (Lancashire Quality of Life Profile), needs (Camber well Assessment of Need), psychopathology and social functioning. Variables that were amenable to change through case management were investigated as predictors of quality of life.ResultsSocial variables accounted for 7% of the variance for subjective quality of life, compared with 19% for clinical variables, and 20% for unmet needs. The strongest predictors of subjective quality of life were unmet basic, social and functioning needs, depression and positive psychotic symptoms.ConclusionsSubjective quality of life in severely mentally ill patients is predicted by clinical variables and unmet needs. The results identify priority areas for the attention of case managers who seek to improve quality of life in these patients.

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Case management after acquired brain injury compared to care as usual: study protocol for a two-year pragmatic randomized controlled trial

10.21203/rs.3.rs-29724/v1 ◽

2020 ◽

Author(s):

Annemarie Stiekema ◽

Christine Resch ◽

Mireille Donkervoort ◽

Natska Jansen ◽

Kitty HM Jurrius ◽

...

Keyword(s):

Cost Effectiveness ◽

Brain Injury ◽

Case Management ◽

Self Efficacy ◽

Unmet Needs ◽

Acquired Brain Injury ◽

Well Being ◽

Family Needs ◽

Randomized Controlled

Abstract Background: People with acquired brain injury may suffer from cognitive, emotional and behavioural changes in the long term. Continuity of care is often lacking, leading to a variety of unmet needs and hindering psychosocial functioning from the occurrence of brain injury up to years thereafter. Case management aims to prevent (escalation of) problems and to facilitate timely access to appropriate services. In other populations, case management has shown to improve psychosocial well-being. In this study, we aim to evaluate the feasibility of case management after acquired brain injury and its effectiveness and cost-effectiveness, compared to care as usual.Methods: This is a pragmatic randomized controlled study with repeated measures in adults with ABI and their family, taking place between November 2019 and December 2021 in three provinces in the Netherlands. Participants will be randomly allocated to either the case management group, receiving case management from hospital discharge up to two years thereafter, or the control group, receiving care as usual. Effectiveness will be evaluated every six months for 18-24 months by patient-reported psychosocial well-being (Hospital Anxiety and Depression Scale (HADS), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) restriction subscale and the Life Satisfaction Questionnaire (LiSat)), self-management (Patient Activation Measure (PAM)) and care needs (Longer-term Unmet Needs after Stroke (LUNS)). Family outcomes include self-efficacy (Carer Self-Efficacy Scale (CSES)), caregiver burden (Caregiver Strain Index (CSI)), psychosocial well-being (LiSat, HADS), family needs (Family Needs Questionnaire (FNQ)). Feasibility will be evaluated using qualitative methods, assessing fidelity, dose delivered, dose received, reach, recruitment and context. Cost-effectiveness will be determined by the EQ-5D-3L and service use.Discussion: At the moment there is no integrated health care service for people with acquired brain injury and their family members in the long-term. If case management is shown to be feasible and (cost)-effective, it could bridge the gap between patients’ and families’ needs and the available services.Trial registration: Netherlands Trial Register, NL8104. Registered 22 October 2019, https://www.trialregister.nl/trial/8104.

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A Comparison of Unmet Needs for Dental and Medical Care Among Persons with HIV Infection Receiving Care in the United States

Journal of Public Health Dentistry ◽

10.1111/j.1752-7325.2001.tb03350.x ◽

2001 ◽

Vol 61 (1) ◽

pp. 14-21 ◽

Cited By ~ 48

Author(s):

Kevin C. Heslin ◽

William E. Cunningham ◽

Marvin Marcus ◽

Ian Coulter ◽

James Freed ◽

...

Keyword(s):

United States ◽

Hiv Infection ◽

Medical Care ◽

Unmet Needs ◽

The United States

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Unmet needs for medical care among migrants in Finland

European Journal of Public Health ◽

10.1093/eurpub/cku162.020 ◽

2014 ◽

Vol 24 (suppl_2) ◽

Cited By ~ 1

Author(s):

P Koponen ◽

H Kuusio ◽

I Keskimäki ◽

M Mölsä ◽

K Manderbacka ◽

...

Keyword(s):

Medical Care ◽

Unmet Needs

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Case management after acquired brain injury compared to care as usual: study protocol for a 2-year pragmatic randomized controlled superiority trial with two parallel groups

Trials ◽

10.1186/s13063-020-04804-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Annemarie P. M. Stiekema ◽

Christine Resch ◽

Mireille Donkervoort ◽

Natska Jansen ◽

Kitty H. M. Jurrius ◽

...

Keyword(s):

Cost Effectiveness ◽

Brain Injury ◽

Case Management ◽

Unmet Needs ◽

Acquired Brain Injury ◽

Well Being ◽

Family Needs ◽

Randomized Controlled ◽

Superiority Trial

Abstract Background People with acquired brain injury may suffer from cognitive, emotional and behavioural changes in the long term. Continuity of care is often lacking, leading to a variety of unmet needs and hindering psychosocial functioning from the occurrence of brain injury up to years thereafter. Case management aims to prevent (escalation of) problems and to facilitate timely access to appropriate services. In other populations, case management has shown to improve psychosocial well-being. In this study, we aim to evaluate the feasibility of case management after acquired brain injury and its effectiveness and cost-effectiveness, compared to care as usual. Methods This is a pragmatic randomized controlled superiority trial with two parallel groups and repeated measures in adults with ABI and their family, taking place between November 2019 and December 2021 in three provinces in the Netherlands. Participants will be randomly allocated to either the case management group, receiving case management from hospital discharge up to 2 years thereafter, or the control group, receiving care as usual. Effectiveness will be evaluated every 6 months for 18–24 months by patient-reported psychosocial well-being (Hospital Anxiety and Depression Scale (HADS), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) restriction subscale and the Life Satisfaction Questionnaire (LiSat)), self-management (Patient Activation Measure (PAM)) and care needs (Longer-term Unmet Needs after Stroke (LUNS)). Family outcomes include self-efficacy (Carer Self-Efficacy Scale (CSES)), caregiver burden (Caregiver Strain Index (CSI)), psychosocial well-being (LiSat, HADS), family needs (Family Needs Questionnaire (FNQ)). Feasibility will be evaluated using qualitative methods, assessing fidelity, dose delivered, dose received, reach, recruitment and context. Cost-effectiveness will be determined by the EQ-5D-3L and service use. Discussion At the moment, there is no integrated health care service for people with acquired brain injury and their family members in the long term. If case management is shown to be feasible and (cost)-effective, it could bridge the gap between patients’ and families’ needs and the available services. Trial registration Netherlands Trial Register NL8104. Registered on 22 October 2019.

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