scholarly journals Child Health Clinical Outcome Review Programme: Health Care Utilisation, Care Pathways and Educational Status in Children and Young People with Adolescent Mental Health problems with a focus on Self harm, Eating Disorders and Anxiety and Depression

Author(s):  
Sophie Wood ◽  
Ann John ◽  
Alison Kemp ◽  
Bethan Carter ◽  
Melissa Wright

ABSTRACT ObjectivesTo use routinely collected datasets and data linkage to identify patterns of healthcare utilisation by children and young people (CYP) with adolescent mental health (AMH) disorders across the four UK Nations, with a particular focus on self-harm, anxiety and depression and eating disorders. The analysis will focus on healthcare utilisation during transition from child to adult services and, where possible, on the interface between different care settings e.g. primary and secondary care and health and social care. In addition we will determine the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that CYP with AMH disorders receive. ApproachData has been requested from the national data providers in each country: The Health and Social Care Information Centre - England The Secure Anonymised Information Linkage (SAIL) databank - Wales Information Services Division – Scotland  The Honest Broker Service- Northern Ireland As well as other sources: The Clinical Practice Research Datalink  The Paediatric Intensive Care Audit Network. A number of restrictions and information governance regulations have had to be negotiated and put in place in order to access and store the data in the SAIL Databank, Swansea University. Descriptive cross sectional analysis is underway to address the key questions. RationalThe project has arisen from the report ‘Overview of Child Deaths in Four UK Countries’ which found that 30-40% of 13-18 year olds were affected by mental health, learning difficulties or behavioural conditions. The diagnosis, management and services available for mental disorders in CYP are of growing concern and a source of controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services, as well as, that between the NHS and other sectors is often disjointed. Thresholds for referral to Child and Adolescent Mental Health Services (CAMHS) are high and many adolescents are treated, at least initially, in primary health care systems. ImplicationsAnalysis of routinely collected health datasets has the potential to describe the nature and extent of health needs and health care utilisation for CYP with AMH disorders (self-harm, depression/anxiety, eating disorders). Furthermore the knowledge obtained from using routinely collected healthcare data, will inform future routine data collection across the UK for CYP with AMH disorders.

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 18 ◽  
Author(s):  
Katharine Mark ◽  
Dominic Murphy ◽  
Sharon Stevelink ◽  
Nicola Fear

Little is known about ex-serving military personnel who access secondary mental health care. This narrative review focuses on studies that quantitatively measure secondary mental health care utilisation in ex-serving personnel from the United States. The review aimed to identify rates of mental health care utilisation, as well as the factors associated with it. The electronic bibliographic databases OVID Medline, PsycInfo, PsycArticles, and Embase were searched for studies published between January 2001 and September 2018. Papers were retained if they included ex-serving personnel, where the majority of the sample had deployed to the recent conflicts in Iraq or Afghanistan. Fifteen studies were included. Modest rates of secondary mental health care utilisation were found in former military members—for mean percentage prevalence rates, values ranged from 12.5% for at least one psychiatric inpatient episode, to 63.2% for at least one outpatient mental health appointment. Individuals engaged in outpatient care visits most often, most likely because these appointments are the most commonly offered source of support. Post-traumatic stress disorder, particularly re-experiencing symptoms, and comorbid mental health problems were most consistently associated with higher mental health care utilisation. Easily accessible interventions aimed at facilitating higher rates of help seeking in ex-serving personnel are recommended.


2020 ◽  
pp. 1-28
Author(s):  
Kristian Park Frausing ◽  
Michael Smærup ◽  
Per Lindsø Larsen ◽  
Kirsten Maibom ◽  
Knud Juel ◽  
...  

Abstract A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.


2012 ◽  
Vol 15 (10) ◽  
pp. 1966-1972 ◽  
Author(s):  
Niamh Rice ◽  
Charles Normand

AbstractObjectiveThe present study aimed to establish the annual public expenditure arising from the health and social care of patients with diet-related malnutrition (DRM) in the Republic of Ireland.DesignCosts were calculated by (i) estimating the prevalence of DRM in health-care settings derived from age-standardised comparisons between available Irish data and large-scale UK surveys and (ii) applying relevant costs from official sources to estimates of health-care utilisation by adults with DRM. No attempt has been made to estimate separately the costs of DRM and any associated disease, since each can be a cause or consequence of the other. The methods used are adapted from an evaluation of the cost of malnutrition in the UK by the British Association for Parenteral and Enteral Nutrition (2009).SettingsHospitals, nursing homes, out-patient clinics, primary-care clinics and home care.SubjectsAll adult patients receiving hospital in-patient, out-patient or specified community health-care services.ResultsThe annual public health and social care cost associated with adult malnourished patients in Ireland is estimated at over €1·4 billion, representing 10 % of the health-care budget. Most of this cost arises in acute hospital or residential care settings (i.e. 70 %), with nutritional support estimated to account for <3 % of spend.ConclusionsThe cost associated with the care of patients with DRM is substantial and may rise as the proportion of older people within the population increases, a group at increased risk of DRM. Despite growing pressure on health-care budgets, little attention has been focused on the economic burden associated with DRM in Ireland or the potential for savings arising from improved detection and treatment of those at risk.


Author(s):  
Sophie Wood ◽  
Sarah Rees ◽  
Ting Wang ◽  
Amanda Marchant ◽  
Ashley Akbari ◽  
...  

IntroductionThe diagnosis, management and services available for mental disorders are of growing concern and controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services is often disjointed and thresholds for referral to Child and Adolescent Mental Health Services are high. Objectives and ApproachRoutinely collected healthcare datasets and data linkage were used to identify patterns of healthcare utilisation by young people and young adults with mental health disorders across the four UK Nations. We explored the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that children and young people with mental health disorders receive. Data was requested from the national data providers in each country. A series of descriptive analyses were performed and methods were developed for cross- national comparisons to be made (e.g. Four Nation Person Spell). ResultsIt is feasible to explore healthcare utilisation across the four countries of the UK using routine data. However the recording, availability and access varied considerably between countries, making meaningful comparisons challenging. Descriptive analyses showed strong deprivation gradients in the diagnoses and care provided for young people and young adults with mental health disorders. Depression and anxiety were the most commonly recorded mental health conditions in primary care. In secondary care drug/alcohol disorders and self-harm were the most commonly recorded. Re-admissions to emergency departments were higher for those admitted for self-harm or psychiatric conditions. Conclusion/ImplicationsRoutine data has the potential to make a difference to care. However collection and access needs to be standardised in order to improve efficiency and effectiveness in improving the care for children and young people with mental health disorders. MQ has funded an Adolescent Data Platform to facilitate this.


2017 ◽  
Vol 28 (1) ◽  
pp. 100-111 ◽  
Author(s):  
B. Roberts ◽  
N. Makhashvili ◽  
J. Javakhishvili ◽  
A. Karachevskyy ◽  
N. Kharchenko ◽  
...  

AimsThere are an estimated 1.5 million internally displaced persons (IDPs) in Ukraine because of the armed conflict in the east of the country. The aim of this paper is to examine utilisation patterns of mental health and psychosocial support (MHPSS) care among IDPs in Ukraine.MethodsA cross-sectional survey design was used. Data were collected from 2203 adult IDPs throughout Ukraine between March and May 2016. Data on mental health care utilisation were collected, along with outcomes including post-traumatic stress disorder (PTSD), depression and anxiety. Descriptive and multivariate regression analyses were used.ResultsPTSD prevalence was 32%, depression prevalence was 22%, and anxiety prevalence was 17%. Among those that likely required care (screened positive with one of the three disorders, and also self-reporting a problem) there was a large treatment gap, with 74% of respondents who likely required MHPSS care over the past 12 months not receiving it. For the 26% (N = 180) that had sought care, the most common sources of services/support were pharmacies, family or district doctor/paramedic (feldsher), neurologist at a polyclinic, internist/neurologist at a general hospital, psychologists visiting communities, and non-governmental organisations/volunteer mental health/psychosocial centres. Of the 180 respondents who did seek care, 163 could recall whether they had to pay for their care. Of these 163 respondents, 72 (44%) recalled paying for the care they received despite government care officially being free in Ukraine. The average costs they paid for care was US$107 over the previous 12 months. All 180 respondents reported having to pay for medicines and the average costs for medicines was US$109 over the previous 12 months. Among the 74% had not sought care despite likely needing it; the principal reasons for not seeking care were: thought that they would get better by using their own medications, could not afford to pay for health services or medications, no awareness of where to receive help, poor understanding by health care providers, poor quality of services, and stigma/embarrassment. The findings from multivariate regression analysis show the significant influence of a poor household economic situation on not accessing care.ConclusionsThe study highlights a high burden of mental disorders and large MHPSS treatment gap among IDPs in Ukraine. The findings support the need for a scaled-up, comprehensive and trauma-informed response to provision of MHPSS care of IDPs in Ukraine alongside broader health system strengthening.


Author(s):  
Meghan O'Neill ◽  
Emmalin Buajitti ◽  
Peter D Donnelly ◽  
Kathy Kornas ◽  
Laura Rosella

IntroductionHomicide is an important cause of death for older youth and adult Canadians; however, little is known about health care use prior to death among this population. ObjectivesTo characterise health care use for mental health and addictions (MHA) and serious assault (herein referred to assault) one year prior to death among individuals who died by homicide in Ontario, Canada using linked mortality and health care utilisation data. MethodsWe report rates of health care use for MHA and assault in the year prior to death among all individuals 16 years and older in Ontario, Canada, who died by homicide from April 2003 to December 2012 (N=1,541). Health care use for MHA included inpatient stays, emergency department (ED) visits and outpatient visits, whereas health care use for assault included only hospital-based care (ED visits and inpatient stays). Sociodemographic characteristics and health care utilisation were examined across homicide deaths, stratified by sex. ResultsOverall, 28.5% and 5.9% of homicide victims sought MHA and assault care in the year prior to death, respectively. A greater proportion of females accessed care for MHA, whereas a greater proportion of males accessed assault-related health care. Males were more likely to be hospitalised following an ED visit for a MHA or assault related reason, in comparison to females. The most common reason for a MHA hospital visit was for substance-related disorders. We found an increase over time for hospital-based visits for assault prior to death, a trend that was not observed for MHA-related visits. ConclusionsA large proportion of homicide victims interacted with the health care system for MHA or assault in the year prior to death. An increase in hospital-based visits for assault-related reasons prior to death was observed. These trends may offer insight into avenues for support and prevention for victims of homicide.


2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Eyvind Ohm ◽  
Kristin Holvik ◽  
Marte Karoline Råberg Kjøllesdal ◽  
Christian Madsen

Abstract Background Previous research has generally found lower rates of injury incidence in immigrant populations than in native-born populations. Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury. Methods We conducted a nationwide register-based cohort study of all individuals aged 25–64 years who resided in Norway as of January 1st 2008. This cohort was followed through 2014 by linking sociodemographic information and injury data from primary and secondary care. We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Six categories of injury were defined: fractures, superficial injuries, open wounds, dislocations/sprains/strains, burns and poisoning. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status. Results Immigrants had a 16% lower incidence of injury in primary care than non-immigrants (adjusted IRR = 0.84, 95% CI 0.83–0.84), and a 10% lower incidence of injury in secondary care (adjusted IRR = 0.90, 95% CI 0.90–0.91). Immigrants from Asia, Africa and European countries outside EU/EEA had lower rates than non-immigrants for injuries treated in both primary and secondary care. Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries. Conclusions Health care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared to non-immigrants. Incidence rates were especially low for immigrants originating from Asia, Africa and European countries outside EU/EEA, and for treatment of fractures, poisoning, self-harm and sports injuries.


Health Policy ◽  
2019 ◽  
Vol 123 (9) ◽  
pp. 851-863 ◽  
Author(s):  
Emily Satinsky ◽  
Daniela C. Fuhr ◽  
Aniek Woodward ◽  
Egbert Sondorp ◽  
Bayard Roberts

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