bluuebunny/crossref_metadata_2025_split huggingface dataset:
Service Contacts Among the Children Participating in the British Child and Adolescent Mental Health Surveys
Authors: Ford Tamsin , Hamilton Helena , Goodman Robert , Meltzer Howard 
Published: January 2005

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed up over 3 years. Parents provided summary information on service contacts for emotional, behavioural and concentration difficulties, with more detailed information being obtained by telephone interview for selected subgroups.Results:  Having a psychiatric disorder predicted substantially increased contact with social services, special educational needs resources, the youth justice system and mental health services (district CAMHS and tier four, but not tier two). Of those children with psychiatric disorders, 58% had been in contact with at least one of these services for help with emotional, behavioural or concentration difficulties, including 23% who had been in contact with mental health services.Conclusions:  British children attend a wide variety of services for help with emotional, behavioural and concentration difficulties. The proportion seeing specialist mental health services is higher than that generally reported in the research literature.
Justifiable Psychopharmacology or Overzealous Prescription? Examining Parental Reports of Lifetime Prescription Histories of Psychiatrically Hospitalised Children
Authors: Zakriski Audrey L. , Wheeler Elizabeth , Burda Jeffrey , Shields Ann 
Published: January 2005

Background:  This research investigated parent reports of pre‐admission psychotropic medication histories of psychiatrically hospitalised children in the United States. The emphasis was on identifying factors related to potentially overzealous medication use.Method:  Diagnosis, insurance type, and demographics for 170 consecutive admissions were assessed via research case conference and chart review. An extreme group of children with lengthy medication histories (n = 20) was also identified, and prescription and diagnostic patterns for this group were compared to other medicated children in the sample (n = 100). Cumulative medication history, rather than specific polypharmacy, was examined.Results:  Psychopharmacotherapy was common (71%). Privately insured children, children with previous psychiatric hospitalisations, and children with Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), and the specific comorbidities of ODD/ADHD, and ODD/Parent Child Relational Problems had more past medication trials. Depressed children had fewer. Analyses of the extreme group suggest that young, privately insured, oppositional children with parent‐child relationship problems were at highest risk for overmedication (including multiple trials of stimulants, as well as mood stabilisers, central adrenergic agonists, and antipsychotics).Conclusions:  Results raise important questions about the role of health care pressures on clinical practice in the United States.
Father's Involvement and Psychological Adjustment in Indian and White British Secondary School Age Children
Authors: Flouri Eirini 
Published: January 2005

Background: The study aimed to explore the relationship between father's involvement and psychological adjustment in Indian and White British secondary school age children.Method: Psychological adjustment in the 360 White British and 222 Indian children of the study was measured with the Strengths and Difficulties Questionnaire (SDQ). All children lived in biological two‐parent families and attended the same secondary school in South England.Results: Indian girls and White British girls reported similar levels of adjustment and father's involvement, although compared to White British boys Indian boys reported both lower total difficulties scores and higher prosocial behaviour scores, as well as higher levels of father's involvement. Multiple regression analyses showed that even after controlling for age, sibship size, family's socio‐economic status, and inter‐parental conflict, father's involvement was positively associated with prosocial behaviour in both genders in both ethnic groups. Father's involvement was not related to Indian boys’ or girls’ difficulties. However, in White British boys father's involvement was negatively related to peer problems, whereas in White British girls father's involvement was negatively related to total difficulties, conduct problems, and peer problems.Conclusions: There would be merit in future studies extending our knowledge about differences in the relationship between father's involvement and child outcomes.
The Impact of Medicaid Managed Care on Hospitalizations for Ambulatory Care Sensitive Conditions
Authors: Bindman Andrew B. , Chattopadhyay Arpita , Osmond Dennis H. , Huen William , Bacchetti Peter 
Published: January 2005

Objective. To determine whether Medicaid managed care is associated with lower hospitalization rates for ambulatory care sensitive conditions than Medicaid fee‐for‐service. We also explored whether there was a differential effect of Medicaid managed care by patient's race or ethnicity on the hospitalization rates for ambulatory care sensitive conditions.Data Sources/Study Setting. Electronic hospital discharge abstracts for all California temporary assistance to needy families (TANF)‐eligible Medicaid beneficiaries less than age 65 who were admitted to acute care hospitals in California between 1994 and 1999.Study Design. We performed a cross‐sectional comparison of average monthly rates of admission for ambulatory care‐sensitive conditions among TANF‐eligible Medicaid beneficiaries in fee‐for‐service, voluntary managed care, and mandatory managed care.Data Collection/Extraction Methods. We calculated monthly rates of ambulatory care‐sensitive condition admission rates by counting admissions for specified conditions in hospital discharge files and dividing the monthly count of admissions by the size of the at‐risk population derived from a separate monthly Medicaid eligibility file. We used multivariate Poisson regression to model monthly hospital admission rates for ambulatory care‐sensitive conditions as a function of the Medicaid delivery model controlling for admission month, admission year, patient age, sex, race/ethnicity, and county of residence.Principal Findings. The adjusted average monthly hospitalization rate for ambulatory care‐sensitive conditions per 10,000 was 9.36 in fee‐for‐service, 6.40 in mandatory managed care, and 5.25 in voluntary managed care (p<.0001 for all pairwise comparisons). The difference in hospitalization rates for ambulatory care sensitive conditions in Medicaid fee‐for‐service versus managed care was significantly larger for patients from minority groups than for whites.Conclusions. Selection bias in voluntary Medicaid managed care programs exaggerates the differences between managed care and fee‐for‐service, but the 33 percent lower rate of hospitalizations for ambulatory care sensitive conditions found in mandatory managed care compared with fee‐for‐service suggests that Medicaid managed care is associated with a large reduction in hospital utilization, which likely reflects health benefits. The greater effect of Medicaid managed care for minority compared with white beneficiaries is consistent with other findings that suggest that managed care is associated with improvements in access to ambulatory care for those patients who have traditionally faced the greatest barriers to health care.
How Well Does Medicaid Work in Improving Access to Care?
Authors: Long Sharon K. , Coughlin Teresa , King Jennifer 
Published: January 2005

Objective. To provide an assessment of how well the Medicaid program is working at improving access to and use of health care for low‐income mothers.Data Source/Study Setting. The 1997 and 1999 National Survey of America's Families, with state and county information drawn from the Area Resource File and other sources.Study Design. Estimate the effects of Medicaid on access and use relative to private coverage and being uninsured, using instrumental variables methods to control for selection into insurance status.Data Collection/Extraction Method. This study combines data from 1997 and 1999 for mothers in families with incomes below 200 percent of the federal poverty level.Principal Findings. We find that Medicaid beneficiaries' access and use are significantly better than those obtained by the uninsured. Analysis that controls for insurance selection shows that the benefits of having Medicaid coverage versus being uninsured are substantially larger than what is estimated when selection is not accounted for. Our results also indicate that Medicaid beneficiaries' access and use are comparable to that of the low‐income privately insured. Once insurance selection is controlled for, access and use under Medicaid is not significantly different from access and use under private insurance. Without controls for insurance selection, access and use for Medicaid beneficiaries is found to be significantly worse than for the low‐income privately insured.Conclusions. Our results show that the Medicaid program improved access to care relative to uninsurance for low‐income mothers, achieving access and use levels comparable to those of the privately insured. Our results also indicate that prior research, which generally has not controlled for selection into insurance coverage, has likely understated the gains of Medicaid relative to uninsurance and overstated the gains of private coverage relative to Medicaid.
From Medicaid to Uninsured: Drop‐Out among Children in Public Insurance Programs
Authors: Sommers Benjamin D. 
Published: January 2005

Objectives. To estimate a national disenrollment rate among children in Medicaid and the Children's Health Insurance Program (CHIP); to determine what share of disenrollment is due to acquiring other insurance or losing eligibility; and to examine what demographic and policy factors make disenrollment more likely.Data Sources. Insurance status, income, and demographics from the Current Population Survey (CPS) March Supplement (1998–2001); eligibility data from the National Governors Association; and policy data from the former Health Care Financing Administration (HCFA), state welfare offices, and previous research.Study Design. The study used a nationally representative sample of 5,551 children in Medicaid or CHIP. The key outcomes were the percentage of children still enrolled 1 year later, and the share of disenrollees who became uninsured despite remaining eligible. Multivariate logistic regression was used to explore demographics and policies predictive of disenrollment.Data Collection and Analysis. CPS data were extracted using the Census Bureau's Federal Electronic Research and Review Extraction Tool 1.0. Data analysis was performed using Stata 7 (Stata Corporation 2001).Principal Findings. Of the children enrolled in Medicaid or CHIP, 27.7 percent were no longer enrolled 12 months later. Of those, 45.4 percent dropped out despite apparently remaining eligible and having no other insurance—corresponding to 3.0 million children annually. Drop‐out varied significantly across states. Children without siblings in public insurance were at a higher risk for drop‐out. Children with more educated parents were more likely to leave Medicaid for private insurance or to lose Medicaid eligibility, while black children and infants were less likely to lose their eligibility. Decreased Medicaid provider reimbursement rates were strongly associated with drop‐out, while Medicaid managed care increased the exodus to private insurance.Conclusions. Drop‐out from Medicaid and CHIP is a significant policy concern and helps explain the persistence of uninsurance among millions of eligible children. Clinical encounters with providers appear to play a key role in preventing drop‐out.
Incentives in a Medicaid Carve‐Out: Impact on Children with Special Health Care Needs
Authors: Inkelas Moira 
Published: January 2005

Objective. To evaluate whether a specialty care payment “carve‐out” from Medicaid managed care affects caseloads and expenditures for children with chronic conditions.Data Source. Paid Medicaid claims in California with service dates between 1994 and 1997 that were authorized by the Title V Children with Special Health Needs program for children under age 21.Study Design. A natural experiment design evaluated the impact of California's Medicaid managed care expansion during the 1990s, which preserved fee‐for‐service payment for certain complex medical diagnoses. Outcomes in time series regression include Title V program participation and expenditures. Multiple comparison groups include children in managed care counties who were not mandated to enroll, and children in nonmanaged care counties.Data Collection/Extraction Methods. Data on the study population were obtained from the state health department claims files and from administrative files on enrollment and managed care participation.Principal Findings. The carve‐out policy increased the number of children receiving Title V‐authorized services. Recipients and expenditures for some ambulatory services increased, although overall expenditures (driven by inpatient services) did not increase significantly. Cost intensity per Title V recipient generally declined.Conclusions. The carve‐out policy increased identification of children with special health care needs. The policy may have improved children's access to prevailing standards of care by motivating health plans and providers to identify and refer children to an important national program.
The “Minimizing Antibiotic Resistance in Colorado” Project: Impact of Patient Education in Improving Antibiotic Use in Private Office Practices
Authors: Gonzales Ralph , Corbett Kitty K. , Leeman‐Castillo Bonnie A. , Glazner Judith , Erbacher Kathleen , Darr Carol A. , Wong Shale , Maselli Judith H. , Sauaia Angela , Kafadar Karen 
Published: January 2005

Objective. To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices.Data Sources/Study Setting. Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods.Study Design. A nonrandomized controlled trial of a household and office‐based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n=7) were compared with local and distant control practices.Data Collection/Extraction Methods. Office visits were extracted by managed care organizations using International Classification of Diseases‐9‐Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days.Principal Findings. Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p=.18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p<.002 and p=.006 compared with distant and local control practices, respectively).Conclusions. In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician‐directed efforts.
Self‐Medication of Mental Health Problems: New Evidence from a National Survey
Authors: Harris Katherine M. , Edlund Mark J. 
Published: January 2005

Objective. To evaluate the association between past 30‐day use of alcohol, marijuana, and other illicit drugs and past year unmet need for and use of mental health care.Data Source. A subsample of 18,849 respondents from the 2001 National Household Survey on Drug Abuse and the 2002 National Survey on Drug Use and Health. Subjects were between the ages of 18 and 65 years and had least one past year mental disorder symptom and no past year substance dependency.Study Design. Logistic regressions of past 30‐day substance use on past 12‐month unmet need for mental health care and past 12‐month use of mental health services controlling for clinical and sociodemographic characteristics. Predicted probabilities and corresponding standard errors are reported.Principal Findings. Use of illicit drugs other than marijuana increased with unmet need for mental health care (4.4 versus 3.2 percent, p=.046) but was not reduced with mental health‐care use. Heavy alcohol use was not associated with increased unmet need for mental health care, but was higher among individuals with no mental health care use (4.4 percent versus 2.7 percent, p<.001). By contrast, marijuana use did not appear associated with either unmet need or mental health care use.Conclusions. Substance use varies with past year unmet need for mental health care and mental health care use in ways consistent with the self‐medication hypothesis. Results suggest that timely screening and treatment of mental health problems may prevent the development of substance‐use disorders among those with mental disorders. Further research should identify subgroups of individuals for whom timely and appropriate mental health treatment would prevent the development of substance‐use disorders.
The Administrative Control System of Substance Abuse Managed Care
Authors: Sosin Michael R. 
Published: January 2005

Objective. This article searches for the dimensions of the administrative structures in outpatient substance abuse managed care that control the behavior of agency providers. It also ascertains how these dimensions, and several financial mechanisms, affect key aspects of the providers services: the average number of sessions of care that are delivered, the rate of completion of care, and the (estimated) rate at which clients control their substance use.Data Sources. The data were collected in 1999 for this investigation.Study Design. These data come from a nationally representative, cross‐sectional sample of individual contracts between outpatient drug treatment providers and the Behavioral Health Managed Care Organizations (BHMCOs) that are empowered to regulate the delivery of services. Provider responses are analyzed here.Data Collection Methods. Factor analyses at a contract level examine the structural dimensions of the control system. Multivariate analyses at the same level rely on generalized linear models to predict the dependent variables by the structural dimensions and financial mechanisms.Findings. The factor analyses suggest that there are six multiple variable structural dimensions. The multivariate analyses suggest that the dimension that mandates follow‐up of discharged clients tends to relate to more sessions of care and perhaps a higher rate of service completion. Most other dimensions are found to relate to fewer sessions of care, lower rates of service completion, or lower rates of control of substance abuse. No structural dimension relates to all dependent variables. Financial mechanisms evince varying relations to the sessions of care. They rarely relate to the other dependent variables.Conclusion. The results generally suggest that providers, payers, or policymakers might affect service provision by selecting BHMCOs that stress particular structural dimensions and financial mechanisms. However, managed care contracts most heavily rely on structural dimensions that restrict treatment sessions and fail to predict superior client outcomes.
Testing for Statistical Discrimination in Health Care
Authors: Balsa Ana I. , McGuire Thomas G. , Meredith Lisa S. 
Published: January 2005

Objective. To examine the extent to which doctors' rational reactions to clinical uncertainty (“statistical discrimination”) can explain racial differences in the diagnosis of depression, hypertension, and diabetes.Data Sources. Main data are from the Medical Outcomes Study (MOS), a 1986 study conducted by RAND Corporation in three U.S. cities. The study compares the processes and outcomes of care for patients in different health care systems. Complementary data from National Health And Examination Survey III (NHANES III) and National Comorbidity Survey (NCS) are also used.Study design. Across three systems of care (staff health maintenance organizations, multispecialty groups, and solo practices), the MOS selected 523 health care clinicians. A representative cross‐section (21,480) of patients was then chosen from a pool of adults who visited any of these providers during a 9‐day period.Data Collection. We analyzed a subsample of the MOS data consisting of patients of white family physicians or internists (11,664 patients). We obtain variables reflecting patients' health conditions and severity, demographics, socioeconomic status, and insurance from the patients' screener interview (administered by MOS staff prior to the patient's encounter with the clinician). We used the reports made by the clinician after the visit to construct indicators of doctors' diagnoses. We obtained prevalence rates from NHANES III and NCS.Findings. We find evidence consistent with statistical discrimination for diagnoses of hypertension, diabetes, and depression. In particular, we find that if clinicians act like Bayesians, plausible priors held by the physician about the prevalence of the disease across racial groups could account for racial differences in the diagnosis of hypertension and diabetes. In the case of depression, we find evidence that race affects decisions through differences in communication patterns between doctors and white and minority patients.Conclusions. To contend effectively with inequities in health care, it is necessary to understand the mechanisms behind the problem. Discrimination stemming from prejudice is of a very different character than discrimination stemming from the application of rules of conditional probability as a response to clinical uncertainty. While in the former case, doctors are not acting in the best interests of their patients, in the latter, they are doing the best they can, given the information available. If miscommunication is the culprit, then efforts should be aimed at reducing disparities in the ways in which doctors communicate with patients.