Life satisfaction and health related quality of life among low-income medical patients: The mediating influence of self-esteem

This study investigated the relationship between life satisfaction, self-esteem, and perceived health for an ethnically diverse, low SES sample of primary care patients. Results indicated that several specific domains of health-related quality of life (HRQL), including health perception, social functioning, mental health, and energy/fatigue, significantly predicted life satisfaction in this sample of 60 patients. Self-esteem mediated this relationship, partially with health perception and fully with the remaining three domains. The results of this study underscore the importance of healthcare interventions that consider the bidirectional relationship between physical and emotional well-being.     

Sexuality and Health Among Chinese Seniors in Canada

Research on sexuality among older immigrants is extremely inadequate. This paper presents the results and analysis based on a national survey using a random sample of 2,272 Chinese-Canadian seniors. Self-reported health is examined in relation to a range of demographic as well as sexuality variables. Logistic regression analysis shows that language (English) ability and income play an important role in the health of Chinese-Canadian seniors, along with the sexuality variables. Among men, both the frequency of sexual activity and satisfaction with sex life have a positive effect on health. Among women, only sexual satisfaction is found to be significant. Results from this study can inform future research, service delivery, and policymaking in health care and social service for seniors.     

Enhancing mental health and well-being outcomes for psychotherapy and counselling through idiographic analysis: A four-quadrant approach

Mental health and well-being outcomes in psychotherapy and counselling have largely been studied through the use of standardised nomothetic measurement. A key limitation is that nomothetic measurement and current statistical analyses do not necessarily capture the outcomes of the complicated and individual psychotherapy processes. There is an increased interest in the use of idiographic patient-reported outcome measures (I-PROMs), which are uniquely useful because they may explore areas of importance that are unexplored by nomothetic outcome measures. We argue that to optimise the value of I-PROMs, it is necessary to consider their contribution alongside standardised nomothetic measures. However, there are important considerations with respect to whether or not I-PROMs from different clients, or indeed from the same client, can be meaningfully explored at a team/service level, and alongside standardised nomothetic outcomes. We provide worked examples on real client data to show that delineating four quadrants of analysis is important to explore the breadth of information: (a) individual progress on single items, (b) individual progress by aggregated scores, (c) team/service-level progress by goal item/theme and (d) team/service-level progress by aggregated scores.     

基于基尼指数的双目标CD-CAT选题策略

双目标CD-CAT的测验结果既可用于形成性评估也可用于终结性评估。基尼指数可度量随机变量的不确定性程度, 值越小则随机变量的不确定程度越低。本文用基尼指数度量被试知识状态类别以及能力估计置信区间后验概率的变化, 提出基于基尼指数的选题策略。Monte Carlo实验表明与已有的选题策略相比, 新策略的知识状态分类精度和能力估计精度都较高, 同时能有效兼顾题库利用均匀性, 并能快速实时响应, 且受认知诊断模型和被试知识状态分布的影响较小, 可用于实际测验中含多种认知诊断模型的混合题库。     

A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.     

A Preliminary Study of Activation,Stress, and Self-Management of Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

Connections between Family Centered Care and Medical Homes of Children with Neurodevelopmental Disabilities: Experiences of Diverse Families

Cultural issues tied to race/ethnicity are important aspects in delivering medical home services to children with neurodevelopmental disabilities and their families. To better understand family satisfaction with family centered care (FCC) in medical homes of children with disabilities, this study investigated whether family race/ethnicity, in addition to parent and child characteristics, significantly influenced family perceptions of FCC in three areas: family-provider partnership, care setting practices and policies, and community coordination and follow-up. Based on the life course theory for optimizing children's developmental trajectories, examining connections between family race/ethnicity and satisfaction with health care allows for identification of strengths and weaknesses in medical home services delivery, and offers opportunities for family support and improvement in outcomes for children with disabilities. This study developed an original empirical survey using a structured questionnaire developed by Family Voices, a national advocacy organization dedicated to promoting the well-being of children with disabilities and their families. The study collected data for 122 families in a large urban area in the northeastern United States. Multivariate analyses revealed that family race/ethnicity significantly contributed to the prediction of parental satisfaction with medical homes of children with disabilities, and to families' perceptions of FCC in care setting practices and policies, and community coordination and followup, but not to family provider partnership. Non-White families reported significantly lower satisfaction. Discussion emphasizes that health care providers need to become more vigilant in providing culturally sensitive care. To enhance FCC practices and policies, the study advances a checklist of ten essential areas that promote culturally sensitive interactions between families of children with disabilities and their medical and non-medical health care providers.     

Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

Ethical Issues in Family-Centered Primary Care

In 1969 a new primary care medical specialty, family practice, was formally created. One element in the development of this specialty from the roots of general practice was an understanding of the importance of family process in health and health care. Family physicians are now trained to work with families in the provision of primary medical care, and many provide some formal family counseling and therapy. The family physician who works with families faces many of the same ethical conflicts with which family therapists are confronted. The primary relationship of the family physician to his or her patients, however, as the provider of continuing health care, modifies these conflicts and creates new and vexing problems.     

Translating policy principles into practice to improve health care access for adults with intellectual disabilities: a research review of the past decade

This article extracts principles from two Surgeon General reports, Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation (2002) and Call to Action to Improve the Health and Wellness of Persons with Disabilities (2005), and combines them with the Objectives from Chapter 6 of Healthy People 2010 to create a policy framework. This framework is used to review literature from the past decade on access to health care and health promotion for persons with intellectual and developmental disabilities (IDD). Review of the literature indicates an emerging evidence base for health promotion programs for persons with IDD. Research in health care and health promotion access requires improvements in surveillance and measurement of quality of life, as well as increased participation of persons with IDD and their families in its implementation. While international guidelines for primary health care have been developed for people with IDD, US guidelines are specialty focused and address specific conditions. Despite its recognized importance, there is surprisingly little information on training programs for health care providers to improve care of persons with IDD. Financing of health care continues to threaten access to comprehensive care for persons with IDD, particularly regarding coordination of care and availability of providers who accept Medicaid patients. Community-based sources of health care have been slow to emerge, and there is clear need for assumption of responsibility for providing care to persons with IDD. Future US policy should include consideration of environmental factors in health care access.     

Practical Guidance for Targeting Insomnia in Primary Care Settings

Insomnia is among the most prevalent conditions in primary care. Despite the development of well-established, evidence-based cognitive and behavioral interventions for insomnia, they are not typically applied in primary care environments. One method for improving primary care delivery of these interventions is to integrate behavioral health providers as a service delivery team member in this environment. The population health focus and time-limited appointments of primary care require that these well-established interventions are adapted for effective implementation in primary care. Using a case example, we describe practical methods of delivering these interventions in the primary care setting.     

Satisfaction,involvement, and unconditional care: The perceptions of children and adolescents receiving wraparound services

Client satisfaction has emerged as an important variable in evaluating outcomes for mental health treatment, yet studies have seldom queried children and adolescents about their perceptions of the services they receive. The present study surveyed 20 youths receiving community-based, wraparound services about their satisfaction, sense of involvement, and feelings of unconditional care. Unconditional care, in this case, referred to the youth's sense that his or her caretakers would remain stable regardless of what happened. Each of these variables was in turn related to behavioral adjustment. It was found that both youths' sense of involvement and their perceptions that their care was unconditional were strongly associated with satisfaction with services. However, neither satisfaction nor involvement were correlated with the severity of subjects' acting-out behaviors. Subjects' perception that care was unconditional was strongly, negatively correlated with the severity of acting-out behaviors. Thus, while the relationship between satisfaction and behavior remains unclear, it appears that youths' perceptions of the stability of their services plays a role in their acting out. It was concluded that youths' feelings about their services can provide meaningful information for researchers and service providers.     

Primary care counsellors’ experiences of working with treatment resistant depression: A qualitative pilot study

Treatment resistant depression (TRD) is a severe and enduring form of depression that does not respond fully to medication. Although the evidence base for effective psychological treatments is not yet established, it is inevitable that counsellors working in primary care will encounter patients with this presentation. This pilot study explores the experience of four primary care counsellors with this patient group using Interpretative Phenomenological Analysis (IPA) and considers the implications for training and practice.     

门诊老年患者医疗服务中存在的问题及其改进

文章从门诊老年患者就医需求的角度对医疗服务进行思考,认为医护人员在服务理念、有效沟通以及主动服务等方面存在的问题亟需改进。提出医护人员应当确立以老年患者需求为中心的门诊医疗服务理念,做到主动关心、及时询问、有效沟通、合理安排,从而提高老年患者就诊的满意度。     

Behavioral Health Services Influence Medical Treatment Utilization Among Primary Care Patients with Comorbid Substance Use and Depression

Although research has shown benefits of integrating psychological care in primary care settings, it is unclear how this form of treatment impacts individuals with comorbid substance use and depression. The findings are also mixed concerning how frequently this comorbid population seeks primary care services. This study examined the associations between substance use, depression, and medical treatment utilization among 224 primary care patients. The aim of the investigation was twofold. First, to determine if depression increases medical treatment utilization among patients with substance use disorders; second, to evaluate if behavioral health treatment reduces medical service utilization. A moderated mediation model with bootstrapping analyses revealed that depression strengthened the relationship between substance use and primary care treatment utilization (both medical and behavioral health). The model also indicated that behavioral health services were associated with fewer primary care visits for individuals with comorbid substance use and depression. Clinical and social implications are discussed.     

Externalizing behavior challenges within primary care settings

Primary care providers encounter a substantial number of behavioral health concerns leading to the increasing provision of psychological interventions within medical settings. Externalizing disorders present a particular challenge to physicians and stand to benefit a great deal from early intervention. Providing behavioral health services in primary care can reduce barriers to treatment, stigma associated with mental health, and cost of service provision. Given these advantages, scholars have examined the provision of behavioral health interventions within primary care settings. This review provides a critical overview of the extant evidence base and offers suggestions for future efforts in this area.     

美国医疗系统的中流砥柱:非营利性私立医院

系统介绍了美国医疗系统的主流--非营利性私立医院的起源、性质、运行情况以及在医疗服务中的地位,并将之与营利性医院进行对比,以揭示限制医疗市场化的重要意义.     

Psychological therapy in primary care: work in progress

This paper considers the benefits to the mental health of patients of the provision of psychological services in primary care. I describe by means of context, the development of such a service over the last 7 years. In the following section I discuss the question of who is 'the patient' who gets referred and who can benefit from psychological treatment in a primary care setting. More specifically I consider the spectrum of psychopathology of patients who are referred in primary care for psychological help and in relation to this question I discuss what would constitute a meaningful clinical intervention. In the last section, I look at the question of what needs to be in place for a successful psychological service in a primary care setting. I argue that, while benefits for mild to moderate psychological problems have been documented by research findings, clinical scrutiny of the interventions in primary care suggest that this is not necessarily the case when it comes to patients with more severe psychological problems. I further argue that there are still important issues to be considered and researched and structures to be put into place before we can safeguard the clinical effectiveness of psychological interventions in primary care.