Factors related to the use of ambulatory mental health services in three provider plans

Gender, mental health service use and objectively measured physical activity: Data from the National Health and Nutrition Examination Survey (NHANES 2003-2004)

OBJECTIVE: To examine the relationship between physical activity levels measured objectively by accelerometry and the use of mental health services (MHS) in a representative sample of males and females. METHOD: NHANES 2003-2004 is a cross-sectional study of the civilian, non-institutionalized US adult population. Participants reported whether or not they had seen a mental health professional during the past 12 months. Three measures of daily physical activity (light minutes, moderate-vigorous minutes, and total activity counts) and sedentary minutes were determined by accelerometry. The relationship between physical activity and use of MHS was modeled with and without adjustments for potential socioeconomic and health confounders. RESULTS: Of the 1846 males and 1963 females included in this analysis, 7 and 8% reported seeing mental health professionals during the past 12 months, respectively. Men who used MHS were significantly less active than men who did not use MHS (227,700 versus 276,900 total activity counts, respectively, p < 0.05). Men who did not use MHS engaged in 38 min (95% CI 16.3, 59.0) more of light or moderate-vigorous physical activity per day than men who used MHS. Physical activity levels of women, regardless of MHS use, were significantly lower than men who did not use MHS. Differences in total physical activity between women who did and did not use MHS were small (1.3, 95% CI - 14.0, 11.4). CONCLUSION: Men and women who used MHS were relatively sedentary. Additional research is warranted to determine if increasing physical activity levels results in improved mental health in individuals who use MHS.

Managed care for preventive services: a review of policy options

In summary, the managed care system we propose for preventive services is designed to limit the potential for overcare under FFS payment and for undercare under capitation and comprehensive fixed fees. It bases payment on the provision of a complete set of preventive services, thus limiting the tendency of physicians to provide only the relatively high-profit services, such as screening tests, while neglecting the lower-profit services, such as counseling. It also allows primary care providers to outsource selected services to lower-cost providers, such as laboratories, health educators, and counselors, and community-based health promotion programs, thus encouraging greater efficiency. In addition, the proposed system funds both primary and high-risk preventive case management to ensure that individuals receive preventive services appropriate to their age, sex, and risk factors. Finally, the proposed system monitors the use of preventive services, relying on physician reminders to stimulate the appropriate provision of preventive care and denying payment for unauthorized care. Existing research suggests that none of the individual strategies for managed care can be expected to achieve all of the goals of managing and promoting the appropriate use of preventive services as defined by the U.S. Preventive Services Task Force (1989). To be most effective, we conclude that the strategies need to be coordinated and integrated into the current health care delivery practices of HMOs, PPOs, and point-of-service plans. In addition, the strategies require additional provider training in preventive care. With this support, the proposed model has the potential to improve quality, control costs, and increase the appropriate use of preventive care. While many of the individual components of the proposed managed care model have been evaluated for preventive services, a great deal more research is needed to evaluate the effect of combining these elements into a coordinated and comprehensive approach to managing preventive care. Research is also needed on workable ways to invite people not currently receiving medical care into the health care system to receive preventive care. To inform policy development, the impact of the proposed managed care model--both on preventive services utilization for specific screening, immunization, and counseling services, and on total health care costs and patient health status outcomes--needs to be evaluated.

Predictors of health in new mothers

This survey study was conducted to determine the variables that predict mothers' mental health, work readiness, and use of health services several weeks after they give birth to, or adopt a baby. Regression analyses on 313 married women (108 first-time adoptive mothers, 72 first-time biological mothers, and 133 controls) showed a strong link between biological mothers' postpartum health and their infants' health; this relationship was not observed for adoptive mothers and their infants. Biological mothers' postpartum health problems were also related to their smoking, fatigue, and current work at a job; further, their readiness to work at a job two months postpartum was greater if they were in good general health, had not had a cesarean section, and were not currently breastfeeding. The results suggest that many mothers continue to have unique health needs several weeks after delivery and, if substantiated by future studies, these findings may have implications for postpartum health care practices and for maternity leave policy.