Taylor S; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 12.
UCLA, 264 Haines Hall, Los Angeles, CA 90095-1551; Tel: ; Fax: ; E-mail: sltaylor@ucla.edu
RESEARCH OBJECTIVE: National studies of mental health service utilization among HIV-infected persons report 70% need mental health care and over two-thirds of those receive it. However, no one has comprehensively examined both contextual and individual factors related to mental health service utilization. This multi-level analysis examined environmental-, medical service- and individual-level characteristics associated with: 1) receiving any versus no mental health services and 2) receiving intense mental health visits -one or more per month- versus not. STUDY DESIGN: Data were from the HIV Cost and Services Utilization Study - HCSUS - mental health survey conducted in 1997-1998. HCSUS is the first study to randomly select and interview a nationally representative sample of HIV-infected adults receiving medical care, excluding emergency departments. It used a three-stage clustered sampling design to first sample metropolitan statistical areas -MSAs-, then medical providers, and finally HIV-positive clients. Multiple logistic regression analyses were conducted using Stata statistical software to account for the clustered nature of the multi-level data. POPULATION STUDIED: HIV-positive persons in the continental United States who either perceived need for mental health services or met the criteria for five psychiatric diagnoses using the World Health Organization's Composite International Diagnostic Interview (CIDI), (n=639). PRINCIPAL FINDINGS: Only one of the eight contextual factors was related to receiving any mental health care when controlling for individual characteristics. People with HIV and need for mental health care using medical providers in private facilities versus public were less likely to receive any mental health care. Also, people with anxiety or panic disorders were less likely to receive any services while persons perceiving need or having moderate versus mild psychiatric disorders were more likely. Three contextual factors were related to receiving intense visits when controlling for individual characteristics. Receiving intense visits was positively related to MSAs' per capita number of psychologists and psychiatrists and having a case manager while it was negatively related to MSAs' per capita income. In addition, Medicaid recipients versus privately insured persons were less likely to receive intense visits while college educated persons were more likely. Region of the country, MSAs' number of AIDS cases, using medical provider who are HIV specialists, and medical providers' number of HIV patients were unrelated to either outcome. CONCLUSIONS: Whether or not persons with HIV receive any mental health care seems to be more related to their needs than to contextual elements. However, once clients enter the mental health care system, contextual factors seem to have a larger role than client characteristics in the number of visits they receive. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: These findings emphasize the need for interventions in private hospitals to improve linking patients to mental health care. Service centers might want to increase the availability of case managers to help clients navigate the system and, therefore, receive more visits. Finally, policies should focus on increasing provider supply in areas where there are the fewest. PRIMARY FUNDING SOURCE: AHRQ
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Adult
- Delivery of Health Care
- HIV Infections
- HIV Seropositivity
- Health Services Needs and Demand
- Humans
- Insurance, Health
- Interviews as Topic
- Mental Disorders
- Mental Health Services
- Psychiatry
- United States
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102274168
From Meeting Abstracts