Referral

About: Referral is a research topic. Over the lifetime, 27614 publications have been published within this topic receiving 479918 citations.

Factors Associated With Child Mental Health Service Use in the Community

Abstract: Objective To determine the association of parent, family, and child factors with mental health services need and utilization. Method Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. Results 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. Conclusion Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples. J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(7):901–909.

Increasing Identification of Psychosocial Problems: 1979–1996

Abstract: Objective. To examine the changes in identification of pediatric psychosocial problems from 1979 to 1996. Research Design. Comparison of clinician-identified psychosocial problems and related risk factors among large primary care pediatric cohorts from 1979 (Monroe County Study) and 1996 (Child Behavior Study). Data were collected from clinician visit questionnaires developed originally for the 1979 study. Setting. Private practice offices of 425 community-based pediatricians and family practitioners across both studies. Patients. We enrolled all children from 4 to 15 years of age who presented for nonemergent services in primary care offices. The 1979 study included 9612 children seen by 30 clinicians and the 1996 study included 21 065 children seen by 395 clinicians. Selection Procedure. Each clinician enrolled consecutive eligible patients for both studies. Measurements and Results. From 1979 to 1996, clinician-identified psychosocial problems increased from 6.8% to 18.7% of all pediatric visits among 4- to 15-year-olds. We found increases in all categories of psychosocial problems, except for mental retardation. Attentional problems showed the greatest absolute increase (1.4%–9.2%) and emotional problems showed the greatest relative increase (.2%–3.6%). The use of psychotropic medications, counseling, and referral also increased substantially. In particular, the percentage of children with Attention deficit/hyperactivity problems receiving medications increased from 32% to 78%. These increases in psychosocial problems were associated with increases in the proportions of single-parent families and Medicaid enrollment from 1979 to 1996. Changes in clinician characteristics did not appear to be the source of increases in clinician diagnoses of psychosocial problems. Conclusions. Substantial increases in the identification of psychosocial problems in primary care paralleled demographic changes in children presenting to primary care offices and in the larger population.

Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients

Abstract: BACKGROUND Limited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end-of-life care. METHODS All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end-of-life care indicators. RESULTS Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P < .001), fewer hospitalizations (48% vs 81%; P < .003), and fewer hospital deaths (17% vs 31%; P = .004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P < .001), fewer hospital admissions (52% vs 86%; P < .001), fewer hospital deaths (18% vs 34%; P = .001), and fewer intensive care unit admissions (4% vs 14%; P = .001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28-0.66; P < .001) was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-2.50; P = .03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18-5.59; P = .02) were associated with more aggressive end-of-life care. CONCLUSIONS Patients who were referred to outpatient PC had improved end-of-life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral. Cancer 2014;120:1743–1749. © 2014 American Cancer Society.

Cost-effectiveness of systematic depression treatment among people with diabetes mellitus

Abstract: Context Depression co-occurring with diabetes mellitus is associated with higher health services costs, suggesting that more effective depression treatment might reduce use of other medical services. Objective To evaluate the incremental cost and cost-effectiveness of a systematic depression treatment program among outpatients with diabetes. Design Randomized controlled trial comparing systematic depression treatment program with care as usual. Setting Primary care clinics of group-model prepaid health plan. Patients A 2-stage screening process identified 329 adults with diabetes and current depressive disorder. Intervention Specialized nurses delivered a 12-month, stepped-care depression treatment program beginning with either problem-solving treatment psychotherapy or a structured antidepressant pharmacotherapy program. Subsequent treatment (combining psychotherapy and medication, adjustments to medication, and specialty referral) was adjusted according to clinical response. Main Outcome Measures Depressive symptoms were assessed by blinded telephone assessments at 3, 6, 12, and 24 months. Health service costs were assessed using health plan accounting records. Results Over 24 months, patients assigned to the intervention accumulated a mean of 61 additional days free of depression (95% confidence interval [CI], 11 to 82 days) and had outpatient health services costs that averaged $314 less (95% CI, $1007 less to $379 more) compared with patients continuing in usual care. When an additional day free of depression is valued at $10, the net economic benefit of the intervention is $952 per patient treated (95% CI, $244 to $1660). Conclusions For adults with diabetes, systematic depression treatment significantly increases time free of depression and appears to have significant economic benefits from the health plan perspective. Depression screening and systematic depression treatment should become routine components of diabetes care.