While it is established that rural residents often seek care for mental health problems in primary care settings, or in some cases in a Community Mental Health Center, lack of providers and lack of insurance may lead those with mental illness to the hospital emergency room (ER). Critical Access Hospitals (CAHs) are, by definition, located in small, remote and underserved rural communities and must offer 24-hour emergency services. In such communities, access to local mental health services is more likely to be a problem, and the ER may be a key piece of the mental health ?safety net.? This study investigates the extent and types of cases that present with mental health problems in CAH ERs, as well as the resources available to ER staff for addressing such problems and what actually happens to such patients.
Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. In addition, 184 of these hospitals completed ER logs documenting all ER visits in two 24-hour periods, with details about presenting symptoms, treatment, and final disposition.
The pilot study was conducted to test the appropriateness of a nutrition and food security survey and estimate the prevalence of food security and its relationship with dietary intake habits among Somali refugees (n = 35) resettled in the United States. The other main objective was to estimate the association between acculturation and dietary intake habits. The interviews with the Somali mothers indicated that 72% of households were food insecure and, in comparison, the intake of fruits and green leafy vegetables was significantly lower among the food insecure households than among secure households (p < .05). Both of the acculturation indicators used in this survey, living in the United States for four years or more and having English language proficiency, were associated with a high intake of snack items among participants. Future studies examining the influence of food security and acculturation on health outcomes such as body weight are warranted among refugees in the United States.
In 2008, the Maine Department of Health and Human Services, Office of MaineCare Services, contracted with the Muskie School of Public Service to design and complete a survey of Maine physician practices. The survey was administered by mail with telephone follow-up between August 29, 2008 and April 3, 2009. Two hundred forty-five (245) physicians and 364 office managers responded, representing 414 separate practice sites. The survey obtained information on respondents' experience with MaineCare, perceptions of MaineCare's business practices, attitudes towards potential incentives for MaineCare participation, and satisfaction with MaineCare program elements, such as the Primary Care Physician Incentive Payment (PCPIP) and Primary Care Case Management (PCCM) management fee.
Higher uninsured rates among rural compared to urban residents have been well documented, but do not adequately provide a full picture of coverage and access to care in rural areas. This study looks at the relative richness of coverage among privately insured rural residents, to determine their rate of ?underinsurance? and whether and how it differs from urban residents. The authors found that even with private health insurance coverage, a sizable portion of out-of-pocket costs is borne by the insured, particularly rural residents. Six percent of privately insured urban residents are underinsured compared with 10 percent of rural adjacent and 12 percent of rural nonadjacent residents. Policy implications for coverage expansion, for providers, and for small businesses are discussed.
This paper reports on the first phase of the study to identify barriers to integration of behavioral and physical health services and potential solutions to overcoming these barriers. The report includes an extensive literature review, an analysis of different approaches and models to integration, and a review of integration initiatives in Maine, other states, and Canada. Results from interviews and focus groups with Maine stakeholder organizations are also included.
Three years of national survey data (2000, 2002, 2004) were used to examine the scope of services offered by Critical Access Hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in these changes, and the reasons administrators gave for reported service expansions. Additionally, the authors looked at how services in CAHS have changed over time.
Consistent with our findings in previous surveys, conversion to CAH status has not led to downsizing of services. Most CAHs offer a core set of services including radiology, laboratory services, emergency rooms, swing beds, pharmacy, outpatient rehabilitation, outpatient surgery, and specialty clinics. While this core has not changed significantly over the period of three surveys, many CAHs have added or expanded services not dependent on inpatient capacity.
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