Estimating local-area needs for psychiatric care: a case study.
BACKGROUND
Different approaches to estimating local catchment-area needs for psychiatric services are illustrated and compared.


METHODS
Data from an epidemiological morbidity survey of a random sample of 496 adults were available, as were actual service utilisation rates. Four types of utilisation were modelled (i.e. overall, out-patient, in-patient, emergency clinic) using social indicators available from Statistics Canada census-tract data. Finally, a case-control study compared out-patients from a deprived and an affluent catchment area, matched case by case for primary diagnosis, age, sex and residential status (n = 52).


RESULTS
Modelling proved highly predictive of utilisation, the overall-use model accounting for 73% of the variance. The case-control study indicated a higher rate of Axis II traits, substance abuse and needs for social care in the deprived catchment area.


CONCLUSIONS
Resource allocation based on the social indicators modelling method was more consistent with sensible distribution of human resources. None of the methods, however, appear to reflect adequately the severity of caseloads evidenced in the case-control study.
Lesage
A D
AD
Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Montréal, Canada.
Clerc
D
D
Uribé
I
I
Cournoyer
J
J
Fabian
J
J
Tourjman
V
V
Van Haaster
I
I
Chang
C H
CH
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D008875:Middle Aged; D015233:Models, Statistical; D010343:Patient Admission / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014600:Utilization Review