Journal of ISSN: 2373-6445JPCPY

Psychology & Clinical Psychiatry
Research Article
Volume 3 Issue 2 - 2015
The Economic Justification of Running the Online Medical Care in High Schools 2
Mahsa Houshdar*
Hooshdar Medical Technology Company, Iran
Received: June 29, 2014 | Published: August 01, 2015
*Corresponding author: Mahsa Houshdar, Hooshdar Medical Technology Company, Iran - Karaj - Taleghani Ave - No 455 - Second Floor, Tel: 009832264770, 00989354928132; Email: @
Citation: Houshdar M (2015) The Economic Justification of Running the Online Medical Care in High Schools 2. J Psychol Clin Psychiatry 3(2): 00129. DOI: 10.15406/jpcpy.2015.03.00129

Abstract

Introduction: Online Medicare is a method in which parts of a medical process, whether diagnostics, monitoring or treatment itself, will be done by using online services. The website (www.hooshdar.com) is an effort to bring fairness in health to people across the globe using modern methods. We choose psychiatric disorder depression and anxiety to be our focus in phase one. With this system we can search for psychiatric problems of several persons in schools, factories or other organs, and create psychiatric profiles for them. With this system we can find out who needs lab exams, and by feeding the results to the system, we can create a medical and psychiatric profile for each person.

  1. In order to find out system’s feasibility we need to know the following:
  2. Is there a large enough demand for the system or not?
  3. Are the potential users of the system prepared to pay for it?
  4. What are the specifications of users who are prepared to pay for the services?

Method: We examined the system in three high schools, A state high school in Fardis Karaj ( Lower middle class neighborhood), A state high school in Gohardasht Karaj (above average neighborhood), and A private high school in Gohardasht Karaj (above average neighborhood. We examined the system to find out its economical justification, we found out that each applicant student must pay 7$ for using the system and its benefits for the system to be profitable.

The advantages of using the system:

  1. Free visit by a physician, if needed.
  2. Free visit by a psychiatrist, if needed.
  3. Fifty percent off in price of lab examination, if needed.

Expect in deprived area, the students divided in to two groups: Group one: the ones who participated in using the system and its advantages, every one paid 7$. Group two: the ones who participated in using the system without using the advantages, they paid nothing. In both groups the prevalence of depression and anxiety, and their severity were measured.

Results: The severity of depression in two groups show: In the state high schools, not only in Lower middle class neighborhood ,but also in above average neighborhood, need for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is significant with P value 0.031 < 0.05 & P value 0.005< 0.05. In private high school: Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is not significant with P value 0.940 < 0.05.

Conclusion: The data show that in the state high schools in Lower middle class neighborhood & above average neighborhood, the more is the need for medical psychological services, the more is the interest for paying for it. Thus for operating the system in different neighborhoods, different ways must be used.

For example: In deprived neighborhoods: running the system without financial support for performing lab examination is not possible1. In state high schools, when we present the system to ones who are motivated to receive this attendance and accept to pay for it, we get the best results. In private high school, there is no problem for performing lab examination for all of the students, and then giving medical, psychological and psychiatric services to ones who are motivate.

The economic justification of running the online medical care (www.hooshdar.com) in high schools

Introduction

Online Medicare is a method in which parts of a medical process, whether it’s diagnosing, monitoring or the treatment itself, will be done by using online services. The system in the website (www.hooshdar.com) is an effort to bring fairness in health to people across the globe using modern methods. We choose psychiatric disorder depression and anxiety to be our focus in phase one.

Why we chose depression and anxiety in the first line of online Medicare?

  1. The prevalence; The global mean prevalence for depression is about %17 in the life period [1].This is about %14 to %24 in adolescent [2]. The global mean for anxiety is %25 in total [3]. It is %30.5 in women and %19.2 in men [3].
  2. The second reason for this choice is the morbidities that can be caused by these two diseases. Depression & anxiety can cause decrease in concentration that will reduce interest in doing homework. It can cause fatigue and drowsiness, all of which cause academic failure [4]. Depression can cause antisocial behavior in adults; disobedience of rules is its consequence [5]. It can cause conduct disorder in adolescents too [4]. It can increase the chance of addiction to opium or alcohol [4]. Conduct disorders can cause following problems in adolescents: aggressive behavior causing bodily harm to oneself or others, destruction of property, theft and fraud, disturbing law and order related to their age [6].
  3. Neither depression nor anxiety does not always occur spontaneously, in many cases they are created because of some other diseases, such as diabetes or hypo or hyperthyroidism [7].

Thus, if we can diagnose depression & anxiety, finally we can find the medical diseases which trigger them. Then we can use a plan for a combined treatment. By this way we can prevent many academic failure and aggressive behavior in the high schools.

For finding the main diseases which should be considered:

First, I considered the 13 to 19 year old depressed or anxious patients, who were referred to my personal office for medical disorders, they showed:

Hypothyroidism (%11.1), Impaired GTT (%8.33), Reactive hypoglycemia (%5.5), Hypocalcemia (%13.88), Vitamin b12 deficiency (%38.88), Poly cystic ovary(%2,52), Thalassemia (%2.52).

After this research it was decided to search Hypothyroidism, vitamin B12 deficiency, Hypocalcemia, diabetes, impaired fasting glucose level, hypoglycemia, and anemia in persons, who were presented for lab examination by the system. After two years it was decided to change hypocalcaemia with vitamin D deficiency.

With Ministry of Education’s permission, we decided to operate this system in high schools. As pilot study, we operated the system in one state high school in lower middle class neighborhood, one state high school in above average neighborhood and one private high school in above average neighborhood .In deprived area, the economical justification had been done in previous study8. Participating in this program was neither mandatory nor free, thus the results cannot be generalized, but it can show the relationship between depression and anxiety with medical diseases in Iran and the effectiveness of operating the system in schools in decreasing these two problems.

Methods

Feasibility of study

Production of each product must be economically justifiable.
Thus, how can we earn money with the system?

The economic use of the system

With this system we can search psychiatric problems of several persons in schools, factories or organs, and create psychiatric profiles for them, with the system we can find out who needs lab exams, and by feeding the results to the system, we can create a medical and psychiatric profile for each person.

In order to find out system’s feasibility we need to know the following:

  1. Is there a large enough demand for the system or not?
  2. Are the potential users of the system prepared to pay for it?
  3. What are the specifications of users who are prepared to pay for the services?

In high schools we examined the system to find out its economical justification, we found out that each applicant student must pay 7$ for using the system and its benefits for the system to be profitable.

The advantages of using the system:

  1. Free visit by a physician, if needed.
  2. Free visit by a psychiatrist, if needed.
  3. Fifty percent off in price of lab examination, if needed.

The students divided in to two groups:

  1. –  Group one: the ones who participated in using the system and its advantages, every one paid 7$.
  2. –  Group two: the ones who participated in using the system without using the advantages, they paid nothing.

In both groups the prevalence of depression and anxiety, and their severity were measured.

Results

The results are studied in four subjects

  1. Severity of depression in participants who accepted to pay for project.
  2. Severity of anxiety in participant who accepted to pay for the project.
  3. Severity of depression in participants who did not accept to pay for project.
  4. Severity of anxiety in participant who did not accept to pay for the project (Table 1- 5).

Normal

Severe Depression
Refer to Psychiatrist & Psychologist
Doing lab exam

Moderately Severe
Depression
Refer to psychiatrist
Performing lab exam

Moderate Depression
Refer to Psychologist
Performing Lab Exam

Mild Depression
Supportive Therapy

Total Participant

17

15

20

30

27

109

15.60%

13.80%

18.30%

27.5%

24.7%

 

Table 1: Severity of depression and the consequent needs of students who participated in project by paying money.A state high school in Fardis Karaj (Lower middle class neighborhood).

Normal

Severe
Anxiety refer to Psychiatrist & Psychologist
Doing Lab Exam

Moderately
Severe Anxiety
Refer to Psychiatrist
Performing Lab Exam

Moderate
Anxiety refer to
Psychologist
Performing Lab Exam

Mild Anxiety
Supportive Therapy

Total
Participant

19

0

21

35

34

109

17.4%

0%

19.2%

32.1%

31.2%

 

Table 2: Severity of anxiety and the consequent needs of students who participated in project by paying money. A state high school in Fardis Karaj (Lower middle class neighborhood).

Normal

Severe
Depression Refer to Psychiatrist &
psychologist
Doing lab exam

Moderately severe
Depression Refer to
Psychiatrist Performing lab exam

Moderate
Depression refer to Psychologist
Performing lab exam

Mild depression
Supportive Therapy

Total
Participant

69

12

21

37

87

227

30.3%

5.2.%

9.2%

16.2%

38.3%

 

Table 3: Severity of depression and the consequent needs of students who participated in project without paying money. A state high school in Fardis Karaj (Lower middle class neighborhood).

Normal

Severe Anxiety
Refer to Psychiatrist & Psychologist Doing Lab Exam

Moderately Severe
Anxiety refer to
Psychiatrist Performing Lab Exam

Moderate Anxiety Refer to Psychologist Performing Lab Exam

Mild Depression
Supportive Therapy

Total
Participant

90

3

11

43

72

233

 

5.2.%

9.2%

16.2%

38.3%

 

Table 4: Severity of anxiety and the consequent needs of students who participated in project without paying money. A state high school in Fardis Karaj (Lower middle class neighborhood).

 

Group One

Group Two

Need for lab. Exams.

%51.2

%24.5

consultation With a psychologist Need for

%32.1

%18.4

Need for consultation with a psychiatrist

%19.2

%4.7

Need for consultation with both

%0

%1.3

Table 5: The difference on need to services between two groups in anxiety in , A state high school in Fardis Karaj ( Lower middle class neighborhood).

Statistical results for anxious patients in a state high school in Fardis Karaj (lower middle class neighborhood)

Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is significant with P value 0.001>0.05 (Table 6).

 

Group One

Group Two

Need for lab. Exams.

%59.6

%30.8

consultation With a psychologist Need for

%27.5

%16.2

Need for consultation with a psychiatrist

%18.3

%9.2

Need for consultation with both

%13.7

%5.2

Table 6: The difference on need to services between two groups in depression in, A state high school in Fardis Karaj ( Lower middle class neighborhood).

Statistical results for depressed patients in a state high school in Fardis Karaj (lower middle class neighborhood) –               

Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is significant with P value 0.031>0.05.

The data show that in the state high school in middle economic class area the more is the need for medical services, the more is the interest in paying for it. How to run the system and how much is charged, can naturally absorb the ones who need the services more (Table 7-11).

Normal

Severe Depression Refer to Psychiatrist & psychologist
Doing Lab Exam

Moderately
Severe depression
Refer to psychiatrist
Performing Lab Exam

Moderate
Depression Refer to
Psychologist
Performing Lab Exam

Mild depression
Supportive Therapy

Total
Participant

 

36

3

11

20

43

112

 

%32.1

%2.6

%9.8

%17.8

%38.3

%100

Table 7: Severity of depression and the consequent needs of students who participated in project by paying money. A state high school in Gohardasht Karaj, above average neighborhood.

Normal

Severe Anxiety
refer to Psychiatrist & Psychologist Doing Lab Exam

Moderately Severe Anxiety refer to Psychiatrist Performing Lab Exam

Moderate Anxiety refer to Psychologist Performing Lab Exam

Mild Anxiety Supportive Therapy

Total
Participant

43

1

4

17

48

113

%38

%0.8

%3.5

%15

%42.4

%100

Table 8: Severity of anxiety and the consequent needs of students who participated in project by paying moneyA state high school in Gohardasht Karaj (above average neighborhood).

Normal

Severe Depression
refer to Psychiatrist & Psychologist
Doing Lab Exam

Moderately Severe
Depression refer to
Psychiatrist Performing Lab Exam

Moderate Depression
refer to Psychologist
Performing Lab Exam

Mild Depression
Supportive Therapy

Total
Participant

107

9

18

39

88

261

%40.9

%3.4

%6.9

%14.9

%33.7

%100

Table 9: Severity of depression and the consequent needs of students who participated in project without paying moneyA state high school in Gohardasht Karaj (above average neighborhood).

Normal

Severe Anxiety refer to Psychiatrist &
Psychologist
Doing Lab Exam

Moderately Severe
Anxiety refer to
Psychiatrist Performing Lab Exam

Moderate Anxiety
refer to Psychologist
Performing Lab Exam

Mild Depression
Supportive Therapy

Total
Participant

120

5

10

26

100

261

%45.9

%1.9

%3.8

%9.96

%38.3

%100

Table 10: Severity of anxiety and the consequent needs of students who participated in project without paying money. A state high school in Gohardasht Karaj (above average neighborhood).

 

Group 2

Group 1

No need for medical or Psychological attendance

%70.53

%74.51

Need for lab exams

%32.14

%25.28

Need for consultation with a psychiatrist

%17.8

%14.9

Need for consultation with a psychologist

%9.8

%6.9

                        Need for consultation with both

%2.6

%3.4

Table 11: The difference on need to services between two groups in depression in the a state high school in Gohardasht Karaj (above average neighborhood).

Statistical results for depressed patients in a state high school in Gohardasht Karaj (above average neighborhood) –               

Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is significant with P value 0.005>0.05 (Table 12).

 

Group 2

Group 1

No need for medical or Psychological attendance

%79.13

%84.29

Need for lab exams

%19.46

%15.70

Need for consultation with a psychiatrist

%15

%9.96

Need for consultation with a psychologist

%3.5

%3.8

Need for consultation with both

%0.8

%1.9

Table 12: The difference on need to services between two groups in depression in A state high school in Gohardasht Karaj (above average neighborhood).

Statistical results for anxious patients in a state high school in Gohardasht Karaj (above average neighborhood)

Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is not significant with P value 0.987>0.05.

The data show that in the state high school in middle economic class area the more is the need for medical services, the more is the interest in paying for it. How to run the system and how much is charged, can naturally absorb the ones who need the services more (Table 13-17).

Normal

Severe Depression refer to Psychiatrist & Psychologist Doing Lab
Exam

Moderately Severe
Depression refer to Psychiatrist
Performing Lab Exam

Moderate Depression
refer to Psychologist
Performing Lab
Exam

Mild Depression
Supportive Therapy

Total
Participant

 

23

4

12

28

27

94

 

%24.46

 

%4.25

 

%12.76

 

%28.72

%29.87

%100

Table 13: Severity of depression and the consequent needs of students who participated in project by paying money. A private high school in Gohardasht Karaj, above average neighborhood.

Normal

Severe anxiety
refer to Psychiatrist &
Psychologist Doing lab Exam

Moderately severe
Anxiety refer to
psychiatrist
Performing lab Exam

Moderate anxiety
refer to Psychologist
Performing lab Exam

Mild anxiety
Supportive Therapy

Total
Participant

25

2

4

22

41

94

%26.59

%2.12

%4.25

%23.40

%43.61

%100

Table 14: Severity of anxiety and the consequent needs of students who participated in project by paying money. A private high school in Gohardasht Karaj (above average neighborhood).

Normal

Severe Depression refer to Psychiatrist & Psychologist Doing Lab
Exam

Moderately Severe
Depression refer to Psychiatrist
Performing Lab Exam

Moderate Depression
refer to Psychologist
Performing Lab
Exam

Mild Depression
Supportive Therapy

Total
Participant

8

0

3

6

9

26

%30.76

0

%11.53

%23.07

%34.61

%100

Table 15: Severity of anxiety and the consequent needs of students who participated in project without paying money. A private high school in Gohardasht Karaj (above average neighborhood).

Normal

Severe anxiety
Refer to Psychiatrist &
Psychologist Doing lab Exam

Moderately severe
Anxiety Refer to
psychiatrist
Performing Lab Exam

Moderate anxiety
Refer to Psychologist
Performing Lab Exam

Mild depression
Supportive Therapy

Total
Participant

 

6

2

5

6

7

26

%23.07

%7.69

%19.23

%23.07

%26.92

%100

Table 16: Severity of depression and the consequent needs of students who participated in project without paying money A private high school in Gohardasht Karaj (above average neighborhood).

 

Group 2

Group 1

No need for medical or Psychological attendance

%54.25

%50

Need for lab exams

%45.74

%50

Need for consultation with a psychiatrist

%28.72

%23.7

Need for consultation with a psychologist

%12.74

%19.23

Need for consultation with both

%4.25

%7.69

Table 17: The difference on need to services between two groups in depression in the A private high school in Gohardasht Karaj (above average neighborhood).

Statistical results for depressed patients in a private high school in Gohardasht Karaj (above average neighborhood)                

Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is not significant with P value 0.940>0.05 (Table 18).

 

Group 2

Group 1

No need for medical or Psychological attendance

%70.21

%65.38

Need for lab exams

%29.78

%34.61

Need for consultation with a psychiatrist

%23.7

%23.07

Need for consultation with a psychologist

%19.23

%11.53

Need for consultation with both

%7.69

%0

Table 18: The difference on need to services between two groups in anxiety in A private high school in Gohardasht Karaj (above average neighborhood).

Statistical results for anxious patients in a private high school in Gohardasht Karaj (above average neighborhood)

Needs for medical and psychological attendance between the ones who paid for using the system and the ones who did not pay is not significant with P value 0.914>0.05.

Discussion

In previous study, we found out that the recommendations of the system are more effective in reduction of depression than anxiety. In this study, we can see, in the stat high schools in both lower middle class neighborhood and above average neighborhood the ones who suffer from more depression, are the ones who refer more to the system and accept to pay for it. In deprived areas and in private high schools, using this system is done differently. According to what have been seen in operation of this system in different neighborhoods, we can choose different methods of operating the system in different neighborhoods.

What must be done to make an online medical care system operational in high schools in different neighborhoods?

In deprived neighborhoods running the system without financial support for performing lab examination is not possible.

In state high schools, when we present the system to ones who are motivated to receive this attendance and accept to pay for it, we get the best results.

In private high school, there is no problem for performing the lab examination for all of the students, and then giving medical, psychological and psychiatric services to ones who are motivated.

References

  1. Sadock (2007) Kaplan and Sadok’s Synapsis of psychiatry (10th edn), Lippincott Williams and Wilkins, Philadelphia, USA. pp. 528.
  2. Sadock (2007) Kaplan and Sadok’s Synapsis of psychiatry (10th edn), Lippincott Williams and Wilkins, Philadelphia, USA. pp. 1259.
  3. Sadock (2007) Kaplan and Sadok’s Synapsis of psychiatry (10th edn), Lippincott Williams and Wilkins, Philadelphia, USA. pp. 561.
  4. Sadock (2007) Kaplan and Sadok’s Synapsis of psychiatry (10th edn), Lippincott Williams and Wilkins, Philadelphia, USA. pp. 1260.
  5. Sellers R, Harold GT, Elam K, Rhoades KA, Potter R, Mars B, et al. (2014) Mental depression and co- occurring antisocial behavior: testing mental hostility and warmth as mediators of risk for offspring psychopathology. J child psychol psychiatry 55 (2): 112-120.
  6. Sadock (2007) Kaplan and Sadok’s Synapsis of psychiatry (10th edn), Lippincott Williams and Wilkins, Philadelphia, USA. pp. 581.
  7. Merk manual. (18th edn), pp. 1668.
  8. Houshdar Mahsa (2015) Results of operation online medical care system in high schools. J Psychology and clinical psychiatry 2(3): 00075.
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