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West JC, Pingitore D, Zarin DA. Characteristics of psychiatric patients for whom financial considerations affect optimal treatment provision. Psychiatr Serv 2002; 53:1626-9. [PMID: 12461227 DOI: 10.1176/appi.ps.53.12.1626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important.
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Pingitore DP, Scheffler RM, Schwalm D, Zarin DA, West JC. Variation in routine psychiatric workload: the role of financing source, managed care participation, and mental health workforce competition. MENTAL HEALTH SERVICES RESEARCH 2002; 4:141-50. [PMID: 12385567 DOI: 10.1023/a:1019759029241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study was conducted to examine the association between psychiatrists' demographic characteristics, payment source, and managed care participation and psychiatrists' practice workload, and between the supply of other mental health providers in a psychiatrist's county of practice and psychiatrists' practice workload. Data from the 1996 American Psychiatric Association National Survey of Psychiatric Practice were merged with national countywide measures of mental health workforce and environmental data from the 1996 Area Resource File. In comparison to male psychiatrists, female psychiatrists treat fewer patients per week, provide less total hours of weekly patient care, and obtain fewer new monthly referrals. An increase in psychiatrists' managed care participation was associated with only minor increases in the number of patients per week, weekly time spent in clinical care, and number of new monthly referrals. The supply of other mental health providers was not associated with variation in practice workload. Once psychiatrists participate in managed care plans, an increase in their participation rate does not significantly expand clinical practice workload. The supply of other mental health providers was not significantly associated with variation in psychiatrists' workload, which suggests that substitution effects may not be evident with this aspect of psychiatric practice.
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Pingitore DP, Scheffler RM, Sentell T, West JC. Comparison of psychiatrists and psychologists in clinical practice. Psychiatr Serv 2002; 53:977-83. [PMID: 12161672 DOI: 10.1176/appi.ps.53.8.977] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors compared data from psychiatrists and psychologists in California to determine whether long-standing differences in clinical practice remain after the introduction of managed care and other changes in mental service delivery. METHODS Responses from practicing clinicians in California who participated in the 1998 National Survey of Psychiatric Practice and the 2000 California Survey of Psychological Practice were compared on items related to patient caseload, practice profile, and insurance or reimbursement arrangements. RESULTS Data from 97 psychiatrists and 395 psychologists were available for the study. Psychiatrists reported spending more hours on most aspects of practice and working more total hours per week than psychologists. The weekly caseloads reported by psychiatrists included a greater percentage of persons treated for psychotic conditions than did the caseloads of psychologists. Psychologists reported that their weekly caseloads included a greater percentage of persons treated for anxiety disorders, personality disorders, and other disorders. Psychiatrists reported receiving a greater average payment for services from public insurance, and psychologists reported treating a greater average percentage of patients who did not have insurance coverage. Significant differences in income sources and fee arrangements were observed, and the net reported income of psychiatrists was nearly 80 percent greater than that of psychologists. CONCLUSIONS Long-standing differences in clinical practice patterns remain between psychiatrists and psychologists despite managed care staffing arrangements and treatment strategies that streamline the practices of both provider groups. The significant income and wage differences between psychiatrists and psychologists may be partly due to supply dynamics of the mental health workforce that adversely affect psychologists.
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Kumar A, West JC, Still CD, Komar MJ, Babameto GP. Jejunocolic fistula: an unreported complication of acquired immunodeficiency syndrome-associated lymphoma. J Clin Gastroenterol 2002; 34:194-5. [PMID: 11782623 DOI: 10.1097/00004836-200202000-00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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West JC. Activities outside practice of medicine may carry their own liabilities. Wright v. Jeckle. J Healthc Risk Manag 2001; 21:37-8. [PMID: 11507945 DOI: 10.1002/jhrm.5600210308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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West JC. Hospital may be liable for actions of nurse who molested child. E.P. v. McFadden,-- So. 2d, 2000 WL 303063, No. 298 (Ct. Civ. App. Ala. March 24, 2000). J Healthc Risk Manag 2001; 21:46-7. [PMID: 11411069 DOI: 10.1002/jhrm.5600210208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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West JC, Napoliello DA, Costello JM, Nassef LA, Butcher RJ, Hartle JE, McConnell TR, Finley JW, Kelley SE, Chao S, Latsha R. Preoperative dobutamine stress echocardiography versus cardiac arteriography for risk assessment prior to renal transplantation. Transpl Int 2001; 13 Suppl 1:S27-30. [PMID: 11111956 DOI: 10.1007/s001470050269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Because coronary artery disease is the leading cause of death in patients with end-stage renal disease, we prospectively studied the prognostic value of dobutamine stress echocardiography (DSE) compared to coronary angiography (CA) as an evaluative tool. Thirty-three patients at high risk for coronary artery disease were selected from a cohort of 133 renal transplant candidates and underwent both DSE and CA. In this study, the value of DSE was found to exist in its strong negative predictive value (92%). A negative DSE coupled with a negative clinical cardiac evaluation was found to practicably exclude the necessity for CA. DSE can thus serve as a non-invasive, low cost screening test.
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Wang PS, West JC, Tanielian T, Pincus HA. Recent patterns and predictors of antipsychotic medication regimens used to treat schizophrenia and other psychotic disorders. Schizophr Bull 2001; 26:451-7. [PMID: 10885643 DOI: 10.1093/oxfordjournals.schbul.a033465] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Up-to-date data are needed on the types of treatments used by psychiatrists and the reasons for use of particular treatments. Using 1997 American Psychiatric Association (APA) Practice Research Network (PRN) Study data on patients with schizophrenia and other psychotic disorders, we identified the characteristics of antipsychotic medications (APMs) currently being prescribed and factors associated with the use of particular regimens. In this study population, use of the newer APMs, including risperidone, olanzapine, and clozapine, has increased rapidly and now accounts for over one-half of all APM use. Other intriguing findings include the fact that one-sixth of patients with schizophrenia and other psychotic disorders are concurrently treated with two or more APMs. Factors associated with being prescribed one of the newer APMs risperidone or olanzapine include being elderly, having more education, being white, having psychiatric comorbidity, and making fewer recent visits to a psychiatrist. The APA PRN Study data are an important new resource for mental health services researchers.
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West JC. The devil's in the details--so focus on the fine print! MATERIALS MANAGEMENT IN HEALTH CARE 2000; 9:32-3. [PMID: 15341049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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West JC. Play it safe. Considering reuse? A solid reprocessing contract is your safety net. MATERIALS MANAGEMENT IN HEALTH CARE 2000; 9:29-30. [PMID: 15341048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Zarin DA, West JC. Cost-effectiveness of psychiatrists. Am J Psychiatry 2000; 157:305-6. [PMID: 10671424 DOI: 10.1176/appi.ajp.157.2.305-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shweiki E, West JC, Klena JW, Kelley SE, Colley AT, Bross RJ, Tyler WB. Eosinophilic gastroenteritis presenting as an obstructing cecal mass--a case report and review of the literature. Am J Gastroenterol 1999; 94:3644-5. [PMID: 10606337 DOI: 10.1111/j.1572-0241.1999.01625.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The causes of colonic obstruction are protean. Less common is the diagnosis of eosinophilic gastroenteritis (EGE). EGE is more common as a cause of more proximal bowel obstruction. To our knowledge, this case represents one of the only reported cases of such a lesion causing obstruction in the cecum.
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West JC. Sexual harassment: an ominous liability for healthcare professionals. J Healthc Risk Manag 1999; 19:14-25. [PMID: 10538433 DOI: 10.1002/jhrm.5600190304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sexual harassment can arise in virtually any employment setting. Healthcare facilities must be careful to avoid sexual harassment of their employees both by other employees and by the myriad other persons who may come into contact with their employees in the workplace. Much of what makes sexual harassment an actionable offense are the perceptions of the victim. Employers should take a proactive approach to preventing, detecting and correcting instances of harassment.
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West JC. Washington Statute of Repose held to be unconstitutional. DeYoung v. Providence Medical Center. J Healthc Risk Manag 1999; 19:53-5. [PMID: 10538011 DOI: 10.1002/jhrm.5600190109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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West JC. Production of medical records allowed without patients' consent. U.S. ex rel. Ghaprial v. Quorum Health Resources. J Healthc Risk Manag 1999; 19:67-9. [PMID: 10538442 DOI: 10.1002/jhrm.5600190310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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West JC. Employee handbooks may be implied contracts with employees. Hansucker v. Josephine Sunset Home; Jewell v. North Big Horn Hospital District. J Healthc Risk Manag 1999; 18:84-6. [PMID: 10537850 DOI: 10.1002/jhrm.5600180409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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West JC. Medical leave of absence could be required as reasonable accommodation. Cehrs v. Northeast Ohio Alzheimer's Research Center. J Healthc Risk Manag 1999; 19:55-7. [PMID: 10538021 DOI: 10.1002/jhrm.5600190209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Zarin DA, West JC, Pincus HA, Tanielian TL. Characteristics of health plans that treat psychiatric patients. Health Aff (Millwood) 1999; 18:226-36. [PMID: 10495610 DOI: 10.1377/hlthaff.18.5.226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nationally representative data regarding the organizational, financial, and procedural features of health plans in which psychiatric patients receive treatment indicate that fewer privately insured, Medicaid, and Medicare managed care enrollees receive care from a psychiatrist than is true for "nonmanaged" enrollees. Financial considerations were reported to adversely affect treatment for one-third of all patients. Although utilization management techniques and financial/resource constraints commonly applied to patients in both managed and nonmanaged plans, performance-based incentives were rare in nonmanaged plans. The traditional health plan categories provide limited information to identify salient plan characteristics and guide policy decisions regarding the provision of care.
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Pincus HA, Zarin DA, Tanielian TL, Johnson JL, West JC, Pettit AR, Marcus SC, Kessler RC, McIntyre JS. Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network. ARCHIVES OF GENERAL PSYCHIATRY 1999; 56:441-9. [PMID: 10232299 DOI: 10.1001/archpsyc.56.5.441] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.
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West JC. Insurer may not limit coverage due to allegations of sexual misconduct. American Home Assurance Co. v. Stephens. J Healthc Risk Manag 1999; 18:64-6. [PMID: 10184977 DOI: 10.1002/jhrm.5600180309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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West JC. Hospital may be liable in spite of due care exercised by agents. Denton Regional Medical Center v. LaCroix. J Healthc Risk Manag 1999; 18:61-4. [PMID: 10185084 DOI: 10.1002/jhrm.5600180209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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West JC. Physician may be liable for failing to disclose financial conflict of interest. Neade v. Portes. J Healthc Risk Manag 1999; 19:67-8. [PMID: 10620909 DOI: 10.1002/jhrm.5600190408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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West JC, Zarin DA, Peterson BD, Pincus HA. Assessing the feasibility of recruiting a randomly selected sample of psychiatrists to participate in a national practice-based research network. Soc Psychiatry Psychiatr Epidemiol 1998; 33:620-3. [PMID: 9857795 DOI: 10.1007/s001270050102] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study tested the feasibility of recruiting and retaining a randomly selected sample of psychiatrists compared to a volunteer sample to participate in the American Psychiatric Association's Practice Research Network (PRN). One hundred-forty psychiatrists were randomly selected and contacted by phone by peer psychiatrists for recruitment into the PRN. As a comparison group, a sample of 146 self-selected volunteer psychiatrists were also included in the study. Recruited and volunteer psychiatrists were asked to participate in three studies to assess study compliance and retention. The representativeness of each sample was evaluated by comparing the psychiatrists' sociodemographic and practice characteristics to existing national data on psychiatrists. Study response rates and long-term retention rates were compared for the two groups. Sixty-one percent of the recruited sample who were eligible to participate in the network were willing to participate. Both the recruited and volunteer samples were broadly representative of the American Psychiatric Association's membership (with some differences in race, ethnicity and board certification). Of the recruited sample, 74.5% (38/51) successfully completed the network's first three pilot studies compared to 72.5% (98/135) of the volunteer sample. No psychiatrists in the recruited sample withdrew from the network compared to 2.1% (3/138) of the volunteer sample. These findings indicate a randomly selected sample of psychiatrists can be recruited and retained to participate in practice-based research. These methods can be used to enhance the generalizability of observational health services research studies, which require the participation of practicing clinicians. More effective methods should be tested to enhance participation rates.
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West JC. Agency not liable for actions of nurse supplied by agency. Hansen v. Caring Professionals, Inc. J Healthc Risk Manag 1998; 17:51-3. [PMID: 10169966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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West JC. Post-traumatic stress disorder may be compensable. Means v. Baltimore County, Maryland. J Healthc Risk Manag 1998; 17:50-1. [PMID: 10184778 DOI: 10.1002/jhrm.5600170408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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