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Sanzone EM, Kam O, Sanzone KE, Bai M, Rodecker N, Shad MU, Varghese SP, Barlati S, Kirschner M, Kooner P, Velligan DI, Aiyer R, Waszkiewicz N, Castle DJ, Cowan RL, Koola MM. Mobile Delivery Program to Prevent Relapse and Improve Functioning in Patients With Psychiatric Diseases. J Psychiatr Pract 2024; 30:364-373. [PMID: 39357019 DOI: 10.1097/pra.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
The term "revolving door patients" refers to those who are frequently rehospitalized for relapse. This phenomenon can be explained by a multitude of factors, including a lack of medical and/or social support. On the basis of a review of various modalities of psychiatric treatment, such as long-acting injectables, assisted outpatient treatment, and telehealth, it is clear that a major underlying issue among people with psychiatric diseases who lack insight into their mental and physical health is medication nonadherence. Therefore, we propose a mobile delivery program (MDP) in which health care professionals deliver medications and care to psychiatric patients in their own homes. The target patient population for MDP is patients with medication nonadherence, frequent emergency department visits, and missed appointments. Patients with mental illnesses, especially schizophrenia, are disproportionately represented among the homeless and incarcerated populations. By implementing MDP, we can help break the cycle of incarceration for patients with mental illnesses and homelessness. In addition, the cost of transportation and salaries for the mobile delivery team would be considerably lower than the billions of dollars spent each year due to relapses, emergency department visits, inpatient admissions, and crime leading to long-term stays in correctional facilities. This model has the potential to reduce relapse, improve functioning, and reduce excess morbidity and mortality. Substantial cost savings for health services can, in turn, be expected.
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Affiliation(s)
| | - Olivia Kam
- Stony Brook School of Medicine, Stony Brook, NY
| | - Kaitlin E Sanzone
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA
| | | | - Nicole Rodecker
- Department of Psychiatry and Behavioral Health, Stony Brook, NY
| | - Mujeeb U Shad
- Department of Psychiatry, University of Nevada, Las Vegas, NV
| | - Sajoy P Varghese
- Department of Addiction Recovery Treatment Services, Veterans Affairs Northern California Health Care System, University of California, Davis, Sacramento, CA
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matthias Kirschner
- Department of Psychiatry, Division of Adult Psychiatry, University Hospitals of Geneva, Geneva, Switzerland, and Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Pavan Kooner
- Department of Psychiatry, West London NHS Trust, London, England, UK
| | - Dawn I Velligan
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX
| | | | | | - David J Castle
- Department of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Ronald L Cowan
- Departments of Psychiatry, Anatomy and Neurobiology, Memphis, TN
- Department of Health Promotions and Disease Prevention, University of Tennessee Health Science Center, Memphis, TN
| | - Maju Mathew Koola
- Department of Psychiatry and Behavioral Health, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ
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Tsai J, Link B, Rosenheck RA, Pietrzak RH. Homelessness among a nationally representative sample of US veterans: prevalence, service utilization, and correlates. Soc Psychiatry Psychiatr Epidemiol 2016; 51:907-16. [PMID: 27075492 DOI: 10.1007/s00127-016-1210-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 03/16/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the prevalence of lifetime homelessness among veterans and use of Veterans Affairs (VA) homeless services, as well as their association with sociodemographic and clinical characteristics. METHODS A nationally representative sample of 1533 US veterans was surveyed July-August 2015. RESULTS Among all veterans, 8.5 % reported any lifetime homelessness in their adult life, but only 17.2 % of those reported using VA homeless services. Prevalence of homelessness and VA homeless service use did not significantly differ by gender. Being low income, aged 35-44, and having poor mental and physical health were each independently associated with lifetime homelessness. Veterans who were White or lived in rural areas were significantly less likely to have used VA homeless services. CONCLUSIONS Homelessness remains a substantial problem across different generations of veterans. The low reported uptake of VA homeless services suggests there are barriers to care in this population, especially for veterans who live in rural areas. Governmental resources dedicated to veteran homelessness should be supported, and obtaining accurate prevalence estimates are important to tracking progress over time.
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Affiliation(s)
- Jack Tsai
- US Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA.
| | - Bruce Link
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.,New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Robert A Rosenheck
- US Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA.,US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, 06516, USA
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Tsai J, Ramaswamy S, Bhatia SC, Rosenheck RA. A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 56:357-367. [PMID: 26354600 DOI: 10.1007/s10464-015-9746-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed.
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Affiliation(s)
- Jack Tsai
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Sriram Ramaswamy
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Department of Psychiatry, Creighton University, Omaha, NE, USA
| | - Subhash C Bhatia
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Department of Psychiatry, Creighton University, Omaha, NE, USA
| | - Robert A Rosenheck
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
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Kästner D, Büchtemann D, Warnke I, Radisch J, Baumgardt J, Giersberg S, Kopke K, Moock J, Kawohl W, Rössler W. Clinical and Functional Outcome of Assertive Outreach for Patients With Schizophrenic Disorder: Results of a Quasi-Experimental Controlled Trial. Eur Psychiatry 2015; 30:736-42. [DOI: 10.1016/j.eurpsy.2015.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022] Open
Abstract
AbstractBackgroundThe majority of studies support modern assertive health service models. However, the evidence is limited for parts of continental Europe, as well as for the pharmacological adherence outcome parameter.MethodWe conducted a quasi-experimental controlled trial including adult patients with a schizophreniform disorder and a maximum of 60 points on the Global Assessment of Functioning Scale (GAF). Interventions (n = 176) and controls (TAU, n = 142) were assessed every six-month within one year in 17 study practices in rural areas. Mental and functional state were rated using the Brief Psychiatric Rating Scale (BPRS) and the GAF. Functional limitations and pharmacological adherence were patient-rated using the WHO-Disability Assessment Schedule II (WHODAS–II) and the Medication Adherence Report Scale (MARS). We computed multilevel mixed models.ResultsThe GAF and BPRS of both groups improved significantly, yet the increase in the intervention group was significantly higher. In contrast, patient-rated variables – WHODAS–II and MARS – neither showed a stable temporal improvement nor a difference between groups.ConclusionOur findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.
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Baser O, Xie L, Pesa J, Durkin M. Healthcare utilization and costs of Veterans Health Administration patients with schizophrenia treated with paliperidone palmitate long-acting injection or oral atypical antipsychotics. J Med Econ 2015; 18:357-65. [PMID: 25525771 DOI: 10.3111/13696998.2014.1001514] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to compare real world healthcare costs and resource utilization between patients with schizophrenia treated with paliperidone palmitate long-acting injection (PP) and oral atypical antipsychotics (OAT). METHODS Patients (18-64 years) were selected from the Veterans Health Administration dataset (1 July 2007-31 May 2012). Patients with 2+ claims for PP or 2+ claims for the same OAT comprised the two study cohorts with the first prescription date designated as the index date. Participation in the VA healthcare system for 24 months pre- and 12 months post-index, schizophrenia diagnosis (International Classification of Disease 9th Revision Clinical Modification [ICD-9-CM] code 295.1x-6x, 295.8x-9x) and ≥1 claim for an antipsychotic medication during the baseline period were required. Propensity scores and Mahalanobis metric distances with calipers were used to create two matched cohorts. All-cause healthcare utilization and costs for the 12-month follow-up period were compared between matched cohorts. RESULTS The matching process produced two cohorts of 335 patients with similar baseline characteristics. During the 12-month follow-up period, patients in the PP cohort had lower mean inpatient costs (18,560 vs $31,505, p = 0.002), lower frequency of hospitalization (34% vs 53%, p < 0.001) and fewer average inpatient days (13.24 vs 24.18, p = 0.002) vs matched OAT patients. While mean pharmacy costs were higher for the PP cohort ($10,063 vs $4167, p < 0.001), mean total healthcare costs were not significantly different ($45,529 vs $52,569, p = 0.128). CONCLUSION VA patients, diagnosed with schizophrenia and treated with PP, had lower inpatient costs and admission rates compared to a matched cohort of OAT patients. Total healthcare costs were not significantly different.
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