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Adams DR, Pérez-Flores NJ, Mabrouk F, Minor C. Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study. Psychiatr Serv 2024; 75:402-409. [PMID: 38018150 PMCID: PMC11062805 DOI: 10.1176/appi.ps.20230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. METHODS In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. RESULTS Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. CONCLUSIONS Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Nancy Jacquelyn Pérez-Flores
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Fatima Mabrouk
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Carolyn Minor
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
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Adams DR. Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic. Community Ment Health J 2024; 60:88-97. [PMID: 37097491 PMCID: PMC10127985 DOI: 10.1007/s10597-023-01127-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work and Public Health, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, USA.
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3
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Oskvarek JJ, Zocchi MS, Black BS, Celedon P, Leubitz A, Moghtaderi A, Nikolla DA, Rahman N, Pines JM. Emergency Department Volume, Severity, and Crowding Since the Onset of the Coronavirus Disease 2019 Pandemic. Ann Emerg Med 2023; 82:650-660. [PMID: 37656108 DOI: 10.1016/j.annemergmed.2023.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
STUDY OBJECTIVE We describe emergency department (ED) visit volume, illness severity, and crowding metrics from the onset of the coronavirus disease 2019 (COVID-19) pandemic through mid-2022. METHODS We tabulated monthly data from 14 million ED visits on ED volumes and measures of illness severity and crowding from March 2020 through August 2022 compared with the same months in 2019 in 111 EDs staffed by a national ED practice group in 18 states. RESULTS Average monthly ED volumes fell in the early pandemic, partially recovered in 2022, but remained below 2019 levels (915 per ED in 2019 to 826.6 in 2022 for admitted patients; 3,026.9 to 2,478.5 for discharged patients). The proportion of visits assessed as critical care increased from 7.9% in 2019 to 11.0% in 2022, whereas the number of visits decreased (318,802 to 264,350). Visits billed as 99285 (the highest-acuity Evaluation and Management code for noncritical care visits) increased from 35.4% of visits in 2019 to 40.0% in 2022, whereas the number of visits decreased (1,434,454 to 952,422). Median and median of 90th percentile length of stay for admitted patients rose 32% (5.2 to 6.9 hours) and 47% (11.7 to 17.4 hours) in 2022 versus 2019. Patients leaving without treatment rose 86% (2.9% to 5.4%). For admitted psychiatric patients, the 90th percentile length of stay increased from 20 hours to more than 1 day. CONCLUSION ED visit volumes fell early in the pandemic and have only partly recovered. Despite lower volumes, ED crowding has increased. This issue is magnified in psychiatric patients.
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Affiliation(s)
- Jonathan J Oskvarek
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Summa Health System, Akron, OH.
| | - Mark S Zocchi
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Bernard S Black
- Pritzker School of Law, Northwestern University, Chicago, IL
| | | | | | - Ali Moghtaderi
- Department of Health Policy and Management, the Milken Institute School of Public Health, George Washington University, Washington, DC
| | | | - Nishad Rahman
- Department of Emergency Medicine, Sinai Hospital, Baltimore, MD
| | - Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
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4
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Chen V, Barrera CA, Golden K, Perez-Stable C, Carreon RL, Boyd JW. Availability of Outpatient Child Psychiatric Care During COVID-19: A Simulated-Patient Study in Three U.S. Cities. Psychiatr Serv 2023; 74:1277-1280. [PMID: 37287227 DOI: 10.1176/appi.ps.20220623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In this study, the authors sought to ascertain the availability of outpatient child psychiatric appointments in three U.S. cities. METHODS Using a simulated-patient methodology, investigators called 322 psychiatrists who were listed in a major insurer's database for three U.S. cities, and they attempted to make appointments for a child with three payment types: Blue Cross-Blue Shield, Medicaid, and self-pay. RESULTS Initial appointments were available 11% of the time, and it was most difficult to obtain an appointment under Medicaid coverage. Nineteen percent of phone numbers were wrong, and 25% of psychiatrists were not accepting new patients. CONCLUSIONS These results are concerning given the current mental health crisis among youths and suggest the need for more psychiatrists, higher reimbursement rates for psychiatric services, and continued efforts to increase access to care. This study also highlights the need for insurance companies to maintain accurate information in their databases.
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Affiliation(s)
- Victoria Chen
- Baylor College of Medicine, Houston (Chen, Golden, Perez-Stable); Department of Psychiatry (Barrera, Carreon, Boyd) and Center for Medical Ethics and Health Policy (Boyd), Baylor College of Medicine, Houston
| | - Christina Aldrich Barrera
- Baylor College of Medicine, Houston (Chen, Golden, Perez-Stable); Department of Psychiatry (Barrera, Carreon, Boyd) and Center for Medical Ethics and Health Policy (Boyd), Baylor College of Medicine, Houston
| | - Katelyn Golden
- Baylor College of Medicine, Houston (Chen, Golden, Perez-Stable); Department of Psychiatry (Barrera, Carreon, Boyd) and Center for Medical Ethics and Health Policy (Boyd), Baylor College of Medicine, Houston
| | - Caitlin Perez-Stable
- Baylor College of Medicine, Houston (Chen, Golden, Perez-Stable); Department of Psychiatry (Barrera, Carreon, Boyd) and Center for Medical Ethics and Health Policy (Boyd), Baylor College of Medicine, Houston
| | - Rudy Lozano Carreon
- Baylor College of Medicine, Houston (Chen, Golden, Perez-Stable); Department of Psychiatry (Barrera, Carreon, Boyd) and Center for Medical Ethics and Health Policy (Boyd), Baylor College of Medicine, Houston
| | - J Wesley Boyd
- Baylor College of Medicine, Houston (Chen, Golden, Perez-Stable); Department of Psychiatry (Barrera, Carreon, Boyd) and Center for Medical Ethics and Health Policy (Boyd), Baylor College of Medicine, Houston
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Saenz JL, Villarreal VR. Prevalence of Depression Among Adults With Diabetes Mellitus and the Relationship Between Improvement in Depressive Symptoms and Glycemic Control. Cureus 2023; 15:e48241. [PMID: 38054137 PMCID: PMC10694021 DOI: 10.7759/cureus.48241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Depression is one of many comorbid conditions associated with diabetes. The rationale for this study is to examine the prevalence of depressive symptoms in adults with diabetes mellitus type II. Furthermore, the association between depressive symptoms and glycemic control will also be analyzed. MATERIALS AND METHODS A chart review of 59 diabetes mellitus type II patients from a family practice clinic in San Juan, Texas was performed. These patients were screened for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) during their annual physical exam. Since many of these patients have been treated in this clinic for many years for their multiple comorbidities, it is possible to evaluate their responses to the PHQ-9 over consecutive years and compare them with their glycemic control using a HbA1c level. Data was evaluated by using biological parameters, such as age and gender, and the clinical parameter of a HbA1c level. Inferential statistics, such as prevalence, frequency, correlation, and p-value, were also used in analyzing the data. RESULTS Depressive symptoms were analyzed using the PHQ-9. In 2016, 2017, and 2018, female diabetics were found to have a higher prevalence of depressive symptoms. When comparing diabetes and age, in 2016, those who were between the ages of 65 and 74 and 75 and older had a higher incidence of depressive symptoms. Furthermore, in 2017 and 2018, patients 75 and older also had a higher frequency of depressive symptoms. The controlled diabetic population was also found to have a greater rate of depressive symptoms. However, after careful analyzation, there was no significant relationship between glycemic control and depressive symptoms. CONCLUSION Many diabetics have comorbid depressive symptoms. Even though this study showed no relationship between depressive symptoms and glycemic control, the treatment of depressive symptoms in diabetics may help to prevent the multiple life altering complications that diabetes can cause.
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Affiliation(s)
- Jessica L Saenz
- Family and Community Medicine, Oceania University of Medicine, Apia, WSM
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Sun CF, Correll CU, Trestman RL, Lin Y, Xie H, Hankey MS, Uymatiao RP, Patel RT, Metsutnan VL, McDaid EC, Saha A, Kuo C, Lewis P, Bhatt SH, Lipphard LE, Kablinger AS. Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US. Gen Hosp Psychiatry 2023; 84:12-17. [PMID: 37290263 DOI: 10.1016/j.genhosppsych.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify potential barriers to care, this study examined the general psychiatry outpatient new appointment availability in the US, including in-person and telepsychiatry appointments, comparing results between insurance types (Medicaid vs. private insurance), states, and urbanization levels. METHOD This mystery shopper study investigated 5 US states selected according to Mental Health America Adult Ranking and geography to represent the US mental health care system. Clinics across five selected states were stratified sampled by county urbanization levels. Calls were made during 05/2022-07/2022. Collected data included contact information accuracy, appointment availability, wait time (days), and related information. RESULTS Altogether, 948 psychiatrists were sampled in New York, California, North Dakota, Virginia, and Wyoming. Overall contact information accuracy averaged 85.3%. Altogether, 18.5% of psychiatrists were available to see new patients with a significantly longer wait time for in-person than telepsychiatry appointments (median = 67.0 days vs median = 43.0 days, p < 0.01). The most frequent reason for unavailability was provider not taking new patients (53.9%). Mental health resources were unevenly distributed, favoring urban areas. CONCLUSION Psychiatric care has been severely restricted in the US with low accessibility and long wait times. Transitioning to telepsychiatry represents a potential solution for rural disparities in access.
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Affiliation(s)
- Ching-Fang Sun
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Robert L Trestman
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Yezhe Lin
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Department of Psychiatry, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Xie
- Joseph J. Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maria Stack Hankey
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, Virginia, USA
| | | | - Riya T Patel
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | | | - Atreyi Saha
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Chin Kuo
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York, USA
| | - Paula Lewis
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Shyam H Bhatt
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
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Sun CF, Singh N, Tenzer MM, Kablinger AS. Factitious dermatitis in children and adolescents is highly comorbid with psychiatric disorders. J Psychosom Res 2023; 166:111170. [PMID: 36724627 DOI: 10.1016/j.jpsychores.2023.111170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Factitious dermatitis (FD) is a psychocutaneous disorder characterized by self-induced skin lesions. FD is related to mental illness, but the correlation is poorly defined in the pediatric population. Our study aims to investigate the risk of psychiatric disorders diagnosed after the FD diagnosis in children and adolescents. METHODS We conducted a retrospective cohort study over a seven-year period (2016-2022) to measure the incidence and risk ratio of psychiatric disorders in patients under age 19 years. The FD cohort was defined as patients with FD (International Classification of Diseases, ICD-10-CM: L98.1); the control cohort was defined as patients who attended a regular dermatology visit by applying a diagnostic code of disease of the skin and subcutaneous tissue (ICD-10-CM: L00-99). RESULTS A total of 453 patients were identified for analysis. We found that FD patients were more likely to be diagnosed with anxiety disorder (Relative risk [RR] 7.63; P < 0.001), obsessive-compulsive disorder (RR 6.20; P < 0.001), attention-deficit hyperactivity disorder (RR 4.90, P < 0.001), depression (RR 2.27; p = 0.02), sleep disorder (RR 2.23; P = 0.01), impulse disorder (RR 2.20; P = 0.04), and conduct disorder (RR 2.14; P = 0.04) within 1 year following the diagnosis of FD. CONCLUSION FD is highly comorbid with psychiatric disorders. Though some practitioners believe FD could result from experimental or recreational behavior in children and adolescents, possible underlying psychiatric disorders should never be overlooked.
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Affiliation(s)
- Ching-Fang Sun
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Neha Singh
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Martha M Tenzer
- Health Analytics Research Team (HART), Carilion Clinic, Roanoke, VA,USA
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
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Rankin KA, Mosier-Mills A, Hsiang W, Wiznia DH. Secret shopper studies: an unorthodox design that measures inequities in healthcare access. Arch Public Health 2022; 80:226. [PMID: 36329541 PMCID: PMC9635177 DOI: 10.1186/s13690-022-00979-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Secret shopper studies are particularly potent study designs that allow for the gathering of objective data for a variety of research hypotheses, including but not limited to, healthcare delivery, equity of healthcare, and potential barriers to care. Of particular interest during the COVID-19 pandemic, secret shopper study designs allow for the gathering of data over the phone. However, there is a dearth of literature available on appropriate methodological practices for these types of studies. To make these study designs more widely accessible, here we outline the case for using the secret shopper methodology and detail best practices for designing and implementing them.
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Affiliation(s)
- Kelsey A Rankin
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, CT, USA.
| | | | - Walter Hsiang
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, CT, USA
| | - Daniel H Wiznia
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, CT, USA
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9
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Fleary SA, Joseph PL, Gonçalves C, Somogie J, Angeles J. The Relationship Between Health Literacy and Mental Health Attitudes and Beliefs. Health Lit Res Pract 2022; 6:e270-e279. [DOI: 10.3928/24748307-20221018-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Hwang WC, Chan CP, Fujimoto KA. Call Me Back: Examining Provider Biases Through Callback Rates and Responsiveness. COUNSELING PSYCHOLOGIST 2021. [DOI: 10.1177/00110000211018148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We conducted a phone-based field experiment to investigate the callback rate of psychologists. Providers ( N = 903) in Los Angeles, California who were selected from a health maintenance organization insurance panel list were left voicemails by actors simulating patients of various backgrounds (i.e., race, gender, clinical diagnosis, and ethnic distinctiveness of name). Findings indicated that 71.5% of providers did not return calls to prospective patients. There were no main effects of race and ethnicity on callback. However, ethnic distinctiveness of name moderated the effects of diagnosis. Providers were more responsive to depressed patients with ethnic names, but less responsive to patients with ethnic names and personality or substance abuse disorders. These findings are important because unresponsive providers and insurance companies that do not provide up-to-date panel listings can act as barriers to care, which can have deleterious consequences for help-seekers. Advocacy recommendations and the importance of cultural competency are highlighted.
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Kelley AT, Smid MC, Baylis JD, Charron E, Binns-Calvey AE, Archer S, Weiner SJ, Begaye LJ, Cochran G. Development of an unannounced standardized patient protocol to evaluate opioid use disorder treatment in pregnancy for American Indian and rural communities. Addict Sci Clin Pract 2021; 16:40. [PMID: 34172081 PMCID: PMC8229269 DOI: 10.1186/s13722-021-00246-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD) disproportionately impacts rural and American Indian communities and has quadrupled among pregnant individuals nationwide in the past two decades. Yet, limited data are available about access and quality of care available to pregnant individuals in rural areas, particularly among American Indians (AIs). Unannounced standardized patients (USPs), or "secret shoppers" with standardized characteristics, have been used to assess healthcare access and quality when outcomes cannot be measured by conventional methods or when differences may exist between actual versus reported care. While the USP approach has shown benefit in evaluating primary care and select specialties, its use to date for OUD and pregnancy is very limited. METHODS We used literature review, current practice guidelines for perinatal OUD management, and stakeholder engagement to design a novel USP protocol to assess healthcare access and quality for OUD in pregnancy. We developed two USP profiles-one white and one AI-to reflect our target study area consisting of three rural, predominantly white and AI US counties. We partnered with a local community health center network providing care to a large AI population to define six priority outcomes for evaluation: (1) OUD treatment knowledge among clinical staff answering telephones; (2) primary care clinic facilitation and provision of prenatal care and buprenorphine treatment; (3) appropriate completion of evidence-based screening, symptom assessment, and initial steps in management; (4) appropriate completion of risk factor screening/probing about individual circumstances that may affect care; (5) patient-directed tone, stigma, and professionalism by clinic staff; and (6) disparities in care between whites and American Indians. DISCUSSION The development of this USP protocol tailored to a specific environment and high-risk patient population establishes an innovative approach to evaluate healthcare access and quality for pregnant individuals with OUD. It is intended to serve as a roadmap for our own study and for future related work within the context of substance use disorders and pregnancy.
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Affiliation(s)
- A Taylor Kelley
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Building 2, Salt Lake City, UT, 84148, USA.
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA.
| | - Marcela C Smid
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E 2B300, Salt Lake City, UT, 84132, USA
| | - Jacob D Baylis
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Elizabeth Charron
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Amy E Binns-Calvey
- Jesse Brown VA Medical Center, Medical Services, 820 S Damen Ave, Chicago, IL, 60612, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois At Chicago, 840 South Wood Street, CSN 440, Chicago, IL, 60612, USA
- Edward Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, 5000 5th Avenue, Hines, IL, USA
| | - Shayla Archer
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Building 2, Salt Lake City, UT, 84148, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Saul J Weiner
- Jesse Brown VA Medical Center, Medical Services, 820 S Damen Ave, Chicago, IL, 60612, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois At Chicago, 840 South Wood Street, CSN 440, Chicago, IL, 60612, USA
| | - Lori Jo Begaye
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Gerald Cochran
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
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Cha P, Brindis CD. Early Affordable Care Act Medicaid: Coverage Effects for Low- and Moderate-Income Young Adults. J Adolesc Health 2020; 67:425-431. [PMID: 32631732 DOI: 10.1016/j.jadohealth.2020.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the effects of early Medicaid expansions on young adults, who also benefitted from a private dependent coverage expansion. METHODS We used the American Community Survey 2008-2013 to study three early expansion states-California, Connecticut, and Minnesota-using difference-in-differences. Control states are weighted combinations of other states and are similar to expansion states in the prepolicy periods. We analyze young adults and subgroups of women and men. RESULTS Early Medicaid reduced uninsurance and improved public coverage among low- and moderate-income young adults beyond the private dependent coverage expansion, but results differed across states. California, which targeted up to 200 percent of the federal poverty level (FPL), reduced uninsurance 1.3 percentage points (4.2% relative to mean) and increased public insurance by 1.4 percentage points (14.0%). Connecticut, which targeted up to 56 percent of FPL, had no change to uninsurance but a 5.4 percentage point (42.5%) increase in public coverage. Minnesota's programs (up to 75 and 250 percent of FPL) produced a 4.2 percentage point (21.9%) decline in uninsurance for their lowest income group, but no measurable changes for their moderate-income group. Young men benefitted more than women. Their uninsurance declined as much as 6.0 percentage points (25.0%, in Minnesota) and their public coverage increased up to 9.1 percentage points (61.5%, in Connecticut). CONCLUSIONS Medicaid expansion benefits young adults, even those with moderate incomes, and even following a private dependent expansion. Results were larger and concentrated among young men, who historically had little engagement with the program.
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Affiliation(s)
- Paulette Cha
- PhD Program in Health Policy, University of California, Berkeley, Berkeley, California.
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, San Francisco, California
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Hsiang WR, Lukasiewicz A, Gentry M, Kim CY, Leslie MP, Pelker R, Forman HP, Wiznia DH. Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019838118. [PMID: 30947608 PMCID: PMC6452575 DOI: 10.1177/0046958019838118] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.
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Affiliation(s)
| | | | | | | | | | | | - Howard P. Forman
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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Shand FL, Batterham PJ, Chan JKY, Pirkis J, Spittal MJ, Woodward A, Christensen H. Experience of Health Care Services After a Suicide Attempt: Results from an Online Survey. Suicide Life Threat Behav 2018; 48:779-787. [PMID: 28960505 DOI: 10.1111/sltb.12399] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/29/2017] [Indexed: 11/28/2022]
Abstract
Failure to provide follow-up care after a suicide attempt is associated with increased risk of reattempt. This online survey examined the experiences of patients of the Australian health system after a suicide attempt. Just over half of the participants had a psychiatric assessment within 1 week of their attempt. Fewer than half believed they had been offered enough help. Low service satisfaction was associated with lower help-seeking intentions. Support for individuals who have made a suicide attempt needs to be enhanced, and an integrated approach to care is required, including improved referral pathways and staff attitudinal change.
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Affiliation(s)
- Fiona L Shand
- Black Dog Institute, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Jade K Y Chan
- University of New South Wales, Sydney, NSW, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | | | - Helen Christensen
- Black Dog Institute, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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Meyer JD, McKean AJS, Blegen RN, Demaerschalk BM. Emergency Department Telepsychiatry Service Model for a Rural Regional Health System: The First Steps. Telemed J E Health 2018; 25:18-24. [PMID: 29742036 DOI: 10.1089/tmj.2017.0293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. INTRODUCTION We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). MATERIALS AND METHODS We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. RESULTS The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. DISCUSSION Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. CONCLUSIONS Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.
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Affiliation(s)
- James D Meyer
- 1 Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Alastair J S McKean
- 1 Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Rebecca N Blegen
- 2 Center for Connected Care, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Bart M Demaerschalk
- 2 Center for Connected Care, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.,3 Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Bishop TF, Seirup JK, Pincus HA, Ross JS. Population Of US Practicing Psychiatrists Declined, 2003-13, Which May Help Explain Poor Access To Mental Health Care. Health Aff (Millwood) 2018; 35:1271-7. [PMID: 27385244 DOI: 10.1377/hlthaff.2015.1643] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A large proportion of the US population suffers from mental illness. Limited access to psychiatrists may be a contributor to the underuse of mental health services. We studied changes in the supply of psychiatrists from 2003 to 2013, compared to changes in the supply of primary care physicians and neurologists. During this period the number of practicing psychiatrists declined from 37,968 to 37,889, which represented a 10.2 percent reduction in the median number of psychiatrists per 100,000 residents in hospital referral regions. In contrast, the numbers of primary care physicians and neurologists grew during the study period. These findings may help explain why patients report poor access to mental health care. Future research should explore the impact of the declining psychiatrist supply on patients and investigate new models of care that seek to integrate mental health and primary care or use team-based care that combines the services of psychiatrists and nonphysician providers for individuals with severe mental illnesses.
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Affiliation(s)
- Tara F Bishop
- Tara F. Bishop is an associate professor of health policy and research (courtesy) at Weill Cornell Medical College, in New York City
| | - Joanna K Seirup
- Joanna K. Seirup is a research data analyst in health care policy and research at Weill Cornell Medical College
| | - Harold Alan Pincus
- Harold Alan Pincus is a professor and vice chair of the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and director of quality and outcomes research at New York-Presbyterian Hospital, both in New York City
| | - Joseph S Ross
- Joseph S. Ross is an associate professor of internal medicine at the Yale University School of Medicine, in New Haven, Connecticut
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Medford‐Davis LN, Prasad S, Rhodes KV. "What Do People Do If They Don't Have Insurance?": ED-to-ED Referrals. Acad Emerg Med 2018; 25:6-14. [PMID: 28846179 DOI: 10.1111/acem.13301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore 1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED and 2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits. METHODS This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semistructured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached. RESULTS A total of 143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. A total of 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. Fifty-one percent of patients completed a survey and qualitative interviews were conducted with 23 fracture patients. Fifty-three percent of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. Seventy-three percent reported receiving the same tests at both EDs. Interview themes identified multiple health care visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain. CONCLUSIONS The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or records, incurring duplicate testing and patient anxiety.
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Affiliation(s)
| | | | - Karin V. Rhodes
- The Office of Population Health Management Northwell Health/Hofstra Medical School Great Neck NY
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18
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Ndumele CD, Cohen MS, Cleary PD. Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees. JAMA Intern Med 2017; 177:1445-1451. [PMID: 28806455 PMCID: PMC5710214 DOI: 10.1001/jamainternmed.2017.3766] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/07/2017] [Indexed: 11/14/2022]
Abstract
Importance Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. Objective To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. Design, Setting, and Participants We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards. Main Outcomes and Measures Reported access to specialty care in the previous 6 months. Results Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-in-differences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities. Conclusions and Relevance Specialty access standards did not lead to widespread improvements in access to specialist physicians. Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions.
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Affiliation(s)
- Chima D. Ndumele
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Michael S. Cohen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Paul D. Cleary
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Medford-Davis LN, Beall RC. The Changing Health Policy Environment and Behavioral Health Services Delivery. Psychiatr Clin North Am 2017; 40:533-540. [PMID: 28800807 DOI: 10.1016/j.psc.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Deinstitutionalization has left an inadequate supply of inpatient psychiatric beds. Simultaneous cuts to public funding and insurance coverage for outpatient mental health treatment have increased the frequency of acute psychiatric crises. The resulting lack of available options has shifted the burden of treatment to emergency departments and the criminal justice system. Recent legislation has improved insurance access, but rules are not always enforced and there are still few options for care. Discussion of mental health care delivery must acknowledge that many emergent behavioral health crises arise in the context of acute substance intoxication, withdrawal, or dependence.
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Affiliation(s)
- Laura N Medford-Davis
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA.
| | - Rakel C Beall
- Meninger Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX 77030, USA
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20
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Cama S, Malowney M, Smith AJB, Spottswood M, Cheng E, Ostrowsky L, Rengifo J, Boyd JW. Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 47:621-635. [DOI: 10.1177/0020731417707492] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. Providers were less likely to have available appointments for children on Medicaid, which is public insurance for low-income people. The most common reason for being unable to make an appointment was that the listed phone number was incorrect. Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Increasing the number of both types of providers may be necessary to increase access to mental health care for children.
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Affiliation(s)
- Shireen Cama
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anna Jo Bodurtha Smith
- Department of Obstetrics-Gynecology, Johns Hopkins Medical School, Baltimore, Maryland, USA
| | - Margaret Spottswood
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Elisa Cheng
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Louis Ostrowsky
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - J. Wesley Boyd
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
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21
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Bishop TF, Ramsay PP, Casalino LP, Bao Y, Pincus HA, Shortell SM. Care Management Processes Used Less Often For Depression Than For Other Chronic Conditions In US Primary Care Practices. Health Aff (Millwood) 2017; 35:394-400. [PMID: 26953291 DOI: 10.1377/hlthaff.2015.1068] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary care physicians play an important role in the diagnosis and management of depression. Yet little is known about their use of care management processes for depression. Using national survey data for the period 2006-13, we assessed the use of five care management processes for depression and other chronic illnesses among primary care practices in the United States. We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012-13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006-07, regardless of practice size. In contrast, use of diabetes care management processes has increased significantly among larger practices. These findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered.
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Affiliation(s)
- Tara F Bishop
- Tara F. Bishop is an associate professor in the Department of Healthcare Policy and Research at Weill Cornell Medical College, in New York City
| | - Patricia P Ramsay
- Patricia P. Ramsay is a research specialist and administrative director of the Center for Healthcare Organizational and Innovation Research (CHOIR) in the School of Public Health, University of California, Berkeley
| | - Lawrence P Casalino
- Lawrence P. Casalino is the Livingston Farrand Professor of Public Health and chief of the Division of Health Policy and Economics in the Department of Healthcare Policy and Research, at Weill Cornell Medical College
| | - Yuhua Bao
- Yuhua Bao is an associate professor of healthcare policy and research at Weill Cornell Medical College
| | - Harold A Pincus
- Harold A. Pincus is a professor and vice chair of Columbia Psychiatry, Columbia University; director of quality and outcomes research at New York-Presbyterian Hospital, and codirector of the Irving Institute for Clinical and Translational Research at Columbia University, all in New York City. He also is a senior scientist at the RAND Corporation
| | - Stephen M Shortell
- Stephen M. Shortell is the Blue Cross of California Distinguished Professor, a professor of organization behavior, director of CHOIR, and dean emeritus, all at the School of Public Health, University of California, Berkeley
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Tipirneni R, Rhodes KV, Hayward RA, Lichtenstein RL, Reamer EN, Davis MM. Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in Michigan. Health Aff (Millwood) 2017. [PMID: 26202057 DOI: 10.1377/hlthaff.2014.1425] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act expands health insurance coverage to millions of Americans, but the availability of health care services for the newly insured population remains uncertain. We conducted a simulated patient (or "secret shopper") study to assess primary care appointment availability and wait times for new patients with Medicaid or private insurance before and after implementation of Michigan's Medicaid expansion in 2014. The expansion, which was made possible through a section 1115 waiver, has a unique requirement that new beneficiaries must be seen by a primary care provider within 60-90 days of enrollment. During a period of rapid coverage expansion in Michigan, we found that appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients, compared to availability before the expansion. Wait times remained stable, at 1-2 weeks for both groups. Further research is needed to determine whether access to primary care for newly insured patients will endure over time.
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Affiliation(s)
- Renuka Tipirneni
- Renuka Tipirneni is a Robert Wood Johnson Foundation Clinical Scholar and clinical lecturer in the Department of Internal Medicine at the Medical School and a member of the Institute for Healthcare Policy and Innovation, both at the University of Michigan, in Ann Arbor
| | - Karin V Rhodes
- Karin V. Rhodes is an associate professor of emergency medicine and director of the Center for Emergency Care Policy and Research at the Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Rodney A Hayward
- Rodney A. Hayward is a professor of internal medicine and public health and a member of the Institute for Healthcare Policy and Innovation at the University of Michigan and a senior research scientist at the Veterans Affairs Center for Clinical Management Research, both in Ann Arbor
| | - Richard L Lichtenstein
- Richard L. Lichtenstein is the S. J. Axelrod Collegiate Professor of Health Management and Policy at the School of Public Health and a member of the Institute for Healthcare Policy and Innovation, both at the University of Michigan
| | - Elyse N Reamer
- Elyse N. Reamer is a research assistant at the Robert Wood Johnson Foundation Clinical Scholars Program in the Medical School at the University of Michigan
| | - Matthew M Davis
- Matthew M. Davis is a professor of pediatrics, internal medicine, and public policy and deputy director of the Institute for Healthcare Policy and Innovation at the University of Michigan
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Olin SCS, O'Connor BC, Storfer-Isser A, Clark LJ, Perkins M, Hudson Scholle S, Whitmyre ED, Hoagwood K, Horwitz SM. Access to Care for Youth in a State Mental Health System: A Simulated Patient Approach. J Am Acad Child Adolesc Psychiatry 2016; 55:392-9. [PMID: 27126853 PMCID: PMC4970515 DOI: 10.1016/j.jaac.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/01/2016] [Accepted: 02/26/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine access to psychiatric care for adolescents with depression in outpatient specialty clinics within a state mental health system, using a simulated patient approach. METHOD Trained callers posed as the mother of a 14-year-old girl with depression, following a script. A stratified random sample (n = 264) of 340 state-licensed outpatient mental health clinics that serve youth was selected. Clinics were randomly assigned to season and insurance condition. We examined whether access varied by season, clinic characteristics, and caller insurance type. Weighted logistic and linear mixed effects regression models were fitted to examine associations with appointment availability and wait times. RESULTS Among clinics at which a treatment appointment could be scheduled, appointment availability differed by season. Clinics that had participated in state-sponsored trainings targeting access were more available. Wait times for treatment appointments varied by season and region. Wait times in New York City were shorter than in some other regions. Although callers were 4.1 times more likely to be able to schedule a psychiatry appointment in the spring, wait times for psychiatry appointments were significantly longer in the spring than in the summer (49.9 vs. 36.7 days). Wait times for therapy appointments were significantly shorter in community than in hospital clinics (19.1 days vs. 35.3 days). CONCLUSION Access to psychiatric care for youth with depression was found to be variable in a state system. State-sponsored trainings on strategies to reduce wait times appear to improve care access. The simulated patient approach has promise for monitoring the impact of health care policy reforms on care quality measures.
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Choo EK, Garro AC, Ranney ML, Meisel ZF, Morrow Guthrie K. Qualitative Research in Emergency Care Part I: Research Principles and Common Applications. Acad Emerg Med 2015; 22:1096-102. [PMID: 26284696 DOI: 10.1111/acem.12736] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 03/15/2015] [Accepted: 04/12/2015] [Indexed: 11/28/2022]
Abstract
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. This article, Part I of a two-article series, provides an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field, including observation, individual interviews, and focus groups. In Part II of this series, we will outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research.
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Affiliation(s)
- Esther K. Choo
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Aris C. Garro
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Megan L. Ranney
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Zachary F. Meisel
- Department of Emergency Medicine; University of Pennsylvania; Philadelphia PA
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Ranney ML, Thorsen M, Patena JV, Cunningham RM, Boyer EW, Walton MA, Spirito A, Zatzick DF, Morrow K. "You need to get them where they feel it": Conflicting Perspectives on How to Maximize the Structure of Text-Message Psychological Interventions for Adolescents. PROCEEDINGS OF THE ... ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES. ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES 2015; 2015:3247-3255. [PMID: 26640419 DOI: 10.1109/hicss.2015.391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mobile psychological interventions are of growing interest, particularly for populations with little access to traditional mental health services. Optimum structural components of these interventions are unknown. In this study, twenty-one adolescents (age 13-17) with past two week depressive symptoms were recruited from the emergency department to participate in a semi-structured interview, to inform development of a text-message-based depression prevention intervention. Teens expressed conflict about intervention structure. Although trust and reliability were essential to sustain engagement, teens disagreed about how to best maintain reliability; whether the program should be "pushed" or "pulled"; and what the ideal degree of human interaction would be. These findings highlight the challenges in automating psychological interventions that are normally delivered face-to-face. Data indicate a broad desire for developing tailoring methods for system design (duration, frequency, and level of interactivity). The paper closes with thoughts about potential solutions to these structural issues for mobile psychological interventions.
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Cheng TC, Lo CC. Domestic Violence and Treatment Seeking: A Longitudinal Study of Low-Income Women and Mental Health/Substance Abuse Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:735-59. [DOI: 10.2190/hs.44.4.d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.
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Abar B, Abar CC, Boudreaux ED. Feasibility of audit methods to study access to substance use treatment. J Subst Abuse Treat 2013; 45:395-9. [PMID: 23871507 DOI: 10.1016/j.jsat.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
Audit studies represent an emerging method for examining disparities in access to care, like substance use treatment, whereby fake patients (i.e., actors) attempt to procure a service with one or more characteristics isolated across condition. This allows for manipulation of variables, like insurance status, that are normally fixed or impossible to standardize with precision when studying actual patients. This pilot study explored whether these methods were feasible for the examination of community-based substance use treatment access. Masked telephone calls (n=48) were made to providers (k=8) in a single city seeking an appointment. A male and female "patient" made calls in three insurance status conditions: no insurance, state-funded insurance, and private insurance. All other subject characteristics were held constant. Results showed an audit design to be a feasible method for examining disparities in access and demonstrated substantial barriers to voluntary treatment. Implications and future directions are discussed.
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Affiliation(s)
- Beau Abar
- Department of Pediatrics, Center for the Study of Children at Risk, Brown University Alpert Medical School & Women and Infants Hospital of RI, Providence, RI 02908, USA.
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Abstract
CONTEXT In connection with health care reform, the U.S. Department of Health and Human Services commissioned a "mystery shopper," or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over "government spying" on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. METHODS We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. FINDINGS Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. CONCLUSIONS As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate socially valuable knowledge.
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Affiliation(s)
- Karin V Rhodes
- Perelman School of Medicine and School of Social Policy & Practice, University of Pennsylvania, PA 19104, USA.
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Bridler R, Orosz A, Cattapan K, Stassen HH. In need of psychiatric help--leave a message after the beep. Psychopathology 2013; 46:201-5. [PMID: 22964830 DOI: 10.1159/000341729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Every day, a substantial proportion of the general population experiences the distressing and frightening signs of an upcoming psychiatric illness. The consequences can be enormous because severe psychiatric disorders typically cause the loss of the ability to work and often mean a long-term burden for both the patients and their families. Even though most developed countries have an exceptionally high density of general practitioners and psychiatrists in private practice, getting a mental health appointment and seeing a doctor is often very difficult for patients with acute psychiatric symptoms. This study aimed at quantifying the time delay involved in seeking medical attendance when psychiatric disorders begin to develop. METHODS Two female actors with well-proven experiences of realistically simulating the clinical presentation of depression and psychotic disorders made systematic phone calls to 106 psychiatrists in private practice and 106 general practitioners (GPs) of the Zurich City area. The actors asked for an appointment at the doctor's earliest convenience due to acute psychiatric symptoms. We assessed (1) the number of phone calls it took to reach each doctor; (2) the time it took to book an appointment; (3) the time span between the first phone call and the earliest available appointment, and (4) the possibility of personal contact with a doctor prior to booking the appointment. RESULTS A total of 383 phone calls were made by the two actors (227 to psychiatrists and 156 to GPs) which resulted in analyzable data from 102 psychiatrist and 106 GP practices. Two thirds (68%) of the phone calls to the psychiatrists in private practice were answered by voice mail, compared to 21% among the GPs. A personal contact was established with 56% of the psychiatrists and 95% of the GPs. On average, 7.3 phone calls were necessary to successfully book an appointment with a psychiatrist. Almost half of the psychiatrists (45.6%) were not accepting new patients so appointments were able to be booked in less than one third of cases (30.4%). The situation was significantly better with GPs (p < 0.002) but depended on clinical diagnosis (p < 0.01). The waiting time to seeing a psychiatrist often far exceeded 7 days. CONCLUSIONS A high density of psychiatrists in private practice does not necessarily improve the long and troublesome circumstances of obtaining a mental health appointment in acute psychiatric situations. Under these circumstances, a considerable proportion of patients might give up prior to seeing a doctor. This has important implications--many patients could miss the potential benefits from timely therapeutic interventions which can significantly modify both the acute and long-term course of the illness. The situation might be improved if psychiatrists and GPs joined forces in the form of group practices or networks as this would readily ensure (1) a rapid mental health triage by assessing and categorizing the urgency of mental health-related problems, and (2) timely therapeutic interventions whenever indicated.
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Affiliation(s)
- René Bridler
- Psychiatrische Privatklinik Sanatorium Kilchberg, Kilchberg, Switzerland.
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Marcus SC, Bridge JA, Olfson M. Payment source and emergency management of deliberate self-harm. Am J Public Health 2012; 102:1145-53. [PMID: 22515853 PMCID: PMC3483957 DOI: 10.2105/ajph.2011.300598] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether health insurance type (private vs Medicaid) influences the delivery of acute mental health care to patients with deliberate self-harm. METHODS Using National Medicaid Analytic Extract Files (2006) and MarketScan Research Databases (2005-2007), we analyzed claims focusing on emergency episodes of deliberate self-harm of Medicaid- (n=8,228) and privately (n=2,352) insured adults. We analyzed emergency department mental health assessments and outpatient mental health visits in the 30 days following the emergency visit for discharged patients. RESULTS Medicaid-insured patients were more likely to be discharged (62.7%), and among discharged patients they were less likely to receive a mental health assessment in the emergency department (47.8%) and more likely to receive follow-up outpatient mental health care (52.9%) than were privately insured patients (46.9%, 57.3%, and 41.2%, respectively). CONCLUSIONS Acute emergency management of deliberate self-harm is less intensive for Medicaid- than for privately insured patients, although discharged Medicaid-insured patients are more likely to receive follow-up care. Programmatic reforms are needed to improve access to emergency mental health services, especially in hospitals that serve substantial numbers of Medicaid-insured patients.
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Affiliation(s)
- Steven C Marcus
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, School of Social Policy and Practice of the University of Pennsylvania, Philadelphia, USA
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Bisgaier J, Cutts DB, Edelstein BL, Rhodes KV. Disparities in child access to emergency care for acute oral injury. Pediatrics 2011; 127:e1428-35. [PMID: 21606154 DOI: 10.1542/peds.2011-0011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined the impact of insurance status on dental practices' willingness to schedule an appointment for a child with a symptomatic fractured permanent front tooth. PATIENTS AND METHODS Between February and May 2010, 6 research assistants posed as mothers of a 10-year-old boy seeking an urgent dental appointment. Two calls 4 weeks apart, with the same clinical scenario, were made by the same caller to a stratified random sample of dental practices, one-half of which were enrolled in the state's combined Medicaid and Children's Health Insurance Program (CHIP) dental program. The only difference in the calls was the child's insurance coverage (Medicaid/CHIP versus private Blue Cross dental coverage). We estimated differences in the log-odds probability of scheduling an appointment for a child with public versus private insurance by using exact conditional (fixed-effects) logistic regression, which accounts for paired data. RESULTS Of 170 paired calls to 85 dental practices (41 participating in the Medicaid program), only 36.5% of Medicaid beneficiaries obtained any appointment compared with 95.4% of Blue Cross-insured children with the same oral injury. Among dental providers enrolled in the Medicaid program, children with Medicaid were still 18.2 times more likely to be denied an appointment than privately insured counterparts (95% confidence interval: 3.1 to ∞; P < .001). CONCLUSIONS Illinois dentists, including those participating in Medicaid, are less likely to see a child for an urgent dental complaint if the child has public versus private dental coverage. These results have implications for developing policies that improve access to oral health care.
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Affiliation(s)
- Joanna Bisgaier
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA 19104, USA
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Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC. Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations. J Community Health 2011; 36:733-40. [DOI: 10.1007/s10900-011-9367-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Groot M, Kushnick M, Doyle T, Merrill J, McGlynn M, Shubrook J, Schwartz F. Depression Among Adults With Diabetes: Prevalence, Impact, and Treatment Options. Diabetes Spectr 2010; 23:15-18. [PMID: 22485068 PMCID: PMC3318918 DOI: 10.2337/diaspect.23.1.15] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In Brief
Patients with type 1 or type 2 diabetes are two times more likely to experience depression than their peers without diabetes. Comorbid depression results in deleterious effects on glycemic control, worsened diabetes complications, functional disability, and premature mortality. Once identified, depression can be effectively treated with antidepressant medications, psychotherapy, or a combination of both. Patients and providers should monitor depressive symptoms to identify their recurrence and work collaboratively to address barriers to care that exist in both urban and rural areas.
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Affiliation(s)
- Mary de Groot
- Mary de Groot, PhD, is an associate professor in the Department of Medicine at the Indiana University School of Medicine in Indianapolis. Michael Kushnick, PhD, is an associate professor, and Mark McGlynn, BA, is a graduate student at the Ohio University School of Recreation and Sport Sciences in Athens. Todd Doyle, MS, and Jennifer Merrill, MS, are graduate students at the Ohio University Department of Psychology in Athens. Jay Shubrook, DO, is an associate professor, and Frank Schwartz, MD, is a professor at the Ohio University College of Osteopathic Medicine in Athens
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de Groot M, Kushnick M, Doyle T, Merrill J, McGlynn M, Shubrook J, Schwartz F. A Model of Community-Based Behavioral Intervention for Depression in Diabetes: Program ACTIVE. Diabetes Spectr 2010; 23:18-25. [PMID: 22514361 PMCID: PMC3327507 DOI: 10.2337/diaspect.23.1.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Depression affects one in four people with diabetes and significantly affects diabetes health. Earlier studies of the treatment of depression have documented that cognitive behavioral therapy (CBT) and exercise have each been found to be effective in treating depression in people with and without diabetes in the context of medical settings. Individuals in rural areas lack regular access to medical centers and require treatment options that may be adapted for local communities. To date, no studies have combined CBT and exercise for people with diabetes. This article presents a translational behavioral depression intervention study designed for individuals with type 2 diabetes in a rural Appalachian region as a model of an interdisciplinary approach to the treatment of depression in diabetes.
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Affiliation(s)
- Mary de Groot
- Mary de Groot, PhD, is an associate professor in the Department of Medicine at the Indiana University School of Medicine in Indianapolis. Michael Kushnick, PhD, is an associate professor, and Mark McGlynn, BA, is a graduate student at the Ohio University School of Recreation and Sport Sciences in Athens. Todd Doyle, MS, and Jennifer Merrill, MS, are graduate students at the Ohio University Department of Psychology in Athens. Jay Shubrook, DO, is an associate professor, and Frank Schwartz, MD, is a professor at the Ohio University College of Osteopathic Medicine in Athens
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Larkin GL, Beautrais AL, Spirito A, Kirrane BM, Lippmann MJ, Milzman DP. Mental health and emergency medicine: a research agenda. Acad Emerg Med 2009; 16:1110-9. [PMID: 20053230 DOI: 10.1111/j.1553-2712.2009.00545.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems. As an increasing fraction of undiagnosed and untreated psychiatric patients passes through the revolving doors of U.S. EDs, the opportunities for improving the art and science of acute mental health care have never been greater. These opportunities span macroepidemiologic surveillance research to intervention studies with individual patients. Feasible screening, intervention, and referral programs for mental health patients presenting to general EDs are needed. Additional research is needed to improve the quality of care, including the attitudes, abilities, interests, and virtues of ED providers. Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real-world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems.
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Affiliation(s)
- Gregory Luke Larkin
- Department of Surgery, Emergency Medicine Division, Yale University School of Medicine, New Haven, CT, USA.
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Broderick KB, Ranney ML, Vaca FE, D'Onofrio G, Rothman RE, Rhodes KV, Becker B, Haukoos JS. Study designs and evaluation models for emergency department public health research. Acad Emerg Med 2009; 16:1124-31. [PMID: 20053232 DOI: 10.1111/j.1553-2712.2009.00557.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract Public health research requires sound design and thoughtful consideration of potential biases that may influence the validity of results. It also requires careful implementation of protocols and procedures that are likely to translate from the research environment to actual clinical practice. This article is the product of a breakout session from the 2009 Academic Emergency Medicine consensus conference entitled "Public Health in the ED: Screening, Surveillance, and Intervention" and serves to describe in detail aspects of performing emergency department (ED)-based public health research, while serving as a resource for current and future researchers. In doing so, the authors describe methodologic features of study design, participant selection and retention, and measurements and analyses pertinent to public health research. In addition, a number of recommendations related to research methods and future investigations related to public health work in the ED are provided. Public health investigators are poised to make substantial contributions to this important area of research, but this will only be accomplished by employing sound research methodology in the context of rigorous program evaluation.
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Affiliation(s)
- Kerry B Broderick
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
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